Tuesday, April 29, 2008

Frequent Questions on Female Sexual Health

Q My wife and I had a great sexual relationship before we were married, but she has since lost interest completely. I know this sounds common, but there are symptoms which make me think it could be medical: extreme vaginal dryness, breast tenderness, little vaginal sexual sensations. It seems like her interest declined after she quit the pill.

Could it be a hormone deficiency? Don't give me the psychological babble, I've tried everything. She is defensive about the issue and claims to be happy without it.

A The symptoms you describe are most often related to menopause. I am unable to determine your wife's age from the information given; keep in mind that menopause can begin as early as 35. Consulting a physician with all her medical symptoms would be helpful.

As suggested, one of the most common causes of vaginal dryness is low estrogen production. Poor estrogen production is characteristically associated with menopause. However, low estrogen levels are also found immediately before and after a period. You may want to consider if there is a particular time when the dryness and other symptoms are most prominent. Being on birth control pills does give a woman an estrogen hormonal boost, so it would follow that not taking the pill would consequently reduce estrogen hormone levels.

I'll avoid the psycho-babble but would suggest that a thorough medical check-up may discover a very treatable problem. Discussing issues with a professional will also often reduce any negative ("defensive") feelings since a more factual meeting can remove the emotions surrounding such intimate issues.

Q Lately I have been experiencing dryness during intercourse. It is very uncomfortable for me and my husband. I have used a moisturizing product, but I'm wondering if there is something else I can do to prevent this.

A Vaginal dryness is a symptom that many women experience. Unfortunately this is most noticeable during intercourse, causing mild to severe discomfort. Dryness can occur as early as age 18 but certainly is most common for those women of menopausal age. There are many other causes of vaginal dryness that also exist. These include certain medications (some antibiotics, anti-depressants, infertility drugs), stress, diet, tampon use or condom use, pre/post-partum time, and excessive exercise.

One of the most common factors resulting in vaginal dryness is low estrogen production. Again, poor estrogen production is most often related to menopause. However, low estrogen levels are also found immediately before and after your period. Consider if there is a particular time when the dryness is more prominent.

The use of over-the-counter moisturizers and creams are generally the first line of defense to reduce this dryness. It would be important for you and your physician to look at the whole picture though: your diet, exercise pattern, other symptoms you may be experiencing (hot flashes? mood swings? sleeplessness?), any medications you are on, etc. There are prescription estrogen creams that are available for your use which may solve this problem. Also, oral estrogen replacement may be indicated. As with all medications, consultation with your physician is a must

Q I'm a 24 year old woman who used to really enjoy sex from 16-18, after that I have not really been interested. And when I do have sex I have a really hard time enjoying it and getting any pleasure out of it. No matter what I've tried, from aromatherapy to foreplay I can not get into it why? Have I lost my hormones? Help!!

A Don't worry--you haven't lost your hormones. Actually, a decrease in hormone levels that normally enhance sexual desire will not occur for you for MANY years (after you're 45 most likely). Let me suggest some other reasons why you may feel less than satisfied with your sex life.

First, you should read the excellent article entitled 7 Steps to Sexual Fitness. Outlined are eight considerations that are helpful in keeping balance and focus in your life, which in turn will make you a more healthy and active individual. When one area of your life is out of whack--be it diet, exercise, sleep, or whatever--you can feel the consequences in other areas of your life, including your sex drive. The healthier you are, the better you can expect your sex life to be.

Secondly, sexual intimacy ideally involves a partner with whom there is trust and respect. You should enjoy being with this person, and there is real commitment. You can count on disappointment if there is no other connection than sex. If your lovemaking is with someone you really want to be with and you care about, fulfillment and pleasure will follow.

So ask yourself these questions:

  1. Is the rest of my life in order? (work completed, phone calls made, kids cared for?)

  2. Am I taking care of myself? (sleeping enough, good diet, plenty of exercise?)

  3. Is the environment conducive to intimacy? (comfortable surroundings, privacy?)

  4. Who is my partner? (how do I really feel being with this person?

Once you have these factors in control, consider trying one of the new female sex response stimulants. These increase the blood flow and responsiveness of the clitoris-vagina area and can enhance the pleasure of sex.

Q Hi, I got married about a month ago and my husband is my first and only partner. and after every time we make love and I either sit up or stand up to go to the restroom, this sticky clear substance runs down my leg. it's kind of like the discharge I get every month but there's a lot more of it. I don't know much about sex and stuff. my mother never talked to me. Is this normal?

A During sexual intercourse, the female body produces a natural lubricant in the vagina that reduces friction and allows you greater comfort. When a man reaches climax, if he ejaculates into you, his penis releases semen (fluid consisting of sperm and other secretions) into the vagina. Both of these substances will therefore be present in your vagina after you have vaginal intercourse. As you move from a lying down to a sitting or standing position, these substances will empty from the vagina. The discharge will be sticky because of the natural make-up of the secretions. The color should be whitish. This is a totally normal occurrence after sex and absolutely nothing to worry about.

However, should any discharge have a foul odor associated with a fever and chills and/or itching, contact your gynecologist immediately. This is not a normal occurrence, and probably indicates that you have some sort of infection.

Good hygiene following intercourse is always recommended. Use warm water and soap to clean the vaginal area. Maintaining good hygiene practices will reduce your incidence of urinary tract infections and vaginal yeast infections, which are occasionally associated with intercourse. Some gynecologists also recommend that women urinate following intercourse to aid in prevention of urinary tract infections.

Q My wife is a virgin and was just wondering what's the easiest way to penetrate w/o hurting her. Using condom. how long will it take b4 she feels comfortable having intercourse. Thanx

A It is vital that a man and woman's first sexual experience together be a positive one. Women often experience some discomfort at first, which may last for a week or so. A common way your fianc饠 could reduce this initial discomfort is by stretching the opening to the vagina by digitally (using two fingers) exercising/massaging the area with a "scissors-like" motion. She could do this exercise as she showers daily. I assume she has used tampons. The insertion of her fingers into the vagina is done in the same manner. Although a bit awkward in positioning, this technique of stretching the vaginal opening prior to sexual intercourse will decrease potential discomforts associated with penetration.

You can also maximize comfort for your fianc饠by using a lubricant. Many brands are available at your local pharmacy. Condoms are often pre-lubricated but additional lubrication may be necessary. Be prepared.

The best way to make your first sexual experience together a positive one is have open communication. Talk about expectations, concerns, etc. prior to being together, when you are together, and afterwards.

Q Enjoying Sex After Menopause

A An article in the February issue of the Journal of the American Medical Association (JAMA) contained a research study on sexual dysfunction that garnered extensive media coverage. The findings may surprise you: 43% of women and 31% of men in the US suffer from sexual dysfunction. Pretty large numbers. Significantly more people have sexual issues than Hollywood, fashion magazines, and even many doctors lead us to believe.

Simply stated, sexual dysfunction is a common problem. Almost half of all American women struggle with it. And we don't know what to do about it. Viagra has come to the rescue of many aging men, but what about us women? So far we've been left out in the cold.

The truth is that as we age and reach menopause, many women lose interest in sex. Our bodies simply stop producing the same levels of sex hormones as they did when we were younger. As sex hormone levels decline, so does desire. To make matters worse, many women develop vaginal dryness, which can make sex painful. At the same time, some men are losing their drive and ability to perform, so we may not even notice the drop in our own libido. But now that we know better?and men are finding help?we should make an effort to get a piece of the action!

I've listed below four suggestions for increasing your sex drive, enhancing arousal, and combating sexual problems after menopause. Give them a try and see if you notice a change for the better.

  1. Hormones: Why worry about hormones? Because scientists have begun to realize that menopause devastates us hormonally. Women produce less and less testosterone, the "male" sex hormone, as they age. By the age of 40, they have half as much testosterone as they did when they were 20. Research has shown that a low testosterone level means lack of sexual desire. As if that weren't enough, estrogen levels also decline by 80-90% during menopause. Low estrogen levels cause vaginal dryness, which leads to painful intercourse, and diminished blood flow to the vagina, which interferes with arousal and pleasure during sex.

    This may be devastating to some women. Many doctors recommend hormone replacement therapy (HRT) as a solution. Taking estrogen can help rid us of all symptoms of menopause including moodiness, vaginal dryness, and hot flashes. In addition, it may reduce the risk of cardiovascular disease, osteoporosis, and some cancers. Testosterone therapy has been shown to enhance desire, induce feelings of well being, and combat menopausal symptoms. However, testosterone may produce unwanted side effects such as acne, increased risk of heart disease and breast cancer. HRT is a serious treatment with many important factors figuring in. It should be carefully considered with your doctor.

  2. Supplements: For many women, the real problem is not lack of sexual interest but a generally low energy level. We work, manage the household, take care of our kids, husbands and parents, and at the end of the day simply don't have the energy to engage in sexual activity. To give yourself an added boost, try taking a nutritional supplement with ginseng or ginkgo. Both herbs have been taken for hundreds of years as natural energy enhancers.

    Supplements can also provide our bodies with the raw materials they need to perform better, naturally. For example Arginine, an amino acid that is found in nuts, meat, and dairy, enhances blood flow. Taking a nutritional supplement with Arginine can improve arousal by increasing the flow of blood to the vagina during sexual activity.

  3. Diet: I have a friend who had a terrible time with menopause. She experienced huge emotional swings, gained weight, and suffered debilitating hot flashes. After consulting an alternative medicine doctor who advised her to eat lots of soy, she completely changed her diet. She became a vegetarian, replaced meat with tofu and milk with soymilk, and added more fresh vegetables to her meals. Within a few months she had lost weight, all her symptoms had disappeared, and?she was surprised to discover?her sex drive had improved tremendously. You better believe she's stuck with this diet!

    Studies show that one valuable resource for women is soy. Soybeans contain phytoestrogens, or plant estrogens, that may help replace the estrogen that your body is naturally producing less of over time. Japanese women, who eat a diet heavy in soy, have far lower levels of breast cancer and less trouble with menopausal symptoms. A suggestion is to inject more soy into your diet and see what it does for you. In general, remember that you should eat a diet that is low in fat and high in fresh fruits and vegetables.

  4. Physical problems: Vaginal dryness can be easily treated with lubricants such as KY Jelly, available at most drugstores and supermarkets. You'll need to apply the lubricant every time you have sex. Do not use scented oils and lotions. These lubricants may irritate the vagina and penis. If you use condoms, avoid Vaseline as it destroys the condom material.

    If you find that your vaginal walls have relaxed over time, as do many women, there is hope. A simple exercise, known as the Kegel exercise, can improve your muscle tone and help you to enjoy sex more. Simply squeeze the muscles around your vagina as if you were trying to stop yourself from urinating midstream. Contract these muscles for one minute, then release. Repeat at least 10 times, and increase the number of repetitions over time. You can do these exercises any time ? while you're working at a desk, while driving, or even when you're watching TV.

Q I'm concerned about my personal odor, especially when I'm on my period. Which douche product would you recommend?

A Vaginal odor is a big concern for many women. In fact, 3 out of 10 women in the US douche regularly. It's easy to be self-conscious about your smell. However, I would urge you not to worry so much about your odor. How you smell is a natural part of who you are.

More importantly, douching is dangerous. I strongly urge you NEVER to douche. Douching products contain chemicals that can be irritating to your vagina and urethra. Moreover, douches kill the natural bacteria that live in your body and help you to stay healthy. Therefore, douching makes you more susceptible to vaginal infections such as bacterial vaginosis (BV), yeast infection, and to the STD chlamydia. Studies show that douching may also increase women's risk of ectopic pregnancy and pelvic inflammatory disease (PID), a condition which, if left untreated, can lead to infertility.

That having been said, it is important for you to keep yourself clean. Wash your vaginal area daily with warm water and a hypoallergenic, unscented soap like Dove that will not irritate the region. Make sure to completely towel dry and to wipe thoroughly after using the bathroom. Also, wear cotton underwear rather than silk or synthetic material. Cotton allows your skin to breathe better, which will also prevent odor from accumulating.

Q Tell Your Doctor You've Had Sex?

A Your mom takes you to the family doctor?or the pediatrician you've seen since you were ten?for a check-up. You need a physical to sign up for school sports, or maybe you're there because you get a check-up every year. No big deal, right? Except this year, your doc pops the big question: "Are you sexually active?" What do you say to that? If you have had sex, do you HAVE to tell him? Why should you? If you do tell the truth, is your doctor going to pass the word on to your mom in the waiting room?

First, let's deal with the whole privacy thing. If you tell your doctor that you want whatever you tell her to remain confidential?that is, just between you, her, and the wall?then you should let her know that because she will probably listen to you. In fact, many states have passed special laws giving teenagers the right to see a doctor without their parent's consent for sexual health services like sexually transmitted disease, or STD, testing and treatment (all 50 states except South Carolina) and birth control (23 states). Being able to get those services without parental permission usually means that you are also allowed to keep them confidential.

But if you really want to be sure that no one tells your parents, then you should go to a Planned Parenthood clinic or a public or government-funded clinic. Both offer FREE and confidential birth control and STD services to anyone under 18 years of age, male or female. It doesn't even matter how much money you or your parents earn?it's still free. That's because the federal government pays for teen services to make sure that all teens who need birth control, STD testing, or pregnancy tests can get them without needing their parent's consent, or even letting them know. But most teens don't know that they qualify for these services. To find a Planned Parenthood clinic, call their national hotline at 1-800-230-PLAN. To find a public or government-sponsored clinic, look in the phone book in the city or county white pages under "Health Center."

Now back to your doctor popping you the big SEX question. Why bother telling him you're no longer a virgin in the first place? I mean, if nothing's wrong with you, then why is it his business anyway? Actually, even if your doctor doesn't ask you whether you've had sex, you should volunteer this information. Here's why: you may have an STD like chlamydia, herpes, or genital warts, and not know it. STDs may make you infertile if you don't get them treated. Teens have the highest risk of all Americans of getting an STD. Four million teens get an STD every year. By age 24, one in three people who have had sex will have picked up an STD.

Most teens don't realize they are at risk?in part because they haven't heard that most people who have an STD DON'T have any symptoms. So you and your boyfriend or girlfriend may be soul mates and monogamy may be your word, but if either of you has had sex with anyone before, then you could be sharing a disease without knowing it. The only way to know for sure is to get tested. And women, it's not enough to get an annual pelvic exam during your visit to the Ob-gyn. Studies show that most doctors don't automatically test you for STDs as part of routine care. You have to ASK for it.

So yes, tell your doctor you have had sex, and surprise her by asking to get tested for STDs.

Q Will eating a lot of red meat increase my hormones and help make me a Sexual Tyrannosaurus?

A Some people think that since cattle are given hormones to promote growth, humans might actually get an overload of hormones from eating red meat, especially when rare or raw. Actually, the industry is regulated tightly: hormones cannot be given to cattle just before they go to market. By the time you buy and eat the meat, then, hormone levels are close to normal.

Red meat, in general, is high in amino acids, B vitamins, zinc and other minerals that are needed for optimum sexual performance. However, as with most things, just because a little bit is good that does not mean a lot is better. Moderation in all things, my friend. In particular, beef is high in saturated fats, which can clog your arteries and thereby restrict blood flow to your sex organs ? meaning that you have more trouble getting erections. So feel free to eat some red meat as part of a balanced diet, but don't overdo it!

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