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Movember: Visiting the “Dick Doctor”

Movember: Visiting the Dick Doctor

Published by Grow A Pair.

Movember was something of great interest and concern to us as a team! So our guest Thabani Gigaba agreed to take one for the team and visit the “Dick Doctor” for a Men’s Health examination in support of Movember! We would like to inspire and motivate all men to be healthy and get their goods checked!

Thank you to:

Our guest – Thabani Gigaba

Dr. Elna from My Sexual Health for your informative consultation and ongoing support.

Cool Your Jets, Anja Venter and Ilze van Heerden for the awesome illustration and animation.

Amazing humans for the music track: “The Beast from Benoni”, “The Phoenix Strangler”, “Hammer Head” & “Gunslinger” by The Moths.

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Movember Chat – What should we know?

Movember Chat – What should we know?

Published by Grow A Pair.

Movember was something of great interest and concern to us as a team! So we decided to meet up with a couple of guys and discuss some Men’s Health related issues. We discussed numerous topics regarding men’s health and what we should know as men or women about our bodies!

Thank you to:

Our guests – Kagiso Motsei, Thabani Gigaba, Thlabaki Setlalentoa, George Sotiropoulos.

Dr. Elna from My Sexual Health for your ongoing support.

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Sex Q & A with Dr. Elna Rudolph

Sex Q & A with Dr. Elna Rudolph

Dr. Elna Rudolph answers a few questions about sex.

My partner wants to try anal sex more often, but I don’t enjoy it. I’m worried that if I don’t do it, he will feel unfulfilled…

There are certain no-no’s when it comes to sex in relationships and they are different for each couple. The one might never want to have sex unless she first had a shower, the other will never allow oral sex, and another will not do it with the lights on. These taboos should be respected by the partner, but it does not mean that they cannot shift when the reasons behind them are explored and some basic information with specific suggestions are given in the form of sex education or formal therapy.

When it comes to anal sex being one of the taboos, there are usually two reasons: Firstly some people have religious or moral issues with it. These can be quite difficult to shift and should sometimes just be respected. The other reason is that it is just too uncomfortable and therefore really not enjoyable. Guys expect that they will be able to just penetrate their partners as easily as it looks in porn. The reality is that most people have to go through a process to get used to being stimulated first around and then in the anus. Start with some light touch and rubbing and then move to inserting a well lubricated little finger and then progressively go larger from there. If you are really committed to it, you could also practice by yourself to get used to what it takes for the anal sphincter to relax. Like any muscle, it has the ability, but it takes time. If you perceive the attempt at penetration to be threatening and you anticipate the pain, the muscle will just go into spasm and make it more difficult and unpleasant.

How many times a week is it normal to masturbate? I’m in a long-term relationship and masturbate at least once a week, but my partner says he never does.

It depends on many things. If there is so-called “desire discrepancy” in a couple (which is the case in most relationships!) the partner with the higher desire is left frustrated if he or she does not masturbate. Masturbating is also a form of self-loving and soothing. You might get something completely different from masturbating than what you get from sex and therefore remain to have a need for it although you are in a very sexually fulfilling relationship. More than five times a week probably becomes excessive (according to international definitions anyway). It is also normal to never masturbate if you are in steady relationship. Whatever works for you.

I found a stash of lesbian porn on my husband’s computer and watched a video out of curiosity. It really got me off. What does this mean? Am I a closet lesbian?

Not necessarily. Up to 80% of women get turned on by some girl-on-girl action! You are a lesbian (if we have to use such a rigid term) if you would like to build a life with another woman. If lesbian porn excites you, you have just expanded your repertoire of excitement and fantasy.

I sometimes feel like my husband and I are more in the best friend zone than sexually connected. What can I do to get the spark back?

Make sure that you create special experiences when it comes to sex. The longer the relationship, the more difficult it is to create more and more exciting sexual experiences and then you get stuck in a rut.

It is however possible to create a special experience in a different way each time. Take time to make love through sensual massages and external stimulation, do the romantic candle lights and special music thing, make regular dates for love making, increase the oxytocin (bonding hormone) between you by looking each other in the eye, hugging and cuddling – all things to make a concerted effort to say: this is a special relationship with an intimate bond, not merely a friendship.

The more you are like friends, the more difficult these things are, but get started sooner rather than later!

How do I get my partner to go down on me more often?

Ask for it! Make sure you have the hair and hygiene under control and buy some special lubes that taste nice to encourage him. Returning the favor also goes a long way in encouraging him! (His favour might not be oral sex, it might be something else he loves that you are not doing frequently – find out what that is).

My guy doesn’t know how to make me climax – while he’s well-endowed, he’s not an expert at making it work. How do I nudge him in the right direction?

Firstly, you have to be honest about the fact that you are not getting there. Make it about you, not him. Tell him that there is only a specific way that works for you to come and you want to show him how to help you to get there. Show him how you do it and let him get involved in taking over more and more of the stimulation each time.

If he is offended by this and does not want to cooperate, think twice about sorting out a budget or raising kids with him!

How do I tell if he has an STI?

Sometimes you see a discharge, sore, blister, bump or wart in your genital area. It might have a bad smell or burn when you urinate. The reality is that most of the times you won’t even know about it. You will have to get tested.

I’ve just woken up from a night of tantric sex, but I’ve broken out in a nasty rash – I think it might be from the latex condoms we used. Are there any others we could try?

You could get latex-free condoms, but they are very difficult to find. Order them off the internet. It can also be due to oils you used for massaging.

I’m really in love with my partner but I struggle to get turned on by him. What should I do?

Check your hormone levels. Getting turned on is heavily dependent on testosterone. If you are taking an oral contraceptive, it breaks down and block your testosterone and therefore it is difficult to become sexually aroused. Some women just don’t produce enough testosterone. It can be supplemented through the skin, though. Never ever through injections!

My partner is amazing in bed, but he enjoys taking drugs before sex. I sometimes do it with him, but it bothers me that he wants to be high when we’re having sex. How do I tell him?

Be honest about it. tell him that you value the relationship and that you would like to have real intimacy with him and not just a fun, exhilarating experience. Ask him to do it your way every second time.

My partner is always super aroused when we’re in public, and not so much in private. While the thrill of getting caught is sexy, I’m over the riskiness. How do I get him to be as aroused when we’re at home?

It has to do with his sexual arousal template that was probably formed in his brain before the age of nine! He will have to learn that he has a very rigid arousal template and that it can actually be adapted and expanded. He also has to learn that sex is sometimes not that exciting, sometimes it is more special and for the purpose of bonding than for the purpose of that ultimate high. Guys with a rigid arousal template often have problems with real intimacy and if the problem is really severe, it should be addressed in therapy.

I’m very attracted to my partner, but during sex, I get uncomfortable and clamp up. How do I get over this?

That sounds like it could be vaginismus. We are a team of professionals that specialise in helping women deal with this problem. I wish there was a one-liner answer to that one, but unfortunately there isn’t. It’s usually caused by a combination of medical conditions, childhood trauma, religious upbringing with excessive guilt, poor sex education, psychological as well as relationship issues. These all need to be addressed for you to stop clamping up with the man you love.

Help! His penis is too big!

You can use muscle relaxants, better lube, vaginal dilators and even physiotherapy to get over this hurdle! There is also a device from Pure Romance, called Super Stretch Lips, that you can put over his penis to keep a part of it outside of the vagina during intercourse, but it is usually the girth that is the problem. Make sure you have pleeently of foreplay in order for your body to get ready for penetration.

Help! His penis is too small!

Make sure you get satisfied before penetration happens. You can also do kegel exercises and even see a physiotherapist that specialises in the area to help you strengthen your muscles in order to “feel” him better. A device like a We-Vibe also helps to improve the sensation during penetration if you need more than what he ‘has to offer’.

My boyfriend asked me to stick a finger in his bum while we were having sex. At first, I wasn’t keen, but eventually I agreed, and he said he had the most intense orgasm ever. Now he wants to do it all the time. Does this mean he’s gay?

No, not at all! It just means that he has discovered his p-spot. The nerve that supplies sensation this area is the same as the one that supplies your clitoris, so you do the math.

My new boyfriend has marathon-runner stamina in the bedroom. Sex goes on forever. I actually start getting bored and sometimes even chafed. How can I make him come faster?

Ask him to! If he can’t, he has what is called delayed ejaculation. Although it is a difficult condition to treat in sex therapy or sexual medicine, it can be done. Firstly, check if he is not on anti-depressant drugs that may be causing the problem. That can easily be changed to a different type, if it is the case. You can also tell him that you will help him come in another way or he can get himself there (which is usually much quicker) but you are only up for ten minutes of penetration in any one round (the vagina struggles to stay lubricated for longer than that in most women).

I want to do a striptease for my guy but I’m really uncoordinated and I’m worried it’s going to be more comedy than sexy. What’s the best costume to wear that’s easy and sexy to remove?

Probably a man’s shirt, tie and a top hat. Make sure you have the sexy stockings with dispensers and heals that you can still move in to complete the outfit (or at least that is what I’m told by the Carmen Electra Strip Tease DVD that was given by a friend! Not exactly the content covered in a Master’s Degree in Sexual Health!).

I don’t feel pain during sex, but afterwards, I bleed for two to three days, as if I’m having a period. What’s up?

You probably have an infection. See a gynae or doctor who knows something about this as soon as possible! Worst case scenario – it might be a cancer, so don’t wait!

I had my period twice last month. Google says it may be due to stress and my diet. But now I’m feeling some pain below my stomach. What could it be?

Ovarian cysts can cause abnormal bleeding and lower abdominal pain. You need to see a gynae or at least get a pelvic ultrasound done.

What can I do to reduce wetness before and during intercourse?

It may sound a bit strange, but you can just be practical about it and keep a towel handy to remove some of the excess moisture. We also compound a special cream to be applied into the vagina prior to sex to reduce the lubrication. Just also check for an infection. Sometimes the wetness is not lubrication but actually from an infection. Another option is to go onto a low dose estrogen contraceptive. That often causes vaginal dryness which could help in your case.

How do I tighten and strengthen my vaginal muscles?

You can get lots of information about Kegel Exercises on the internet – with different variations and programmes. Many women find it difficult to isolate these muscles and end up squeezing everything but their vaginal muscles. There are physiotherapists who specialise in this area. They will teach you how to do it through biofeedback.

My husband is 63; I’m 31, but he wants sex every day – sometimes twice a day! I can’t keep up. What should I do?

It can be that he just has a very healthy appetite but it can also be that he has a discomfort in his pelvic area that is released through intercourse, something called persistent genital arousal disorder, or it might be that he has an addiction. With professional help, it can be established which one of the three it is. The point however, is that his high desire cannot be your responsibility. You can have sex as many times as you are willing and able to, but the rest of the time, he will have to sort it out himself.

It can also be a hormonal imbalance which can be addressed medically, so get help if you are taking strain.

I lost my brother six months ago, but am still feeling the loss so I have bouts of depression that kill my sex drive to the point where I don’t even want to be touched or kissed, and its taking strain on my marriage. I can’t take anything hormone based as I have a factor 5 laiden disorder. Is there anything I can do or try to help me out my slump?

One the one hand you just have to be patient with yourself and give yourself time to get over this extremely traumatic life experience. It takes time and it is normal to lose your libido when you have depression.

On the other hand, make sure you get professional help. See a psychologist and take an anti-depressant that does not take your libido away. Something that works very well, but only if you are not anxious, is a drug called bupropion. It can actually boost your libido even if you don’t have depression.

My cramps before and during my period are awful! Is there anything I can do to ease them?

You can go onto the pill or have the Mirena inserted. Natural medicine like Premular or Femiscript also helps. Many women find benefit from using Evening Primrose Oil.

My IUD cut my guy during sex. Is something wrong?

Yes, definitely! It is falling out and probably not effective as a contraceptive anymore! Have it removed and replaced immediately. Sometimes when the strings are cut too short, they sting the partner, but if he got a cut, it was from the actual device itself and it should be removed.

My partner and I are both virgins. How can we make our first time really special?

By taking it really slow. Make sure you have covered base one, two and three before you try to have sex. Also make sure he can insert two fingers into your vagina without hurting you. Don’t expect to have orgasms, just enjoy the uncharted waters of really being one for the first time. You can add more movement and stimulation as time goes on.

My friends say they love having their nipples played with. Mine aren’t sensitive so I don’t really enjoy it. Is there something wrong with me?

No, you probably have other areas that get you going, focus on those and make sure you partner knows about them. If they are not very sensitive, normal kissing and sucking might not feel like much to you. Try a bit more pressure that goes towards pain (but not painful) – that could be very intense and pleasurable for women with nipples that are not very sensitive. Vibration also makes a difference.

What does an orgasm feel like?

It is different for every women – some say it feels like sneezing and others like dying! You have to find out for yourself. One thing that all orgasms have in common is a climax (or a few of them) and then a fall. There is a definite point where you can feel that you are experiencing a release. If the release is gradual or the pleasurable sensation just kind of weans off, you did not have an orgasm. You will know if you did.

I keep getting yeast infections, but my guy won’t treat himself at the same time.

Yeast infections love the vaginal pH, they usually don’t survive on a guy’s penis. The fact that you are getting recurrent infections is not due to him not being treated, it is most likely due to you not being sufficiently treated, or it might not a yeast infection but bacterial vaginosis or even an STI. If it is an STI, he will need to be treated as well. Guys get candida only if they have very low immunity like with HIV or diabetes.

Getting rid of yeast infections often require repeated regular dosages of oral anti-fungal medication, restoring the balance of the pH in your vagina and removing triggers for yeast infections like bubble baths and food that is high in sugar.

We often see atypical yeast infections like candida glabrata. You should get a vaginal swab MCS and ask for specific culture and sensitivity for the candida.

 

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These types of guys often have problems with erections…

These types of guys often have problems with erections…

 

Condom users, protecting themselves against diseases and unwanted pregnancy

Over-worked guys with loads of stress and responsibilities

Seemingly healthy guys with chronic conditions like high blood pressure or diabetes

Successful guys with demanding and/or successful partners with high expectations

 

The ones with the beer-bellies

 

Older guys (when it comes to erections, “older” starts at forty!)

How about you?!

Did you know:  Erectile problems can be a sign of heart disease? Check here if you are at risk:

  • Are you smoking?
  • Did you smoke for more than one year before quitting?
  • Are you taking more than 21 units of alcohol per week (one unit is one beer, one glass of wine or a single tot of hard liquor)
  • Do you get less than 30 min of exercise at least 5 days a week?
  • Do you eat less than five fresh fruits and vegetables per day and often eat fried and processed foods?
  • Did your father have a heart attack or stroke before the age of 55, and your mother before 65?
  • Do you have a big belly?
  • Do you suffer from any of the following? *
    • High blood pressure (More than 130/85)
    • High cholesterol (LDL more than 3)
    • High blood sugar levels (diabetes or pre-diabetes) (fasting glucose >5)
    • Low testosterone levels (early morning sample lower than 12)
    • Kidney disease (eGFR < 60)
    • Prostate problems (elevated PSA, BPH or infection)
    • Abdominal circumference of more than 102 cm?
    • Highly sensitive CRP above 2
    • Sleep apnoea

*If you don’t know any of your scores, ask your doctor to do these tests for you.

If you answered YES to any of these questions, you might have problems with your erections already, or might develop problems in the near future.  Even more serious: You might have heart disease that you’re not aware of.

Other causes for Erectile Dysfunction (ED)

  • Nerve problems: After surgery or injury to the pelvic area (including the prostate), or other conditions such as multiple sclerosis, Parkinson’s Disease, spinal cord injuries and neuropathies.
  • Pelvic floor muscle problems including weakness and spasm.
  • Medication such as anti-depressants, sedatives, blood pressure medication (especially b-blockers and diuretics), and drugs that lower testosterone, such as spironolactone, as well as medicine for stomach ulcers and heartburn.
  • Recreational drugs such as dagga or cocaine.
  • Psychological factors such as performance anxiety or relationship problems.
  • Sexual problems in your partner.
  • Medical conditions such as Peyronie’s Disease.
  • Urinary problems (going too often, dribbling afterwards, hesitancy and weak stream).
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Honeymoon Crash Course – Sexual Health 101

Honeymoon Crash Course – Sexual Health 101

By Dr Elna Rudolph.

Wedding night jitters? Welcome to Sexual Health 101 – find everything you need to know about sex and your sexual health before you set off on your honeymoon.

 

Things to do before your honeymoon

  1. Start getting excited about sex!

It doesn’t matter whether you’re still a virgin or if you have been sexually active before – sex inside of marriage is very special and something that you can look forward to.

If you are a virgin:  You most probably decided to remain a virgin for your wedding day due to religious convictions and that is wonderful.  To manage to do this, you have had to say “no” to the natural processes in your body – being attracted to the one you love but not able to express it fully.  In some ways this resulted in the suppression of your sexuality. Like many of us, you also probably grew up in a household and society in which you didn’t get the most positive messages about sex, sometimes even believing that it is wrong or dirty and definitely not enjoyable.

It is very important that you start with positive self-talk about sex now.  If you have been avoiding reading and learning about sex, now is the time!  Start buying magazines like Women’s Health Magazine and Intimacy/Intiem as well as books about sex. Attend an engagement course where there is good sex education, speak to your close friends and family members you trust – do what you have to get a positive mindset about sex and become excited about it!  It is also important to discuss sex with you fiancée now, if you haven’t done so before.  You have to know what his ideas and expectations are before you get married.  If you find this too difficult, we can help you.

If you realise that you have particularly negative ideas about sex, or are terrified of it, please make an appointment to speak to one of us before you get married.

If you have been abstaining for a while:  Many girls have been sexually active before but decided to abstain for a period before they get married.  In this case you may have switched off your brain for sex.  It is important to make sure that you don’t have negative ideas about sex and that sex will still be physically possible.  Although you are abstaining, allow yourself to think about sex positively and develop an excitement for the new beginning that is waiting for you!  If sex was previously not what you had hoped for, get help now to make sure that marital sex is what it is meant to be for you.

If you have been sexually active:  It is necessary to believe that the best is yet to come.  Don’t settle for what you have been used to.  Buy a few magazines and books to inspire you again to develop new ideas.  If sex is already a problem, why not invest some time and energy now into fixing it, before you start your life together officially?

  1. Prevention of Pregnancy:

Choosing a sex-positive contraception is extremely important!  There is no point in using a method to prevent you from falling pregnant during sex if that method is going to take away your sex drive altogether!

Hormonal Contraception:

This is the method most women still prefer to use and includes the pill, the patch or the ring, as well as the injections, implants and the Mirena.  All of these methods are extremely effective.  The side-effects vary according to the method you choose as well as your body’s response to it.

Whether the pill, patch, ring, injection or implant is going to take away your libido or not, is genetically predetermined, but unfortunately we don’t have a way of knowing beforehand.  Something to look out for is your arousablity.  If you are not responding to stimulation like kissing and other forms of foreplay the way you used to, it is most likely due to your contraception.  If you don’t get aroused, you will also feel drier and orgasm will be more difficult.

The Mirena is a sex-positive contraceptive.  It does not take over the hormones of your entire body – it only works in the uterus where it thickens the mucous in your cervix to make it impossible for sperm to enter into the uterus.  It does not cause an abortion.  It also does not cause bad skin, but it also does not fix acne like the pill does.  Only 4% of people who have had the Mirena inserted were unhappy with it and had it removed.

We insert the Mirena under conscious sedation – it is not a painful or traumatic experience at all!  It lasts for 5 years but can be removed at any point if you want to fall pregnant.

If you are already using a method that you are happy with, stay on it.  Start looking for the right contraceptive at least six months before you get married – sometimes you have to try a few options before you find the right one for you.

If you would like to discuss these options, please make an appointment with one of us.

Other methods:

Condoms are effective contraception, if they are used from the start of intercourse and correctly.  If there are any concerns about breakage, make sure you use the morning after pill (which is available without prescription from pharmacies).

Natural methods like avoiding your most fertile days and withdrawing can also be effective, but about one in 5 women using these methods will fall pregnant within a year.

  1. Make sure both of you have a clean slate:

If you or your hubby-to-be have had sex with one person without a condom before, you may have been exposed to HIV, syphilis, Hepatitis B, HPV, Herpes, Gonorrhoea, Chlamydia, Thrichomoniasis and many other infections.  Even if it was years ago, you can have these infections without even knowing about it and you can certainly transmit them to your partner or become infected by him if you are having unprotected intercourse.

We do a few blood tests and give you presumptive prophylactic treatment for the rest.  Please make an appointment to avoid taking anything that belongs in your past, into your marriage.

  1. Prevent Infections and Cancer:

There are vaccinations available to prevent cervix cancer – the cancer responsible for killing most women in Africa. They are Cervarix and Gardasil.  Gardasil also prevents genital warts in men and women as well as throat cancer, penile and anus cancer.  It is highly advisable that you get these injections before you become sexually active.  Even if you are sexually active, get it sooner rather than later.  Men can also take Gardasil.  Everybody needs three injections over a six months period.

You can also get vaccinated against Hepatitis B, which is a sexually transmitted infection.  It is advisable to get vaccinated against measles again as an adult and against pertussis before you have babies, so you might want to do it all at once now.

Your GP may not be aware of this, contact our offices if you would like to arrange vaccination for you and your fiancée.

  1. Pap Smear and Gynae Examination:

If you have not been sexually active and are under 25 years old, you do not need a pap smear or a pelvic exam or an internal ultrasound before you get married.  Many women see us anyway because they want to know whether everything is functioning normal and if they will be able to have sex.  At this visit we also discuss contraception, infections, immunizations and prescribe antibiotics for the honeymoon.

If you have been sexually active for a year, you need a pap smear.  You should have it done at least every second year in your twenties and every third year in your thirties.  When you are in your thirties, you can also request an HPV test to check for the virus that causes cervix cancer.

The First Night

If you are still a virgin and nervous about the first night, here are answers to some of the most important questions you may have:

Will penetration be possible?

Make sure that you are able to insert tampons and at least two fingers into your vagina before you get married.  If you are not able to do so, please come and see us.  In that case the vaginal canal is too narrow and we will help you with creams and exercises to stretch the canal in order for penetration to be possible.

If it is impossible to penetrate, don’t worry about it – you have the rest of your lives to get it right!  Enjoy the other things there are to sexual intimacy and  make an appointment when you get back from honeymoon so that we can help you find the cause and treat it.

Will it hurt?

If you can insert tampons and two fingers, it should not hurt too much.  It is extremely important to make sure that you are very aroused by the time you try to attempt penetration.  If you are not aroused, you are dry, the uterus sits low in the vagina and the muscles around the vagina are not relaxed – all of these factors will contribute to pain.  If it hurts, don’t worry too much about it.  It will get better every time you try.

Use extra lubrication for the firsts few attempt. Apply it to your vaginal opening and to the head and shaft of his penis.  Our advice is to not use flavoured lubes during the honeymoon – it might cause infection.  You can use flavoured products for massages, but rather avoid them in the beginning and slowly introduce them as you get used to sex.

If sex continues to hurt, enjoy other forms of stimulation and come and see us – sex should not hurt!  We will find the cause of your pain and treat it.

Will it bleed?

If you have been using big tampons, it might not bleed.  This does not mean that you are not a virgin! It might also bleed quite a lot and more than once – that is normal.

What is the best position for first-time sex?

The so-called missionary position, where the women is laying on her back, is most likely the best.  Put a pillow under your bum to make the angle easier for him to penetrate and make sure that you are very aroused by the time he tries.

Take it slow.  You might find that there is some resistance, but with very mild pressure, he should be able to get through it.   You can use your hand to guide his penis in the right direction and to determine the pace at which he proceeds.  Don’t expect to be able to do heavy thrusting during the first attempt – just enjoy being so extremely close and intimate.  If you are comfortable, you can start with gentle movement.

Some women prefer to be on top – they feel more in control and can lower themselves onto their husband’s penis at a pace that they are comfortable with.

You might find that only one or two positions are comfortable initially – that is okay!  As you get used to it, it might become more and more comfortable to try other positions.

What is the best time?

You might choose not to have sex on the night of the wedding.  You are so tired after the biggest day of your life and often the drinks have been flowing for you and for him.  Tiredness and alcohol interfere with sexual performance.  You have been waiting for this night for a very long time – it is perfectly okay to wait one more night and try it the next day.

Men have higher testosterone levels in the morning and therefore they also have higher libidos in the morning.  Make sure you have some refreshing gum on the bedside table to do away with those morning breaths – they can be a bit of a passion killer!

What is good foreplay?

If you have only been kissing up to the wedding day, it is unrealistic to think that you will be comfortable with foreplay and penetrative sex right away.  You might want to take it slow and just give your bodies the chance to get used to each other before you attempt penetration.  It can even take a few days or weeks before you feel ready, and that is perfectly okay!

Foreplay usually involves intimate kissing, caressing the entire body as well as touching, licking, sucking and kissing the breasts and genitals.  There are all kinds of oils and lotions to help you make foreplay more sensual and exciting.

The most sensitive areas for women are their breasts and the clitoris.  The clitoris sits just under the place where the lips split, just below the bony area.  It is extremely sensitive and therefore oral stimulation of the clitoris works particularly well.  The G-spot is about one third into the vagina on the anterior wall and best stimulated with a finger.  Not all women have one, so don’t worry too much about it if you can’t find it on your honeymoon!

For men, the most sensitive area is the head of the penis, although the scrotum, testis and perineum (area behind the scrotum), as well as the nipples, can also be stimulated to give him pleasure.

To feel comfortable with foreplay, you may want to make sure that you are fresh ‘down there’.  It is best to take a relaxing bath or shower (together, if you are comfortable with it) to relax and get yourself in the mood.

Will we have orgasms?

It is very likely that your husband will have an orgasm very soon after penetration – that is perfectly normal in the beginning.  It is also likely that he will not have an orgasm at all, due to the pressure of performing.  Don’t worry about it and just enjoy the fun and intimacy of the experience.  If any of these problems continue after the honeymoon, make an appointment with us – it is easy to treat and not necessary to cause you stress.

Only one third of women experience so-called vaginal orgasms – that is an orgasm during penetrative sex.  Another third will have it during penetration, but only if her clitoris is stimulated.  This can be done with his hand, her hand, a small external vibrator or other forms of indirect stimulation.  Another third of women can only orgasm through foreplay with either manual, oral or vibratory stimulation of her clitoris.

Remember: you can have perfectly satisfying sex without having an orgasm! Do not put too much pressure on yourself in the beginning.  It is extremely important that you know your own body to guide your husband to give you the right stimulation.  If you have been uncomfortable to explore yourself, it will take some time for you to figure it out and that is okay.

Do not expect to see any fluid when you have an orgasm.  It is also normal to expel up to a cup full of fluid during orgasm, but that only happens for the minority of women.

It is your right to have an orgasm during every sexual encounter, but you do not have to feel obliged!  If you continue to struggle to reach an orgasm, make an appointment with us, we will be able to guide you.

What happens after sex?

If you did not use a condom, his semen will eventually run out of your vagina.  For some women this happens immediately and for some it happens over the next few hours or days.  Make sure you have some tissues close to the bed to avoid making a mess.  Some also prefer to put a towel under them in case they make a mess.  Some women can just put some tissue or a small pad into their panties and sleep like that, but most prefer to get up, sit on the toilet for a while in order for the semen to run out.  It is also a good idea to pass urine after sex – that clears any bacteria that might have moved up your urethra during sex to avoid a bladder infection.

Some people prefer to take a shower after sex.  Make sure you use the right soaps when you clean your genital area.  Do not douche or try to wash the semen out of your vagina! This can be extremely harmful! It washes away all the good bacteria and that causes pH imbalances which can result in irritation and infection. It is extremely important to wipe or rinse any flavoured lubrication, or any other product you might have used during sex, as these can cause significant irritation and even infection.

If you feel a bit sensitive after sex, you can apply a special intimate soothing gel to ease the irritation.  It is normal to experience some burning after sex but it should subside within a few minutes.  If it lasts longer than that, make an appointment – it is not normal to be uncomfortable for hours and days after sex.

Infections

Bladder infections:

Many women get bladder infections when they become sexually active.  You will feel a discomfort in your bladder, have the need to go to the toilet frequently, and experience a burning sensation after urination.  Use Citro-Soda  when you feel the irritation.  Drink lots of berry juice or buy berry supplements to take daily on your honeymoon.

If you begin to get a fever and feel ill, you will need an antibiotic.  You will need to see a doctor for a prescription.  If you see us before you get married, we will give you a prescription to buy antibiotics to take with you on your honeymoon, if you would like be prepared for emergencies.

Yeast infections:

Thrush or candida is also a common problem when you become sexually active.  If you have an itchiness and a white discharge, it is most likely candida.  You can buy some Canestan or Canalba cream before you go on your honeymoon.  We also prescribe a tablet for candida if you see us before you get married – you may not particularly want to be inserting cream in your vagina twice a day on your honeymoon!

Other infections:

Remember: up to a tablespoon full of vaginal discharge per day is normal! If it itches, burns or has a foul smell, it is not normal.  In that case you will have to be examined to see what the problem is.

As noted before:  If one of you has had sex without a condom before, you will need to be tested and treated for sexually transmitted infections, even if you do not have any symptoms.  Please make an appointment.

If you struggle with frequent infections, please come and see us.  It is not normal to have more than three infections in a year and the cause of the infections should be treated.

Additional Notes

Libido:

It is normal for men to desire sex much more frequently than women.  Initially, most women experience spontaneous desire for sex, but as time goes by it is normal for women to only develop desire once foreplay has started.  In other words, most women start sex completely neutral and then develop desire after some good stimulation has taken place.

Sometimes the man is the low desire partner.  This can be normal, but it can also be a sign of serious medical, psychological or relationship problems.  If you are worried about it, please contact us.

If a man cannot get, or maintain, an erection every now and then, it is okay, but if it remains a problem, please make an appointment for him – it can be a sign of heart disease and thorough investigations are necessary.

Frequency:

If you read popular magazines you would think that people are having sex every day or at least three times a week.  There is no such a thing as “normal.”  It depends on what works for both of you.  The reality is that most people are having sex only once a week or less.

Make sure you make time for each other regularly and if it leads to sex, great!  Spend fifteen minutes every day, one night a week, one weekend a month and one week a year just in each other’s company – no phones, television, computers, animals or kids.  Just the two of you, talking to each other about the things that are on your hearts.

Also: Sex should not be a big affair that takes an hour every time, it is too much of an effort to maintain such high standards.  Sometimes a quickie can be very exciting and more than good enough.  But: make sure that you do put in effort regularly – buy an exciting product or a piece of lingerie or try something you read in a magazine.  The more often you try something new and exciting, the less likely you are to become bored of your sex life.

We have some exciting products you can purchase discreetly from our online shop – you don’t have to enter a dodgy shop where you don’t want to be seen! Visit My Sexual Health Shop to browse our products.

On a serious note:

If you have experienced any degree of sexual abuse, if sex is an unpleasant event for you, if you are concerned about a porn addiction or sexual requests that your partner makes that you are not comfortable with, or if there has been infidelity – all of these can be dealt with effectively in therapy.  Please contact us to arrange an appointment – don’t allow anything, big or small, to interfere in your marriage.

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The Complications of Untreated Chlamydia

The Complications of Untreated Chlamydia

By Rebekah Kendal.

We take a closer look at the complications that men and women might experience as a result of untreated chlamydia.

Because at least half of the people with chlamydia don’t experience any symptoms, it is possible to have the infection without realising it.  According to Dr Elna Rudolph, a medical doctor and sexologist from My Sexual Health, it is possible to develop complications over time if the infection goes untreated, particularly if you get infected repeatedly.

Complications in women

  • Pelvic Inflammatory Disease (PID): “The most serious complication is PID,” says Rudolph, “where the infection goes into the fallopian tubes and around the ovaries and other areas in the pelvis.”
  • Infertility: PID can cause scarring and obstruction in the fallopian tubes, which can result in infertility. It can also increase your risk of miscarriage and ectopic pregnancy.
  • Bartholin’s cyst: Untreated chlamydia can cause the glands that produce lubricating mucus during sex, Bartholin’s glands, to become blocked, resulting in a cyst. An abscess may form if the cyst becomes infected.
  • Increased risk of STIs: “If you have untreated chlamydia, you are actually at much higher risk of contracting other infections such as gonorrhoea and HIV,” explains Rudolph.
  • Infection in newborns: Chlamydia can be passed from a mother to her child during delivery. According to Rudolph, this usually results in an eye infection, which can be treated with an antibiotic ointment.

Complications in men

  • Epididymitis and prostatitis: “Chlamydia can cause infections of the epididymis, the sperm pipe next to the testicles, or an infection in the prostate that can cause pain during intercourse, fever and chills,” says Rudolph.
  • Urethritis: Inflammation of the urethra (urine tube) is most commonly caused by chlamydia. Symptoms of urethritis include a cloudy white discharge from the tip of the penis and pain or burning during urination.
  • Reiter Syndrome: “Occasionally chlamydia is associated with a condition called Reiter Syndrome where there is a reaction to the infection, which affects the whole body,” says Rudolph. “This can cause joint swelling, and can affect the eyes and urethra.”

Shared complications

If chlamydia is contracted during oral or anal sex, it can result in complications that can affect both men and women. “You can get a sore throat, painful swallowing, coughing and fever,” explains Rudolph. “In the anus, it usually causes a discharge and can cause bleeding and painful sex.”

Treatment

“PID and testis infections can be treated with antibiotic treatment and occasionally surgery if abscesses have formed. The infertility can sometimes be reversed, but only with very specialised surgery of the fallopian tubes,” counsels Rudolph. “The Reiter Syndrome is treated with anti-inflammatory drugs and resolves by itself over time.”

For more information and other sex-related queries, visit www.mysexualhealth.co.za.

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Eager Beaver

Eager Beaver

By Nichi Hodgson, Originally published in Women’s Health Magazine, 2015. Edited by Dr. Elna Rudolph.

Things we love about vaginas: they have more names than Snoop Dogg. People have written poems, songs and plays about them, and in our overexposed, overtly sexualized world, vaginas still hold the power to appall, enthrall and excite. Oh, and give birth. But it turns out we still have a few tricks to learn…

Oral sex how-to (for him)

A guide you might want to subtly leave on his bedside table…

  1. “While you’re kissing, press a thigh between her legs,” says sex expert Midori, author of Wild Side Sex (like Madonna, she only needs one name). “Now, grind in, moving up and down. It’s the washing-machine-on-spin-cycle principle – the overall vibration has a greater effect than just using a finger or two.” Noted.
  2. “Next, start to nibble through her skirt as a teasing prelude – she should soon start grinding on your face. But before her panties come off completely, try breathing and licking her through them. It’ll make for a truly explosive touchdown when your tongue finally makes direct contact with her clitoris.”
  3. Now to master your technique. “If you want to practice clitoral stimulation, put a Tic Tac in a sandwich bag. Learn to suck the mint between your lips without using your teeth, then keep it there, while using your tongue to tease it.” Well, that’s something they never mentioned in the advert.

Question Time…

Things you never learnt during high school sex ed…

Q. Can my Rabbit give me an STI?

A. If you’ve had one before, yes, you can get it again from your vibrator, says sex educator Kate McCombs. “Toys made from porous material can harbor infections. Choose silicone, glass or stainless steel and clean them in soap and hot water.” Non-electric silicone ones can even go in the dishwasher. Just watch out who unloads it.

Q. Can his cold sore give me genital herpes?

A. In a nutshell: yes. According to Dr Natalie Hinchcliffe, “The HSV 1 type (usually the oral kind) can be passed to your genitals, even if lesions aren’t present.” Cold sores on your cooch? Not ideal. Dr. Elna Rudolph adds that “the notion that HSV1 is an oral infection and HSV2 is a genital infection is no longer true.  You can get “cold sores” on your genitals and genital herpes in your mouth and on your lips.  If he has ever had a fever blister, he can give you genital herpes! The chance is slim, but not zero.  In SA 80% of people have HSV1 in their mouths – it leaves a very small minority that can safely have oral sex!”

Q. Could I become vibrator-dependent?

A. Afraid so, says sex therapist Sarah Berry. “Too much vibrator use can desensitise you. If you’re struggling to orgasm with a partner, cut out the toys until you get used to manual stimulation again.” Turn off to get turned on. “If your brain gets used to reaching orgasm in a specific way, without variations, it becomes learned behavior and deviating from that becomes difficult”, says Rudolph.  “Make sure you love yourself in many different ways to keep your clitoris (and brain!) sensitive to all kinds of stimulation.”

Q. Is it possible to grow a vagina?

A. Actually, yes. US scientists have pioneered a way to lab-grow a vagina from a woman’s own cells. It can then be implanted into her body. The process takes just six weeks and the vagina even has full sexual function. But what do they do with the old one?

Three things your vajayjay would veto

Treat your vagina with kindness and it will return the favour.

1. Smoking

The risk of cervical cancer is about double in smokers,” says Hinchcliffe. “Smoking also puts you at greater risk of certain STIs, including trichomonas – you know, the one that gives you a horrible, foul-smelling discharge.” Stub it out for the sake of your vag. Rudolph adds: “It is much more difficult for your body to fight off the damage cause by HPV infection if you smoke.  Women who already have abnormal pap smears have a much higher chance of it getting worse and worse, even up to the point of cervix cancer, if they smoke.  Some infections like the foul-smelling Trichomonas is also more common in smokers.”

2. Douching

“Your vagina actually cleans itself, so there’s no need to douche it with anything,” explains Hinchcliffe. “In fact, bacterial vaginosis is significantly more common among women who douche, as is general irritability in the area. Your vagina is not meant to smell like a rose, so stop trying to make it.” But if you insist, for gynae’s sake put down the lemon verbena soap on a roap and use a specially formulated wash with the right pH balance. FEMAGENE products won’t upset your beaver’s balance, BUT only if you use it externally.  Never ever use any soap inside your vagina and definitely don’t squirt anything into your vagina. It kills all the good stuff and makes your situation worse in the long run. Bacterial Vaginosis, a condition where one or more of the natural bacteria in your vagina overgrows and cause a smelly discharge, is much more common in women who douche or try to wash inside their vaginas.

3. Penetration-only orgasms

Too many of us still prioritise the hole as the goal – to our sexual detriment. A study by neuroendocrinologist Dr Kim Wallen found that seven percent of women can climax from penetrative sex alone. What’s more, he calculated the “C-V ratio” to show it’s the distance between your clitoris and vagina that likely determines your ability to have a hole-in-one orgasm. The perfect pump-to-pleasure measurement was found to be 2.5cm. If yours is longer than that, don’t let him think it’s only his magic wand that counts.

For when your hoo-haa isn’t feeling hunky dory…

Find out when your lady garden needs some love…

> Symptom: Burnt skin thanks to a bad bikini wax

Unless the skin is blistered, this doesn’t require medical attention. Just treat as you would any other burnL run under cold water, apply cream such as E45, avoid intercourse until healed and, most importantly, get yourself a new beautician, pronto!

> Symptom: Discharge after intercourse

As long as there’s no strange colour or sudden change in consistency, it’s normal. Discharge increases with sexual arousal and the amount varies from woman to woman. And if a guy ejaculates inside you, expect to leak.

> Symptom: Soreness or irritation after exercise

A dragging sensation could indicate vaginal prolapse. Cycling is one of the worst culprits for beaver-bruising, as a study in the BMJ found female cyclists were at particular risk of infections and swelling. Saddle and handlebar positions are important – German scientists found sitting with your upper body at a 30-degree angle to the bike frame can reduce blood flow to your vagina by up to 70 percent. Stand up on your pedals every 10 minutes to avoid this.

> Symptom: Pain during and after sex

One in five women experience pain during intercourse.  There can be various reasons for this from serious gynaecological conditions to hormonal imbalances, infections to muscles spasms and nerve abnormalities.  These need to be excluded and then managed by an experienced multi-disciplinary team that can also address the psychological aspects of suffering from painful intercourse.  Treatment might involve using vaginal dilators, physiotherapy and various creams as well as sorting out any infections and gynae problems.

> Symptom: Bleeding between periods

This warrants some form of medical investigation, as it can be caused by infection, cervical cancer or ectropion (also known as cervical erosion). Ectropion is a normal response to hormones and usually occurs in women of reproductive age, especially those using hormonal contraception. It can be scary, but as long as your smear tests are normal, it’s unlikely to be a long-term worry.

> Symptom: Pain at the top of your pubic bone

Generally means pelvic inflammatory disease (PID), an ovarian cyst or endometriosis. PID symptoms include fever, unusual discharge and bleeding between periods. Cysts cause acute pain on one side, but often go away by themselves. Painful sex, severe period pain and pain going for a number two could be endometriosis, which can be eased with oral or hormonal contraceptives.

 

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Sex and Pain

Painful Sex

Many women who complain about low libidos actually experience pain during sex, according to Dr Elna Rudolph, head of the multi-disciplinary team at My Sexual Health in Pretoria.

“When it comes to sex, some medical practitioners feel out of their depth. They know that when sex is painful it can cause a massive divide in a relationship, but they don’t know how to address the issue and they often end up telling the patient there is nothing ‘wrong’ with her, because a clinical examination does not reveal any overt pathology like visible lesions, discharges or anatomical abnormalities.  As a result, patients tend to move from one medical practitioner to the next hoping for a solution. In some instances, it takes years before she is diagnosed and treated.”

Dr Rudolph noted that every time a woman is told that there is nothing wrong with her or that it is ‘all in her head’, she interprets it as meaning there is in fact something seriously wrong with her, because nobody can figure it out.

She appealed to doctors to refrain from using the phrase ‘it is all in your head’ when consulting a patient who complains about painful sex.  Rather say that you cannot find the cause for the pain and refer her to a centre that specialises in the management of painful intercourse.

An Approach to Dyspareunia:

The DSM V now reads Genito-Pelvic Pain/Penetration Disorders and throws all causes for dyspareunia under one psychiatric diagnosis.  The fact that it is in the DSM V acknowledges that dyspareunia has a significant psychological impact on a patient, but it should not be interpreted as “sexual pain is all in the mind.”  This umbrella-term certainly also does not aid in diagnosing and treating the cause of the pain.  The next section aims to provide an approach to dyspareunia: Pain during sex can be either deep or superficial.

Deep Dyspareunia:

Gynaecological Disorders:

Deep pain usually signals a gynaecological problem like ovarian cysts, fibroids, endometriosis, occasionally a retroverted uterus (although this is a relatively common finding, it is seldom the cause of the pain), pelvic inflammatory disease and neoplastic disorders.  If the patient has deep dyspareunia and the cause cannot be diagnosed and or treated by the GP, referral to a gynaecologist is very important.

Bowel Disorders:

Irritable or Inflammatory Bowel Disease as well as simple constipation can cause dyspareunia.  If there is any occult faecal blood, weight loss or any other danger sign, the patient should be referred for colonoscopy.

Bladder Disorders:

A chronic, untreated urinary tract infection and other bladder pathology can cause painful intercourse.  A condition that is often missed is painful bladder syndrome, formerly known as interstitial cystitis.  This is now seen as a pain disorder involving central sensitization rather than being an organic disease.  The patient experiences pain over the bladder and what feels like chronic or recurrent urinary tract infections, but with sterile urine with or without hematuria.  If there is hematuria, urological referral is advised.  If not, it should be treated like a pain disorder in the context if an experienced multi-disciplinary team.  Medications that are used include anti-histamines, gabapentin, pregabalin, amitriptyline, duloxetine, anti-inflammatories, muscle relaxants, etc.

Other Causes:

Repeated abdominal and pelvic surgeries contribute to a large portion of deep dyspareunia.  It also sometimes seen in patients who over-train their core muscles like pilates instructors, triathletes and dancers.  In these cases, referral for myofascial release by a specialist pelvic function physiotherapist can solve the problem.

Superficial Dyspareunia:

Superficial pain is experienced around the vaginal opening and on attempted penetration. Patients usually describes a sharp stinging, burning or tearing sensation and that it feels like her partner is hitting a wall inside her vagina.

It is important to distinguish between localised and generalised pain.

Localised:

Localised pain can be organic and nociceptive in nature with a clear cause like a visible herpes ulcers or fissures.  In the cases where there is a lesion with an unknown cause, especially if it does not respond to empirical therapy in two weeks, a biopsy should be taken to make the correct diagnosis.  Lichen Sclerosis, Erosive Lichen Planus, Spongiotic Dermatitis and undiagnosed Genital Herpes are common causes of localised genital pain.  To take a biopsy of normal looking skin or mucosa is usually of no value – it will just show mild inflammatory changes and make no contribution to the diagnosis or the treatment plan.

Fissures:

Fissuring or splitting of the posterior fourchette – which can occur at the first attempt at sex or years later –  can cause pain that is described as: ‘like a paper-cut’, ‘knife-like’ or as a tearing sensation.  They have mild to severe pain with penetration and might tear when inserting tampons or during gynaecological examination. They often see bleeding or spotting after sex and will complain of itching, burning or stinging when the area comes into contact with semen, water or urine.  An examination will reveal a tiny split or linear erosion at the midline of the base of the vagina on the perineal skin. In addition, the posterior fourchette may form a tight band or tent (membranous hypertrophy).  Splitting occurs when the posterior fourchette is pulled into the vagina and experiences friction from thrusting, especially if there is not enough lubrication or if the mucosa is atrophic due to hormonal changes.  Correcting the hormonal imbalance, using a non-irritating protective substance like Aquaphor, using a silicone lubricant and making sure the fragile part does not get pushed into the vagina during penetration by manually pulling down on it with a thumb when inserting the penis, works very well.  If this does not help, it is usually due to an undiagnosed chronic infection or other skin condition and a biopsy is warranted.

Genito-Urinary Syndrome of Menopause:

Previously known as atrophic vaginitis, this condition causes significant discomfort and impairment of quality of life for older women.  If peri- or post-menopausal woman experiences pain during sex, it is probably due to a local oestrogen deficiency. They also experience significant urinary symptoms: they feel as though they have recurrent infections, when in fact they don’t and they often have trouble with incontinence as well.  Post- menopausal women who are on topical oestrogen are twice as like as their oestrogen-deficient peers to be sexually active.

Provoked Vestibulodynia:

A common form of localised pain where there is no visible pathology is Provoked Vestibulodynia.  This condition is easily diagnosed by touching the vestibule with a wet ear bud.  If the patient experiences a burning or stinging sensation, it is called allodynia and it is diagnostic.  The patient should be asked to rate the pain out of 10 at the following positions:  above the urethra, under the urethra, as well as at the the 4’O clock 6’O clock and 8’O clock positions.   This condition is due to neuroproliferation and can be genetic, due to recurrent infections or due to hormonal abnormalities caused by hormonal contraception or menopause.  If only the posterior aspect of the vestibule is affected, it is due to a hypertonic pelvic floor with irritation of the pudendal nerve.

Oral contraceptives, especially the low-dose anti-androgenic ones cause a relative oestrogen and testosterone deficiency in the vestibillum, which induces neuroproliferation, in some women.  It is more likely to happen in those who start off with congenital neuroproliferation around the vaginal opening.  You will find that those patients also have a sensitive umbilicus.  Look out for vestibulodynia in the patients with the sensitive umbilicus, those who can’t use tampons and first-time pill users.

Recurrent infections can also cause neuroproliferation, but one of the biggest contributors in those with recurrent infections is the repeated use of topical anti-fungals.  In a sensitive vestibule, it causes a chemical dermatitis that feels like and infection, but is only worsened by continuous use of topical agents.  Do a vaginal swab and ask for sensitivity to be done on the candida if there is any.  We see many cases of candida glabrata and ducreii in clinical practice and it is most likely do to over-use of conventional anti-fungal treatments that selects for the resistant strains.  Only treat what you find on the swab and aim for oral treatment rather than topical treatment in these cases.

In our experience, women with very small labia minora and an exposed introitus are more likely to suffer from provoked vestibulodynia.  It is most likely due to higher exposure of the vestibule with irritation of the nerve-endings.

Provoked Vestibulodynia is treated by taking away the cause of the neuroproliferation, restoring the hormonal balance of the vestibule, treating the associated neuropathic pain and correcting the pelvic floor hypertonicity if it is present.

Hypertonic Pelvic Floor:

Almost all cases of superficial pain will have some degree of pelvic floor hypertonicity.  It is often a chicken-and-egg situation where one is not sure if the muscle spasm caused the nerve irritation or if it was the other way around.  The most important aspect of the treatment of superficial dyspareunia is making sure that the pelvic floor has normal tone.  In the presence of hypertonicitiy, the pain is maintained, and cure is very difficult.

Injury such as traumatic vaginal delivery, pelvic surgery, positional insults such as prolonged driving or occupations that require prolonged sitting, gait disturbances, traumatic injury to the back or pelvis, and sexual abuse can cause the muscles in the pelvic floor to go into spasm.

Vaginismus:

According to the DSM V the more up-to-date term to use would be a “penetration disorder” but with vaginismus there is a distinct phobic reaction and avoidance behaviour associated with attempts at penetration. A hypertonic pelvic floor certainly contributes to vaginismus.  In our clinic, most women with vaginismus also have another superficial pain disorder and the vaginismus is merely a response to repeated attempts at penetration that was extremely painful.  Most of our vaginismus patients have also never been able to use a tampon.  Some do have a history of sexual abuse and dysfunctional families, but that is actually a small percentage.  Almost all patients have a history of a strict religious upbringing, very little sex education as well as negative ideas and messages about sex from early childhood.

The research show that this condition is best managed in the context of a multi-disciplinary team.  These patients need to have the contributing medical conditions like provoked vestibulodynia diagnosed and treated, but they also need sex therapy, relationship therapy, cognitive behavioural therapy (where she learns to take control of her own vagina and what happens in her genital area), dilator therapy and physiotherapy by a women’s health physiotherapist who specialises in the treatment of sexual dysfunction (there is only a handful around!)  During the treatment process sex is forbidden but the couple is given sensate focus exercises to re-establish intimacy if it has dwindled and to rewire the women’s mind – she has to learn that sensual experiences are not always threatening can be pleasurable.  She also needs to get in touch with her sexual self – something that most patients suffering from vaginismus though would never be possible.

The patient will see each of the multi-disciplinary team members alone or with her partner a few times during the treatment period.  When we are satisfied that she is physically and emotionally ready to attempt penetration, it is done in a gradual manner where the partner first helps with dilators and then gently attempts penetration when they are both ready.

The process does consume a lot of resources: time, money, emotional energy, but it is all worth it in the end.  The treatment success of a program like this is very high, all over the world.

Generalised superficial pain:

Generalised superficial pain is often unprovoked and not only associated with intercourse, although an attempt at penetration can worsen the pain.  This is referred to Vulvodynia can be seen as a chronic pain syndrome. The pain usually comes and goes with some patients experiencing long pain-free intervals and some have constant pain that gets better and worse depending on a whole range of factors.

Pudendal Neuralgia:

A specific form of superficial pain is called pudendal neuralgia where patients experience a burning pain in the distribution of the pudendal nerve.  The pain can be in the whole area from the clitoris to the anus or only one specific branch.  It can also be unilateral or bilateral.  This pain usually gets worse when the patient is sitting and better if they are lying on their sides.  The treatment involves physiotherapy, pharmacotherapy with drugs like pregabalin or gabapentin, often pudendal nerve blocks (which is also diagnostic) and only occasionally surgery where a narrowing of Alcock’s canal can be demonstrated.

Chronic Pelvic Pain:

An estimated 40% of diagnostic laparoscopies and 12% of hysterectomies are performed for pelvic pain, according to Weiss et al.  Although diagnositic laparoscopy is necessary to diagnose some important causes of chronic pelvic pain like endometriosis, repeated exploratory laparoscopies and especially laparotomies is not advised.  In fact, it worsens the condition due to scar tissue formation and with worsening of myofascial pain.  This is a complicated condition with often no clear cause or multiple contributing factors.  In many cases, conventional treatment is ineffective and management by a multi-disciplinary team is required.

Other Chronic Pain Disorders:

Patients with disorders like fibromyalgia and rheumatoid arthritis have a higher incidence of dyspareunia – deep or superficial as well as chronic pelvic pain.  In these situations the underlying painful condition should be treated optimally, but it is often necessary to address the painful intercourse separate as well.

Persistent genital arousal disorder:

This condition is marked by constant or intermitted feeling of genital arousal with or without spontaneous orgasms. Its unwanted and not due to sexual stimulation or thoughts and causes significant distress for the patient.  Of late, this condition is seen as a type of genital pain disorder and is treated much like vulvodynia in specialised sexual pain centres.  Referral is advised.

Some useful tips

  • If a women complains about dyspareunia, ask her to tell you about the pain. Let her talk for a minute or two – the diagnosis is usually already clear if you just allow her to describe her symptoms.
  • Then get a good history and ask about her overall physical health and medication use.
  • If a woman is tense or scared, take the time to reassure her by giving her a step-by-step account of what you are going to do next. Start the examination with a general exam and then by touching her thighs – after informing her of your intension – then move to the vulva.
  • In addition, if the patient is scared, do not use a speculum at the first examination – a finger and an ear bud are all you need to diagnose the cause of superficial pain.
  • Always ask a patient to rate her pain on a scale of 1-10 and to describe the sensation. Make a note of this and compare it at the follow-up consultation.  If there is no improvement, refer the patient.
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Candida or Thrush

Candida or Thrush

Published by Femagene.

Dr. Elna Rudolph shares everything you need to know about candida and how to prevent and treat it.

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Why and what to expect from annual check-ups

Why and what to expect from annual check-ups

Published by Femagene.

Dr. Elna Rudolph shares the importance of going for annual check-ups.