Oestrogen Side-Effects and Complications

In our experience at MSH, trans females or non-binary individuals requesting Gender Affirming Hormone Treatment feel great on oestrogen.  We always start with a low dose and work up slowly to avoid unwanted side-effects.  The following side-effects may occur at any dose but is more likely to happen at higher dosages.  Most of them disappear after a few days.

If you read the list, you may be inclined to think that no person should ever take the risk of taking hormones! But in actuality, most people experience only benefits and no side-effects from oestrogen.  It is however important to be knowledgeable about all the risks and make an informed decision.

The most important side-effects are those that might be a sign of having a blood clot or an embolism (where the blood clot dislodges into the lung or brain). Those are marked in bold. If you suspect that you might have a blood clot, you will need to have it investigated immediately.  If your doctor is not available, you will have to go to the emergency department of your nearest hospital and say that you are on oestrogen therapy and suspect that you have a blood clot.  In our practice we are aware of one cis-female who developed a blood clot on hormones, but that was also due to an uncontrolled inflammatory disease in her colon. It is a rare side-effect, but very serious if it does occur.  If you smoke, you have a much higher risk to develop a blood clot.  You are advised against taking oestrogen if you are smoking.  You are also advised against taking oestrogen if you have known heart disease.

Along with its needed effects, oestradiol (the active ingredient contained in oestrogen implants, patches, creams, gels and pills) may cause some unwanted effects. Although most of these side effects are vary rare, they have been reported in clinical trials and/or in real-life situations.  It is not known if the reported cases are directly due to oestrogen in all cases, but here is the list:


  • clear or bloody discharge from the nipple
  • dimpling of the breast skin
  • inverted nipple
  • lump in the breast or under the arm
  • persistent crusting or scaling of the nipple
  • redness or swelling of the breast
  • sore on the skin of the breast that does not heal
  • pain
  • milky discharge
  • non-cancerous breast growths
  • breast cancer

Central Nervous System:

  • irritability
  • feeling sad or empty
  • lack of appetite
  • tiredness
  • trouble concentrating
  • trouble sleeping
  • headache
  • migraine
  • dizziness
  • vertigo
  • aggravation of epilepsy
  • feeling of pins and needles (if in both hands/feet it is unlikely to be a sign of a blood clot, but if it is in only one limb, it could be a sign of a blood clot)
  • depression
  • nervousness
  • mood swings
  • change in libido
  • anxiety

Heart and lungs:

  • fast heartbeat
  • noisy, rattling breathing
  • tightness in the chest
  • trouble breathing when at rest
  • trouble breathing or swallowing
  • changes in blood pressure – high blood pressure or low blood pressure
  • venothrombo-embolism (when a blood clot dislodges into your lung or brain)
  • upper respiratory tract infection
  • heart attack
  • stroke


  • hives, itching, or rash
  • Redness
  • If redness is associated with swelling and pain, it could be a sign of a blood clot
  • Varicose veins (if painful they could be a sign of a blood clot, but usually not a dangerous one. Still advisable to seek medical attention)
  • skin discoloration
  • acne
  • alopecia (loss of hair)
  • hyperhidrosis (excessive sweating in certain areas)
  • night sweats
  • eczema

With implants:

  • local reaction to the oestradiol implant
  • infection at the implant site
  • bleeding at the implant side
  • non-healing of the implant wound
  • erosion of the implant through the skin
  • scarring of the implant wound
  • scar tissue formation in the tract made for the implant
  • damage to nerves and blood vessels around the implant
  • pain at the site of the implant
  • oestrogen overdose
  • allergic reaction to the local anaesthetic used
  • allergic reaction to the plaster/steri-strip used


  • decrease in the amount of urine
  • pain or feeling of pressure in the pelvis
  • diarrhoea
  • abdominal pain
  • flatulence
  • nausea and vomiting
  • abdominal distension


  • deep vein thrombosis (a blood clot, usually in your lower leg, but it can occur anywhere)
  • fever or chills
  • hot flushes
  • joint pain, stiffness, or swelling
  • pain, redness, or swelling in the arm or leg
  • swelling of the eyelids, face, fingers, lips, hands, feet, or lower legs
  • back pain
  • headache and migraine
  • weight gain
  • ear congestion
  • loss of voice or hoarseness
  • nasal congestion
  • runny nose
  • sneezing
  • sore throat
  • leg cramps
  • visual disturbances
  • abnormal liver tests
  • jaundice
  • fluid retention
  • allergic reaction, including anaphylactic shock

Possible Symptoms of Oestradiol Overdose:

  • dizziness
  • drowsiness
  • nausea
  • stomach pain
  • tenderness of the breasts
  • unusual tiredness or weakness
  • vomiting

Some side effects of oestradiol may occur that usually do not warrant medical attention. These side effects may go away during treatment as your body adjusts to the medicine.  If you are worried at all, experiencing worsening of side-effects or are experiencing a serious side-effect, please contact your doctor immediately.  If your doctor is not available, you will have to go to the emergency department of your nearest hospital.

This document was adapted from: https://www.drugs.com/sfx/oestradiol-implants-side-effects.html with additional information added.


Dr Elna Rudolph
Written by Dr Elna Rudolph – Medical Doctor, Sexologist and Clinical Head of My Sexual Health.
086 7272950

CHANGING GENDER: Things that matter!

Many of my transgender patients want to go through the process of having their names and gender markers changed on their IDs. I provide them with the letter they need, but the process involves much more than that.  I asked one of my patients, Max, to share his journey with you, which he very kindly and eloquently did!  I hope you find this helpful.

Dr Elna Rudolph
Clinical Head of My Sexual Health


Max’s Story: My 2 year application process

Last week I confirmed that my new ID book is in the final stages of processing; my name has been updated, and the gender marker change is receiving final approval. If all goes well, I should be able to collect it in 10 working days. Given that this can be quite a challenge and has taken me over 2 years, I am feeling particularly grateful that my experience has gone smoothly. In fact, when that little green book is in my hands, I plan to post feedback to the Department of Home Affairs through as many mediums as possible, commending them on this instance of service delivery. Sometimes they do get it right and it impacts lives! I hope that soon it can become the standard experience for all.

In the months since I applied in June 2014, I have received many requests for information regarding the process of updating one’s ID book. So I thought it would be helpful to write a post detailing all that I know. I will fight this fight until I help others to complete their process.

Changing gender

In terms of section 27(A) read with the provisions of the Alteration of Sex Description and Sex Status Act (No. 49 of 2003).

Applications can be made by:

Persons who have undergone a sex change operation or medical treatment resulting in their gender reassignment.  In such cases two medical reports are required:

  1. one by the medical practitioner who applied the procedure or medical treatment or by a medical practitioner who has experience in such procedures or treatments, and
  2. a report by a second medical practitioner who has independently examined the application to established his/her gender.

Your Rights As A Transgender South African

Our constitution is actually very progressive, particularly around the rights of transgender individuals. In 2003 the law was changed to allow transgender individuals to change their name and gender WITHOUT having any kind of surgery. In Section 1 of Act 49, it states:

“Any person whose sexual characteristics have been altered by surgical or medical treatment resulting in gender reassignment may apply to the Director General of the National Department of Home Affairs …”

The key term to take note of here is “gender reassignment” which is defined in the legislation as:

“… gender reassignment means a process which is undertaken for the purpose of reassigning a person’s sex by changing physiological or other sexual characteristics, and includes any part of such a process …”

This statement is really very helpful because it means that 1.) gender reassignment is recognised as a process that happens over time, 2.) is not limited to alterations made to genitals, and 3.) that there is no specific juncture within such a personal and individually varied process that must be reached before a person “qualifies” to change their ID book. This is truly revolutionary and very empowering; in a country where a vast majority do not have the resources to consider surgical options, being able to align their ID documents is a vital step towards their true expression being recognised.

** It is important to note that gender reassignment, as it is currently defined, is still dependent on some form of medical intervention. “Sexual characteristics” refers to either primary (genitals) or secondary (hormone-related identifiers) characteristics and are required to reflect, to some degree, one’s identified gender expression.

In Short: you must have undergone surgery and/or be on HRT (Hormone Replacement Therapy or rather Gender Affirming Hormone Treatment as we prefer to call it) such that primary and/or secondary sexual characteristics align or are aligning with your identified gender in order to amend the gender marker in your ID book.

Where Is Gender Marked In A South African ID Book?

Gender is indicated within your unique ID number. The first six digits reflect your date of birth. The next four digits are where gender is indicated. A value less than 5000 correlates to female, while greater than 5000 correlates to male.


When you apply to have your gender amended, you will receive a new ID number. The four digit gender marker should then correctly reflect your identified gender.

What Do You Need To Apply?

  • Form BI 526 (application for an amendment)
  • On this form you indicate which of the particulars are erroneous (in this case, gender) and you are applying to have amended.
  • Form BI 9 (application for identity book/card)
  • Form BI 24 (notice of birth)
  • This form must be filled in twice
  • The first form is filled in with your assigned gender
  • The second form is filled in with your identified gender
  • VERY IMPORTANT: on the first letter (assigned gender) write “OLD” in big, bold letters on the top of the form. On the second letter (identified gender) write “NEW” in big, bold letters on top of the form.
  • In Summary: both forms are filled in with identical information EXCEPT your gender, with your old information on the form you have indicated as “OLD”, and the information which your ID book should be amended to on the form you have indicated as “NEW”.
  • 2 letters from medical professionals who have assisted with gender reassignment (or affirmation, as we like to call it):
  • Both letters need to state that gender reassignment has taken place. Please refer to the next section for more details and samples.
  • The first letter should be supplied by your main doctor, typically your surgeon or doctor prescribing your hormones .
  • The second letter simply needs to confirm the first letter, and can be supplied by a psychologist, GP, or other medical professional assisting you.
  • A copy of your birth certificate
  • Your existing ID book and a copy thereof
  • Full-colour photos for ID (at least 2)
  • R 210 [R 70 – gender amendment; R 140 – reissue of ID book]
  • I paid less than this, but the fees are subject to change. Better to be prepared and take a little extra.

When I applied for my change I did not need the copy of my birth certificate, but I also had to get slightly different forms. Sometimes the DHA will not be as organised as we might like, so I recommend taking as much with you as possible, and be prepared to adapt.

Supporting Letters

As stipulated above 2 letters are required to support your application to change the gender in your ID book. Once again Gender Dynamix has been most helpful and supplied me with an overview – which you can send to your doctors – of exactly what the letters should say.

Through helping individuals in the country with this process GDX has found that the implementation of Act 49 is not always carried out correctly. Unfortunately, clerks often do not pass on applications to the relevant legal department and instead make judgements according to their own opinions. GDX has found that letters that are phrased briefly and to the point are fast-tracked. It is not required to provide details regarding the individual’s process. So long as your medical professionals state that gender reassignment has taken place, then the requirements have been met. The overview also states that GDX has ensured that such brevity is completely legal, which may come up as a concern for your doctors.

How Long Does It Take?

This is one aspect where the law and the implementation of the law do not line up. Due to the safety concerns for someone whose presentation and legal identifications may not match, the importance for efficient turn-over times on re-issuing ID books has been recongised. Ideally it should take no longer than 8 weeks to receive your new ID book. But at DHA you will be informed that the waiting period is 6 – 8 months. We can only hope that this will improve as processes are streamlined. Even though mine took 2 years with a fight.

Final Notes From Me

I submitted my application through the Department of Home Affairs Krugerdorp in Gauteng. I recommend them because my overall experience was very positive. I was incredibly nervous and prepared at any moment to have to deal with discriminatory behaviour, but everyone that I asked regarding forms and procedures was very helpful, polite and able to provide the answers I needed. The individual that processed my application was particularly wonderful. Due to the fact that amending your gender entails a long waiting period, I wanted to change my name at the same time. I was told that every amendment needed to be done separately, but when I appealed to the lady processing my documents, she allowed me to submit both changes at once.

My advice: be over-prepared.

We all know that at any DHA everyone is impatient. So the faster you can be processed, the happier everyone will be, including the person processing your application. Be polite, and if you need to argue, logic and flattery (in my experience) are the way to go. If you want to change your name and gender at once, for example, I suggest pointing out that doing both in one saves them time, effort and paperwork.

** make sure that when you pay for the services that the cashier notes that you are paying for multiple amendments. My application was briefly delayed when I had to return to the DHA to pay for the name change, which the cashier had not noted the first time round.

Be aware of the reality. It is quite possible that you will encounter difficulties, whether discriminatory or administrative. Try not to part with original documents and provide copies instead. Keep your copies of the application forms, and take note of the reference numbers on them. Breathe deeply, know that it is your right to have an ID book that reflects your identity correctly, and there are organisations to help you if you do have issues.

Finally, if you can, have someone to support you and go with you to DHA. My partner came with me, and was a very steadying presence during the process. Especially if you are nervous, having a significant other, family member or friend with you can be very reassuring.

Track The Progress

I highly recommend calling the DHA Hotline at 080 060 1190 on a regular basis (every 2 weeks) to checkup on the status of your application. Make sure to ask for a reference number after each call. Don’t panic if for several months the status is some variation of “being processed”. GDX does offer to assist with tracking applications. If you email them your details, the date that you applied and the reference numbers of calls you have made, they will follow up with the DHA. I did not need to call in the backup, but if you do experience any problems I recommend contacting them.

There is also a mobile app you can download that queries the DHA database. It was very exciting to see the status go from Step 1 of 4 to Step 2 of 4, but beyond that it has been too vague to be helpful. Phoning in was far more satisfactory.

So there you go. I hope this proves helpful and worth the read to anyone seeking to amend their ID book. I’m sure the process will change in time.

As hard as it is to be patient and wait just remember it will be worth it at the end.

I’m a email away: maxtjacobs@gmail.com

A phone call away: 0814905451

Facebook: Things That Matter Trans Support


Find more information on transgender sexual health here, or read our blog articles relating to all transgender matters.

Max is a patient of Dr Elna Rudolph. For enquiries, please contact My Sexual Health.

Dr Elna Rudolph
Dr Elna Rudolph – Medical Doctor, Sexologist and Clinical Head of My Sexual Health.
086 7272950
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New MSH Silicone Dilators – a breakthrough in treating painful intercourse

About the new MSH Silicone Dilators

This product is our pride and joy because it has helped so many couples to have pain-free intercourse. They have been custom made here in South Africa, according to the needs of the thousands of individuals and couples that the My Sexual Health (MSH) doctors have treated for vaginismus and other forms of painful intercourse.

Two major advantages are that the silicone dilators have a soft tip and they do not cause infections. We have many patients who have tried plastic or glass dilators in the past, as well as other household items, but they all prefer our silicone dilators now, because of their softness and suppleness. You can also place the silicone dilator in hot water before you use it to retain heat – so much more comfortable than plastic or glass objects that can cause reflex muscle spasm due to being cold.

The highest quality material for its specific purpose has been used in the manufacturing process, and each product is individually casted and sterilised – our products are not mass produced.

We also make a size six (6) and a size seven (7) dilators for women who have a partner with a penis larger than the size five (5). However, the penis of a typical man is between a size four (4) and five (5) dilator. The silicone dilators can be purchased individually should you not need the whole set. We also make “stub dilators” with the same girth as the standard sizes, but they are much shorter and therefore easier to sleep with or keep inside you during the day.

The silicone dilators can be cleaned either with normal fragrance-free soap, or the soap from the FEMAGENE range, and warm water – rinsed and dried thoroughly before storing it in a cool and dry place.

What is the Success Rate of the MSH Dilators?

According to statistics from our MSH doctors, patients progress on average to the number four (4) and five (5) dilator within three (3) to four (4) weeks if they take their medication and see the physiotherapist. Those who do not progress as well, often need Botox or further intensive psychological treatments.

Our dilators have shown work particularly well not only for treating vaginismus but for a host of other conditions too! Pelvic surgery, radiation for genital and rectal cancers, transgender patients with neo-vaginas or any other intersex condition where a vagina had to be constructed or stretched, women who cannot use tampons, women who find intercourse difficult due to a long period of abstinence, menopause setting in or due to skin conditions like lichen sclerosis and lichen planus, after childbirth, and for painful anal intercourse.

How the MSH Treatment Process works

After you have been evaluated by one of our MSH doctors, you will likely get a prescription for a special medicinal cream to address the hormonal and nerve problems you may have, as well as treatment for infections or treatment to prevent infections, muscle relaxants and further medication to help you cope with anxiety when you are dilating or visiting the physiotherapist.

MSH patients see a specialist pelvic function physiotherapist to teach them breathing and positioning techniques, evaluate their pelvic floor muscles, show them how to actively relax their pelvic floor muscles, demonstrate to them how to use the dilators and progress from the different sizes, and help them with trouble shooting when they get stuck. Specialist pelvic function physiotherapists also attempt to find and treat the cause for tight pelvic floor muscles, rather than just addressing the symptoms.

We also recommend that you use the medication for about ten (10) days before visiting the physiotherapist and preferably first see the physiotherapist before you attempt to use the dilators.

Some patients experience painful intercourse due solely to medical reasons. If, however, you expect that there may also be a psychological component (especially if you were victim to childhood sexual abuse or traumatic sexual experiences), we strongly recommend that you also see one of the specialist psychologists or trained hypnotherapists on our team.

If you have not seen one of the MSH doctors and you are struggling with your dilators, please visit one of them as soon as possible. There is usually an untreated medical condition preventing you from progressing, or psychological issues which have not been attended to. Thousands of women around the world have cured their vaginismus and other sexual pain conditions by only using dilators. If you feel comfortable to first try it on your own – go for it! (But please do see a doctor who specialises in pelvic pain if you have any concerns).

How to use your MSH Silicone Dilators step-by-step

  • Select an appropriate time and a warm comfortable place – allow for relaxation and no interruption.
  • Position your body lying down with your legs bent – place pillows or cushions under your turned-out thighs to allow your leg muscles to completely relax.
  • You can warm the dilator before using it – put it in hot water for 5-10 minutes to slightly warm it (avoid it getting too hot).
  • Apply your prescribed cream if you are a MSH patient. Make sure you rub it in around the opening and into the opening, using the tip of your finger, for at least two (2) minutes.
  • Very important: if you are not using these dilators for vaginismus, but for another reason relating to being transgender, intersex or a male, please ask your MSH doctor or physiotherapist if you have any uncertainties.

Step One: Lubrication

You can use any kind of lubrication, however, we recommend that you use Pjur Body Glide Lube or Pjur Med Premium Glide if you struggle with recurrent infections, or if you are very sensitive. If you are being treated by one of the MSH doctors, you can also use the cream they have prescribed as a lubricant. These lubricants can be ordered online from www.MySexualHealthShop.co.za.

Avoid lubricants containing petrochemicals as these can cause pelvic floor tissue irritation and exacerbate pain. Even natural oils can disturb the natural balance of your vagina and contribute to painful intercourse.

Place a small amount of lubricant on the tip of the dilator and around the opening of the vagina.

Step Two: Breathe

Focus on your breathing by using a series of slow, deep breaths. Try to breathe with relaxed, deep breaths so that your belly rises when breathing in and falls when breathing out. This is called diaphragmatic breathing and its purpose is to switch on your parasympathetic nervous system, which makes you feel safe and relaxed, and switch off your fight and flight reaction, which is often over-active in people with vaginismus or painful intercourse.

Count while you are breathing. If you take four (4) counts to inhale, try to take eight (8) counts to exhale. Continue diaphragmatic deep breathing for up to five (5) minutes at the outset of the session.

Step Three – Scanning

Scan your body for any area of muscle tension from head to toes. Notice any muscular tension around your eyes, jaw, throat, shoulders, buttocks and legs. Mentally encourage each area to relax and loosen with each exhalation. As you exhale, let the pelvic area soften with each breath. Visualise or imagine this area in a state of softness, relaxing further with every exhalation.

Step Four: Insert the Dilator

  • Start with the smallest size dilator and gradually progress to a larger size as comfort permits.
  • Rest the narrow end of the dilator against the opening whilst continuing relaxed diaphragmatic breathing.
  • Gently insert the end of the dilator into the entrance when you feel ready to do so.
  • Gradually insert the dilator to a tolerable depth. Keep the level of discomfort minimal – if you feel any discomfort, pause for up to a minute at a time, continuing to breathe and relax your pelvic floor.
  • When discomfort has eased, progress further while stopping at regular intervals to get your body accustomed to the sensation and lengthening of the tissue.
  • Try to keep the dilator in for 30 minutes at a time.
  • If you find that the dilator goes in easily, it is time to progress to the next size. Some people will start the session with a smaller dilator, leave it in for five (5) minutes and then feel ready to progress to a larger dilator.
  • Never force the dilator beyond a level of personal comfort.

Step Five: Dilator Withdrawal

  • After your session, gently withdraw the dilator and allow yourself to rest and recover before getting up.
  • Make sure you are completely relaxed before withdrawing the dilator. The pelvic floor will often contract as a reflex reaction when you start to withdraw. Just give your body time to relax.
  • It is normal to feel a burning sensation after dilating. This is due to the stretched muscles that irritated the nerves. If you are an MSH patient, you can use the cream your doctor prescribed after dilating again. You can also use the FEMAGENE Soothing Gel after dilating.
  • Wash the dilator with warm soapy water thoroughly, dry and store. No need to wash or wipe the cream or lubricant from your genital area – it will only irritate the area more.

Frequency and Timing of Dilator Therapy

  • Aim to use your dilator for 30 minutes during each session. However, when starting out, this time frame may be well reduced.
  • We recommend that you dilate every day for 30 minutes. Many of our patients get comfortable enough to sleep with their dilators a few hours every night (wear leggings to keep it in) or buy the stub dilators and walk around with them during the day.
  • Once you have established pain-free intercourse, we recommend that you maintain the relaxation of the pelvic floor muscles by either dilating, having sex or having physiotherapy three (3) times a week (i.e. if you are having pain-free sex three (3) times a week, there is probably no need to keep on dilating, but if you are getting to sex only once per week, you will need some regular dilating to maintain the relaxation of the pelvic floor.

Additional Dilator Therapy Techniques

These are some of the typical dilator therapy techniques that may be discussed during your visit to the therapist or doctor regarding their suitability for use:

  • Gradually increasing the depth of dilator penetration.
  • Massaging in a circular motion.
  • Moving the dilator diagonally i.e. forwards and backwards, and left to right.
  • Moving the dilator in and out of the vagina while maintaining gentle pressure against the vaginal wall.
  • Maintaining gentle pressure against an area of discomfort for up to 60 seconds.
  • Involving your partner in dilator therapy.

Important Precautions to take while using Dilators

  • Keep discomfort to a minimum – you should not feel physical or psychological discomfort when you are dilating. Of course, you will need to push yourself a little to progress to the next size, but if you feel overly anxious or uncomfortable, first speak to your doctor, your physiotherapist or psychologist about it.
  • Avoid using a dilator with active pelvic infection and see your doctor if you think that you might have an infection.
  • Avoid using a dilator immediately following pelvic surgery – be guided by your specialists’ recommendations regarding all forms of post-operative penetration and dilator use. You also do not want to wait too long either – as soon the sutures have dissolved, you should be able to begin with dilator therapy.
  • Dilating should never lead to bleeding – if you are bleeding, you MUST see a doctor. It may be due to infection or extreme thinning of the outer layer of your vagina.
  • Never use someone else’s dilator.
  • Clean and dry your dilator thoroughly after each use.

How to Progress to Intercourse:

Once you can insert the number five (5) dilator without physical or emotional discomfort, we recommend that you involve your partner in the process. Only when your partner can insert the number five (5) dilator without causing discomfort for you, you can progress to attempt penetration as if your partner is the next size dilator (rather than through a passionate love-making session). We find that it is better if you take the first few attempts at penetration very slowly and then progress to normal intercourse when you are comfortable with penetration.

If you or your partner suffer from painful intercourse, please make an appointment to see one of our specialist health care providers.

To purchase any of our MSH Silicone Dilators, visit the My Sexual Health Shop.
For more information on MSH Silicone Dilators, contact us on 086 7272 950

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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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Candidiasis is a fungal infection in the body. There are many species of Candida, but the most common species that causes infection is called Candida albicans.

Candida albicans occurs normally in small amounts in the body. An overgrowth of the fungus, Candida albicans is what causes candidiasis. Candidiasis can affect many parts of the body including the mouth, throat, oesophagus (food pipe) and the genitourinary tract (vagina, bladder or penis).

It is extremely common amongst people from all walks of life.

Vaginal infection

A vaginal infection with Candida albicans is sometimes referred to as “thrush” or a “yeast infection”

It is very common: 3 out of every 4 women will have this infection at least once (if not more) in their lifetime! It is normal to have some Candida present in the vaginal canal, however an overgrowth of Candida can cause a symptomatic yeast infection.

So how does the infection occur?

The normal vaginal canal requires a very carefully regulated pH and the presence of healthy bacteria. The presence of “good” bacteria helps to keep the growth of Candida under control. Many factors can cause the Candida to “overgrow” and cause an infection. These factors include antibiotics, stress, fragranced toiletries and steroid use amongst many others. Many woman “douche” the vagina, and this can contribute to thrush. As it removes the healthy bacteria from the vagina and changes the pH within the vagina.

What are the symptoms?

Thrush can cause itching of the vulva, vaginal discharge (thick white discharge – “cottage cheese”), burning/pain on urination and burning/pain during sex.

What are the treatment options?

Some treatments are available over-the-counter (without prescription). These are usually vaginal creams and tablets which are placed into the vagina. Your doctor may also prescribe a tablet (usually Fluconazole) which is an “anti-fungal” and works against the Candida albicans.

Penile Infection

Candida can also affect the penis. It usually affects the head of the penis, and causes redness, burning/pain during urination/sex, and a rash. It can occur because of an overgrowth of bacteria or from direct contact with a partner with a thrush infection. It can be treated in the same way (creams which are applied or with tablets to drink).

What can be done to prevent Candida infection?

Avoid using perfumed and fragranced soaps in and around the genitals. Avoid vaginal douche: this does not help clean out the infection, it only makes it worse. Your doctor can suggest a probiotic to use to help replace the “good bacteria” in the vagina. Use condoms to prevent the spread of infection and partner re-infection.

IMPORTANT: Although thrush can be spread via sex, it is NOT a sexually transmitted infection. Meaning, that it can occur without sexual intercourse.

Although thrush can be treated with over-the-counter medications, it is advised that you consult your doctor so that they can make sure it is not another type of infection/illness.

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Avoid these things before sex…

Avoid these things before sex…

Here are a few very handy tips we should ALL take note of…

Published by X’s & O’s. For more sex tips, visit http://www.xsandos.net

From one trans to another

Coming to terms with being Trans is incredibly difficult. So is telling people, if you choose to. You spend all this time obsessing about how they are going to take it, or worrying about others simply not understanding. You spend hours trying to think of different ways to explain the concepts of sex and gender in a way that everyone will comprehend, and at some points, you have to accept that there will be people who will never “get it”. You mull over how people will react if you change how you look, what you wear etc. You worry about whether or not people will invalidate you for wanting to look a certain way. You try so hard to “pass” because not passing means constant ridicule, and you spend so much time trying to figure out how to change your voice, how to change your face, just so you can feel more like yourself.

Even then, people will not always be kind. People are rarely kind about things they don’t understand. So sometimes, Trans people don’t ever come out. They stay hidden, because being hidden is easier than loosing everyone. It is easier than being labelled a freak. It is easier than being completely alone. As a trans person who went through these feelings, and still going through them, I want to tell other trans people that things really do get better. Whether you are out or not, being yourself is always the best idea. Yes, people are going to be shitty about it. That is almost guaranteed. You will get better at hearing transphobic comments. Some days they will bother you a lot, but you will find people who will help you through that. You’ll find out who your friends really are. I certainly did. I thought I was going to lose everyone I loved, but I didn’t. Yes, I lost some people, and you will too. But you don’t need people like them, people who can’t accept you for who you are. Being yourself is like breaking out of a cage; it’s going to be painful at first, and every once in a while you might lose your footing, but you are free. Nobody can take your freedom from you and it is so worth being free.

What I am trying to say is be yourself. There is no one else like you. Nobody can invalidate you. Nobody can take away from the content of your character. At the end of the day, you have to look at yourself in the mirror and feel content with what you see. That is what matters. The rest will fall into place. You are brave enough to be yourself; each and every one of you. You will not ever really be alone. You won’t lose everyone. You will grow a thicker skin than you ever thought you could, and one day you will feel so happy with yourself that hateful comments will simply make you laugh. It is hard to see it now, but it is possible and it will happen. YOU are human! You are not the names people call you. Your value is decided by YOU, and no one else. The most important thing in life is to be happy with yourself, and you will be. You will be fine.

– Anonymous –

All images courtesy of Google

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Sexual Health Tests: What You Need When

Sexual Health Tests: What You Need When

Published in Clicks Clubcard Magazine, June 2015.

Knowing your ‘status’ isn’t only about HIV. Getting checked out for other STIs is crucial to protect your health – and your fertility.

Flavoured condoms for everyone? This is not the usual type of headline you see in newspapers… But with Health Minister Aaron Motsoaledi recently announcing that the Department of Health was going to be handing these out at universities, it’s a clear sign that South Africa has come a long way in finding solutions to curb the spread of HIV and other sexually transmitted diseases (STI). The innovative move comes off the back of research by the Human Sciences Research Council (HSRC) that more and more South Africans are having unsafe sex and have no fear of getting infected with HIV/Aids. And it’s not just varsity students – the stats show that this attitude is worsening across all age groups. The good news – and boy do we need some – is that because our country has far-reaching treatment programmes fewer people are dying from the disease.

Read the full article here.

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Let’s talk about sex

Let’s talk about sex

In today’s complicated and tricky world, sex is becoming an increasingly more difficult thing to define. “Sex” can mean vastly different things to different people. Each person has their own particular definition of what it means to have a “healthy sex life”.

I was asked by a student publication to address the question: “How should we as students view sex in our lives?”

It is impossible to give a single straightforward answer to this question. For example, one student may view sex as a taboo, whereas another may see it as “fun” or as healthy part of a relationship. Each student is unique, with specific personal thoughts and opinions about sex. To attempt to prescribe an all-encompassing view that all students can apply to themselves, would be a futile task.

The important message is that students, regardless of what their belief systems or personal choices are, should be encouraged to make informed choices and be safe.

Safety cannot be stressed enough. Being “safe” is more than simply using condoms. “Safety” means looking after your health, which includes your sexual health. Medical concerns such as pap smears, family planning and HIV testing are just as important as addressing your personal concerns and ideas regarding sex and sexuality.

Safety is not an issue of morality, safety is for everybody.

Irrespective of your personal choices and behaviour regarding sex, sexuality and relationships, you should be addressing your sexual health. Campus Health Centres at Universities do provide sexual and gender health services.

Our generation is unique in that we live in a world where information is so easily available. It is quite literally at our fingertips. When deciding how to view sex in your own life, endeavour to get all the information you need in order to make safe and fulfilling choices.

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Q: Am I bisexual or a lesbian?

Am I bisexual or a lesbian?


Q: For the first time in my life I had an erotic dream about a hot girl that I work with and now and can’t stop thinking about her. Does that mean I am bisexual or a lesbian?

A: Not necessarily. What you are describing is actually quite common. Women can be aroused by a wide variety of images and fantasies. Now doesn’t that come as a surprise?

Sex research revealed that when men viewed images of straight sex, gay sex and animal sex, they were only aroused by their personal preference – straight men do not think man-on-man action is hot and vice versa. But straight women viewing similar images responded to all of them with sexual arousal – some experienced only objective arousal (an increase in vaginal secretions while viewing these images); others experienced subjective arousal (feeling mentally aroused).

While this research suggests that women might be turned on by various kinds of action, it doesn’t mean that we have a wider variety of sexual preferences.

What I have found in my practice, is that women are often very upset – even disgusted – about their fantasies or dreams involving other women. They start to assume that they might be gay or bisexual, and if that doesn’t fit in with their value system it can cause severe distress for them.

Some have even gone on to experiment with same sex experiences, enjoyed it and now don’t know how to make sense of it all – they’re sexually attracted to and want a long-term commitment with men, but they don’t understand why their minds and bodies might secretly respond to women.

The feedback that I give is that there’s a big difference between the things that we might find exciting and the way we actually choose to live our lives. Compare it to an affair for instance: having a hot stint with that married guy from senior management might be very exciting, but is it worth risking loosing the things we value the most in our lives?