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Lubrication

Lubrication

This is an interview with me by Boitumelo Matshaba from Move! Magazine about lubricants. Make your pick!

Read the full article here.

Make sure you also check out our products to enhance sexual pleasure.

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When Pleasure Becomes Pain

When Pleasure Becomes Pain

Painful sex is one of the most common conditions I treat in my practice.  This article was written for medical doctors to help them to make the correct diagnosis if you have painful intercourse and more importantly point you and your doctor in the right direction to get treatment that takes the pain away completely.  I hope you or your doctor find it helpful!  You are more than welcome to make an appointment for this assessment and the appropriate treatment.

Please also have a look at our amazing products for the treatment for sexual pain.

Interested in reading more about sexual pain?  The My Sexual Health blog has many articles available on the subject.

Written by Dr Elna Rudolph

Dr Elna Rudolph
Written by Dr Elna Rudolph – Clinical Head of My Sexual Health
011 568 4800
www.DrElnaRudolph.co.za
www.mysexualhealth.co.za
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Botox Injections for Sexual Pain, Vaginismus and Vulvodynia

Botox has been proven to be a safe and effective treatment for sexual pain, vaginismus and more recently also for vulvodynia.   Depending on the diagnosis and cause of the pain, it is used in conjunction with various other medical treatments, physiotherapy, counselling, hypnotherapy and sex therapy.  We do not recommend it as first line therapy for any form of sexual pain, but we have helped many patients by adding Botox to their treatment plan.  I (Dr Elna Rudolph) have presented the results of those patients who needed Botox for the treatment of their sexual pain at the International Conference of Sexual Medicine in Portugal.  My research from our clinic shows that our patients perceive Botox to be a safe and effective treatment for sexual pain, vaginismus and vulvodynia.  I have also found that it works exceptionally well for couples in unconsummated relationships and for people who cannot use tampons.

A few facts about Vaginal Botox:

  • Botox does not take away the sensation around your vagina.
  • Botox does not change the appearance of your vagina or vulva.
  • The procedure we use only relaxes the small muscles around the vaginal opening that makes penetration difficult or irritates the nerves and cause burning and stinging. We only use Botox in the external pelvic floor muscles.  It therefore does not help for deep pelvic pain, only pain on insertion.
  • In eight years of using Botox as treatment, we have never had a patient or partner who complained that the vagina was too big or too relaxed after the procedure, or that it influenced their ability to experience pleasure during foreplay or intercourse. It just makes it less sensitive to pain and to being stretched.
  • Complications such as a leaking bladder or leaking stools have never happened in our clinic and it is extremely unlikely to happen due to the technique we use. We also use real Botox that does not have a tendency to spread to other areas. These are however two of the listed possible complications of Botox.  If either of these complications do occur, it is reversible after three to four months when the Botox begins to work out of your system.
  • The procedure is performed under conscious sedation in our procedure room at the practice.

The Botox will only begin to take effect after ten to fourteen days.  It will then work for three to four months.  If you have established regular intercourse during this time, it is highly unlikely that you will need to repeat the Botox procedure.  Less than 10% of our patients have had to repeat the procedure.

I cannot guarantee that Botox will make your sex completely pain-free or take away your vulvodynia, but if I recommended it to a patient it is because I believe there to be a very good chance that it will make a significant difference.  If I could offer it for free, I would recommend it to 90% of my pain patients.

If you have never been able to insert the number 5 dilator, please talk to me about signing consent for a partial hymenectomy to be performed during the Botox procedure.  In some cases, the hymen may be too tight, and the number 5 dilator cannot be inserted, despite relaxing the muscles completely.  In these cases, it is advisable to make a few small incisions in the hymen.  We do not use any stitches and there is usually minimal bleeding (bleeding as much as during a normal menstrual cycle is nothing to worry about).  The bleeding usually stops within a day or two, but some spotting might occur when the dilator is inserted.  This usually also stops within a week after the procedure.  If you aren’t able to dilate after a partial hymenectomy, the slits may heal with scar tissue formation and the procedure will have to be repeated.

You can also have a Mirena inserted or have a pap smear done during the procedure.  Please discuss this with me before the procedure and remind me about it on the day of your procedure.

What to expect from the procedure:

On arrival, you will be given a local anaesthetic cream to be applied around your vaginal opening.  You should arrive at least 15 minutes prior to your scheduled appointment to allow enough time for the anaesthetic cream to take effect.

If you are having your Botox procedure done by me in Bryanston, you will first meet with Dr Jeanne Aspeling, who will be performing your conscious sedation.  This is a very light form of anaesthesia where you will be partially awake and aware, but you will not have any memory of the event.  It helps you to relax enough to allow me to perform the procedure.

I will then clean the area and inject 10 ml of a long-acting local anaesthetic into your external pelvic floor (around the outside of your vaginal opening).  These injections are somewhat painful.  I will then inject 50 units of Botox, mixed with saline, into the affected muscles. You will receive between 20 and 30 injections in total, so you can expect some bleeding and bruising.  The sensation will come back later during the course of the day when the local anaesthetic wears off, and the Botox will take up to fourteen days to start working.

There will be no pain initially, but as soon as the anaesthetic starts to work out of your system, you may experience pain.  Many patients contact me after the procedure, worried because it feels like the pain is worse than before the procedure.  This is just the body’s reaction to the minor trauma caused by the injections.  The Botox will start working in ten to fourteen days.  Just use the biggest dilator you can insert and take a break for a day if you have to.

Continue to use your Fluconazole weekly to prevent candida infection and contact the practice immediately if you think you have developed an infection or any other complication.

DILATORS:

You have to spend as much time as possible with the largest dilator inside you.  Start as soon as you get home and stay in bed for the rest of the day and night.  Over the weekend you will be able to resume normal activities, but it is still advisable to keep the dilator in for as many hours as possible.  Put a heavy book or other object between your legs to keep it in place if it keeps slipping out.  We suggest that you sleep with the dilators during this two-week period, if you are able to.  If it becomes uncomfortable during the night, you can remove it.  If it becomes too painful to use your dilators, especially if you have pain for an extended period after removing it, take a break for a day before trying again.

You may want to get a stub dilator to make it easier to sleep with your dilator or to walk around with it inside your vagina.  They are the same girth as the normal dilator, but they are shorter, and the outside is oval shaped to make it more comfortable between your legs.  They are available in sizes 3 to 6 and can be purchased at the practice or from www.mysexualhealthSHOP.co.za.

If we have been treated with Botox for vulvodynia, you may be too tender and irritated to keep the dilators in for such long periods.  Just do as much as your body allows you to do.

Please bring your dilators with you on the day of the procedure as I may need to use them during your procedure.

SEX:

The Botox will take at least ten to fourteen days to start working.  Please do not attempt intercourse before then and also not before you are able to insert the number 5 dilator.  If you feel ready, please do attempt intercourse before you see me for your two-week follow-up. Please follow the steps in the “Penetration Programme” initially – you can request the programme to be emailed to you by our staff.

FOLLOW-UP:

I would like to see you again two weeks after your procedure.  Please arrange the follow-up appointment with my staff when you book your Botox appointment to avoid disappointment. The follow-up appointment is included in the cost of the Botox and can be claimed from your medical aid (the amount that your medical aid pays out for a normal GP consultation).

I recommend that you see your physiotherapist shortly before you see me for your follow-up.  It helps to get rid of the tightness around the muscles that may still be pinching the nerves.  Since Botox only helps for superficial pain, you may need to continue seeing the physiotherapist for deeper pain or other problems.

After your two-week follow-up, if you are having pain-free intercourse, I would like to see you again between six weeks and six months, depending on your situation and condition.  I will then evaluate the need to repeat the procedure and confirm that all your sexual problems have been resolved.  Although most of our patients go on to have pain-free or much more comfortable sex after the procedure, up to half of our patients still experience some form of sexual dysfunction a few months or years after the procedure.  Please be aware of this.  You may still need to get additional help for your libido, for instance, or any difficulties with orgasm, any fears around sex or any relationship issues.  Remember that we have a comprehensive team of experts who will be very happy to assist you.  You are welcome to arrange a follow-up appointment with me at any time.

SCHEDULING AN APPOINTMENT FOR YOUR BOTOX PROCEDURE:

The best time for performing the Botox procedure is on a Friday, or any other day which would allow you to keep activity to a minimum for at least two days following the procedure, mostly because we would like you to have as much possible time to dilate.  I will give you a certificate for sick leave if you need it.

Some medical aids pay a portion of the procedure.  You are welcome to contact the practice for a quotation to send to your medical aid.

To make a booking:

  1. Booking your Botox procedure is a sensitive matter, so please call my office on 011 568 4844 to book your appointment. I am usually fully booked a few weeks ahead so book as early as you can.
  2. If you would like to have a Mirena® fitted at the same time, please inform my staff. We do keep the Mirena in stock, and you don’t need a prescription for it.  If you have the Mirena fitted during your Botox procedure, you will only pay extra for the Mirena device – the procedure will be included in the Botox price, making it possible for you to claim more money back from your medical aid.
  3. You will be asked to pay the full amount at least four days prior to your procedure (we do not keep Botox in stock – we order it as soon as your appointment has been confirmed and paid).

Please be sure to arrange for someone to collect you from the procedure room. Under no circumstances will you be allowed to drive during the first 8 hours after receiving the conscious sedation, and you should also not be left unaccompanied for the rest of the day.

If you experience any complications due to the procedure, please email me immediately (elna.rudolph@mysexualhealth.co.za).  Pain, bleeding and bruising are normal for the first few days.  Infection and problems with your bladder or bowel are unexpected problems, so I would definitely want to know about them.

Written by Dr Elna Rudolph

Dr Elna Rudolph
Written by Dr Elna Rudolph – Clinical Head of My Sexual Health
011 568 4800
www.DrElnaRudolph.co.za
www.mysexualhealth.co.za
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Kyleena – The Hottest New Birth Control Option

Kyleena is a new intra-uterine system (IUS) very similar to the Mirena.  It is a device that is inserted into the uterus to serve as a so-called Long-Acting Reversable Contraceptive (LARC) and it’s a great option for every woman from as early as the teenage years (yes, you can use the Kyleena even if you have never had children!).

I recently attended training on the Kyleena and thought our readers may be interested in a bit more in-depth knowledge:

*Please Note: I have not been paid, asked or contracted by Bayer to write this article – I do it purely to inform our readers on the latest contraception options available.

 

How does the Kyleena work?

It secretes a very small amount of Levonorgestrel into your uterus daily, for a period of at least five years.  Levonorgestrel is a progestogen – a chemical produced by scientists to work similarly to your own progesterone.  It prevents pregnancy by changing the mucus in the mouth of your womb (your cervix) to make it impossible for sperm to swim through it.

How is it different from the pill?

  • It does not contain any estrogen.
  • It contains about a tenth of the amount of Levonorgestrel used in the pill and only 1% of the amount used in the morning after pill (i.e. much less hormones and much more natural to your body).
  • It does not suppress ovulation the way the pill does – your body continues to ovulate naturally.
  • It is much safer! In one study it was shown that you are up to 20 times more likely to fall pregnant on the pill than you are on Kyleena or the Mirena, over a three-year period.  If used correctly and with perfect consistency, the pill should be very safe, but the reality is that most women do not use it correctly. In fact, it is estimated that up to one in ten women fall pregnant on the pill within the first year!
  • On the pill, if you have diarrhoea or take anti-biotics, you risk falling pregnant. Kyleena remains effective regardless of what you do, what you take or what illness you might have!

How is it different form the Mirena?

  • The Kyleena contains less hormone (Levonorgestrel) in total than the Mirena and releases a smaller amount of it per day.
  • It is significantly smaller than the Mirena and therefore easier and less painful to insert.
  • Fewer women on the Kyleena will stop bleeding completely than on the Mirena (25% vs 60%).
  • Kyleena is not registered for menopausal women to use as endometrial protection in conjunction for estradiol hormonal treatment, like the Mirena is.
  • Kyleena is not registered for the treatment of heavy menstrual bleeding like the Mirena is.

What are my chances of falling pregnant on the Kyleena?

According to the research done by Bayer during the testing of the product, less than 1% risk over three years (for the pill, that figure is about 10%) and 1.4% over five years.

What are the advantages of the Kyleena?

  • Fit and forget – nothing that you can do (apart from removing it!) can influence its efficacy. Once it is in, you can forget about birth control – it’s taken care of!
  • No change in body weight was observed during the studies – it does not make you gain weight!
  • Among the studies, 99% of patients were satisfied with the Kyleena after using it for five years. That is much higher than the satisfaction rate on the pill for instance. Four out of five patients taking part in the studies chose to have the Kyleena inserted again after five years – a very good indication that they were happy with it!
  • It has no effect on bone mineral density like other progestogen-only contraceptives (because it just works inside the uterus).
  • You will have lighter, shorter and less painful periods compared to not taking a contraceptive.
  • You will have instant return to fertility if you have it removed – you can even fall pregnant the same day!
  • Like all other intra-uterine devices or systems, it reduces the risk of cancer in the cervix.
  • It does not increase or reduce the risk for breast or ovarian cancer.
  • It can be even used by women who have not had children and we frequently insert IUSs for virgins at MSH!
  • If you use it for longer than 18 months, it is more cost-effective than being on the pill.

What are the potential complications of having the Kyleena fitted?

  • The most dangerous complication is that the doctor might push the device right through your uterus (womb).  That is called a uterine perforation.  It could result in the Kyleena ending up in your abdomen and that you will need to have it surgically removed.  This happens in about once in 1000 cases and is slightly more likely to happen if you have recently had a baby.
  • It could move or fall out.  During the studies, this happened in 3.7% of cases.  If you have significant bleeding or pain after having it fitted, you should have an ultra-sound done to ensure that it is in the correct place.People have historically believed that intra-uterine devices or systems could cause infections like Pelvic Inflammatory Disease.  This was proven to be untrue in the case of Kyleena and Mirena.
  • Although it is very rare, you may get a vaso-vagal attack, which is similar to fainting when you have your blood drawn, and your blood pressure and pulse rate could fall very low, causing you to feel sick.  Your doctor should have emergency treatment available to treat you if this happens.
  • You are slightly more at risk of getting so-called “functional cysts” on your ovaries.  Up to one in five women on Kyleena/Mirena will sometimes show a cyst on their ovaries when doing an ultrasound, but it will not cause pain or any other problems and it should disappear within two to three months. It does not result in more surgeries for cysts than in the general population.
  • Although not really a complication, in about 4% of the study cases, the doctors were not able to get it fitted the first time.  In such a case you may be referred to have it inserted in theatre.
  • Ectopic (tube) pregnancies:  Kyleena does not cause ectopic pregnancies, but if you do fall pregnant on the Kyleena, please see a gynaecologist immediately and make sure it is an intra-uterine pregnancy and not an ectopic.  Up to half of pregnancies on the Kyleena or Mirena are ectopic pregnancies.  Tube pregnancies can be very dangerous, even life-threatening.  Remember: pregnancies on the Kyleena are extremely rare, but please see your doctor immediately if it does happen.

Will it be painful to have the Kyleena inserted?

  • 8% of women in the studies rated the pain from insertion as severe.
  • 20% said that the insertion was “not even uncomfortable”.

If you are worried about pain, we prefer to insert it during your menstruation and we also offer conscious sedation to patients who prefer to be sedated.

IN SHORT:  If falling pregnant is not on the radar of your immediate future and if you prefer to use birth control that does not influence your hormones or menstrual cycle, Kyleena is most likely the best contraceptive choice for you.

I hope this information has answered most of your questions.  Again, please note that Bayer did not pay or ask me to write this article and the information provided are from my notes taken during the training session.

Please do not hesitate to contact any of the MSH doctors if you have any questions. Our doctors have inserted hundreds of IUSs over the years and will be very happy to answer your questions and fit your device if you select the Kyleena as contraceptive.

Dr Elna Rudolph
Written by Dr Elna Rudolph – Clinical Head of My Sexual Health
011 568 4800
www.DrElnaRudolph.co.za
www.mysexualhealth.co.za
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Platelet Rich Plasma Treatment for Sexual Dysfunction

Platelet Rich Plasma (PRP) is a novel treatment modality involving the use of elements from a person’s own blood to promote healing and rejuvenate certain areas of the body.

Although it has been used to treat sports injuries for years, it was recently put in the spotlight by Kim Kardashian who had the so-called “Vampire Facial” where the platelet rich plasma is injected into the face to make you look younger.

PRP has gained popularity in sexual medicine, with what is known as the “O-shot” or “P-shot”. These “shots” are advertised to enhance sexual function – to make the penis bigger and more sensitive and to make the female genitalia more sensitive and enhance orgasm.

PRP has been widely researched and has proven to be successful in treating the following conditions:

  • Lichen Sclerosis
  • Incontinence
  • Decreased Vaginal or Penile Sensitivity (with difficulty to orgasm)
  • Small Penis
  • Erectile Dysfunction
  • Peyronie’s Disease

Patients suffering from these conditions can make an appointment for an initial evaluation. We do not offer the product to any patient who has not been consulted and evaluated for its suitability. You can request a thirty-minute appointment and state that it is for a PRP evaluation. Once you have been fully informed about the procedure, as well as other treatment options available for your condition, an appointment will be scheduled for the procedure.

You will arrive thirty minutes before your appointment with the doctor. A nursing sister will take a blood sample from you. Two big ampules are filled with blood and then spun down in a centrifuge. During this process, the platelet rich plasma gets separated from the rest of the cells. The trained nursing sister then extracts the PRP and activates it by adding chemicals. The PRP is then prepared in a sterile syringe, for the doctor to be used during the procedure.

You will be offered a very potent local anesthetic cream that you have to apply to your genital area as soon as your blood sample has been taken. This cream is usually sufficient as an anesthetic, but we do also offer conscious sedation (where a light anesthetic is administered through a drip by another doctor), or a ring block of the penis for men. This will be discussed with you during your first consultation.

The doctor will prepare the area by cleaning it with a disinfectant. The PRP is then administered by multiple injections using a very small needle. The areas that will be injected will also be discussed with you during the first consultation. In women, it might include the clitoris, around the vaginal opening, the labia and in the area of the G-spot. In men it might include the carona (ring around the head and specifically the frenulum) of the penis, the head and the shaft. The procedure takes only a few minutes and you will be able to go back to work or resume your daily activities if you did not receive conscious sedation.

The risks involved in PRP are minimal. It is still seen as an experimental treatment when it comes to sexual health related issues. No serious adverse events have been reported in the literature. Any injection can cause bleeding and infection. You will be observed for bleeding after the procedure and advised to report any sings of infection. The procedure will not be performed in patients with active, untreated infections. We can also not perform the procedure on patients who are taking blood thinners as there might be an increased risk of bleeding.

One of the complications that have been reported anecdotally, is unwanted orgasms by women. A prolonged erection in men is also a theoretical risk. Men with erections lasting longer than four hours, should report to casualties. Women with unwanted orgasms or any other complications in men and women, should inform the doctor who performed the procedure immediately.

We now have the facilities at the Bryanston practice to offer PRP to patients. Patients are required to first book a consultation in order to evaluate them for the appropriateness of the procedure.

To book your consultation, please phone 086 7272 950. Please state that it is for a PRP evaluation. When you then book the actual procedure, make sure you mention that it is for PRP and find out exactly what time you will see the nurse and what time you will see the doctor. If you decide to use conscious sedation, please also inform the receptionist in order to book the second doctor who will be performing the conscious sedation.

Dr Elna Rudolph
Article written by Dr Elna Rudolph – Medical Doctor, Sexologist and Clinical Head of My Sexual Health.
086 7272950
www.DrElnaRudolph.co.za
www.mysexualhealth.co.za
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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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LOCALISED PROVOKED VULVAR PAIN (Vestibulodynia)

LOCALISED PROVOKED VULVAR PAIN (Vestibulodynia)

Localised provoked vulvar pain (vestibulodynia) is a term used to describe pain upon penetration of the vagina. There is also tenderness to touch around the vaginal opening (vestibule) during physical examination. It occurs in women of all ages. It is estimated that approximately 15% of women will experience this type of vulvar pain sometime in their lifetime. Other names used in the past to describe this pain included vulvar vestibulitis syndrome, superficial dyspareunia and vulvodynia.

What causes it?

Researchers are studying vestibulodynia to learn more about the cause of the pain. In the last two decades they have shown that the painful tissue of the vestibule has increased nerve endings and inflammation. Although the cause is unknown at this time, there are theories that chronic inflammation from frequent yeast infections, hormonal changes, poor sexual arousal or chronic skin conditions may trigger the pain. It is likely that there is a combination of factors involved in the cause of vestibulodynia.

What are the symptoms?

Pain with vaginal penetration during sexual activity is the most common symptom experienced by most women with vestibulodynia. The pain can be described many different ways including burning, stinging, tearing, throbbing, searing and occasionally itchy. Some women may experience pain for several hours or days after intercourse. Some women may also have pain with tampon insertion or speculum exam during a routine gynaecologic exam. Most women have pain only with touch to the vestibule and are otherwise not bothered by pain.

What do I see?

The appearance of the vulva can vary with each woman. Some women will have redness at the vaginal opening but some will not. For many, the vulva and vestibule look entirely normal.

How is it diagnosed?

Vestibulodynia is a clinical condition which means that there are no laboratory tests or X—ray imaging that are done to secure the diagnosis. However, it is important that you see a practitioner who is experienced in the management of vulvar conditions. By listening to your history and performing a physical examination, your practitioner can be sure there is no other reason for your pain. Your physical examination may include a “Q—tip test” which is when your doctor or practitioner touches the vestibule gently with a Q—tip to determine if you have pain or not. Your health care provider may feel that other tests are necessary and these could include swabs to rule out infections or a biopsy to exclude skin conditions.

How can I help myself?

It is important to minimize irritation to the vulva and vagina. Avoiding soaps, detergents and scented products is ideal. Bland lubricants that are unscented are best for sexual activity. Ask your health care provider for suggestions. White cotton underwear is best and thongs, G strings, synthetic fabrics and tight clothing against the vulva should be avoided. Lidocaine in the form of a liquid, gel or ointment can provide relief when it is applied directly to the vestibule. This can be used for sexual activity as a way to reduce the pain. If you experience such sexual difficulties it may be helpful to see a sexual therapist and it may be best to avoid penetrative intercourse until your symptoms improve.

What do I see?

Many different treatment options have been tried for vestibulodynia. Some women experience a great sense of relief just knowing that the pain they are experiencing is real and has a name. With a supportive team that may include a spouse or partner, gynecologist, physical therapist (physiotherapist), sexologist, pain specialist, and psychologist most women will have improvement of their pain. Often, different treatment options are combined to maximize therapy.

Since research supports that there may be changes in the nerve endings in this condition, some of the treatment options target the nervous system of the vulva. These are sometimes called “neuromodulators” or “chronic pain medicines”. Examples of these medicines include the oral tricyclic medications like amitriptyline, notriptyline, imipramine and desipramine. These medications are used in high doses as an anti—depressant but they do not work in this way when they are used in smaller doses to treat pain problems. In these situations, they are used to try and reduce the hypersensitivity of the nerve endings. Other medicines used for this pain condition include gabapentin, pregabalin, and duloxetine. Recent research has also looked at these same medicines made up as a cream that are then applied directly to the vestibule where the pain is occurring. These medicines include 2—6% gabapentin cream and 2% baclofen—amitriptyline cream.

Other therapies that have been studied for the treatment of vestibulodynia are physical therapy (physiotherapy), sexual therapy, psychological therapy and surgery. Physical therapy means working directly with a therapist that specializes in rehabilitation of the muscles of the pelvis. Many women with vestibulodynia also experience sore, tight muscles of the pelvis which contribute to their distress. Learning how to relax and soften these muscles can often reduce pain but usually requires learning how to work with these muscles. Tools that the physical therapist may use include vaginal massage, heat therapy, biofeedback and dilator work. Each of these will be tailored to the special need of the patient.

There is also good evidence that women who have vestibulodynia often suffer from sexual problems. This can include low desire (poor libido), difficult arousal (poor natural lubrication or wetness) and lack of orgasm. Many couples feel troubled by their sexual problems. Engaging in sexual counselling has been shown not only to help couples with intimacy, but often reduces pain. Finding ways to have sexual activity in a non—painful way is very important towards healing.

Finally, surgery is another option that has been studied for the treatment of vestibulodynia. This outpatient surgery is performed by gynaecologists who specialize in vulvar conditions. The surgery called a vestibulectomy literally involves removing the superficial skin of the vestibule (painful skin) and advancing a piece of non—painful skin over the excised area. Surgical outcomes are best when it is coupled with both physical therapy and sexual therapy.

Vestibulodynia is a challenging and difficult disorder for women and couples to manage. Many vulvar experts believe that there is no single treatment that will cure this disorder. Using a combined approach of treatments is often the most successful in reducing pain. This means that a treatment plan incorporating physical therapy, sexual therapy and direct treatment for the vestibule skin may be suggested. Usually, with this combined therapy plan, most women will have improvement of their pain.

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When Your Libido Goes AWOL

When Your Libido Goes AWOL

By Catriona Ross, for Women’s Health Magazine.

Has your sex drive packed up and headed for the hills? Whether the reason’s medical or you simply need the right touch to get into the mood, you’re not alone.

So, while having lunch at your desk, you suddenly you recall how your man’s chest looked when he stepped out of the shower this morning, sculpted and glistening. Maybe he’ll be up for sex when he’s home from work, you speculate. I could greet him wearing only high heels… You’re smiling, already glowing with the mere anticipation of sex.

Sound familiar? Well, probably not, since statistics show that the norm for many women, especially those in long-term relationships and those with kids, is that they’re generally not in the mood for sex. The National Health and Social Life Survey, published in the US, showed that approximately 32% of women surveyed had experienced lack of libido.

Alexia* used to be proud of her healthy sex drive. An attractive working mom in her thirties with a five-year-old son, ruggedly hunky husband and a love of fast cars, she says her lusty libido has waned over the years and, at times, disappeared completely. ‘I had a lot of resentment towards my husband at one point and I didn’t want him to touch me with a barge pole. Also, having a child definitely affected our sex life and my libido. Eleven years into our relationship, the passion has gone in the bedroom,’ she admits.

There’s a multitude of physiological and psychological reasons why we may lose interest in sex, from high blood pressure to insufficient blood flow to the clitoris, to domestic boredom – but low libido may also simply be the standard mode for women in long-term relationships, experts believe, and your best bet is to cultivate an open mind.

When medication messes with your mojo

‘A few years ago, when I went onto antidepressants, I completely lost my libido, and yes, my husband did complain,’ says Jenna*, 34. ‘I couldn’t feel anything; it was like a local anaesthetic to my nether regions. The medication worked for the depression but not for my sex life: I didn’t want to have sex at all, but we were trying for a baby, so I had sex anyway. Mentally, I couldn’t function properly on this medication either. I told my psychiatrist, and as soon as he changed me to a different type of medication, things came right. It took about two weeks for the new medication to work and the old one to wear off – and all sensation came flooding back. It was lovely!’

Certain prescription antidepressants have a dramatic affect on one’s sex drive; a US report suggests that 33% of women taking antidepressants will experience a loss of libido and difficulty achieving orgasm. ‘The standard class of anti-depressants, SSRIs such as Prozac, are terrible for your libido as they affect your sex hormones,’ says Dr Elna Rudolph, sexual health physician and head of MySexualHealth.co.za.

Other drugs that may suppress your sex drive include antipsychotics, antiepileptic drugs, antihypertensives and diabetes medication, antihistamines taken daily (for hayfever, for instance) and pain medicine that’s taken daily. Of course, not taking medication you need, whether it’s for diabetes or depression, is dangerous, and potentially damaging to your libido. Depression, for example, affects your brain hormones, reducing levels of dopamine which affects your drive in general and therefore lowers libido.

Beware the contraceptive connection. ‘The better your Pill is for your skin, the worse it is for your libido,’ warns Rudolph. ‘The same applies to the patch, and the injection is the worst of all.’ As the authors of a 2011 US study into the Pill’s effects on clitoral and vulvar sensation explain, many women taking low oestrogen-dose combined oral contraceptive pills (OCPs) complain of decreased libido and arousal. OCPs result in decreased biologically-available testosterone, an important factor influencing female sexual drive. In the study, those women on OCPs were found to have significantly lower levels of free testosterone – approximately 38% lower – than those not on OCPs.

What you can do about it: According to Rudolph, anti-depressants such as Agomelatine, Bupropion and Trazodone have a neutral effect on the libido, but it’s essential to consult a professional before changing your prescription. Libido-wise, a better contraception option is the vaginal ring called the Nuva ring, the new oral contraceptive Qlaira, or Mirena – the T-shaped, hormone-releasing intrauterine (IUD) device, which works by not allowing sperm to enter the uterus and doesn’t affect your natural testosterone levels, although that’s not guaranteed for everyone, and it costs a few thousand rand. A copper T IUD device costs approximately R80 and doesn’t influence libido, but increases bleeding significantly, she adds.

The downside of having a baby

Tara*, 34, has been with Jerry* for seven years. They have a toddler, and she’s five months’ pregnant with their second child. ‘Sometimes I wonder, “Will I ever be up for sex again?” she sighs. ‘For the first year after our son was born, I was desperate for sleep, with just enough energy to survive each day; sex was superfluous. Each night I’d go to bed anxious, worrying about how many hours of sleep I could get before the baby woke up. I was so not available at night – night was sacred, for sleeping – so if we had sex, it had to be in the daytime.’

‘I felt resentful of Jerry, and I know he felt rejected, that I loved our baby more than him. We had our son in our bedroom for over a year, then we realised we needed to reclaim the marital bed and moved into the guest room downstairs, where we did have some fun times.’

Pregnancy and new motherhood are legendary libido killers – after all, ‘you’ve moved from being primarily a lover to primarily a mother,’ Rudolph notes. The strong hormonal changes associated with pregnancy and breastfeeding, combined with sleep deprivation and being under so much stress, will cause the natural libido to be suppressed in most women.’

What you can do about it: Make the marriage, and sex, a priority, Rudolph advises. ‘Take time out from your baby, make yourself look pretty and go on a date.’ It also helps not to have your child sleeping in your room. But don’t panic about the lack of sex, she says: ‘You could also choose to see yourself as just giving sex a break for a few months.’

When you’re programmed that way

Some people are genetically less wired for sex than others. Cherie*, a confident, outspoken woman in her forties, says, ‘I’ve never been interested in sex; once a month would be more than enough for me. This caused problems in my marriage almost from the start, especially after we had our two children. I’ve faked more orgasms than you can believe! I’m very independent, and my husband’s controlling ways also made me resentful, which had a huge impact on my already low libido. We had no sex for the last three years of our marriage. He’s a very good man – he remained faithful all those years and still loves me, but I can’t give him what he wants. I’ve been celibate for five years now and do not miss a sexual relationship at all, although I get plenty of opportunities. I like living alone; however, I miss the sharing, the closeness, the cuddling up in bed that a relationship brings. My ideal relationship would be with a man who doesn’t live with me, and who shares my low libido.’

What you can do about it: ‘Sex is all about hormones, and if your hormones aren’t in balance, you’re fighting a losing battle,’ says Rudolph. As a physician, her first approach with a patient is to stabilise her hormones to help her feel good, then suggest lifestyle changes. She runs through possibilities: ‘It could be more oestrogen, progesterone, testosterone, dopamine, being on the wrong pill, being menopausal.’ Also, be realistic about who you are. ‘If you’ve never been interested in sex, the chances of your becoming a nymphomaniac are not great,’ she says.

Body image blues

When you look in the mirror, do you see only your flaws? If so, chances are you’re obsessing over them in bed too. Women are generally very self-conscious about their bodies, explains clinical sexologist Catriona Boffard: if you have a negative view of your body, you probably won’t feel sexy and confident naked, ‘and it’s therefore less likely that you’ll want to take your clothes off in front of someone, even a long-term partner.’ For a woman, sex is about an emotional connection and feeling safe with your partner, she says. ‘Negative body image can have a direct impact on your libido by hindering your feelings of openness and emotional safety – even if your partner repeatedly tells you how beautiful you are.’

Lizette*, 27, says, ‘Last winter I picked up weight, and then put on more while on holiday in Mauritius. My boyfriend, Jaco*, and I stayed in a hotel where there were buffets, and we ate. My butt is big, man! I can feel my thighs are bigger, and I have cellulite. We were on beaches with people prancing around in their bikinis, and I felt self-conscious and not so attractive and sexually desirable. I need to feel that he desires me, as that turns me on. It’s affected my sex drive; I’ve told Jaco when I’m just not feeling it. He’s sporty and in good shape and he’s learnt not to say anything about my appearance. But when I complained recently about putting on weight, he said, “Maybe exercise a bit more? Go walking?”, whereas I wanted him to say, “You look fine,” and not try to fix me.’

What you can do about it: Get to know your body, intimate bits included, Boffard advises, as ‘understanding your body can help you feel more confident in your own skin. If keeping the lights on isn’t your thing, but your partner wants to see you, light candles and wear a sexy satin slip or lingerie that makes you feel more confident.’ But if deep-seated body issues from childhood are blocking you, book a few sessions with a psychologist.

Maybe you’re normal

For many women, feeling spontaneously horny is the exception rather than the norm, Rudolph says, so don’t think you’re abnormal or ill. Low libido may be a symptom of your too-rushed lifestyle: ‘Busy women see sex as a frivolous activity, so it slips down on your priority list, unless you realise how good it can be, and you see it as a form of stress relief.’

And perhaps it’s time the world stopped regarding low libido in women as a dysfunction. No, we don’t wake up with ‘morning glories’, but we certainly can get into the mood, given the right treatment. For us, the traditional male model of sexual functioning (first you feel horny, then you have sex) isn’t true. First, we need some sexy stimulation, then we start feeling like it. This alternative ‘circular model’ of female sexual response presented by Dr Rosemary Basson, a clinical professor in the department of psychiatry and director of the University of British Columbia Sexual Medicine Program: ‘…many of us, while sexually healthy and satisfied, agree they frequently begin a sexual experience sexually neutral,’ she wrote in a 2001 paper.

Also, women consider that attraction, passion, trust and intimacy are more significant than their genital response, according to research by British biomedical scientist Dr Roy Levin. So, we need to feel happy in a relationship to have good sex – or any sex at all!

What you can do about it:

‘If you’re a low-libido woman, don’t let sex go out the door,’ advises Rudolph. ‘Find ways of doing it for your own reasons, or you’ll eventually hate it if you’re only doing it for your husband’s sake. Besides, men hate “pity sex”; they want their partners fully involved.’

Make time to feed your brain, perhaps with movies or erotic literature that conform to your value system. (Don’t expect hard-core lesbian porn to excite you if you’re more of a romantic Mills & Boon type). This creates positive pathways in your brain regarding sex, making it easier for spontaneous desire to arise, Rudolph explains.

A holiday or weekend away can work some sexy magic, as your mind isn’t cluttered with daily To-Do lists. Anxiety is a passion-killer: overthinking problems causes an overproduction of cortisol, which can actually make sex painful. It helps to accept that you often won’t feel like sex, but stay open to sensitive, satisfying stimulation from your partner that’ll warm you up. Says Rudolph, ‘If, after foreplay, you don’t get in the mood, you can either disengage – or choose to continue with sex because it’s a fun, intimate thing to do, using lube if you’re unlubricated, or participate in a sexual encounter without penetration.’

Teach your man how to touch you, and know where each others’ arousal hotspots are. Melissa*, 30, says, ‘My boyfriend used to do this really deep massage on my buttocks and my inner thighs, which was such a turn-off for me; the lightest, feather-like touch is what gets my erogenous zones going. It took me years to actually tell him.’

*Names have been changed.

 

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Multiple Sclerosis: Your Guide to Sexual Health & Intimacy

Multiple Sclerosis: Your Guide to Sexual Health & Intimacy

Guide to sexual health and intimacy for people living with Multiple Sclerosis, and those who love them. By Dr. Elna Rudolph.

Sexuality is an integral part of every person. Whether you are in touch with it or not, whether you enjoy it or not, whether you can still do it or not – you remain a sexual being. We all have the need to feel loved and give love in return. Apart from that, most people experience great joy in being close to another person – physically and emotionally.

This guide provides information and suggestions to equip you to deal with some of the challenges you might be experiencing in your sexual journey due to your diagnosis of MS.

Download the full guide here.

 

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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.