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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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SENSATE FOCUS THERAPY

Sensate focus therapy is one of the most well-known techniques used in Sex Therapy. It can be applied to almost any sexual dysfunction in men and women. It involves petting, massaging, intimate touch and foreplay – both sensual and sexual. Sensate focus helps you and your partner to get to know each other’s bodies better. It also helps you to identify the different sensual zones on your body and to become more self-aware.
Note that there is a difference between “sensual” and “sexual.” Sexual refers to the physical act of sex. Sensual takes into account all of the messages from your five senses (smell, taste, touch, sight, and sound) and puts them together in an all-encompassing experience. To truly enjoy sex, you and your partner need to learn to be sensual first, then sexual. We refer to this as “Outercourse” before “Intercourse.”

If you have been prescribed Sensate Focus Therapy by your doctor/therapist/sexologist, you can follow these steps:

  1. Decide who is going to give (the GIVER) and who is going to receive (the RECEIVER) first. You can do this by flipping a coin if no one wants to volunteer. The person who gives first has to set the first date and time. It is VERY important that you stick to this first appointment. If for some unforeseen reason, you could not stick to the plan, you have to reschedule with a specific date and time again. Don’t wait for a time when you are both just spontaneously in the mood to do it – that is very unlikely to happen! You have to say: “This Wednesday at 20h00.” Be VERY specific. Do not wait for bedtime using your last little bit of energy for this exercise – it’s always a disaster!
  2. The Giver has to create a romantic atmosphere with candles, music, scented oils – whatever you think your partner might enjoy.
  3. Begin the session by de-stressing and getting your mind ready to be sensual. This might involve taking a quick nap, taking a long bubble bath alone or together, being on your own to fantasize, etc. The more you prepare yourself mentally for the session, the more exciting it will be.
  4. You can do these sessions fully clothed, in your underwear or naked – whatever you and your partner are comfortable with.
  5. When you are ready, the Giver starts to explore the body of the Receiver by stroking lightly and firmly, massaging, caressing, kissing and blowing on the Receiver’s entire back, arms, chest, abdomen, legs, neck and face for twenty minutes.
  6. The Giver is not allowed to touch the breasts or genitals of the Receiver or to kiss the Receiver on the mouth. Kissing on other parts of the body is allowed. A minute or two of passionate kissing is advised after the session, if you feel up to it.
  7. The Receiver is allowed to use sounds to let the Giver know how he or she feels, but no words. It is a good to let your partner know that you are enjoying the moment by the sounds that you make, if you are comfortable doing so.
  8. During this exercise the idea for both the Giver and the Receiver is to become aware of the sensations involved in being touched. Focus on exactly what your partner is doing and what are you enjoying about it. To stay in the moment, it sometimes helps if you tell yourself: “He/She is gently stroking my arm with his/her fingertips. It feels good. I find it relaxing/arousing/erotic”. Don’t put pressure on yourself to find everything your partner does arousing or erotic. Some things might even just be neutral or even mildly unpleasant. It is okay. If you find something uncomfortable, just move your body slightly – don’t say something negative!
  9. If you are one of those very few people who are able to orgasm without breast or genital stimulation, go for it! If you can’t, complete the session by just holding each other until the arousal subsides.
  10. After the session, get a cup of coffee or a glass of wine and tell each other what you have enjoyed about the session. This is the first time you are allowed to use words and you should mention five positive things about the session. The Receiver should go first and then the Giver should also mention five positive things about the session. It is very important to not mention negative things or things you did not like, only positive things. Your therapist will ask you about these things during the session – it is the most important part of the exercise!
  11. Some people find it helpful to draw a body map and make notes on it for example: Neck: kissing, thighs: light touch, lower back: gently blowing, etc. This helps you keep a record of what your partner likes in order to use it when you make love after you have completed your sensate focus therapy.
  12. You can switch roles on the same night or set a date for another night where you will switch roles. It is extremely important that the person who was the Giver during this session, is the first Receiver during the following session. You must take turns to set the date, time and scene.
  13. Do not have sex! There is method in the madness – trust this very well-researched therapy process!
  14. If you are struggling to fit in two sessions a week, it may be saying something about your priorities… We usually recommend a follow-up with your therapist within two weeks.

If you would like some more ideas and become a real expert at erotic message, we recommend reading the following book: Erotic Massage: The Tantric Touch of Love, by Kenneth Ray Stubbs.

Article written by Dr Elna Rudolph – Medical Doctor, Sexologist and Clinical Head of My Sexual Health.
086 7272950
www.DrElnaRudolph.co.za
We 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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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.

 

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Die groot O

Die groot O

Deur Mariette Snyman, oorspronklik gepubliseer in Rooi Rose. Gedeeltelik aangepas deur Dr. Elna Rudolph.

Die ekstase van orgasme – of die afwesigheid daarvan – is vir baie mense ‘n taboe-onderwerp. Maar die invloed wat dit op vroue se welsyn en verhoudings het, moenie onderskat word nie.

Wat sou jy antwoord as iemand jou vra of jy graag op álle vlakke voluit wil leef? Sluit dit vervulling op seksuele gebied in? En indien jou antwoord “ja” is, speel die ervaring van orgasme hier ‘n sleutelrol?

Dié eenvoudige vrae kan ingewikkelde antwoorde hê. Talle vroue wil graag ‘n orgasme beleef, maar het nog nooit. Sommige sou dit graag meer dikwels wou ervaar. Vir baie is dit alledaags, terwyl ander voel dis van minder belang.

Daarby het die samelewing gemengde gevoelens oor die spontane genieting van die seksuele. Enersyds is daar ‘n ooraanbod van eksplitisiete kyk- en leesstof; andersyds het baie van ons grootgeword met die oortuiging dat lekkerkry sleg of sondig is.

Om die saak verder te kompliseer, is daar onsekerheid oor watter soort orgasme “reg” is. Mense wonder of orgasme die fokuspunt van seksuele omgang behoort te wees, of gelyktydige orgasme ‘n realistiese oogemerk is, en oor verskeie ander sake.

Voor ons na verwagtinge, feite en oplossings vir knelkwessies rakende orgasme kyk, kan ons die goedvoelkarakter van orgasme van nader beskou.

“Die daaglikse ervaring van genot is noodsaaklik vir gesondheid en geluk en nié bloot ‘n luukse nie,” sê die Amerikaanse ginekoloog en topverkoperskrywer, dr. Christiane Northrup. In haar boek The secret pleasures of menopause (Hay House, 2008) beskryf sy die omvangryke voordele van die vrystelling van stikstofmonoksied, ‘n gas wat deur ons liggame vervaardig word. Dit stimuleer onder meer ons bloedsomloop, weerstand teen infeksie, weefselherstel en produksie van neuro-oordragstowwe, en gee ons gemoedstoestand en lewenslus ‘n hupstoot.

Interessant genoeg word stikstofmonoksied vrygestel wanneer ons iets ervaar wat vir ons lekker is. “Alle gesonde, volhoubare genietinge baai ons brein en liggaam in hierdie lewegewende gas. Tydens orgasme is daar ‘n ontploffing daarvan. Ons liggame is ontwerp om onbeperkte hoeveelhede plesier te ervaar.”

Hierdie positiewe siening van ons plesierpotensiaal word versterk as ons in ag neem dat die klitoris, wat verantwoordelik is vir seksuele opwekking, suiwer daar is vir vroulike genot. Dit het geen ander funksie nie.

Verwagtinge en feite

“Mans heg baie waarde aan hul verhoudingsmaats se vermoë om ‘n orgasme te kry,” sê dr. Elna Rudolph, kliniese hoof van die MySexualHealth Kliniek in Pretoria en Kaapstad. “In ‘n omvattende studie is 7000 mans uit vyf lande gevra watter aspek van hul seksuele lewe vir hulle die heel belangrikste is. Die gemiddelde antwoord was nie die intensiteit, duur, of ‘n ander faset van hul eie belewenis nie, maar of hul maat ‘n orgasme bereik.”

Hierdie voorkeur stel hoë eise aan vroue. Fisiek is dit moeiliker vir ‘n vrou om ‘n orgasme te kry, en die nodige stimulasie neem veel langer as vir ‘n man. “Ongeveer 5% van alle vroue kry nooit ‘n orgasme nie. Net 30% kry gereeld ‘n klimaks tydens seksuele omgang, en ‘n verdere 30% bereik ‘n orgasme met bykomende klitorale stimulasie tydens penetrasie en ‘n verderder 30% slegs met klitorale stimulasie, nooit tydens omgang nie.”

Onder die verskillende tipes orgasme tel vaginale, klitorale en kombinasie-orgasmes. ‘n Vaginale orgasme vind plaas wanneer die vagina intern voldoende gestimuleer word. ‘n Klitorale orgasme is die gevolg van genoegsame stimulering van die klitoris. Omdat die vagina beduidend minder senu-eindpunte as die klitoris het, vind orgasme makliker plaas wanneer daar ook klitorale prikkeling is – ‘n kombinasie-orgasme.

Baie mense het vooroordele teenoor klitorale en kombinasie-orgasmes, deels omdat die vader van die psigoanalise, Sigmund Freud, klitorale orgasme in die vorige eeu as ‘n “adolessente verskynsel” genoem en beweer het dat “volwasse vroue” suiwer vaginale orgasmes het.

Die kontroversiële G-kol – ‘n erotiese sone op die boonste, voorste wand van die vagina – kan tot orgasme en moontlike ejakulasie lei wanneer dit gestimuleer word.  Die ejakulaat is ‘n kleurlose vloeistof wat net by sommige vroue voorkom.

Sommige vroue kry veelvuldige orgasmes – meer as een op ‘n keer. Nagtelike orgasmes kom voor wanneer erotiese drome ‘n vrou tot ‘n klimaks dryf.  Onwilleurige orgasmes vind soms plaas tydens verkragting of gedwonge seksuele verkeer, en kan skuldgevoelens tot gevolg hê. Anale orgasmes is die gevolg van anale prikkeling; die anus deel ‘n wand met die vagina en dieselfde senuweevoorsiening. Vollyforgasmes duur langer as “gewone” orgasmes en kan kontraksies van liggaamsdele soos die buik, hande en voete asook spirituele piekervarings insluit. Dit word gewoonlik met tantriese seks verbind.

Wat kan skeefloop?

Talle faktore kan orgasmes verhoed, vertraag of strem. Hieronder tel mediese toestande soos diabetes en hartsiektes; die newe-effekte van medikasie, wat sekere soorte slaap- en angswerende middels insluit; alkohol; bindweefselvorming weens verskeie operasies in die omgewing van die bekken; depressie; moegheid; spanning; verhoudingsprobleme; ‘n verhoudingsmaat se seksuele disfunksie of gebrek aan bedrewenheid in die liefdespel; te min tyd of privaatheid; aandagafleibaarheid; ‘n gebrek aan eiewaarde; ‘n swak liggaamsbeeld; morele en geloofswaardes wat die genieting van seks bemoeilik; gevoelens oor huidige of vroeëre intieme verhoudings, en traumatiese ervarings.

“Fisiek gesproke moet die senuweestimulasie en bloedtoevoer in die bekken voldoende wees vir orgasme om plaas te vind,” sê Elna. “Die spiere moet kan ontspan én saamtrek. Verder moet die breinhormone in goeie balans wees.

“Elke vrou moet op ‘n sekere manier gestimuleer word, en sy moet die stimulasie biologies en sielkundig kan prosesseer. Dit beteken sy moet genoeg vertroue in haar maat hê sodat sy bereid is om beheer te verloor in sy teenwoordigheid. Goeie kommunikasie is noodsaaklik.

“Ek sien dikwels paartjies met die volgende geskiedenis: toe hulle getroud is, het hulle min van seks geweet. Voorspel het nie ‘n groot rol gespeel nie en die vrou het nie orgasmes gekry nie. Toe die kinders kom, was sy altyd moeg en wou sy seks net so gou moontlik verby kry. Die man het dus nooit die geleentheid gehad om te leer hoe om haar behoorlik op te wek nie.

“In haar veertigs of vyftigs begin sy boeke lees en met vriendinne gesels, en kom agter sy mis iets. Nou wil sy orgasmes ervaar, en sy is ontevrede. Die man voel hy is ‘n slegte lover en kan hom aan die verhouding onttrek.

“Vir hierdie en ander scenarios is daar raad. Omdat soveel faktore betrokke is, benader ek en my kollegas by die sentrum pasiënte multidissiplinêr. Ons kyk watter persentasie van die probleem biologies, sielkundig, en sosiaal is, en pas die behandeling daarby aan. Dit kan medikasie, fisioterapie, psigo-, verhoudings- en ander vorme van terapie insluit.

Watter oplossings is daar wanneer ‘n vrou sukkel om ‘n klimaks te bereik?

“Tydens seksterapie begin ons gewoonlik deur seker te maak dat daar baie goeie stimulasie is tydens voorspel – ons luister na presies wat paartjies doen en maak dan voorstelle om die stimulasie te verbeter.  Ek maak ook altyd eers seker dat die mediese oorsake aangespreek en medikasie aangepas word om dit so maklik as moontlik te maak.

“Indien al die voorgenoemde in plek is, maar orgasme ontwyk die vrou nogsteeds, gaan dit dalk nodig wees om daardie eerste orgasme alleen te probeer kry met gewone selfstimulasie.  Die druk wat daar op haar is wanneer haar maat by is, veroorsaak ‘n ongunste biochemiese omgewing in haar brein wat orgasme sal verhoed.  Sy moet heeltemal ontspanne wees, sonder enige druk en dit gaan sy waarksynlik net op haar eie regkry.

“Die aard en toereikendheid van seksuele stimulasie – veral van die klitoris – is deurslaggewend. Vroue wat probleme met orgasme ervaar, kan daarby baat vind om hul eie liggaam in hul eie tyd te leer ken en vas te stel presies wat hulle plesier gee. Wanneer hulle op hul eie ‘n orgasme kan bereik, kan hulle hul maat wys wat vir hulle werk en dit dan saam te geniet.

“Hierdie proses is nie so eenvoudig as wat dit klink nie. Baie mense is grootgemaak met die gedagte dat masturbasie onaanvaarbaar is. Wanneer hulle verstaan hoe dit kan help om hulle na orgasme te lei, stel ek ‘n program voor wat hulpmiddels soos erotiese leesstof insluit. Niemand hoef ‘wilde boeke’ te lees nie – hulle kies leesstof wat kongruent met hul oortuigings is. Dieselfde geld vir musiek en flieks.

“Nog ‘n uitstekende hulpmiddel is ‘n klein vibrator. Dit word bloot gebruik om bloedvloei na die klitoris te stimuleer. Dis van groot waarde vir vroue wat leer om op hul eie ‘n klimaks te bereik, of wanneer vaginale stimulasie tydens omgang nie tot orgasme lei nie. Hierdie vibrators is by MySexualHealth, www.pureromance.co.za of www.matildas.co.za beskikbaar.

“Vir orgasme is ‘n verhoogde staat van opwekking nodig. Dit het met jou hele wese te make. Jy kan leer om jou sintuie te gebruik om in die oomblik te wees deur in ‘n gegewe moment op ‘n spesifieke sensasie te fokus sonder om dit in jou kop te probeer omskryf.

“Party mense het iets meer opwindends nodig as dit wat hulle in die oomblik ervaar. Dan kan ‘n fantasie waarin jy jou ervaring na ‘n woud, ‘n strand of selfs ‘n publieke plek verplaas, die verskil maak. Weer eens moedig ek pasiënte aan om fantasieë te gebruik wat met hul oortuigings strook.

“’n Nuttige wenk is dat vroue daarteen moet waak om hul mond tydens die liefdespel toe te maak. As jy op natuurlike wyse saam met die ritme asemhaal, kry jy makliker ‘n orgasme. Jy en jou maat moet kan hoor waarmee julle besig is!

“Wees ook bewus van jou liggaamshouding. Haal die kussing onder jou kop uit en sorg dat jou postuur oop en ontspanne is.

“Baie vroue besef nie dat voorbehoedmiddels hul hormone op ‘n manier kan beïnvloed wat die belewing van orgasme benadeel nie. In sulke gevalle beveel ek eerder die gebruik van ‘n Mirena aan.”

Is orgasme – veral gelyktydige orgasme – die toppunt van seksuele ervaring? Die term “voorspel” impliseer immers dat enige seksuele stimulasie blote voorbereiding vir die “hoofgebeurtenis” is.

“Seks gaan nie primêr oor orgasme nie. Baie vroue kan bevredigende seksuele ervarings hê sonder orgasme. Ek sê altyd vir vroue dis hul reg om elke keer wanneer hulle seks het ‘n orgasme te kry, maar dis nie verpligtend nie. Die keuse behoort aan hulle.

“Omdat mans en vroue se liggame so verskillend werk, is gelyktydige orgasme nie ‘n maklik bereikbare doelstelling nie. Dis ‘n bonus!”

Meer inligting by 086 727 2444, info@MySexualHealth.co.za of www.MySexualHealth.co.za

Eindelik!

Lindie* (29) werk in die skoonheidsbedryf en is twee jaar gelede met haar skoolliefde, Allan*, getroud nadat hulle ‘n ruk saamgebly het.

“Ek het konserwatief grootgeword. As daar ‘n sekstoneel op TV was, het my ma gesê: ‘Maak jou oë toe’ – selfs toe ek al 18 was. Ek het nie eens daaraan gedink om te masturbeer nie.”

Lindie het nooit ‘n orgasme gehad nie. “Vroeg in ons verhouding het ek in ‘n intieme oomblik gedink ek gaan climax. Allan het sy hand oor my mond gesit want daar was ander mense in die huis. Dit het my geblok. Daarna het ek nooit weer tot by daardie vlak van opwekking gevorder nie.

“Dit het my altyd gehinder, veral toe iemand eendag in ‘n geselskap sê as jy nog nie ‘n orgasme ervaar het nie, het jy nog nie regtig seks gehad nie.

“Ek het by ‘n vriendin van dr. Elna Rudolph gehoor. Dit het my verstom dat Elna so gemaklik oor seks praat. Toe sy voorstel dat ek ‘n vibrator kry en verduidelik hoe ek dit moet gebruik, het ek gedink daar is geen manier waarop ek dít sou doen nie! Ek was te skaam. Ná drie dae het ek egter besluit ek kon niks verloor deur dit te probeer nie. Ek het die bullet by ‘n webwerf bestel.

“Ek moes eers op my eie probeer om ‘n orgasme te kry. Aanvanklik was ek baie gespanne. Toe dit uiteindelik gebeur, was ek so chuffed met myself dat ek ‘n dag lank loop en glimlag het. My man wou weet wat aan die gang was! Ek was baie skaam om die vibrator voor hom te gebruik, maar het gou gemaklik geraak daarmee. Hy het gesê ek weet nie hoeveel dit vir hom beteken dat ek ons liefdespel so geniet nie.

“Ek is bly ek het hierdie ervaring op dié tydstip in my lewe gehad. My liggaamsbeeld is beter as in my vroeë twintigs, en ek is gemakliker met wie ek is. Ek oefen en leef gesond, wat my selfbeeld positief beïnvloed. En ek weet hoe om die orgasmes te waardeer!

“Vir enige vrou met dieselfde probleem wil ek sê: moenie moed verloor nie. Jy is nie alleen nie. Jy kan jou lyf terugkry!”

*skuilname

Het jy geweet?

Orgasme …

  • Verlig slaaploosheid, spanning en angs
  • Kikker die gemoed op natuurlike wyse op
  • Verbeter kardiovaskulere gesondheid en verlaag die risiko van tipe 2-diabetes
  • Verhoed en verlig servikale inflammasie en urienweginfeksies
  • Help die liggaam se natuurlik ontgiftingsproses aan
  • Versterk die spiere van die bekkengordel
  • Kan help om ‘n dreigende migraine-aanval in sy spore te stuit
  • Verhoog pyndrempels
  • Vermeerder oksitosoon-vlakke, wat verbind word met passie, intuïsie en sosiale vaardighede
  • Help om menopousale vroue se vaginale membrane gesond te hou

Bronne:

“Becoming orgasmic” deur Julia R Heiman en Joseph Lopiccolo, Fireside, 1987

“Dr Eve se seksboek: ‘n gids vir jongmense” deur dr. Marlene Wasserman, Human & Rousseau, 2008

“Die koekieboek” deur Maritza Breitenbach, Paddycat, 2012

“Menopause made easy” deur Carolle Jean-Murat, Hay House, 1999.

Sien ook www.youtube.com/watch?v=s9QVq0EM6g4

www.rooirose.co.za Ons artikel “Menopouse: ‘n sensueler jy” het meer inligting oor stikstofmonoksied, slaapkamersake, ensomeer.

www.floliving.com

 

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Sex After 50?

Sex After 50? Sex After 50!

How to make it an easier (bicycle) ride…

By Dr. Elna Rudolph.

MBChB (UP); MHSc: Sexual Health (US, Aus); FECSM (Fellow of the European Committee for Sexual Medicine)

Warming up:

Sex after the age of fifty is not unlike cycling after fifty.  There are reasons why people stop doing it, take it up for the first time, enjoy it more than ever and have real physical and psychological challenges with it.

It can be very difficult to raise the subject of sexual activity with any patient, let alone an “older person”.  Not that fifty is old.  Life expectancy is between seventy and eighty years in most first world countries and still around sixty years in South Africa, despite all our public health issues.1

People form new relationships after the age of fifty or have the chance to really start enjoying their lifelong partnerships because other stressors like raising kids together and building a career are not so prominent anymore.  Latest research shows a third of women and half of men remain sexually active after the age of seventy2 and that people participate in a wide range of practices when it comes to solo or partnered sex.3

Getting into Gear:

Unfortunately only 6% of doctors talk to patients about their sexual functioning and the most common reason stated for not taking to patients about it, is their age.4

Due to the sensitive nature of this subject, it is the responsibility of the clinician to initiate the conversation.  It is not that difficult when you follow a rehearsed script.  Here is a suggestion:

“Women over the age of fifty, often have problems with their sexual functioning, how about you?”

This statement and question gives the patient PERMISSION to talk to you about her sexual challenges.  It is the first step in the PLISSIT Model5, followed when we deal with patients with sexual health questions and challenges.  The second step is LIMITED INFORMATION and the third is SPECIFIC SUGGESTIONS.  Only the last step is Intensive Therapy.  As you get more comfortable talking to patients about their sexual concerns, you will realise that there is only a small percentage of patients who need intensive therapy.  Most are helped with limited information and specific suggestions.

Double Tracking:

But how do you have the rest of the dreaded conversation?

When people talk to kids about sex, they tend to feel more uncomfortable than the kids themselves and end up using metaphors and strange euphemisms.  One has to be careful not to sound patronising when speaking to older people about sex, but using a metaphor can make it easier for both the patient and the clinician.

I have found that the cycling metaphor goes a long way in delivering that basic information and those specific suggestions in a way that is comfortable, clear and practical for the patient.  You start by using the word “they” and not “you” and then the patient can personalise it if they want to.  This technique helps you not to make any assumptions but to give the patient the opportunity to put her concerns, fears, challenges and questions into words.

If the woman has a specific complaint like vaginal dryness, you might be able to treat it without having to go into detail.  If however she says:  “Well doctor, we have not had sex in more than a year and I don’t know why” and you feel like rolling your eyes and checking the clock, rather have this five minute limited-information-specific-suggestion-session with the patient:

You can say:

“The reasons why people don’t have sex as the get older are more or less the same as why they don’t ride bicycles anymore.  Let’s go through a few of them and you can tell me which ones, if any, you relate with:”

1. They think they are too old and will look or feel stupid.

If you look at the following graph, it shows that many people remain sexually active till very late in life.  It might not look like and feel like Hollywood and there are some changes and challenges, but you are never just too old for it.

Graph 1:   Percentage of American Performing Certain Sexual Behaviours in the Past Year3

SOLUTION:

The best is to never stop cycling and if you have to due to injury or unforeseen circumstances, get back onto your bike as soon as possible.

If people continue to have sex at relative regular intervals, it never becomes a big issue.  If you have not done it in a long time, it is like getting back on a bike – you are a bit tentative and not sure if you still have that muscle memory to know how.  So how do you do it?  You don’t get on that bike and try to do a three day endurance event.  You try in the driveway first, keeping your feet close to the ground, going slowly, not aiming for distance or speed, just the satisfaction to know that you still can.  When you get the thrill of getting it right, even if it is just balancing your way down a slight slope, you realise that you are creating a special experience.  Not a masterpiece. Not a new record with the greatest of speed in the shortest of time, but something special and enjoyable.  You don’t even have to reach the finish line to have fun.  A leisurely ride in the park can be much nicer than a high profile race.

This kind of explanation is particularly valuable when talking to patients who are struggling with their sexuality due to breast cancer or other disfiguring medical conditions.  It does not have to be perfect to be good.  Refer these patients for “intensive therapy” if your initial reassurance is not enough.

2. They don’t have the physical ability anymore:

Medical conditions and medication used have a significant impact on a post-menopausal woman’s sexual functioning.2

HORMONES:

Menopause is associated not only with decreased desire but also with the physical aspects of sexual response like arousal and orgasm2.  This can partially be due to a decline in free testosterone which is best correlated with increasing age, not necessarily menopause itself.6  The right hormone replacement therapy (HRT) can improve a women’s sexual functioning7 and can include transdermal testosterone therapy in women with low serum levels and a formal diagnosis of sexual interest/arousal disorder (formerly known as hypoactive sexual desire disorder).6

DYSPAREUNIA:

Dyspareunia is also one of the symptoms of the newly described Genitourinary Syndrome of Menopause and can be treated or avoided in most cases by the simple use of topical oestrogen therapy.8  It is no longer available over the counter. Make sure you offer it to your symptomatic post-menopausal patients. Hysterectomy and other pelvic surgeries can also contribute to dyspareunia in this age group.9

MEDICATION USE:

Many women in menopause end up using antidepressants drugs.  The depression itself as well as the medication can cause sexual dysfunction and patients need to be monitored for this.  Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Nor-Adrenalin Reuptake Inhibitors (SNRIs) are the biggest culprits and Bupropion seem to be beneficial on its own or if used as an antidote to treat the sexual side-effects of other drugs.10  Polypharmacy is quite common in postmenopausal women and can contribute to sexual dysfunction.  Try to change the medication to drugs with fever sexual side-effects.

PAIN & WEAKNESS:

Pain and weakness often play a role in making sex practically difficult.  Being willing to listen to the patient’s actual challenge and providing practical solutions will go a long way in helping most patients.  Take painkillers an hour before sex, use a position where there is less strain on the hips for instance, like lying on your side and using a rear-entry approach.

SOLUTION:

As with cycling, it might be necessary to do some preparatory training to before you get back on the proverbial bike again.  Vaginal dilators and physiotherapy are often used in conjunction with topical oestrogen if there has been significant atrophy and especially if vaginismus has developed11.  Sensate Focus exercises are also used to help a couple to gradually restore intimacy in their relationship.  Sex is initially forbidden and sexual massage that gradually becomes more stimulating is practiced over a few weeks to re-establish physical and emotional intimacy.12

3. Their Bicycle is Broken:

Having a partner who suffers from sexual dysfunction is very common in menopausal women.  The woman might still be willing and able, but the partner has developed erectile dysfunction (ED) and therefore intimacy stops all together.  You don’t have to have the latest model in perfect working order to have a fun ride in the park and likewise you don’t need perfect performance to have a special experience with your partner.  Unfortunately men tend to withdraw from intimacy if they can’t trust their performance anymore.  This often leaves women feeling not only physically unfulfilled but emotionally neglected and often induces sexual dysfunction in her.13

Men generally have very poor help-seeking behaviour and when it comes to their sexual performance, they are even less willing to consult their GPs.  When a man’s sexual interest and ability starts to dwindle, it can be an early warning sign of cardiovascular disease.  For this reason we cannot just give a women a prescription for a PDE5-inhibitor for her husband.  He needs to have at least his blood pressure, abdominal circumference, fasting glucose, lipogram and early morning testosterone measured with possible cardiologist referral if significant cardiovascular risk exists.14

That said, we don’t need to be overly cautious when prescribing PDE5-inhibitors to men with erectile dysfunction.  It is generally safe and should just not be combined with nitrates, but men with high blood pressure, diabetes and hyperlipidaemia can safely use it.14,15

Using vacuum pumps and injectables are also options.  These have to be prescribed with the necessary education and support, but once patients learn how to use it, it is generally well accepted.15

4. They don’t have a Bicycle:

Of course many women over fifty don’t have partners anymore.  If you are not sure about this, you might want to start with this one.

Forming new partnerships later in life is common and it can be very rewarding.  It can also be daunting!  The fact it that it is not merely buying a new bicycle, it is much more serious than that!

Women might also start to have more informal relationships for the first time in their lives.  Basically all potential partners that they meet at this age, will have previous sexual experiences and therefore they are at increased risk to pick up a sexually transmitted infection.  They don’t think so, but they are!  Condom use is very poor in this age group and it gets worse as they age.3   Some counselling about safe sex is definitely necessary in this age group.  Use the cycling metaphor again:  you hardly ever see people cycle without helmets on anymore.  The benefits are well-known and therefor it is frowned upon not to use a helmet.  The same goes for sex.  Safety first.  Make sure you are using a condom.  Does not matter how nice, wealthy, respectable or “clean” he looks.

Also note that you should not assume that a woman is having sex with men or only with men.  Rather ask and use the word “partner” to be more inclusive.

5. They have fallen too hard before:

Many women have serious psychological damage due to bad previous sexual experiences.  Secondary vaginismus is not uncommon in this age group.16  Many will be very happy to decrease and even stop sexual activity as their partner’s needs and ability decreases or if they lose their partners.  There are however those who desire to have normal sexual functioning but are held back by psychological issues.  Refer these people to well qualified and experienced clinical sexologists who can address those psychological aspects to help her to gradually “get back on the road’ again.

The home stretch:

It is not so difficult to talk to people over the age of fifty about sex.  Like cycling, give it a go!

You might change her and/or her partner’s life forever.  Remember:  100 orgasms per year can add eight years to a patient’s life – this is serious medicine!17

References:

1. Mayosi BM, Lawn JE, Van Niekerk A, Bradshaw D, Karim SSA, Coovadia HM [Internet]. Health in South Africa: changes and challenges since 2009. The Lancet: Elsevier Ltd; [updated 2012 November 30]. Available from: http://dx.doi.org/10.1016/S0140-6736(12)61814-5
2. Lee DM, Nazroo J, O’Connor DB, Blake M, Pendleton N. Sexual Health and Well-being Among Older Men and Women in England: Findings from the English Longitudinal Study of Ageing. Springer: Arch Sex Behav; [updated 2014 Dec 11; cited 2015 Jan 27]. Available from: http://link.springer.com/article/10.1007/s10508-014-0465-1
3. Herbenick D, Reece M, Schick V, Sanders SA, Dodge B, Fortenberry JD. Sexual Behaviour in the United States: Results from a national probability sample of men and women ages 14-94. J Sex Med. 2010;7 (suppl 5):255-265.
4. Deyer K, Das Nair R. Why don’t Healthcare Providers Talk about Sex? A systemic review of qualitative studies conducted in the United Kingdon. J Sex Med. 2013; 10: 2658-2670
5. Annon JS. PLISSIT Model: A Proposed Conceptual Scheme for the Behavioural Treatment of Sexual Problems. J Sex Ed and Therapy. 1976. Vol 2, nr 1. 10.1080/01614576.1976.11074483
6. Wierman ME1, Arlt W, Basson R, Davis SR, Miller KK, Murad MH, Rosner W, Santoro N. Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline.J Clin Endocrinol Metab. 2014 Oct;99(10):3489-510. doi: 10.1210/jc.2014-2260.
7. Nastri CO1, Lara LA, Ferriani RA, Rosa-E-Silva AC, Figueiredo JB, Martins WP. Hormone therapy for sexual function in perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2013 Jun 5;6:CD009672. doi: 10.1002/14651858.CD009672.pub2.
8. Portman DJ, Gass MLS. Genitourinary Syndrome of Menopause: New Terminology for Vaginal Atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Menopause. 2014; Vol 21, nr 10.
9. Clarke-Pearson DL, Geller EJ. Complications of hysterectomy. Obstet Gynecol. 2013 Mar;121(3):654-73. doi: 10.1097/AOG.0b013e3182841594.
10. Clayton AH, El Haddad S, Iluonakhamhe JP, Ponce Martinez C, Schuck AE. Sexual dysfunction associated with major depressive disorder and antidepressant treatment. Expert Opin Drug Saf. 2014 Oct;13(10):1361-74. doi: 10.1517/14740338.2014.951324. Epub 2014 Aug 22.
11. Int Urogynecol J. 2014 Dec;25(12):1613-20. doi: 10.1007/s00192-014-2421-y. Epub 2014 Jun Understanding and treating vaginismus: a multimodal approach. Pacik PT1.
12. http://www.menopause.org/for-women/sexual-health-menopause-online/effective-treatments-for-sexual-problems/sex-therapy-and-counseling
13. The Association Between Female Sexual Dysfunction and the Husband’s Erectile Dysfunction: Evidence from Married Couples in Hong Kong. Zhang H, Fan S, Yip P.J Sex Marital Ther. 2014 Dec 16:1-9. [Epub ahead of print] PMID: 25514566
14. Nehra A et al. The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease. Mayo Clin Proc. Aug 2012: 87(8):766-778
15. Hackett G. et al. British Society for Sexual Medicine guidelines on the Management of Erectile Dysfunction. J Sex Med 2008:5:1841-65
16. Vaginismus in peri- and postmenopausal women: a pragmatic approach for general practitioners and gynaecologists. Hope ME, Farmer L, McAllister KF, Cumming GP.Menopause Int. 2010 Jun;16(2):68-73. doi: 10.1258/mi.2010.010016. Review. PMID 20729498
17. 100 orgams add 8 years to life

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Love Coach: The Sex Doctor Will See You Now

The Sex Doctor Will See You Now

By Dr. Elna Rudolph, published in Women’s Health Magazine, December 2014.

WH’s resident sex doc shares four of her actual cases with advice so real and raunchy, you’ll want to try it tonight!

Read the full article here.

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Seer Seks

Seer Seks

Die navorsing wys dat soveel as een uit vyf vroue sukkel met pyn tydens seks.  In my praktyk vind ek dat meer en meer vroue daarvan kla en kom aanklop vir hulp.

Ek werk al ‘n geruime tyd saam met Dr. Elna Rudolph en die res van haar multidissiplinere span by haar kliniek, My Sexual Health, waar ons al honderde vroue gehelp het om pynvrye seks te kan geniet – selfs sommige wat in soveel as dertig jaar van getroude lewe nooit seks kon geniet het nie!

Dr. Elna Rudolph is die kliniese hoof van MySexualHealth.co.za en ‘n mediese dokter wat in seksuele gesondheid spesialiseer.  Sy het in Australia, Engeland en Europa verdere opleiding in seksuele gesondheid opgedoen en het ‘n besonderse belangstelling in die hantering van pynlike seks.  Hier is haar siening oor seks wat seer is:

Glo jy dat pyn tydens seks net in vrou se kop is?

Ek het letterlik nog nooit ‘n pasient gesien wie sy pyn tydens seks net in hulle kop is nie.  Daar is altyd ook ‘n fisiese rede vir die pyn – al is dit net die onwillekeurige sametrekking van die bekkenvloer spiere – daar is altyd ‘n rede vir wanneer seks seer is.  As daar ‘n rede is, is daar ook n oplossing!

Die grootste deel van my werk is om die oorsaak van die pyn op te spoor en dan die beste behandelingsplan voor te stel.  Deel van die behandeling sluit meestal ook sessies met jou of ‘n sielkundige in om die emosionele aspekte van die pyn sowel as die impak van die pyn op die verhouding aan te spreek.  Seer seks sit nie in jou kop nie, maar dit lol tog met jou kop en dikwels ook met jou verhouding.

Wat is die mees algemene oorsake van pyn wat jy in jou praktyk sien?

Ek sien meestal wat ons noem “oppervlakkige dispareunie” dit wil sê pyn wat onstaan naby die opening van die vagina waar dit reeds seer is as die man probeer penetreer, of wanneer selfs die gebruik van ‘n tampon seer (of onmoontlik) is.

Mens kry ook “diep dispareunie” wat soms alleen voorkom en soms saam met oppervlakkige dispareunie.  Dit sien ek nie so dikwels nie, want die pasiënte se ginekoloë sorteer hierdie probleem gewoonlik uit voordat hulle by my uitkom.  Die mees algemene oorsake daarvan is endometriose, siste op die eierstokke, prikkelbare derms en hardlywigheid, en dikwels ook die bindweefsel wat vorm as gevolg van herhaaldelike operasies.  Ek hoor dikwels dat dokters vir pasiënte sê dat die oorsaak van hulle pyn hulle baarmoeder is wat “verkeerde kant toe kyk.”  Dit is ‘n baie onwaarskynlike die rede vir hulle pyn – ek dink dit is die moeite werd om ‘n tweede opinie te kry en die saak verder te ondersoek.

Oppervlakkige pyn word gewoonlik veroorsaak deur ‘n kombinasie van probleem met die vel, senuwees en die spiere rondom die vaginale opening.  Hierdie abnormaliteite word veroorsaak deur hormoonwanbalanse (byvoorbeeld die gebruik van die pil, menopouse of swangerskap en borsvoeding), herhaaldelike infeksies, of dit kan ook ‘n genetiese hipersensitiwitiet van die senuwee wees (in so ‘n geval vind ons dikwels dat die pasiënt se naeltjie ook baie sensitief is).

Daar is amper altyd abnormale werking van die bekkenvloerspiere met spasmas, snellerpunte en soms ook swakheid van sekere spiere.  In sommige vroue word hierdie probleme veroorsaak deur die verkeerde postuur, rugprobleme of selfs net spanning en angstigheid.  Sommige vroue het konstante spasma en by ander gaan die spiere net onwillekeurig in spasma wanneer daar ‘n poging is tot penetrasie, en dan kan die vrou dit nie weer willekeurig ontspan nie.

Wat sluit die behandeling van seer seks gewoonlik in?

Dit hang absoluut af van die diagnose.  Dit is gewoonlik ‘n kombinasie van ‘n salf wat spesiaal gemeng word vir die spesifieke diagnose en rondom die vaginale opening aangewend word, dikwels ook medikasie om die senuwees wat betrokke is te herstel en te help vir angstigheid, die behandeling van kroniese infeksies, die herstel van die hormoonbalans, die gebruik van dilators om stelselmatig die weefsel te rek en die brein te leer dat penetrasie iets is wat nie seer is nie en waaroor die vrou beheer het, fisioterapie deur ‘n handjie vol gespesialiseerde fisioterapeute wat die bekkenvloer spiere kan behandel, seksterapie waar die paartjie gehelp word om stelselmatig weer (of vir die eerste keer!) ‘n sensuele verhouding te ontwikkel waar die fokus aanvanklik glad nie op seks is nie, en dan ook dikwels sessies om die sielkundige aspekte van die pyn en die impak op die verhouding aan te spreek, soos wat ek voorheen genoem het.  In sommige gevalle gebruik ons ook Botox of ander inspuitings as die fisioterapie alleen nie help om die spiere laat ontspan nie.

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