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Eager Beaver

Eager Beaver

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

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

Oral sex how-to (for him)

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

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

Question Time…

Things you never learnt during high school sex ed…

Q. Can my Rabbit give me an STI?

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

Q. Can his cold sore give me genital herpes?

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

Q. Could I become vibrator-dependent?

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

Q. Is it possible to grow a vagina?

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

Three things your vajayjay would veto

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

1. Smoking

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

2. Douching

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

3. Penetration-only orgasms

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

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

Find out when your lady garden needs some love…

> Symptom: Burnt skin thanks to a bad bikini wax

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

> Symptom: Discharge after intercourse

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

> Symptom: Soreness or irritation after exercise

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

> Symptom: Pain during and after sex

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

> Symptom: Bleeding between periods

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

> Symptom: Pain at the top of your pubic bone

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

 

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The Science Of Lasting Love

The Science Of Lasting Love

By Georgia Rickard.

A deep and sudden appreciation of Whitney Houston. An uncontrollable urge to share your feelings with YouTube. Twitter PDAs… When love first hits it can send the most level-headed of us loopy, but fast-forward a bit and it’s all quiet nights in and comfy silences. It seems love goes on a journey of its own and now, the relationship between love and science is deepening, with boffins taking romance to the lab to uncover biological meaning behind its evolution. Among their findings: we fall in (and out of) love in predictable patterns that are as old as our species itself.

Phase 1: Falling in limerence

Of course, “predictable” isn’t the word most of us would choose to describe a phenomenon that leaves you giddier than a teary tween at a One Direction concert. “Fall for someone, and the world as you know it pretty much stops,” says psychiatrist Dr George Blair-West. Food drops off the agenda. You need less sleep, but have more energy. Your libido spikes. And you can’t stop grinning, even when people are looking at you like you’re on crack. Which you kind of are, says Blair-West.

“Falling in love triggers the release of huge amounts of dopamine, activating the same neural pathways as cocaine,” he explains. Dopamine – the “reward” hormone – explains your sudden motivation, elation and energy, he says, along with your constant sense of craving, hence the euphoric highs when you’re together, and anxious lows when you’re apart. “It’s basically an addiction,” says Blair-West. “You’re constantly wanting that feeling.”

At the same time, you become slightly, well, obsessed, say Italian researchers. They discovered that the newly-in-love have dramatically lower-than-normal levels of serotonin in their blood – amounts that match those of obsessive-compulsive disorder (OCD) sufferers, according to their results, which compared blood profiles of OCD patients and the lovesick with “normal” controls. Hence your new Rain Man-style habits: thinking about him repetitively; compulsively checking your phone… Scientists reckon we’ve been doing it since forever. Some 40-odd years ago one of them, Dr Dorothy Tennov, even gave the condition a name: limerence. After interviewing more than 600 in-love people, she concluded two major things about it: first, it’s involuntary – you can’t help yourself when it happens (more on that in a moment). And second, the key ingredient is a surprising one: uncertainty. Feeling unsure about your chances with him, worrying he won’t like your outfit, wondering if he’ll find someone else… uncertainty is what spikes your anxiety levels when you’re apart, and gives you a sense of reward when you’re together. It’s why you can barely believe you got together with someone so perfect.

If ever there was something to blame for love-induced blindness, limerence is it. Juiced up on a cocktail of feel-good hormones, limerence leaves you smiling dreamily at things you’d normally be cringing at (Crocs, dad jokes, that thing he does with your tweezers and his toes…) and not only rating your relationship as better than everyone else’s, but rating your new love as hotter than you, say Dutch researchers. They asked 93 couples to rate each other’s attractiveness and found lovers consistently rated their partner as more attractive than themselves – a result of the “positive illusions” we have about our partner, says study co-author Dr Pieternel Dijkstra.

Another study in Evolution and Human Behaviour, which asked 120 participants to look at pictures of attractive strangers and then write an essay on either their current partner or a random topic, concluded that the feeling of love associated with limerence diminishes your perception of others’ attractiveness. The loved-up participants who wrote about their lover recalled factual information about the photos (such as the colour of a T-shirt) rather than physical details about the strangers’ appearances. They were also six times less likely to think about the photos after looking at them, than those who wrote about a random topic. As study co-author Dr Martie Haselton put it, “it’s almost like love puts blinders on.” Not that you care: you’re busy doing other things. Like hoisting your new prize onto a pedestal.

“This is a classic symptom of falling in love,” says Dr Helen Fisher, a biological anthropologist. “The first thing that happens is the person takes on what I call ‘special meaning’ – they become different from every other car in the parking lot. The songs they like, books they read– everything about them becomes special. No matter what they’re actually like, you think they’re great.”

A slippery slope? Maybe, but we just can’t help ourselves. When Fisher and her colleagues gathered 17 men and women – all newly, madly in love – and had them look at pictures of their beloved, their brains lit up in the ventral tegmental – the origin of dopamine production. At the same time, the caudate nucleus was activated – a “basic instinct” area near the centre of the brain that looks after primary survival functions, such as motor skills. “It’s a very primitive part of the brain, linked with drive, craving and motivation, rather than emotion,” says Fisher. These two findings helped explain what Fisher had already suspected: that love is closer to drives like hunger and thirst, than emotional states like misery or cheerfulness. It seems we’re biologically trip-wired to fall for each other.

Phase 2: Love goggles crack

As Katy Perry knows, the madness of limerence is temporary – usually lasting between 18 months and three years, according to social biologist Prof Cynthia Hazan. Why? After tracking the brain chemicals of 5 000 loved-up participants across 37 different cultures, she concluded that it’s a case of chemicals: like any other drug, your tolerance to love eventually gets higher, leaving you in a stable, secure relationship minus the infatuation – or, as was the case with Katy, waking up to realise that the view isn’t quite as good sans pedestal.

Fisher has another theory: limerence evolved as a kind of relationship glue. In a savannah full of predators, two parents would have meant the difference between an offspring’s survival and not, she says – a honeymoon phase ensured we’d work as a team to raise a baby.

Sound loopy? It isn’t – other monogamous animals like foxes, wolves and all kinds of birds (robins, thrushes and more) do the same thing, she says. “They tend to pair up only until their offspring have made it past infancy, then go their separate ways.” This also suggests why there’s a worldwide tendency to divorce around the four-year mark, she adds. “United Nations statistics from 62 countries – dating back to 1947 – show that people around the globe tend to divorce in their fourth year together; just long enough to raise a baby past infancy.” Of course, there are all kinds of factors behind people’s decision to divorce, she admits. “But it does seem like there’s a biological component.”

Whatever the case, experts agree on one thing: limerence almost always fades. As the dopamine high wears off, you start noticing the empty milk bottles in the fridge and begin assessing him with a level head. “Without the infatuation, you find out what kind of relationship you’re really in,” says Blair-West. And that’s not a bad thing. “It can actually be a springboard to something deeper,” he points out. “This is when someone knows all the ‘bad’ things about you and still wants to be with you anyway.”

As you settle in to share Saturday nights on the couch, your brain settles in too: generating less activity in the “passion” region, but significantly more in the area responsible for attachment, say British researchers, who scanned the brains of couples past the two-year mark. As your dopamine and serotonin levels normalise, your anxiety levels do too – along with your libido. You’re no longer spending 80 percent of your time thinking about your partner, says Dr Arthur Aron, a love expert and psychologist – and that’s a good thing, because now you can start getting things done again. “You become more secure; settled. The relationship becomes more stable. You’re less anxious about what they think of you. As long as you’re not bored of each other, it’s a very nice place to be.” You also begin to churn out higher levels of vasopressin, a hormone powerfully associated with commitment and attachment. When US scientists triggered vasopressin production in mouse-like mammals called meadow voles, the normally promiscuous males morphed into attentive, loving dads – sticking by their new partner even when other females tried to woo them away. It’s thought the upswing in vasopressin bonds you to your partner by gently reactivating your dopamine “reward” circuitry whenever you’re near them, unconsciously reinforcing your connection. Powerful stuff.

Phase 3: Saturday nights in

The chemicals may be strong, but will they stay forever? As the founders of extramarital affairs website AshleyMadison.com can tell you, we’re not the most faithful species in the world. Even if you’d never stray, chances are you’ve lusted after a hot barman or colleague – despite being in a loving, committed relationship. Has our brain chemistry cheated us?

Not at all, says Fisher. “There are three different systems in the brain for mating and reproduction. Of the three systems, the first is sex drive – the craving for sexual gratification. The second is passionate love – limerence. The third is attachment, that sense of calm and security you can feel for a long-term partner. And these systems can operate in any combination,” she explains. That’s why you can love but not be “in love”, or feel frenzied lust but no desire to take on his last name – or feel lust for one person, and a deep sense of attachment to another.

These systems can also occur in any order, Fisher adds. “For example, you might feel deep attachment to a friend at work. Then times change, and suddenly you fall madly in love with them – so attachment can come before passionate love.”

And here’s the kicker: you can also flow from one to the other and back again within your relationship, she says. “Or have all three systems going at once.” Which means you don’t have to grow old as platonic friends – you can bring back that first flush of love.

While no one’s worked out the exact formula for putting the love butterflies on speed dial, you can do things to dial up its intensity. One study, published in the Review of General Psychology, concluded that it simply takes elbow grease to stop long-term love morphing into friendship – namely, by taking responsibility for your own happiness, actively managing your self-esteem, and being there for your partner, so that you in turn can feel supported. Another study in Social Cognitive and Affective Neuroscience found that having regular sex, and seeing yourself as part of a team, were both important factors in couples who’ve managed to maintain that “first-stage” infatuation after at least 20 years together (all together now: awww…).

You can also ratchet up your bond by changing your schedule, says Aron. When he asked 60 long-time married couples to devote an hour and a half a week to exciting, novel activities, the couples reported a “much closer” bond after 10 weeks than couples who’d only undertaken enjoyable activities together. “Brains that fire together wire together,” explains Blair-West. “When you’ve experienced strong, positive, mutual emotional experiences, you create mutual neural pathways. Subsequently triggering that rewiring leaves you with a bond that helps you connect.” Novel experiences also trigger the release of dopamine, according to the Journal of Neuroscience – yep, the same reward hormone that got you hooked on your partner in the first place.

As for what constitutes exciting – well, the couples in Aron’s experience were strapped together with Velcro and challenged to crawl their way through an obstacle course while holding a pillow between them (seriously). But you don’t have to go that far, says Fisher. Trying a new cuisine or climbing Table Mountain together will have the same (or similar) effect, she says. We’re pretty sure he won’t object to a bit of novelty in the bedroom either.

For all the research, it seems the secret to long-term love is no secret at all: it takes work. But for all the ups, downs and squabbles over the remote, it’s worth it – and you don’t need a science degree to know that.

Love For Longer

According to world trends, around 50 percent of all marriages end in divorce. Scary! Up your odds with WH relationship expert Dr Elna Rudolph’s advice:

  1. “Take at least 15 minutes to talk to each other every day. Remember, it’s equally important to listen to him as it is to express your feelings.”
  2. “Keep dating and exploring new experiences together. Challenging activities can be a great way to enhance your bond and make great memories.”
  3. “Make time regularly for sex, kissing, hugging and hand holding. A passionate kiss every day is a really easy way to increase intimacy.”

Wild Love

Only three percent of the world’s mammals pair up for longer than a night – and their relationships can be just as tumultuous as ours…

Gibbons

These apes couple up for their entire lives – but have been known to divorce if someone better comes along.

Grey foxes

They stick together until their babies are old enough to be parents themselves. Then they split and start the process with someone else.

Prairie voles

Couples raise babies together and share nests for life, but romp around with other voles too. Shifty.

Swans

Once considered the gold-standard for life-long monogamy, swans actually practice social monogamy – they pair up, but have flings on the side.

It Had To Be You (Or Someone Like You)

Whether you’re a believer in soul mates or a make-it-work kind of gal (and both types can work, says research presented at the American Psychological Society conference), the way we fall in love tends to be the same. “There are a number of scenarios that create the right circumstances for falling in love, but the most common is knowing a person who is reasonably attractive, and receiving some indication that they like you,” says psychologist Dr Arthur Aron. “We did one study where we had a lot of people who’d recently fallen in love tell us what happened. The most common response was, ‘There was this person I knew, who was appropriate and reasonably attractive, and they did something that indicated they liked me. At that moment I felt a huge wave of falling for them.’”

The other scenario involves highly exciting, dramatic conditions, he continues. “An extreme example would be a plane crash or some kind of street demonstration where the police are coming,” he says. Meeting under conditions of high physiological arousal, where your dopamine system is already running at full speed, means “you kind of mistake the arousal for being attracted to the person,” he says. Tell him that on your next anniversary…

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Sex and Pain

Painful Sex

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

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

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

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

An Approach to Dyspareunia:

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

Deep Dyspareunia:

Gynaecological Disorders:

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

Bowel Disorders:

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

Bladder Disorders:

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

Other Causes:

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

Superficial Dyspareunia:

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

It is important to distinguish between localised and generalised pain.

Localised:

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

Fissures:

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

Genito-Urinary Syndrome of Menopause:

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

Provoked Vestibulodynia:

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

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

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

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

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

Hypertonic Pelvic Floor:

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

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

Vaginismus:

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

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

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

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

Generalised superficial pain:

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

Pudendal Neuralgia:

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

Chronic Pelvic Pain:

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

Other Chronic Pain Disorders:

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

Persistent genital arousal disorder:

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

Some useful tips

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

When people find out that I’m a “sex doctor”, it is either a great conversation starter or the ultimate convo killer. Yes, I’m a sex therapist – but I’m also a qualified medical doctor. Some think I watch people have sex, others think I just suggest kinky positions or toys and some don’t even allow their minds to go there. Many have mentioned that they would love to be a fly on the wall in my practice. So allow me to share some of what I’ve learnt over my years of getting people naked (once they leave my office). These four cases represent the most common reasons couples and singles book time with me. And the advice I give them will no doubt keep your bedroom fires burning…

 

The case: Unconsummated marriage

The couple: Erica and Paul, late twenties, married for seven years, both still virgins

Erica and Paul refrained from sex before marriage for religious reasons, but they were excited about finally having sex on their wedding night. They tried, but it felt like he was hitting a wall inside her vagina – it was impossible. Erica knew that the first few times can be uncomfortable, but nothing could have prepared her for the excruciating pain she experienced when Paul tried to insert his penis. She felt like he was cutting her open and after the attempt, the area would burn for hours. They tried lubrication, alcohol, sedatives, foreplay – nothing worked! They saw many doctors who told her that there is nothing wrong with her and psychologists who were convinced that she must have been abused, but she hadn’t been. When they came to see me, she could orgasm through other forms of stimulation, but they desperately wanted a baby.

The treatment: Take control of your vagina.

On examination, I discovered that Erica was born with a condition called Neuroproliferative Provoked Vestibulodynia, where there were too many nerve endings around her vaginal opening (and in her belly button!) The sensitivity made the muscles around her vagina contract, much like an eyelid protects the eye.

This sensitivity and resulting muscle spasm made inserting tampons impossible, never mind a penis! We had to take the sensitivity away, relax the muscles and teach Erica’s brain that something can be inserted into her vagina without causing her pain. In my examination room, she inserted something into her vagina for the first time – an ear bud! A specialist pelvic function physiotherapist taught her relaxation techniques and how to use her pelvic floor muscles. She practiced at home with vaginal dilators every day and applied a special cream around her vagina to help the nerve problem.

Within four weeks, Erica was able to insert a dilator the size of an erect penis into her vagina without any physical or psychological discomfort. Paul then began to help with the dilators and he also attended a few of the physiotherapy sessions. After a follow-up with me, they got the “all-clear” and were able to carefully attempt penetration at home. Success! The better news? Erica popped into my office a few weeks ago – pregnant with their second baby!

 

The case: He comes early – every time

The patient: Nkosi, 35, single

Every time he had sex, Nkosi ejaculated within less than a minute of penetration. At times it was so bad that he ejaculated even before penetration. He was so embarrassed that he began to avoid relationships. He read about the stop-start and squeeze techniques and had been practising for years, but they didn’t work. He also ejaculated within seconds while masturbating.

The treatment: Pop a pill

This doesn’t mean your sex life needs to come to a shuddering halt! Ejaculation is a learned behaviour and can be controlled. If a guy consistently ejaculates in less than a minute, it’s a genetic problem with a specific receptor. No amount of sex therapy, psychotherapy or exercise will get it right. I prescribed Nkosi with an SSRI – an antidepressant that works on this particular receptor.

Nkosi takes the SSRI every day and now lasts about 10 minutes. He’s seeing someone now and they’re planning to get married next year.

 

The case: She can’t orgasm

The couple: Lisa and Ben, married for 15 years

Lisa and Ben are happily married, but both feel like they are missing out on something… Despite Ben’s efforts with oral sex, manual stimulation and penetrative sex, Lisa has never been able to have an orgasm. They have also tried using a vibrator together, but to no avail. Lisa comes from a typical Afrikaans household – she found it difficult to embrace her sexuality initially, but now enjoys sex.

The treatment: Take things into your own hands

The first step is always education: only a third of women orgasm from penetration alone and many don’t know that the most sensitive spots are the clitoris and nipples, not the vagina itself. Lisa and Ben were instructed to do erotic massage, sensate focus exercises (where each partner becomes more aware of the sensations they feel) and up their foreplay skills. I changed Lisa’s antidepressant and sorted out her hormones – she was on a Pill that broke down and blocked her testosterone, making orgasms very difficult. She felt better and they enjoyed the exercises, but still no orgasm.

That’s when I suggested masturbation. After all this time, the pressure of losing control in your partner’s presence makes orgasm very unlikely. She had to do it alone. The idea was strange for her, but she gradually became more and more comfortable and eventually had her first orgasm with the help of a small bullet vibrator. By herself. She then did it in his presence and eventually with his help.

When Lisa came for her check-up this year, she mentioned that it is the best thing that she has ever done for herself and for their relationship. Her husband sent me a big bouquet of flowers!

 

The case: She wants more

The couple: Claire and John, have been together for four years

When Claire and John, who has an extremely demanding job, started dating, they had sex almost daily, but for the last year, it only happens about once a month. Claire cried during the consultation and said she feels completely rejected and it’s influenced her self-esteem. She loves him and didn’t want to leave, but would if the problem wasn’t solved.

The treatment: The two Ts (time and testosterone)

When men don’t want to have sex, there is a good reason for it: either psychological or physical. Being a medical doctor, I always exclude the medical first. John had very low testosterone levels – the hormone he needs for libido. Due to stress, the stimulation of the testis to produce testosterone was shut down. He didn’t make time for any exercise, ate poorly, didn’t sleep enough and was constantly worried about work. He needed to look after himself and de-stress. John was shocked to see how his lifestyle affected his health, and made radical changes. I also advised them to plan for intimacy twice a week, have date nights and do fun things together.

Three months later, they are having sex at least once a week, John’s testosterone is back to normal and Lisa is beaming.

 

NOTE:
  • All images courtesy of Google.
  • Content courtesy of Women’s Health.
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RSG: Pynlike Seks en Lae Libido (Podcast: Painful Sex and Low Libido)

RSG: Pynlike Seks en Lae Libido (Podcast: Painful Sex and Low Libido)

RSG: Seks en Jy, 22 Julie 2016.

Martelize Brink gesels met Dr. Elmari Mulder Craig en Dr. Elna Rudolph oor seksuele disfunksie by vroue, met die fokus op pynlike seks en lae libido.

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7 Ways Brain Health can improve your Sex Life

7 Ways Brain Health Will Improve your Sex Life

Written by: Annie Lizstan for My Sexual Health

Make no mistake; the brain is indeed the ultimate sex organ.  The response to sexual stimulation ultimately begins in the brain, and this is true for most women.  The brain is the center point of all thoughts and emotions, and it is a complicated and intergraded network of neurotransmitters that are responsible for many things, including sexual desires and the response to such desire.  The brain sends signals throughout the body that will begin a chain reaction that leads to the arousal of the genitals.  Sexual arousal begins in the mind because arousal can begin by just thinking about sex, which brings us back to the first point, that the brain is an ultimate sex organ.

Many women will agree, that is difficult for them to get “in the mood” if they are distracted, have a long to-do list, or are physically and mentally exhausted.  If they feel unappreciated by their lover, many women will not feel amorous toward her lover.  When you understand that the brain is a sexual organ, your love life may improve.

In general, sex affects emotional, physical, and social aspects of a person’s life.  Recent studies have concluded that in addition to “mindful meditation” and computer memory training games, sex may make you more intelligent.

Below are several more reasons that a healthy brain will improve your sex life, and a healthy sex if will improve your brain power:

  1. Exercise with your lover, as this can be incorporated into a type of sexual foreplay. Couples bond mentally and physically when they do activities together, such as enjoying a vigorous game of tennis.  Couples will grow closer if they go to the gym together on a regular basis.  Yoga is an excellent activity to do with your partner.  Remember, regular exercise will have you feeling more energized and looking better, which will have a positive effect in the bedroom.  Also, men who regularly exercise (which is a natural way to keep your brain healthy) are less likely to have ED (erectile dysfunction).
  2. Sex is like a drug, and brain enhancement supplements may not be necessary to increase the enjoyment of sex. Sex is a pleasurable act that feels good, because a neurotransmitter (dopamine) is naturally released, and triggers the part of the brain that registers a reward.  Researchers conclude that the “feel good” hormones (dopamine and oxytocin) may improve the connectivity as to how the brain communicates.
  3. “I have a headache” may not be a valid excuse to avoid sex. In fact, recent research shows that sexual intimacy may relieve minor symptoms of pain.  A research study, conducted in Germany, showed that 60% of migraine sufferers who had sex during an episode reported pain relief.
  4. Sex may be a natural memory booster. A controlled laboratory study, conducted in 2010, reported that when rodents were allowed sex on a daily basis for two consecutive weeks, more neurons grew in the hippocampus (the area of the brain that is directly associated with memory function).  A second laboratory controlled study backed up this conclusion.  It is inconclusive if this is true in humans, but you can certainly study this theory for yourself.
  5. Sex will make you sleepy, and this is great news because your body needs to rest for your brain to function at maximum capacity. When the body is completely rested, your energy levels increase and your mood is elevated.  Also, a well-rested body and mind are one of the most popular ways to increase stamina during intercourse.  Scientists think they understand why men have the tendency to get sleepy directly after sex.  The prefrontal cortex will shut down after ejaculation, and this along with the release of feel-good hormones (serotonin and oxytocin) may account for some men rolling over and quickly falling asleep.
  6. As we know, there are specific ways to keep the brain healthy, such as eating right (by avoiding processed foods and eating more fruits and vegetables), and engaging in mentally stimulating activities (like doing crosswords puzzles, learning to play a musical instrument, and learning a new language). But recent clinical studies have shown that having sex later in life (over the age of 50) can boost brain health and ward off signs of dementia.
  7. Sex is relaxing. Frequent sexual encounters mean a less stress-filled life.  People who had sex on a regular basis were less mentally stressed when faced with anxiety (such as faced with having to speak publically).  How does sex decrease stress? Basically, by lowering a person’s blood pressure.

References:

  1. http://nerdslot.com/2016/02/how-to-give-your-sexual-stamina-a-boost/
  2. https://www.performanceinsiders.com/

Author Bio:

Annie Lizstan works as a health and beauty consultant for online websites and an independent researcher by profession. She had completed her studies from university of Arizona and live in Wasilla, Alaska. She always like to explore her ideas about health, fitness, beauty .Recently, she got an opportunity to work on joint health product beneflex .She has experience researching as a passion as well as profession. You can also connect with her on Facebook, Twitter and Pinterest.

Note: imagery courtesy of Google

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ONWELKOME ORGASMES

Onwelkome Orgasmes – My Storie

Deur Mariette Snyman, gepubliseer in Rooi Rose, Maart 2014.

As ’n vrou met behoudende waardes skielik konstante seksuele opwekking ervaar – en dit sonder ’n waarneembare oorsaak – kan haar lewe ’n volslae nagmerrie word.

Lees die volle artikel hier.

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Wedding Night – What to Expect

Wedding Night – What to Expect

Published by Femagene.

Many newlyweds experience nervousness before their first night of having sex. This educational video will give you some peace of mind of what to expect and how to curb the tension.

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Dealing with his high libido

The typical couple that the MSH doctors see, is there because the woman has a low libido – she does not want to have sex as often and as desperately as her man does.

This is quite normal, since men’s testosterone levels are usually above twenty and women’s are below two (and often undetectable if she is on the Pill or post-menopausal.)

Sometimes we want to shout to the guy: “Her brain is just not suspended in testosterone like yours!” But we don’t, but rather explain it nicely – and just knowing that they are actually normal helps the couple a lot.

Research confirms that one of the biggest reasons for couples not getting it on more often is just that they don’t get the timing right.

Does this sound familiar?

> He is a morning person (which is normal because a guy’s testosterone peaks in the early morning) but you like to watch TV till midnight so when he gets up at 5am to go to work, you cant think of anything worse than getting rid of your pyjamas and biting your lip all the way through to avoid breathing your morning breath into his face.

> You both work, get home, bath and feed the kids, put them to bed, drop dead on the couch for two hours and then when you go to bed by 11, you know that he would like to have sex, but it does not happen; you’re just too tired.

What to do:

> Decide how often you would like to have sex in a week, look at your diary and schedule it in. Yes, spontaneous sex is more exciting, but planned sex is better than no sex at all and certainly more convenient than doing it when you would much rather be doing something else.

> Tell him: “I would like to have sex with you every day, but at 8pm, not when we go to bed.” There is no reason why you have to make love at bedtime; rather do it at a more convenient time.

> If you feel pressured to have sex every day and you feel like you could really do with a break, why not negotiate sex-free days with him, where you both consent to not having sex on certain days of the week?

You can keep it on the same days or change it every week. It is amazing what it does to women if that pressure is taken off her. He is not allowed to ask on those days, but if you decide to break the rules now and then from your side, lucky guy!

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Doctor’s Q & A: Meet the Expert

Published in Health Intel, Jul/Aug 2015.

Sexual-health expert Dr Elna Rudolph heads up My Sexual Health – a team of health professionals in Pretoria, Johannesburg, Cape Town and Witbank that offers treatment for all sex- and relationship-related concerns. We asked her for some intimate advice…

Read the full article here.

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