Tag Archive for: Infections

By Dr Elna Rudolph.

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

 

1. Start getting excited about sex!

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

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

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

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

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

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

2. Prevention of Pregnancy:

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

Hormonal Contraception:

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

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

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

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

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

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

Other methods:

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

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

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

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

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

4. Prevent Infections and Cancer:

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

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

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

5. Pap Smear and Gynae Examination:

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

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

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

Will penetration be possible?

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

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

Will it hurt?

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

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

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

Will it bleed?

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

What is the best position for first-time sex?

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

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

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

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

What is the best time?

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

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

What is good foreplay?

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

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

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

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

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

Will we have orgasms?

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

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

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

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

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

What happens after sex?

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

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

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

Bladder infections:

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

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

Yeast infections:

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

Other infections:

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

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

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

Libido:

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

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

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

Frequency:

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

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

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

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

On a serious note:

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