Sexual Health

1- Female Sexual Dysfunction
2- Why Am I Bleeding After Sex?
3- Vaginoplasty and Labiaplasty Procedures
4- Vaginismus

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1- Female Sexual Dysfunction

Female Sexual Dysfunction

A sexual problem, or sexual dysfunction, refers to a problem during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle has four phases: excitement, plateau, orgasm, and resolution.

While research suggests that sexual dysfunction is common (43% of women and 31% of men report some degree of difficulty), it is a topic that many people are hesitant or embarrassed to discuss. Fortunately, most cases of sexual dysfunction are treatable, so it is important to share your concerns with your partner and doctor.

What Causes Sexual Dysfunction?

Sexual dysfunction can be a result of a physical or psychological problem.

• Physical causes. Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart disease, neurological diseases, hormonal imbalances, menopause plus such chronic diseases as kidney disease or liver failure, and alcoholism or drug abuse. In addition, the side effects of certain medications, including some antidepressant drugs, can affect sexual desire and function.
• Psychological causes. These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, or the effects of a past sexual trauma.

Who Is Affected by Sexual Dysfunction?

Both men and women are affected by sexual dysfunction. Sexual problems occur in adults of all ages. Among those commonly affected are older adults, and they may be related to a decline in health associated with aging.

How Does Sexual Dysfunction Affect Women?

The most common problems related to sexual dysfunction in womeninclude:

• Inhibited sexual desire. This involves a lack of sexual desire or interest in sex. Many factors can contribute to a lack of desire, including hormonal changes, medical conditions and treatments (for example, cancer and chemotherapy), depression, pregnancy, stress, and fatigue. Boredom with regular sexual routines also may contribute to a lack of enthusiasm for sex, as can lifestyle factors, such as careers and the care of children.
• Inability to become aroused. For women, the inability to become physically aroused during sexual activity often involves insufficient vaginal lubrication. This inability also may be related to anxiety or inadequate stimulation. In addition, researchers are investigating how blood flow problems affecting the vagina and clitoris may contribute to arousal problems.
• Lack of orgasm (anorgasmia). This is the absence of sexual climax (orgasm). It can be caused by a woman's sexual inhibition, inexperience, lack of knowledge, and psychological factors such as guilt, anxiety, or a past sexual trauma or abuse. Other factors contributing to anorgasmia include insufficient stimulation, certain medications, and chronic diseases.
• Painful intercourse. Pain during intercourse can be caused by a number of problems, including endometriosis, a pelvic mass, ovarian cysts, vaginitis, poor lubrication, the presence of scar tissue from surgery, or a sexually transmitted disease. A condition called vaginismus is a painful, involuntary spasm of the muscles that surround the vaginal entrance. It may occur in women who fear that penetration will be painful and also may stem from a sexual phobia or from a previous traumatic or painful experience.

How Is Female Sexual Dysfunction Diagnosed?

To diagnose female sexual dysfunction, the doctor likely will begin with a physical exam and a thorough evaluation of symptoms. The doctor may perform a pelvic exam to evaluate the health of the reproductive organs and a Pap smear to detect changes in the cells of the cervix (to check for cancer or a pre-cancerous condition). He or she may order other tests to rule out any medical problems that may be contributing to the woman's sexual dysfunction.

An evaluation of your attitudes regarding sex, as well as other possible contributing factors (such as fear, anxiety, past sexual trauma/abuse, relationship problems, or alcohol or drug abuse) will help the doctor understand the underlying cause of the problem and make appropriate treatment recommendations.

How Is Female Sexual Dysfunction Treated?

The ideal approach to treating female sexual dysfunction involves a team effort between the woman, doctors, and trained therapists. Most types of sexual problems can be corrected by treating the underlying physical or psychological problems. Other treatment strategies focus on the following:

• Providing education. Education about human anatomy, sexual function, and the normal changes associated with aging, as well as sexual behaviors and appropriate responses, may help a woman overcome her anxieties about sexual function and performance.
• Enhancing stimulation. This may include the use of erotic materials (videos or books), masturbation, and changes in sexual routines.
• Providing distraction techniques. Erotic or non-erotic fantasies; exercises with intercourse; music, videos, or television can be used to increase relaxation and eliminate anxiety.
• Encouraging non-coital behaviors. Non-coital behaviors (physically stimulating activity that does not include intercourse), such as sensual massage, can be used to promote comfort and increase communication between partners.
• Minimizing pain. Using sexual positions that allow the woman to control the depth of penetration may help relieve some pain. Vaginal lubricants can help reduce pain caused by friction, and a warm bath before intercourse can help increase relaxation.

Can Female Sexual Dysfunction Be Cured?

The success of treatment for female sexual dysfunction depends on the underlying cause of the problem. The outlook is good for dysfunction that is related to a treatable or reversible physical condition. Mild dysfunction that is related to stress, fear, or anxiety often can be successfully treated with counseling, education, and improved communication between partners.

How Do Hormones Affect Female Sexual Dysfunction?

Hormones play an important role in regulating sexual function in women. With the decrease in the female hormone estrogen that is related to aging and menopause, many women experience some changes in sexual function as they age, including poor vaginal lubrication and decreased genital sensation. Research suggests that low levels of the male hormone testosterone also contribute to a decline in sexual arousal, genital sensation, and orgasm. Researchers still are investigating the benefits of hormones and other medications, including drugs like Viagra, to treat sexual problems in women.

What Effect Does a Hysterectomy Have on Female Sexual Dysfunction?

Many women experience changes in sexual function after a hysterectomy(surgical removal of the uterus). These changes may include a loss of desire, and decreased vaginal lubrication and genital sensation. These problems may be associated with the hormonal changes that occur with the loss of the uterus. Furthermore, nerves and blood vessels critical to sexual function can be damaged during the surgery.

How Does Menopause Affect a Female Sexual Dysfunction?

The loss of estrogen following menopause can lead to changes in a woman's sexual functioning. Emotional changes that often accompany menopause can add to a woman's loss of interest in sex and/or ability to become aroused. Hormone replacement therapy (HRT) or vaginal lubricants may improve certain conditions, such as loss of vaginal lubrication and genital sensation, which can create problems with sexual function in women. Also, an oral drug taken once a day, ospemifene (Osphena), makes vaginal tissue thicker and less fragile.

It should be noted that some postmenopausal women report an increasein sexual satisfaction. This may be due to decreased anxiety over getting pregnant. In addition, postmenopausal woman often have fewer child-rearing responsibilities, allowing them to relax and enjoy intimacy with their partners.

When Should I Call my Doctor About Sexual Dysfunction?

Many women experience a problem with sexual function from time to time. However, when the problems are persistent, they can cause distress for the women and her partner, and can have a negative impact on their relationship. If you experience any of these problems, see your doctor for evaluation and treatment.

2- Why Am I Bleeding After Sex?

Why Am I Bleeding After Sex?

You’ve just finished having sex with your partner, when you look down and see blood on the sheets. You don’t have your period and aren’t supposed to get it anytime soon, so what gives?

While vaginal bleeding after sex can be alarming, it’s also fairly common -- affecting up to 9% of menstruating women -- and probably no cause for concern. But it can also be caused by an infection, and in rare cases, it's a sign of cervical cancer.

Why does it happen?

The most common causes for vaginal bleeding after sex both start in the cervix, which is the narrow, tube-like end of the uterus that opens into the vagina.

One of those causes is cervical inflammation, or cervicitis. It can be ongoing and totally harmless, or it can happen because of a sexually transmitted infection that you need to get treated, like chlamydia or gonorrhea. Both types of cervical inflammation can cause bleeding after sex.

A second common reason for bleeding after sex are cervical polyps. They are growths that are usually small -- about 1 to 2 centimeters -- that often appear on the cervix where it connects to the vagina. Most aren’t cancerous, and a doctor can remove them during an appointment.

Other causes of vaginal bleeding after sex include:

• Friction during sex or not enough lubrication
• Normal uterine bleeding if you're just beginning your period or if it’s just ended
• A cervical or vaginal infection
• Genital sores caused by herpes or another condition
• A precancerous cervical spot
• Cervical ectropion (when the inner lining of the cervix pokes through the cervical opening and grows on the vaginal side of the cervix)
• Pelvic organ prolapse (when pelvic organs, like the bladder or uterus, jut beyond the vaginal walls)
• Cancer of the cervix, vagina, or uterus

While many of these causes don’t need treatment and are harmless, sometimes vaginal bleeding after sex can be a sign of a more serious problem.

How do I know if it’s serious?

If you have some minor bleeding occasionally after sex, chances are that everything is fine. But the only way to know for sure is to see your doctor for a physical exam.

If the bleeding happens right before you get your period or within a few days after it ends and it doesn’t happen again, you can hold off on making that appointment. You can also probably hold off if you recently had a pelvic exam and Pap smear and got a clean bill of health. In all other cases -- or if you’re just worried -- it’s best to get checked out to rule out infection or anything more serious.

What if I’ve already gone through menopause?

If you’re postmenopausal, any bleeding after sex isn’t normal. See your doctor to rule out cervical cancer, endometrial cancer, and other issues.

What happens at the doctor’s appointment?

Your doctor’s first step will probably be to ask you some questions to see if there’s an obvious cause for the bleeding, like breakthrough bleeding after you just start to take a birth control pill.

She’ll also want to know if you’re having pain during sex, which can be a sign of inadequate lubrication or infection, depending on when it happens.

Your doctor will give you a pelvic exam and look for any source of the bleeding, like vaginal tears or lesions, signs of pelvic organ prolapse, cervical polyps, or inflammation. If your doctor finds any polyps, she might be able to remove them in the office and send them to a lab for testing, or make a later appointment to have them surgically removed.

During a Pap test, your doctor can swab your cervix to test for sexually transmitted infections like chlamydia and gonorrhea, which can cause bleeding after sex and are treated with antibiotics. The Pap test also detects any sign of abnormal, precancerous growths or cancer cells.

What if my doctor finds something abnormal?

If your Pap test reveals any abnormalities on your cervix at the time of your exam, you’ll probably get a colposcopy. It starts out like a Pap test, but takes a bit longer, and the doctor will use a special magnifying device called a colposcope to get a closer look at the cervix. If your doctor sees anything suspicious, she can take a small sample of tissue for testing.

If bleeding after sex is an ongoing thing, your doctor may recommend a colposcopy even if your Pap test results are normal, to get a better look at your cervix.

If you’re postmenopausal, your doctor might do a transvaginal ultrasoundto get a closer look at the pelvic organs or an endometrial biopsy to look for abnormal cells in the endometrial tissue that lines your uterus.

What if I’m pregnant?

Vaginal bleeding after sex can be scary if you’re pregnant, but it’s probably not a cause for concern. Your cervix may bleed more easily during pregnancy because extra blood vessels are developing in the area.

If my post-sex bleeding is unexplained, will it stop on its own?

It might. A recent study found that just over half of women who had bleeding after sex reported that it cleared up on its own within 2 years.

How can I prevent bleeding after sex?

You can rule out the most innocent causes of bleeding after sex, like friction during intercourse or not enough lubrication, by simply using a lubricant before and during sex.

You can also wait a bit longer after your period ends to start having sex again, if it seems like regular uterine bleeding at the tail end of menstruation is the culprit.

Removing cervical polyps or treating cervical infections should also clear up post-sex bleeding, if either was the cause.

3- Vaginoplasty and Labiaplasty Procedures

Vaginoplasty and Labiaplasty

Vaginoplasty is a procedure that aims to "tighten up" a vaginathat's become slack or loose from vaginal childbirth or aging. Some surgeons claim it can even improve sensitivity -- a claim the American College of Obstetricians and Gynecologists (ACOG) has strongly challenged.

While it's true that vaginal tissues can stretch, surgically tightening the vaginal tissue in itself cannot guarantee a heightened sexual response, since desire, arousal, and orgasm are complex, highly personal responses, conditioned as much by emotional, spiritual, and interpersonal factors as aesthetic ones. In addition, sexual "sensitivity" doesn't automatically lead to more pleasure - it can actually lead to pain.

Labiaplasty, plastic surgery on the labia (the “lips" surrounding the vagina), can be performed alone or with vaginoplasty. Surgery can be performed on the labia major (the larger, outer vaginal lips), or the labia minor (the smaller, inner vaginal lips). Labiaplasty changes the size or shape of the labia, typically making them smaller or correcting an asymmetry between them.

Reconstructive Surgery vs. Cosmetic Surgery

In order to decide if you should consider vaginoplasty or labiaplasty, it’s important to understand the difference between reconstructive surgery and cosmetic surgery.

Reconstructive surgery improves the function of a body part, while cosmetic surgery changes the aesthetics of essentially normal anatomy. You can think of it like a nose job: a surgeon can restructure the interior nasal cavities to help you breathe better or reshape the nose, just for the sake of appearances.

It's a critical distinction, because the American College of Obstetricians and Gynecologists evaluates surgeries and outcomes to fix functional problems, such as urinary incontinence. But ACOG remains skeptical and cautious about cosmetic vaginal surgery due to its risks and lack of scientific data on safety and effectiveness.

Some vaginoplasty procedures, for instance, were originally developed as reconstructive surgeries to repair birth defects when the vagina was malformed, too short, or absent (such as in vaginal agensis), so that a girl could grow up to have normal urination, menstruation, and intercourse.

Surgeries Related to Vaginoplasty and Labiaplasty

More recently, vaginoplasty has grown into a group of cosmetic surgeries marketed as "vaginal rejuvenation" and "designer vagina" procedures. Plastic surgeons and gynecologists are marketing their own array of designer vaginoplasty surgeries, claiming the same benefits to women as with other cosmetic surgeries, such as beauty, self-esteem, and confidence.

In fact, says ACOG, women's genitals naturally have a wide range of normal appearances that are anatomically correct. There's no one "look" or right way for a vagina and labia to be formed.

Recently, laser technology has been introduced by some surgeons for "vaginal rejuvenation" and other vaginal surgeries to replace the traditional scalpel.

Individual doctors who are members of the American Society of Plastic Surgery (ASPS) offer various "vaginal rejuvenation" procedures, but the ASPS itself does not endorse particular surgeries and cautions that "vaginal rejuvenation" surgery may need further scientific study to determine efficacy and success. None of the cosmetic vaginoplasty surgeries are considered accepted, routine procedures by ACOG.

Here are some examples of "vaginal rejuvenation" and "designer vagina" procedures:

"Revirgination." The hymen, the thin tissue at the entrance to the vagina, normally "breaks" the first time a woman has intercourse. A surgery called a hymenoplasty repairs the hymen to mimic its original, virginal state, before a woman was sexually active. Because of the strong religious convictions surrounding the importance of virginity in some cultures, this is among the most controversial of cosmetic vaginal surgeries.

Clitoral unhooding. Some surgeons are marketing a procedure called clitoral unhooding, which removes the tissue that normally covers the clitoris.

G-spot amplification. The front wall of the vagina, some experts believe, holds the highly erotic G-spot, an especially sensitive stimulation site for female arousal and orgasm. The G-spot amplification procedure involves injecting collagen into the front wall of the vagina, theoretically to increase pleasure.

Risks of Vaginoplasty and Labiaplasty

Women's long-term satisfaction and complication rates from vaginoplasty and labiaplasty have not been tracked. Further, because these surgeries have not been evaluated in peer-reviewed medical journals the way other surgeries have been -- some procedures are proprietary and trademarked -- ACOG considers them "unproven."

The risks of vaginal cosmetic surgery include:

• Infection
• Permanent changes in sensation
• Ongoing pain
• Scarring

The best advice for women considering vaginal surgery: talk openly with your doctor about your feelings and concerns about your genitals, as well as your expectations for surgery and any possible non-surgical options. Targeted Kegel-like exercises can tone weak, loose vaginal muscles, for instance, and enhance sexual arousal; and counseling can address issues of sexual self-esteem and confidence.

Some questions to ask your surgeon include:

• What are the short-term and long-term risks and complications of surgery?
• What are the benefits?
• Will I experience reduced sensation in my vagina or clitoris after surgery?
• Will surgery affect my ability to have an orgasm?
• Are there any restrictions on use of feminine hygiene products, such as tampons, after surgery?
• Will surgery affect future pregnancy and childbirth?
• Are my expectations for surgery realistic?
• What are the non-surgical options?

Are Vaginoplasty or Labiaplasty Covered By Insurance?

Most health insurance plans don't cover vaginoplasty, labiaplasty, or other plastic surgery that's elective rather than medically necessary. Only occasionally, according to ACOG, is labiaplasty medically necessary, such as with labia hypertrophy (overgrowth) caused by excess testosterone, congenital conditions, or chronic irritation.

4- Vaginismus

Vaginismus

When a woman has vaginismus, her vagina's muscles squeeze or spasm when something is entering it, like a tampon or a penis. It can be mildly uncomfortable, or it can be painful.

There are exercises a woman can do that can help, sometimes within weeks.

Symptoms

Painful sex is often a woman's first sign that she has vaginismus. The pain happens only with penetration. It usually goes away after withdrawal, but not always.

Women have described the pain as a tearing sensation or a feeling like the man is "hitting a wall."

Many women who have vaginismus also feel discomfort when inserting a tampon or during a doctor's internal pelvic exam.

Causes

Doctors don't know exactly why vaginismus happens. It's usually linked to anxietyand fear of having sex. But it's unclear which came first, the vaginismus or the anxiety.

Some women have vaginismus in all situations and with any object. Others have it only in certain circumstances, like with one partner but not others, or only with sexual intercourse but not with tampons or during medical exams.

Other medical problems like infections can also cause painful intercourse. So it's important to see a doctor to determine the underlying cause of painduring sex

Treatment

Women with vaginismus can do exercises, in the privacy of their own home, to learn to control and relax the muscles around the vagina.

The approach is called progressive desensitization, and the idea is to get comfortable with insertion.

First, do Kegel exercises by squeezing the same muscles you use to stop the flow of urine when urinating:

• Squeeze the muscles.
• Hold for 2 to 10 seconds.
• Relax the muscles.

Do about 20 Kegels at a time. You can do them as many times a day as you want to.

After a few days, insert one finger, up to about the first knuckle joint, inside the vagina while doing the exercises. It's a good idea to clip your fingernails first and use a lubricating jelly. Or do the exercises in a bathtub, where water is a natural lubricant.

Start with one finger and work your way up to three. You'll feel the vagina's muscles contracting around your finger, and you can always take your finger out if you're not comfortable.

For women whose vaginismus is related to fear or anxiety, therapy helps.