Sexual Difficulties

Painful Sex – Dyspareunia

Painful Sexual Intercourse (Dyspareunia)

Pain during sexual intercourse (dyspareunia) is very common. A recent Swedish survey suggested that it occurs in 9.3 per cent of females, with the incidence being higher among the young and inexperienced and relatively low among the over-50s. There are two type of painful sex:

Supercial Dyspareunia – pain occurs on superficial vaginal penetration.

Deep Dyspareiunia – pain occurs with deep vaginal penetration.

Causes of Superficial Pain

Lack of lubrication
Vaginismus
Menopausal or post-menopausal dryness
Vaginal or urinary tract infections
Injury – Injury is more commonly caused by a childbirth tear or the episiotomy cut that is often made during labour. Badly healed stitching can also cause pain. Injury to vulva or vagina can occur during rape or sexual assault and later cause superficial pain or vaginismus
Genital Herpes and other sexually transmitted infections
Vulvitis – This means inflammation of the vulva (the opening to the vagina). It can be due to all sorts of causes, including chemicals in bubble-baths or soaps or irritation from condom latex.
Urethral caruncle – This is a tender small swelling patch that develops at the urinary opening.
Foreign body in the vagina may cause pain. The usual culprit is a forgotten tampon.
Vulvodynia – Pain due to increased sensitivity of the outside part of the sex organs (the vulva)

Causes of Deep Pain

Womb trouble: retroverted uterus and other various womb problems, including fibroids, can cause deep intercourse pain.

Endometriosis: this very common disorder often affects the womb and surrounding tissues. It makes them very tender, particularly near period times.

Ovary problems: cysts on the ovary can cause deep pain. Pain may also be caused if the tip of the penis hits an unusually positioned ovary.

Pelvic inflammatory disease (PID): this is caused by infection. In PID, the tissues deep inside become badly inflamed and so the pressure of intercourse causes deep pain.
Problems with the cervix: the man’s penis hits the cervix at the farthest extent of his thrust. So infections of the cervix and tender places on it can cause pain during deep penetration. This is called ‘collision dyspareunia’.
Ectopic pregnancy: This may be the first awareness of likelihood of preganancy. It is means a pregnancy outside the womb, usually in the Fallopian tube. Pressure on it can be very painful during sex.

Others – irritable bowel syndrome, constipation and other inflammatory bowel diseases , such as ulcerative colitis or Crohn’s disease can be associated with deeply painful sex.

Treatment of Painful Sex

For painful intercourse in women after pregnancy:

Wait at least 6 weeks after childbirth before resuming sexual relations.
Be gentle and patient.
Use lubrication as needed.

For vaginal dryness/inadequate lubrication:

Try water-based lubricants.
If you are going through menopause and lubricants don’t work, talk to your doctor about estrogen creams or other prescription medications.

Other causes of painful intercourse may require prescription medications or, rarely, surgery.

Sex therapy may be helpful, especially if no underlying medical cause is identified. Guilt, inner conflict, or unresolved feelings about past abuse may be involved which ne ed to be worked through in therapy. It may be best for your partner to see the therapist with you. Antibiotics, painkillers, or hormones are amongst the treatment options that may be considered.

Prevention

Good hygiene and routine medical care will help to some degree.
Adequate foreplay and stimulation will help to ensure proper lubrication of the vagina.
The use of a water-soluble lubricant like K-Y Jelly may also help. Vaseline should not be used as a sexual lubricant because it is not compatible with latex condoms (it causes them to break), it is not water soluble, and it may encourage vaginal infections.
Practicing safe sex can help prevent sexually transmitted infections.

Atrophic Vaginitis

Atrophic vaginitis is vaginal dryness due to thinning tissue and decreased lubrication. This is more of a problem occurring around menopause, although it can happen whenever there is reduced or lack of oestrogen – whatever may be the cause of this.

Symptoms

Painful Sex. This may occur because the vagina is smaller, drier and less likely to become lubricated during sex than before the menopause. Also, the skin around the vagina is more fragile, and this can make the problem worse.
Vaginal Soreness – if the vulva or vagina is sore and red. Vaginal soreness, including itching or burning sensations.

Vaginal discharge. There may be a white or yellow discharge. Sometimes this is due to an infection. Infection is more likely if the discharge is smelly and unpleasant.
Vulval Itching. The skin around the vagina is more sensitive and more likely to itch. This can make you prone to scratching, which then makes the skin more likely to itch, and so on. This is called an itch/scratch cycle which can become difficult to break, and can be distressing.
Urinary problems. Atrophic vaginitis may contribute to various urinary problems. This is because of thinning and weakening of the tissues around the neck of the bladder, or around the urethra (opening for urine). For example, urinary symptoms that may occur include an urgency to get to the toilet, and recurring urinary infections, or simply burning sensation on urination due to thining of the membranes.
Light bleeding (Post Menopausal Bleeding) may occur on its own, or after intercourse.

Treatments (see also under Vaginal Dryness) link

Not all women have all of the above symptoms. Treatment may depend on which symptoms are the most troublesome. Because the problem is mainly due to a lack of oestrogen, it can be helped by replacing the oestrogen in the tissues.

Hormone Replacement Therapy (HRT)

This means taking oestrogen in the form of a tablet, gel, implant or patches. This may be the best treatment for relieving the symptoms, but some women don’t like the idea of taking HRT. There are advantages and disadvantages of using HRT.

Vaginal (Topical ) Oestrogen – Oestrogen cream, pessary or vaginal ring containing oestrogen restores oestrogen to the vagina and surrounding tissues without giving oestrogen to the whole body. Usually the treatment is used every day for about two weeks, and then twice a week for a further three months. After this the effect of the treatment may be assessed by your doctor. This treatment usually works well but the symptoms may recur some time after stopping the treatment. Repeated courses of treatment are often necessary.

Lubricating gels

If vaginal dryness is the only problem, or hormone creams are not recommended because of other medical problems, lubricating gels may help. There are two gels which are available in the UK that are specifically designed to help the problem of vaginal dryness. They replace moisture. They are Replens® and Sylk®.

Vaginal Dryness

Vaginal dryness is a common problem for women during and after menopause, although inadequate vaginal lubrication can occur at any age. Vaginal dryness is a hallmark sign of vaginal atrophy (atrophic vaginitis) — thinning and inflammation of the vaginal walls due to a decline in oestrogen. Along with vaginal dryness, you might also have itching and stinging around the vaginal opening and in the lower third of the vagina..

Vaginal moisture

Natural lubrication produced by glands at the neck of the womb (the cervix) keeps the vagina supple and moist. The moisture moves slowly down through the vagina, keeping it clean and removing dead cells. The vaginal moisture is slightly acidic and this helps to keep the area healthy, preventing infections such as thrush. It is perfectly normal for the majority of women to notice a slight white vaginal discharge. During sexual excitement the Bartholin’s glands (two glands at the entrance of the vagina) produce extra moisture to aid sexual intercourse. However, a quarter of women aged 50 -59 experience vaginal dryness problems during sex and 16% experience pain, as vaginal dryness can make intercourse uncomfortable. In addition, there is a possibility that additional vaginal lubrication is produces by fluid that seeps through the walls of the blood vessels encircling the vagina. So that when you’re sexually aroused, more blood flows to your pelvic organs, creating more lubricating vaginal fluid, in addition to that produced by the cervical and Bartholin’s glands. Hormonal changes during your menstrual cycle, childbirth, breast-feeding and menopause, may however disrupt these processes and affect the amount and consistency of vaginal moisture and secretions

Symptoms

Vaginal dryness may be accompanied by signs and symptoms such as: itching, Burning, Soreness, Pain or light bleeding with sex or Urinary frequency or urgency . Vaginal dryness affects many women, although they frequently don’t bring up the topic with their doctors. If vaginal dryness affects your lifestyle, in particular your sex life and relationship with your partner, consider making an appointment with your doctor. Living with uncomfortable vaginal dryness doesn’t have to be part of getting older.

Causes

Decreased oestrogen levels

Menopause – Reduced oestrogen levels are the main cause of vaginal dryness. This occurs around menopause, including premature menopause, where menopause occurs before the age of 40 years. Oestrogen, a female hormone, helps keep vaginal tissue healthy by maintaining normal vaginal lubrication, tissue elasticity and acidity. These factors create a natural defense against vaginal and urinary tract infections. But when your estrogen levels decrease, so does this natural defense, leading to a thinner, less elastic and more fragile vaginal lining. Oestrogen levels can fall for a number of reasons: Menopause or peri-menopause, Childbirth, Breast-feeding, Effects on your ovaries from cancer therapy, including radiation therapy, hormone therapy and chemotherapy, Surgical removal of your ovaries, Immune disorders or Cigarette smoking – all affect oestrogen level and can cause vaginal dryness Before the menopause – Around 17% of women aged 18-50 experience problems with vaginal dryness during sex. Many women may experience vaginal dryness during sex because they are not sexually aroused – this is often caused by insufficient foreplay or psychological reasons such as stress. Other reasons for vaginal dryness before the menopause can be linked to hygiene products such as feminine sprays and harsh soaps, swimming pool and hot tub chemicals and some washing powders. Certain drug treatments such as allergy and cold medications and some antidepressants, can also dry out mucous membranes, including vaginal tissues , as below:

Medications

Allergy (anti-histamine) and cold medications (decongestants), as well as some antidepressants, can decrease the moisture in many parts of your body, including your vagina. Anti-oestrogen medications, such as those used to treat breast cancer, also can result in vaginal dryness.

Douching

The process of cleansing your vagina with a liquid preparation (douching) disrupts the normal chemical balance in your vagina and can cause inflammation (vaginitis). This may cause your vagina to feel dry or irritated.

Medical Conditions, like Sjogren’s syndrome

In this autoimmune disease, your immune system attacks healthy tissue. In addition to causing symptoms of dry eyes and dry mouth, Sjogren’s syndrome can also cause vaginal dryness

Emotional issues

If you are suffering from depression or under tremendous stress, you may also notice some degree of vaginal dryness, especially if associated with loss of sexual interest, or if this also affects your libido. Dryness and lack of arousal can also be a signal of unresolved problems in a relationship

Tests and diagnosis

Diagnosis of vaginal dryness may involve: thorough pelvic assessment, where your doctor visually inspects your external genitalia, vagina and cervix and inserts gloved fingers into your vagina to feel (palpate) your pelvic organs for signs of disease. Other test may include vaginal swabs, to take a sample of vaginal secretions to check for signs of vaginal inflammation (vaginitis) or to confirm vaginal changes related to oestrogen deficiency.

Treatments and drugs

Vaginal oestrogen therapy

In general, treating vaginal dryness due to menopause or lack of oestrogen is more effective with topical (vaginal) oestrogen rather than oral oestrogen. Oestrogen applied to the vagina can still result in oestrogen reaching the bloodstream, but the amount is minimal. Vaginal oestrogen also doesn’t decrease testosterone levels — important for healthy sexual function — the same way oral oestrogen can. Vaginal oestrogen therapy comes in several forms: Vaginal Oestrogens Cream, Ring (Estring), or Tablets (Vagifem)

Lifestyle and Home Remedies For Vaginal Dryness

Lubricant or Moisturiser

Lubricants (K-Y, AquaGel). Water-based lubricants like these lubricate your vagina for several hours. Apply the lubricant to your vaginal opening or to your partner’s penis before intercourse. Moisturisers such as Replens® and Sylk®. imitate normal vaginal moisture and relieve dryness for up to three days with a single application. Use these as ongoing protection from the irritation of vaginal dryness.

Pay attention to sexual needs

Occasional vaginal dryness during intercourse may mean that you aren’t sufficiently aroused. Make time to be intimate with your partner and allow your body to become adequately aroused and lubricated. It may help to talk with your partner about what feels good. Having intercourse regularly also may help promote better vaginal lubrication.

Avoid certain products

Though you may be willing to try just about anything to relieve your discomfort, avoid using the following products to treat vaginal dryness, because they may irritate your vagina: Vinegar, yogurt or other douches, Hand lotions, Soaps, Bubble baths Lifestyle Issues – Boost your water intake. Your first step should be to check your hydration. We should all consume at least ten 8-oz glasses of water a day. This simple step can be surprisingly helpful. Follow a hormone-balancing diet. Give your body the support it needs to make and balance your hormones, starting with your nutrition. The low-fat, high-carb diet many women follow literally starves the body of the nutrients it needs to make sex hormones. The oestrogen needed for vaginal lubrication is made from cholesterol, for example — something women on low-fat diets are severely lacking. You might also think about adding soy and flax seed, which are good sources of phytoestrogens (plant oestrogens).

Vaginismus

Vaginismus is when the muscles around your vagina tighten involuntarily whenever there is an attempt to penetrate it with something. This could be your partner’s penis, your finger, vaginal devices or a tampon. Vaginismus makes sexual intercourse difficult or impossible (the vagina can completely close up) and it can be painful. The symptoms can vary from one woman to the next. Because it disrupts or completely stops your sex life, vaginismus can cause distress and relationship problems and may prevent you from starting a family. It can also make gynaecological and pelvic examinations difficult or impossible. In some cases, a woman may need an anaesthetic before a doctor can examine her. The condition is fairly common, especially in teenage girls and women in their twenties and thirties. It is likely that many women will experience it at some point, even if they have had a history of enjoyable and painless sex.

Types of Vaginismus – There are two types of vaginismus:

Primary vaginismus is when you have never been able to have sex because of the condition.
Secondary vaginismus is when you have previously been able to have sex but now find it difficult or impossible.

Causes of Vaginismus

Many factors can cause vaginismus, but it is not always fully understood why the condition happens. For some women, it may be caused by a traumatic past experience, such as a difficult childbirth or sexual abuse. They may associate sexual activity with pain and learn to avoid intercourse as a way of avoiding further pain.

Sexual issues – There are various different sexual experiences or issues to do with sex which may contribute to vaginismus. An unpleasant sexual experience at a young age, such as a clumsy, painful sexual encounter or examination, can make the body respond in a protective way to stop further pain. Sexual abuse, assault or rape could also cause vaginismus. Having difficulty understanding sex, or having feelings of shame or guilt around sex, could also contribute to vaginismus. For example, you might feel uncomfortable with sex if: a) You’ve had a very strict upbringing where it was never discussed. b) You have been told that sexual desire is wrong or sex is painful. c) You are affected by cultural or religious taboos around sex.

Causes of pain during sex – Any causes of pain during sexual intercourse (dyspareunia) may lead to a woman developing a fear of painful sex. Research suggests that the fear of painful sex may be an important contributing factor to vaginismus. The following may all cause painful sexual intercourse:

previous surgery to the genital area
an infection of the genital area,
radiotherapy to the pelvic area
vaginal dryness, which can occur after the menopause
lack of sexual arousal
side effects of some medicines

Endometriosis and pelvic inflammatory disease are both conditions that can cause pain deeper within the pelvis, including pain during sexual intercourse.

Other possible causes of vaginismus include fear that the vagina is too small for sexual intercourse, fear of getting pregnant, the after-effects of childbirth, relationship problems, tiredness or depression

Symptoms of vaginismus

Symptoms of vaginismus include the following:

difficult or impossible penetration of the vagina, because the muscles in the vagina have tightened
burning or stinging pain and tightness of the vagina if penetrated by a tampon, finger or penis
fear of pain
intense fear of penetration and avoidance of sex
loss of sexual desire if penetration is attempted

Symptoms of vaginismus vary in severity:

Some women are unable to insert anything into their vagina.
Some women can insert a tampon and complete a gynaecological exam, but intercourse isn’t possible.
Other women can try to have intercourse, but it is very painful.
Some women are able to have intercourse, but tightness and pain prevent
Some women experience years of occasional difficulty with sex and have to be constantly ready to control and relax their vagina when the symptoms occur.

Symptoms of vaginismus are completely involuntary and you cannot do anything to stop them. The body has learned to associate penetration with pain. Whenever the body expects penetration, the vaginal muscles tighten as a protective reaction. It is not true that women who have vaginismus do not like or do not want to have sex. Many women with vaginismus enjoy closeness and share sexual pleasure with their partner. They can achieve orgasm during mutual masturbation, foreplay and oral sex. It is only when sexual intercourse is suggested or attempted that the vagina tightens to prevent penetration.

Diagnosing vaginismus

The diagnosis of vaginismus is based on your medical history, your symptoms and a physical examination, if possible. It is helpful to have detailed information on possible cause s described above. This often involves reflecting on quite persoanl issues, such as history of previous traumatic sexual experience. An examination of the genital area is necessary to rule out a physical cause of vaginismus, such as injury or infection. You may also need to be referred for some counselling, and you could suggest it to your partner too.

Treating vaginismus

Treatment of vaginismus depends on whether the cause can be identified. If there is an obvious physical cause, such as an injury or infection, this can be treated with appropriate medication. If the cause is psychological, it may be treated using sex therapy, where you are helped to gradually overcome it using vaginal trainers and relaxation techniques. You will be given counselling or cognitive behavioural therapy (CBT) if necessary.

Sex therapy

Sex therapist will give advice on self-help techniques and may offer counselling to address any underlying psychological issues (such as fear or anxiety) or arrange cognitive behavioural therapy to change any irrational or incorrect beliefs about sex and, if necessary, to educate you about sex. Your treatment plan will be based on your needs. You will be encouraged to take full control of your self -help treatment and go at your own pace. If you have a partner, they can also be involved in your treatment.

Vaginal trainers

A technique to relax the muscles in the vagina involves using a set of vaginal trainers. These are four smooth, penis-shaped cones of gradually increasing size and length, which can be used in the privacy of your own home. The smallest one is inserted first, using a lubricant if needed. Once you feel comfortable inserting the smallest one, you can move on to the second size, and so on. It is important to go at your own pace and it does not matter how long it takes, whether it is days or months. When you can tolerate the larger cones without feeling anxious or any pain, you and your partner may want to try having sexual intercourse. It is important to note that in cases of vaginismus the vaginal cones are not “stretching” a vagina that is “too narrow”. Women who experience vaginismus have a perfectly normal-sized vagina. The cones are simply teaching the vagina to accept penetration without automatically contracting the pelvic floor muscles.

Relaxation and touching

If the cone method is not right for you, relaxation and exploration exercises may help. A bath, massage and breathing exercises are good ways to relax while you get to know your body. Your therapist may also teach you a technique called progressive relaxation. This involves tensing and relaxing different muscles in your body in a particular order. You can then practise tensing and relaxing your pelvic floor muscles before trying to insert your finger or a cone. If you reach the stage where you can put your finger inside your vagina, you can try to insert a tampon, using lubricant if needed. It is important to take things slowly and gently and, when you are ready for intercourse, make sure you are fully aroused before attempting penetration.

Sensate focus

If you are in a relationship, you could try sensate focus. This is a type of sex therapy that you and your partner complete together. It starts with you both agreeing not to have sex for a number of weeks or months. During this time, you can still touch each other, but not in the genital area (or a woman’s breasts). Set aside a time when it is just the two of you. Massage, touch or stroke each other, with or without clothes on. Explore your bodies, knowing that you will not have sex. After the agreed period of time has passed, you can begin touching each other’s genital areas. You may want to spend several weeks gradually increasing the amount of time spent touching the genital areas. You can also begin to use your mouth to touch your partner, for example, licking or kissing them. This can build up to include penetrative sex.

Enlarging the vagina

Surgery can be carried out to enlarge your vagina. This may be necessary if, for example, previous surgery to this area has meant that scar tissue has formed and is either blocking or restricting your vagina. This can occur if it was necessary for doctors to make a cut in your perineum during childbirth. A small operation called a Fenton’s procedure can be done to remove the scar tiss ue. The operation involves neatly cutting out the scar tissue and sewing together the clean-cut edges with small stitches. These should dissolve on their own after a few weeks. The operation will be carried out under either local anaesthetic or general anaesthetic.

BOTOX TREATMENT FOR VAGINISMUS (AND VULVODYNIA)

Botox, a drug derived from a Botulinum toxin, interferes with the transmission of a chemical (acetylcholine) that is responsible for muscle activation. When administered correctly, Botox is as safe as aspirin. Botox has been used for decades to weaken over-active muscles and glands in patients with conditions such as cerebral palsy, stroke, excessive sweating, and migraines, as well as for cosmetic purposes. First used in 1997 for the treatment of Vaginismus, Botox prevents the involuntary spasms that define this condition, allowing women to progressively dilate more comfortably and overcome their fear of penetration. Botox shows few side effects (vaginal dryness being the most common).

How is Treatment of Vaginismus with Botox™ Done?

The first assessment is to find out if you can allow the administration of local anaesthesia cream to do the procedure or whether it is necessary to do the procedure under sedation, or in very few ladies, under general anaesthesia. If you require sedation or general anaesthesia the procedure of this will be different, as you may need to be admitted into the ward or day -case area, rather than in outpatient treatment area. This is extremely useful for women who cannot allow a doctor to touch their genitals in order to conduct an exam. Once the patient is sedated or topical anaesthetic administered, more topical local anaesthesia will be used in the vaginal walls with a massaging technique to break any spasms the introital muscles. This procedure is then followed by injections of Botox™. This massage allows the muscles to relax so that a large dilator can be inserted while the patient once the area has been numbed or if anaesthesia is used. The vaginal dilator in left in place. There is a recovery and rest period after the procedure. During that time you will be taught to remove and re-insert the dilators and then sent home with the dilators and instructions. Follow-up visits are scheduled soon after the first treatment. It is often necessary to have a second or third treatment.

How Does Botox™ Treat Vaginismus or Vulvodynia?

The use of Botox™ relaxes the muscle spasm that causes tightening of the vagina and the resulting pain when attempting intercourse. The same principle applies when it is used for the treatment of painful conditions of the vulva, generally now called Vulvodynia. Botox achieves successful treatment, by numbing the pain-sensitive nerves causing the pain at rest or pain with insertion of tampons, or pain at intercourse. It is important to ensure that there is no limiting skin band causing the pain at penetration, as this will usually need minor surgical treatment. After the procedure, you will immediately find that you have already achieved what is usually the hardest first step, the insertion of the first dilator. The anaesthesia works to ensure that your first experience with the dilator is without much pain, if any, at all. In fact, most patients report that the presence of the dilator does not cause any concern or pain.

Results

What has been observed in research on the use of Botox™ for Vaginismus and Vulvodynia is a very high (75 – 80%) rate of success (meaning pain-free intercourse) within two-to-eight weeks of the treatment. A success rate of 90% has been reported in some clinic series (Pacik 2009). Although Botox™ only lasts two-to-three months when used cosmetically, once the vagina is dilated, additional treatment is generally not necessary, or if a series of treatment if agreed at the beginning, then usually after the third treatment episode. Possible side-effects of Botox : headache, flu-like symptoms, nausea, redness at the injection site, muscle weakness.

Spontaneous orgasms (Persistent Genital Arousal Disorder)

This is a rare condition in which some women suffer from the opposite end of Female Sexual Dysfunction and actually have a problem with sudden, spontaneous, persistent, and uncontrollable genital arousal, with or without orgasm or genital engorgement, unrelated to any feelings of sexual desire. Unfortunately, often these feelings are unpleasant and may be severe enough to make it impossible for them to live normally. This condition of spontaneous orgasms is also called Persistent Genital Arousal Disorder (PGAD). In some of the cases the women have orgasms that last for several minutes which can be triggered by such things as the vibrations of being in a car but sometimes appear completely out of the blue and cause them significant distress, embarrassment and awkwardness. In some cases the women attempt to relieve themselves by masturbating or having sex but normally this only provides a temporary relief and can in some cases actually make the problem worse. The condition of Persistent Genital Arousal Disorder was first described and properl y medicalised in 2001 by Dr Sandra R. Leiblum and Dr Sharom G Nathan, but obviously women have been suffering from this condition for a long time. The embarrassing nature of it means that very few women actually report it, therefore it is not known how many women actually suffer from PGAD. In recent years more and more women have confessed to having it. Most women go through their lives not telling anyone about it.

Furthermore, physical arousal caused by this syndrome can be very intense and persist for ext ended periods, days or weeks at a time. Orgasm can sometimes provide temporary relief, but within hours the symptoms return. The return of symptoms, with the exception of known triggers, is sudden and unpredictable. Failure or refusal to relieve the symptoms often results in waves of spontaneous orgasms. The symptoms can be debilitating, preventing concentration on mundane tasks.

Possible causes and treatment

There is not enough known about persistent genital arousal disorder to definitively pinpoint a cause. Medical professionals think it is caused by an irregularity in sensory nerves, and note that the disorder has a tendency to strike post-menopausal women, or those who have undergone hormonal treatment. However, it can affect a person at any age. Some drugs such as trazodone may cause the side-effect of priapism (which is similar, but not the same condition seen in men), in which case discontinuing the medication may give relief. Additionally, the condition can sometimes start only after the discontinuation of SSRI anti-depressants.

Some of the theories advanced include:

Neurological hypersensitivity – in which normal sensation from areas such as clitoris or pelvic organs gets amplified and result in a persistent or permanent state of arousal at the brain level. Treatment with anti-depressants is advocated. The hypersensitivty may also result after minor trauma to pelvic nerves
Venous congestion of pelvic organs – Women with PGAD may have some form of pelvic venous congestion syndrome. The pelvic and sexual organs are rich in blood supply and sometimes the chronically dilated varicose veins do not respond well to neurologic and hormone signals to contract to normal size especially after the resolution phase of the sexual cycle leading to persistent arousal.
Hormonal Cause – Women who suffer from PGAD after menopause or during a few days before the onset of menstrual cycle may have problems related to hormones such as progesterone. This maybe caused due to over-sensitivity to the arousal effect of Progesterone.
Disorder of Prolactin Release – Prolactin is release during orgasm and it has a role in maintaining the refractory and relief phase after orgasm. Men usually have a much larger release of prolactin after orgasm than women and hence they take time to be aroused the second time. Women have a shorter refractory period due to a smaller release of the hormone. In PGAD, it is possible that there maybe no release or delayed release of the prolactin hormone.
Oxytocin Deficiency – Oxytocin release from pituitary in orgasm gives the calming effect. It reduces stress and its release in clitoral orgasm is even more. There is likelihood of deficiency in the amount of oxytocin released in women suffering from PGAD.
Variant of Tourette’s Syndrome – Tourette’s syndrome is a compulsive tic disorder and the most common tics are of eye blinking, coughing, throat clearing, sniffing, and facial movements. PGAD may be a variant of such a disorder that is associated with compulsive masturbation, intrusive thoughts, and there may be a family history of Tourette’s syndrome or a similar disorder.

In situations where the cause of PGAD is unknown or less easily treatable, the symptoms can sometimes be reduced by the use of antidepressants, antiandrogenic agents, and anaesthetising gels. Psychotherapy with cognitive reframing of the arousal as a healthy response may also be used.

Where the symptoms of the condition have also been linked with pudendal nerve entrapment, regional nerve blocks (and less commonly) surgical intervention have demonstrated varying degrees of success in most cases. There is, however, no evidence for the long-term efficacy of surgical intervention. However, an association of PGAD, with clitoral mass (or swelling) has been described, with relief of symptoms, following surgical removal. In one recent case, accidental discovery of relief of symptoms was noted from treatment with varenicline, a treatment for nicotine addiction

Lack of Orgasm (Anorgasmia)

Definition

Anorgasmia is the medical term for regular difficulty in reaching orgasm after ample sexual stimulation, causing personal distress. Anorgasmia is actually a very common occurrence, affecting at least 1 in 5 women worldwide. Orgasms vary in intensity, and women vary in the frequency of their orgasms and the amount of stimulation necessary to trigger an orgasm. In fact, fewer than a third of women consistently have orgasms with sexual activity. In addition, orgasms often change with age, medical issues or medications.

Symptoms

An orgasm is a feeling of intense physical pleasure and release of tension, accompanied by involuntary, rhythmic contractions of your pelvic floor muscles. Some women actually feel pelvic contractions or a quivering of the uterus during orgasm, but some don’t. Some women describe fireworks all over the body, while others describe the feeling as a tingle. By definition, the major symptoms of anorgasmia are inability to experience orgasm or long delays in reaching orgasm. But there are different types of anorgasmia:

Primary anorgasmia. This means you’ve never experienced an orgasm.
Secondary anorgasmia. This means you used to have orgasms, but now experience difficulty in reaching climax, or not reaching climax at all.
Situational anorgasmia. This means you are able to orgasm only during certain circumstances, such as during oral sex or masturbation. This is very c ommon in women. In fact, about 60-70 percent of women experience orgasm only from stimulation of the clitoris. Some women complain of being able to reach orgasm, by masturbation, only with certain assistance or devices, such as vibrators.
General Anorgasmia. This means you aren’t able to orgasm in any situation or with any partner.

Causes of Anorgasmia

Despite what is seen in the movies, orgasm is no simple, guaranteed experience. This pleasurable peak is actually a complex reaction to many physical, emotional and psychological factors. If you’re experiencing trouble in any of these areas, it can affect your ability to orgasm.

Physical causes

A wide range of illnesses, physical changes and medications can interfere with orgasm:

Medical diseases. Any illness can affect this part of your sexuality, including diabetes and neurological diseases, such as multiple sclerosis. Orgasm may also be affected by gynecologic surgeries, such as hysterectomy or cancer surgeries. In addition, lack of orgasm often goes hand in hand with other sexual problems, such as painful intercourse.
Many prescription and over-the-counter medications can interfere with orgasm. This includes blood pressure medications, antihistamines and antidepressants — particularly selective serotonin reuptake inhibitors (SSRIs). Interestingly, the use of SSRI is now widespread for the management of “anxieities” and depressive illnesses.
Alcohol and drugs. A glass of wine may make you feel romantic, but too much alcohol can restrict ability to climax; the same is true of street drugs.
The aging process. As you age, normal changes in your anatomy, hormones, neurological system and circulatory system can affect your sexuality. The drop in oestrogen that occurs during the transition to menopause can be a particularly notable hindrance of orgasm. Lower levels of this female hormone can decrease sensations in the clitoris, nipples and skin and impede blood flow to the vagina and clitoris, which can delay or stop orgasm entirely. Nonetheless, many women report more satisfying sex with age.

Psychological causes

Many psychological factors play a role in your ability to orgasm, including:

Mental health problems, such as anxiety or depression, Performance anxiety, Stress and financial pressures, Cultural and religious beliefs, Fear of pregnancy or sexually transmitted diseases, Embarrassment, Guilt about enjoying sexual experiences

Relationship Problems

Many couples who are experiencing problems outside of the bedroom will also experience problems in the bedroom. These overarching issues may include:

Lack of connection with your partner, Unresolved conflicts or fights, poor communication of sexual needs and preferences, infidelity or breach of trust

Diagnosis

Diagnosis and effective treatment of anorgasmia depends on the type and cause. If it apparent that one of the causes is violence or sexual trauma, the psychological treatment is the preferred option, sometimes with additional psychosexual counseling. If there is no obvious psychological cause, then a full medical examination is called for. Not every medical professional takes the same course of action but the usual process is for a full examination in the first instance. This will include a full blood count, liver function test, blood tests for oestrogens and testosterone levels, thyroid function, female hormonal profile (FSH, LH, Prolactin), blood sugar and the regular tests for other conditions such as diabetes and heart malfunction. The results are then reviewed in terms of how the hormonal levels in the blood affects, general body functions (e.g. thyroid function), genital blood flow and genital sensation. The clinical or sex therapist may also arrange or conduct tests to evaluate any nerve damage and its extent and relevance to the situation.

Treatments and Drugs

Treatment of anorgasmia may be difficult depending on the underlying cause of your symptoms, but combinations of options are discussed below. For most women, treatment means more than medications. It’s important to address relationship issues and everyday stressors. Understanding your body and trying different types of sexual stimulation may help.

Understand your body better. Understanding your own anatomy and how you like to be touched can lead to better sexual satisfaction. If you need a refresher course on your genital anatomy, do take some time to explore your own body. If you’re uncomfortable with self-exploration, try exploring your body with your partner.
Increase sexual stimulation. Many women who’ve never had an orgasm aren’t getting enough effective sexual stimulation. Most women need direct or indirect stimulation of the clitoris in order to orgasm, but not all women realize this. Switching sexual positions can produce more clitoral stimulation during intercourse; some positions also allow for you or your partner to gently touch your clitoris during sex.
Seek couples counseling. Conflicts and disagreements in your relationship can affect your ability to orgasm. A counselor can help you work through disagreements and tensions and get your sex life back on track.
Try sex therapy. Sex therapists are therapists who specialize in treating sexual problems. You may be embarrassed or nervous about seeing a sex therapist, but sex therapists can be very helpful. Some gynaecologist have interest or experience in sex therapy and may be able to help. Therapy often includes sex education, help with communication skills and behavioral exercises that you and your partner can try at home. For example, you and your partner may be asked to practice “sensate focus” exercises, a specific set of body-touching exercises that teach you how to touch and pleasure your partner without worrying about orgasm. By using these techniques and others, you may learn to view orgasm as one pleasurable part of sexual intimacy, not the whole goal of every sexual encounter.

Medical treatments

Hormone therapies aren’t a guaranteed fix for anorgasmia. But they can help; so can treating underlying medical conditions.

Treating underlying conditions. If a medical condition is hindering your ability to orgasm, treating the underlying cause may resolve your problem. Changing or modifying medications known to inhibit orgasm also may eliminate your symptoms.
Oestrogen therapy. Systemic oestrogen therapy — by pill, patch or gel — can have a positive effect on brain function and mood factors that affect sexual response. Local estrogen therapy — in the form of a vaginal cream or a slow-releasing pessary or ring that you place in your vagina — can increase blood flow to the vagina and help improve desire. In some cases, your doctor may prescribe a combination of oestrogen and progesterone.
Testosterone therapy. Male hormones, such as testosterone, play an important role in female sexual function, even though testosterone occurs in much lower amounts in a woman. As a result, testosterone may help increase orgasm, especially if oestrogen and progesterone aren’t helping. However, replacing testosterone in women is controversial, as it can cause negative side effects, including acne, excess body hair (hirsutis m), and mood or personality changes. Testosterone seems most effective for women with low testosterone levels as a result of surgical removal of the ovaries (oophorectomy).

Alternative medicine

Natural products are available that may help some women who have difficulty reaching orgasm. These oils and supplements work by increasing sensation in the clitoris and surrounding tissue. The following products may benefit some women with anorgasmia:

This botanical massage oil helps warm the clitoris and may increase sexual arousal and orgasm. Link to buy Zestra
This oral nutritional supplement contains L-arginine, a substance that relaxes blood vessels and increases blood flow to the genital area, and the clitoris in particular. This product can cause side effects and may interact with other medications.

Reduced or Loss of Sensation

Loss of Vaginal Sensation

Reduced or Loss of vaginal sensation can be a result of three main reasons:

Excessive Vaginal Lubrication
Vaginal Relaxation / and Vaginal Prolapse
Medical Problem affecting sensation – diabetes, multiple sclerosis, nerve damage, and

Excessive Vaginal Lubrication

There is an optimum level of friction that is required to enable heightened pleasure for both partners, thus leading to easier climax. Excessive natural vaginal lubrication (wetness) can reduce sexual satisfaction and physical pleasure for both partners. Females lose maximum possible stimulation along the vaginal walls, while men lose out on the correspondingly “tight” sensation during penetration. A woman’s vaginal lubrication level increases naturally as arousal increases, but for some ladies, even the slightest turn-on is enough to produce excessive vaginal lubrication.

There is also a natural increase in vaginal secretion, which is noticeable during the mid -cycle, or ovulation period. This coincides with increased libido in most women at the same time, and can be quite frustrating for both, when sexual feelings are heightened. However, if this wetness is there all the time, you should see your doctor to be sure there is no infection, abnormalities, or other problem causing your excessive wetness, especially if it is something new. There are unscientific reports of female ejaculatory fluids, which is not consistent in all women, and is therefore difficult to attribute this as a possible reason for increases wetness. However, the knowledge of this may help a few women who do have “female ejaculation” to understand the nature of their vaginal wetness, with the common sense approach to managing this.

Medical Options:

It is difficult to specifically control the amount of vaginal secretion the body produces. Therefore most of the remedies or suggestion are for individual consideration, as to whether this will be acceptable option.

Medications that reduce body secretions or increase dryness of body surfaces as side -effects abound, but these may not be appropriate because of their side -effects and the fact that they will also cause dryness in other parts of the body. These medications include decongestants, antihistamines, cold formulas and certain antidepressants. Excessive vaginal lubrication due to overgrow changes in the lining of the covering of the mouth of the cervix – cervical ectopy or cervical erosion- can be treated by surgery. This will involve freezing treatment (cryotherapy) to the cervix and may also be done using a laser or electrical wire (electrocautery) on the cervix to reduce secretions. However, there is no guarantee that the problem will not return. Non-Medical Options: There are numerous options, but few realistic ones. Here are some common things couples try and comments about their effectiveness.

1). Douching. This has some impact by reducing the amount of natural lubrication, but the effect tends to vanish as the woman’s arousal increases, resulting in secretions of even more vaginal lubrication. Alum Douche is not recommended, but can create a drying and tightening effect. Alum douche can be irritating and cause yeast infections.

2). Manual Drying – Insert a dry sponge or cloth. One of the more embarrassing techniques as it must be done intermittently. Couples find this a big turn off. The technique though, is to wrap a thin sheet/towel around a couple of fingers. Insert the fingers to soak up excessive vaginal lubrication. Proceed with intercourse. Repeat as necessary. While this method does work, reentry into the vagina is difficult and painful because this method absorbs all of the lubrication. Within a few minutes however, as arousal increases again, there will once again be excessive lubrica tion. With this method, there is no way of controlling the desired level of wetness and tightness.

3). Hormonal Treatment – This effect is difficult to predict, as many women responds differently to various hormonal treatment. Progestogens (either on the ir own or as in mini-pill preparations, which are progesterone-only pills) generally thicken vaginal secretions, reducing its lubricating effect. So also is the use of combined oral contraceptives, especially with suitably higher dose of progestogens. The pros and cons of this needs to be weighed, especially regarding the unwanted side-effects.

4). Vaginal Powders. AbsorbShun natural powder in particular. Is an “all-natural” powder derived from maize plant that either the man or woman can apply to the man’s penis. It is supposed to help to make a difference where nothing else will work. The more powder used, the more absorption, thus allowing the couple to find (and control) their most preferred vaginal lubrication and tightness level. Unfortunately this product has been linked to some pornographic website marketing (we do not support of advocate this), so you need to beware if you are making enquiries about this product, outside our website. Also you need to be aware that use of talc powder has been link to ovarian cancer, so you should be careful about the idea of using any substitute powder for this purpose.

Buy Absorbshun Powder

Vaginal Relaxation (Pelvic Organ Prolapse):

Prolapse occurs when the normal support of the vagina is lost, resulting in “sagging” or dropping of the bladder, urethra, cervix or rectum. Many women notice a bulge but others may feel a looseness or lack of sensation in the vagina with intimacy. As the prolapse of the vagina and uterus progresses, women can feel bulging tissue coming out the opening of the vagina. Different areas of the vagina can prolapse:

Anterior Vaginal Prolapse (also known as cystocele): This type of prolapse occurs when the wall between the vagina and the bladder stretches or detaches from its attachment on the pelvic bones. This loss of support allows the bladder to prolapse or fall down into the vagina. Symptoms may include:

abnormal bladder emptying o urinary frequency
night time voiding
loss of bladder control
recurrent bladder infections o pelvic pressure

Posterior Vaginal Prolapse (also known as rectocele): Weakening of the back wall of the vagina allows the rectum to bulge into the vagina, sometimes stretching low enough to come out of the vaginal opening. Symptoms may include:

difficulty with bowel movements o constipation
loss of stool
pelvic pressure

Uterine Prolapse: When the supporting ligaments and muscles of the pelvic floor that keep the uterus in the pelvis are damaged, the cervix and uterus descend into the vagina and eventually out of t he vaginal opening. Often, uterine prolapse is associated with loss of vaginal wall support (cystocele, rectocele). When the cervix protrudes outside the vagina, the cervix can develop ulcers from rubbing on underwear or protective pads. Symptoms may include:

sense of fullness, pain or pressure in the pelvis
symptoms of anterior or posterior vaginal prolapse o vaginal bleeding

Vaginal Prolapse after Hysterectomy (also known as vaginal “vault” prolapse): If a woman has already had a hysterectomy, the very top of the vagina (where the uterus used to be) can become detached from its supporting ligaments. Depending upon how extensively the top of the vagina is turning inside out, one or several pelvic organs (such as the bladder, small and large bowel) will pr olapse into the protruding bulge.
Enterocele: Occurs when there is a separation of the strong connective tissue at the top of the vagina and the bowel presses against the vagina. This forms a hernia sac into which the bowel can protrude.

Studies have shown that vaginal birth is a risk factor for pelvic organ prolapse. During the birth process the muscles that surround and support the vagina might become stretched and torn. At GyneClinics we offer a unique post-delivery muscle strengthening therapy to improve muscle tone and prevent development of prolapse. Other treatments include pessaries or surgery.

For more information on vaginal relaxation and vaginal prolapse, please see our GyneCosmetics website link

You will also find the following pages on this website very useful:

Vaginal Tigthening

Reduced or Loss of Libido

Lack of sex drive in women (lack of libido)

Lack or Loss of sex drive (lack of libido) is common in women, but quite rare in men. It is a form of ‘female sexual arousal disorder’ (FSAD) or Hypo-active Sexual Desire Disorder (HSDD) . In the UK, family planning clinics and Relate clinics see quite large numbers of women who complain of low libido. It is estimated that at any one time, several hundred thousand women in Britain are troubled by lack of sex drive. Many of these women have no problems with having orgasms. Rather, they have no real desire to have sex and their minds are not turned on by the prospect of love-making. For many women this lack of libido is only temporary. Some will get over it by themselves, and a lot more can be helped by expert medical or psychosexual advice. Others do not really want their sexual desire to be re-initiated and and are quite happy to lead lives without it. .

Causes of Female Loss of Libido

Lack of desire in women can be of either physical or psychological origin.

Physical causes

Anaemia, which is very common in women because of iron loss during periods. Anaemia may also be associated with tiredness, which can explain the to lack of interest.
Major diseases such as diabetes.
Post-Delivery, and Breastfeeding – Loss of libido is very common immediately after childbirth, especially in the first three months – this time varies in different women. It is almost certainly

linked to hormonal changes that occur at this time. The general trauma of childbirth als o plays a part – and after having a baby, many women are too exhausted to think about sex.

Prescribed drugs, particularly tranquillisers and anti-depressants.
Hyperprolactinaemia – a rare disorder in which the pituitary gland is overactive.
Other hormone abnormalities: association between low testosterone levels and abnormalities in the production of luteinising hormone (LH) has been implicated in some studies.
Alcoholism & Drug abuse.

Psychological causes

These causes are very common. It’s understandable that when a woman is having a bad time emotionally, she may lose interest in sex. Psychological causes include:

depression
stress and overwork
anxiety
hang-ups from childhood
past sexual abuse or rape
serious relationship problems with your partner
difficult living conditions, eg sharing a home with parents or parents -in-law.

Treatment of Loss of Libido

Due to the complexities of the various causes of lack of libido, and it various interactions, it is difficult find a specific treatment, other than attempt to treat or address the underlyting casues(s), which can often be due to several factors and which may vary from time to time. Hence, support and understanding from her partner goes a long way in helping a woman overcome this problem. Trying to identify the underlying reasons does a long way in the treatment and may involve the expertise of general practitioner, psychologist, psychosexual counsellor or sex -therapist.

Testosterone

Hormones are often suggested as a treatment for FSAD (HSDD), particularly the male sex hormone testosterone. There is clinical evidence to support the use of testosterone as a treatment for low sexual desire, especially in women who loss of libido is attributable to gynaecologically surgery, especially Hysterectomy (removal of Uterus) and or Oophrectomy (removal of ovaries).

In 2007 a testosterone skin patch called Intrinsa became available in the UK. This patch is only licensed on the NHS for women who have had an early surgically -induced menopause. It may also be helpful in other women with low libido. Side-effects include hairiness, spots, a deep voice and enlargement of the clitoris.

Suction vibrators

Inventions that are supposed to increase female desire do come and go. The gadget applies suction to the clitoris and so increases desire. It is also undeniable that ordinary non-suction vibrators have helped a lot of women in the last decade.

Others remedies such as Viagra or “Desire Creams” have been tried, with varying report of usefulness. (See treatment of anorgasnmia – lack of orgasm)

Female sexual dysfunction occurs when a woman is not able to fully, healthily, and pleasurably experience some or all of the various physical stages the body normally experiences during sexual activity. These stages can be broadly thought of as the desire phase, the arousal phase, and the orgasm phase. Sexual dysfunction also includes painful intercourse.

In women, sexual dysfunction takes many forms and has numerous causes. It is important to address all the aspects of a woman’s sexuality – whether physical, psychological or emotional, physiological (mechanical), or interpersonal – in order to resolve the problems. Female sexual dysfunction is actually quite common. It has been estimated that about 40% of women are affected by sexual dysfunction to some degree, and approximately 1 in 4 women are unable to achieve orgasm.

Causes of Female Sexual Dysfunction

Female sexual dysfunction may be related to physical factors, psychological factors, or a mixture of both. It can also be a matter of problems with technique: some women never fully experience sexual arousal and orgasm because they or their partners lack sexual knowledge. They may not understand how female sex organs respond or are stimulated, or don’t use appropriate arousal techniques. This is quite common amongst religions or cultures where sex is seen as dirty, and women are not expected to enjoy sex, but rather to give their bodies for men’s enjoyment. Hence, the male partner is not patient enough to learn how to pleasure and assit the woman in enjoyment of sex, and in particular assit her in achieving orgasm, as this take a good understanding of what the woman finds pleasurable and how.

Conflict, tension, and emptional “incompatibility” with a sexual partner can cause sexual dysfunction. Depression and medications for depression or other medication used in mental health, which affects mood may be a cause. Also stress a very strong, and often under – estimated contributing factor of female sexual dysfunction.

At the same time, sexual dysfunction has a strong interpersonal component. A person’s view of their own sexuality is largely influenced by culture, society, and personal experience. It may be intimately connected to their own or society’s ideas about the appropriate or inappropriate expression of sexual behaviour. These feelings may cause anxiety because of a personal or cultural association of sexual experience and pleasure with immorality and bad behaviour. Anxiety is then expressed physically by the body in a way that prevents normal sexual function. Anxiety can do this, for example, by stopping or slowing the state of sexual excitement that allows for the lubrication or moistening of the female genitalia – an important step towards fulfilling forms of sexual activity.
Personal character, disposition, and life experience play a role in sexual dysfunction. Fear of intimacy can be a factor in arousal problems. Experiences of abuse, either in childhood or in past or current relationships, can establish a cycle of associating sex with psychological or physical pain. Attempting sexual activity in these circumstances causes more psychological or physical pain. For example, if anxiety prevents lubrication, sexual intercourse can be painful.
Medications, including oral contraceptives, antihypertensives, antidepressants, and tranquilizers are very common causes of sexual dysfunction. Also, the use of oral contraceptives can decrease a woman’s interest in sex, in some cases, while it may increase interest in another. Certain prescription and over-the-counter medications as well as the use of illegal drugs or abuse of alcohol may contribute to sexual dysfunction. Cigarette smoking may have a negative effect on sexual arousal in women
Physical causes include disorders of the genitalia and the urinary system, such as endometriosis, cystitis, vaginal dryness, or vaginitis . Other conditions such as hypothyroidism, diabetes, multiple sclerosis, or muscular dystrophy can have an impact on sexual desire and ability. Surgical removal of the uterus or of a breast may contribute psychologically to sexual dysfunction if a woman feels her self-image has been damaged.
Age – Although women can remain sexually active and experience orgasms throughout their lives, sexual activity often decreases after age 60. While part of this may be due to a lack of partners, changes such as dryness of the vagina caused by lack of oestrogen after menopause may make intercourse painful and reduce desire. After menopause, about 15% of women feel a strong decrease in sexual desire.

Symptoms of Female Sexual Dysfunction

Women who do not enjoy satisfying sexual experiences with their partners often report the following:

lack of sexual desire (low libido)
inability to attain an orgasm
pain or other distress during penile penetration
an inability to fantasize about sexual situations
indifference to, or repulsion by, having sex
feelings of fear or anger towards their partners

Most often, any of these responses have psychological implications. Whether the symptoms are due to physical factors, such as menopause, or have their origins in more deep-seated psychological triggers, many women are likely to feel inadequate or dysfunctional. They blame themselves for not being sexually responsive, have trouble explaining to their partners about how they feel, and experience low self-esteem as a result.

Diagnosing Female Sexual Dysfunction

Establishing the cause of sexual dysfunction is half the battle. The stage of sexual activity at which a woman is having problems may offer some clues. Other evidence may be found through physical and psychological testing. It is worth noting that before a lady, either alone, with her partner or a friend visits a clinician or professional because of sexual dissatisfaction, she has often been under considerable degree of emotional stress and anxiety for a long period of time before seeking help.

In sexual desire disorder, a woman experiences a decreased interest in having sex. If the lack of interest is new and extends to all partners and situations, the doctor will likely consider causes such as medications, medical conditions such as depression, hormonal changes, or imbalances in certain neurotransmitters (the brain’s chemical messengers). On the other hand, sexual desire disorder may be caused by interpersonal factors if it’s confined to one partner or one situation. Loss of libido due to hormone level changes after the menopause, during pregnancy, and in the menstrual cycle can all affect the way a woman see sex.
Sexual arousal disorder refers to a woman’s inability to become lubricated, aroused, or sexually excited, even after being sexually stimulated. This often relates to factors during the sexual interactions, such as relaxation, sexual techniques, but may also relate to problems with the functioning of the genital structures involved in sexual arousal.
Orgasmic disorder means that a woman may enjoy sexual activity but has difficulty reaching orgasm or takes a very long time to reach orgasm. Physical causes are rare, except in cases of nerve damage in the spine. Psychological factors may range from never having learned how to have an orgasm, to unrealistic expectations from a partner, to feelings of guilt at experiencing pleasure. Orgasmic disorder is diagnosed only when a woman has no diffic ulty with arousal, only with climax.

Genophobia

Fear of sexual intercourse in known as Genophobia. A persistent and significant aversion to sexual contact can have a massive impact on a person’s entire sense of well -being, their ability to form relationships, and their level of sexual confidence and self-confidence. For women, the fear of sex may be related to dyspareunia – the act of intercourse is incredibly painful, and women with this condition often avoid intercourse.

Treating and Preventing Female Sexual Dysfunction

The first step in managing female sexual dysfunction is assessment and appropriate treatment. Physical disorders should be treated. For sexual dysfunction associated with aging and dryness of the vagina, vaginal moisturizers or estrogen treatment (such as a vaginal cream, vaginal ring, or low-dose tablet taken by mouth) can be effective.

When psychological factors are foremost, counselling from a psychiatrist, psychologist, or sex therapist may help to remove or reduce the causes. Psychotherapy may be more useful if there has been some trauma in a woman’s background, or problems that stem from stress or relationships. Therapy that includes a sexual partner is more helpful in increasing the chance of learning to experience orgasm.

To both treat and prevent sexual dysfunction, women should understand how their sex organs work and how they can respond. Activities like “Kegel exercises” can make pelvic floor muscles stronger and help women reach orgasm more easily. This is a technique that women of every age can use to enhance sexual pleasure.

To do Kegel exercises, tighten your pelvic floor muscles (these are the same muscles you use to stop the flow of urine when you’re going to the bathroom) for 3 seconds, relax for 3 seconds, and repeat 10 times. Gradually increase the time until you are tightening the muscles for 10 seconds and relaxing for 10 seconds.