FEMALE SEXUALITY
Does pre-menstrual tension affect sexuality?
Yes, it does. Women tend to become irritable with associated symptoms such as nausea, backache, and breast tenderness. There is a feeling of discomfort in the pelvic region and, at times, there may be emotional disturbances and varying degrees of depression. In some women, however, it is found that the sex drive is enhanced, perhaps resulting from increased pelvic congestion, insufficient to cause discomfort but sufficient to cause intense pelvic awareness.
Do oral contraceptive pills prevent pre-menstrual tension?
Yes, oral contraceptive pills do relieve premenstrual tension in about 50 percent and painful periods, i.e., dysmenorrhoea, in 90 percent of women.
Can the breast size be increased?
Certain exercises can help develop the pectoralis major muscles which would add a little bulk to the chest (but not to the breast themselves) and this may help increase the apparent breast size. Plastic surgery (silicone implant) may also prove beneficial. However, one needs to understand the risks involved before undergoing surgery.
Does disparity in breast size require treatment?
The disparity in the size of the breasts may be due to various reasons—physiological and pathological. Disparity due to any pathological cause must be thoroughly investigated and treated. For physiological disparity, no treatment, other than counseling and reassurance, is required. For cosmetic reasons, if the difference is minor, padding the brassiere cup of the smaller beat would suffice. If the difference in size or contour is gross, then an enhancement/ enlargement mammoplasty of the smaller breast or a reduction mammoplasty of the larger one may be carried out after evaluating each case on individual merit.
Does hair on the breast suggest any pathology?
It is not uncommon for a woman to have a few hairs around the aureole of the breast, which does not need any treatment. However, they can be removed by electrolysis by a qualified person, if one desires.
Is it necessary to stimulate the clitoris during sexual intercourse?
The G-spot, or the Grafenberg spot, is an area of increased sensitivity with maximum potential for arousal. It is located on the anterior vaginal wall about two inches from the vaginal opening. After sliding the fingers and with forward, backward or side-to-side movement, the female will be able to pinpoint the spot where she experiences increased sensitivity. With increased stimulation, the G-spot swells like a nodule and becomes firm. Simultaneous clitoral stimulation can enhance sexual pleasure.
What is the most common female sexual problem?
Painful sexual intercourse or inadequate sexual arousal is the most common sexual problem in females.
Note: Painful sexual intercourse need not always be due to inadequate sexual arousal. It can exist as an independent entity.
What could be the cause of excessive vaginal lubrication during sexual intercourse?
Physiologically, lubrication occurs in the vagina during sexual arousal. This could increase in certain conditions of heightened sexual excitement and vaginal infection or allergy. The best course is to find the cause and treat it. At times, a small dose of an antihistamine may prove useful.
Do women have different degrees of lubrication?
Yes, women differ in the amount of vaginal lubrication produced. Even in the same woman, the lubrication may be different from time to time and it depends upon the intensity of stimulation provided. There are also several causes of reduced levels of lubrication as inadequate sexual arousal, local vaginal infection, and hormonal imbalances. Adequate vaginal lubrication is essential for pain-free penetration.
Partners need to communicate about their likes and dislikes. They may also need to increase the time of foreplay. Psychological stimulation such as erotic talk, fantasizing, reading, and viewing erotic material may also prove useful. These stimulants will help increase arousal and hence will aid vaginal lubrication.
Can a virgin become pregnant?
Yes, if the sperms are deposited near the vulva, they may pass through the small pores of an intact hymen and may travel up through the vagina and uterus and fertilize the ovum, resulting in pregnancy.
Is sex safe during pregnancy?
Usually, a healthy woman can safely indulge in sexual activity during pregnancy. However, coitus should be avoided if there is pain and/ or bleeding at any stage. If the woman has aborted in the first three months in the past, coitus during the first trimester should be avoided. In the second trimester coitus is contra-indicated if the woman has a history of ‘habitual abortion’ because the cervical Os, i.e., the mouth of the uterus is incompetent to hold the fetus. In the last trimester, i.e., from the seventh month to labor, one may safely indulge in sexual activity till the day of delivery by adorning the position so as to ensure that the direct weight does not fall on the fetus.
It must be understood that whenever, because for any reason, intercourse is forbidden during pregnancy, the woman must avoid reaching orgasm by any other means including masturbation. The contraction of the uterus following masturbation is far more intense as compared to those of normal sexual intercourse.
An obstetrician may be consulted regarding the indulgence in sexual activity during pregnancy, as each case needs to be evaluated individually.
Are alcohol and smoking safe during pregnancy?
No, both alcohol and smoking are harmful during pregnancy as they may lead to intrauterine growth retardation and fetal malformation.
When can a woman resume sexual intercourse after delivery?
One should not indulge in sexual intercourse…
- If the episiotomy scar (the cut made to ease the birth of the baby) has not healed properly.
- If there is bleeding from the vagina.
Usually, after three weeks of delivery, a woman can comfortably resume sexual activity.
Is episiotomy necessary during normal delivery?
Epistomy facilitates delivery of the fetal head and prevents uncontrolled vaginal and perennial tears. Epistomy is not mandatory, but it plays a protective role.
After pregnancy, many times, couples report that they do not experience the pleasure that they used to. Can this be helped?
After normal delivery often vaginal walls become lax and the penovaginal contact reduces. Thus some people do report less pleasure. This can be helped while stringing the episiotomy, the obstetrician should take one or more stitches, known as ‘husband’s stitch’, to ensure adequate apposition which helps in increasing the penovaginal contact, thus giving more pleasure.
What is the most common cause of a lax vagina? How can it be prevented?
This may occur following childbirth. It can be best prevented by proper management of labor with perinea support and prenatal exercises.
What is the treatment for a lax vagina?
A lax vagina can benefit from Kegel’s exercises. It involves contraction of the perennial muscles—a phenomenon akin to holding the urine and releasing it. Twenty such contractions and relaxations, three times a day, may help increase muscle tone. If this does not work, one may consider vaginal reconstructive surgery.
What conditions can make a woman frigid?
Distraction disturbed interpersonal relationships, anti-hypertensive drugs, tranquilizers, sedatives, hypnotize and sometimes oral contraceptives can lead to a decline in sexual desire. Pain at the time of coitus, whether due to vignettes, pelvic infection, or abnormal uterine positions, may lead to the frigidity of sudden onset.
What are female circumcisions?
It is a barbaric custom of female genital mutilation. In its most disfiguring form—the Pharaonic circumcision practiced in Sudan and Kenya—it involves cutting off of the clitoris, labia majora, and labia minora followed by close apposition of the tissue that remains, leaving only a tiny hole at the bottom for the passage of urine. This severe local mutilation makes sex a painful encounter. In its mildest form, it involves excision of the clitoris or the clitoral hood alone. Such circumcision is performed due to the misconception that unless it is performed a woman will become overtly promiscuous.
Do women masturbate? How?
Yes, women do masturbate. The usual method is by rubbing a finger on the clitoris. The female anatomy permits considerable variations such as thigh rubbing, rubbing clothing between the thighs, and so on.
Do women ejaculate?
Some women do report squirting fluid at the time of orgasm, but this is rare. Whether this can be called female ejaculation is controversial.
Is there a phenomenon in women akin to wet dreams in men?
Yes, women too can have erotic dreams and become aroused and lubricated during sleep. Sometimes, she can even have an orgasm. As there is no ejaculation it is not really a wet dream.
What are women’s misunderstandings about men’s sexuality, which may lead to sexual dysfunctions?
Often, when a man is a premature ejaculator, many women may consider him a poor lover or the woman may make an attempt to reach orgasm early. At times, this kind of thinking leads to a shortening of the period of intimacy. In cases of retarded ejaculation, where there is a delay in reaching orgasm, the woman starts getting a feeling that her partner does not love her or she is not attractive to him anymore, which may disturb the intimate relationship.
Also, most women consider it improper to actively participate in intercourse and prefer to remain completely passive or only minimally responsive, leaving the onus on the male who is now under pressure to perform. This may create situational anxiety that may impair his response and performance. Even if the male is able to perform properly in these circumstances, the minimal or deliberately subdued response of his partner due to traditional misconceptions will leave him with the feeling that the encounter has not been mutually satisfying. If this occurs repeatedly, it instills a sense of inadequacy and frustration in him that may affect his performance and his sex drive may decline.
How should a physician deal with a sexual problem?
After an adequate history taking the physician should try to determine exactly where the problem lies; i.e., misconceptions, unrealistic expectations, disturbed interpersonal relationships, or hostility towards a partner. The physician should counsel the couple as a unit, clarify and explain the situation to them, and clean misconceptions. He may over specific therapy if and when the situation demands.
Where is the psychological sequel of a rape case?
The psychological trauma experienced by a rape victim often exceeds the physical trauma. The affected individual loses her sense of self-confidence and self-esteem and becomes increasingly aware of her vulnerability. She developed negative attitudes towards sex. This will affect her response and performance in subsequence sexual encounters. Some victims avoid sexual intimacy and even if they do indulge, often they tend to recreate and relive the traumatic experience and are unable to continue the encounter. Sometimes; society also considers the victim as promiscuous, who has probably invited the tragedy upon herself. She also becomes the object of the unsolicited attention of males looking for a casual temporary relationship. This could result in further loss of self-esteem and is psychologically detrimental.
Why and how should one perform breast self-examination?
Almost all breast malignancies are first detected by the women themselves. Detection of breast cancer in the early stages, when it is localized is of paramount importance, because if treated early the disease can be cured completely. Hence, the importance of self-examination of the breasts, monthly, as a routine healthy habit, to be practiced by all women above the age of 20 years should be emphasized. It should be performed at about the same time every month, just after the monthly period, when the breast is least likely to be nodular. One must look for any changes since the last time the breasts were examined.
The examination may be performed as follows, examining one breast at a time, first inspecting and then palpating the breast.
INSPECTION
- Start by sitting or standing in front of a mirror, with arms relaxed at the sides. Look for a change in the size or the shape of the breast, puckering or dimpling of the skin, and any discharge from or change in the nipple.
- Next, look for exactly the same things after raising both arms over the head.
The inspection is now complete and one may proceed to palpation of the breast looking for any lump or thickening.
PALPATION
- Lie down and put a pillow under the left shoulder, with the left hand under the head. Using the fingers of the right hand, held together and flat, press gently but firmly with small circular movements, to feel the upper inner quarter of the left breast, starting at the breast bomb and going outward will you reach the nipple line. Feel the region around the nipple.
- Similarly, examine the lower inner part of the left breast. In this region, a ridge of firm tissue may be felt, which is normal.
- Now, bringing the hand down to the side, still using the fingers, feel under the armpit.
- After this, examine the upper outer quarter of the breast, from the nipple line to where your arm is resting, in a similar manner.
- Lastly, with the same gentle pressure examine the lower outer quarter of the breast, starting from the outer part and going to the nipple.
Repeat the same procedure on the right side completing the examination of the breast.
Thus, one broadly looks for a lump, change in size or shape, puckering, dimpling, or any other skin lesion over the breast and any change or discharge from the nipple.
If any abnormality is detected, do not be alarmed, as all lumps or other changes are not cancerous. However, it is best to consult a doctor for a complete and proper evaluation of the condition. Breast cancer is curable and an early diagnosis can make all the difference with respect to the prognosis of a given case. Self-examination of the breasts for early detection of malignancy must be developed as a healthy habit and should be continued lifelong.