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Female Sexuality

There are certain body parts that are associated with sexual activity. While these areas may be focus of physical attention, probably the largest and most sensitive sexual organ is the human brain.

Here are a few of the most common topics relating to female sexuality.

  • Sexual activity and UTIs

    Some women are more likely to get urinary tract infections. This may be related to many things including poor resistance, an injury or surgery in the pelvic area, or use of a catheter. Often, a sudden change in a sexual relationship triggers this – like increased sexual activity or a new partner.

  • Sexual activity and birth control

    Birth control is a term used to define any method or practice that is used to prevent pregnancy. There are many different types of birth control and each is different in the way it’s used, its effectiveness, its side effects, and its costs.

    Overall, your choice of birth control should depend on factors such as your health, frequency of sexual activity, number of partners, and desire to have children in the future. Effectiveness and failure rates of the various types of birth control are key factors, too.

    Some birth control pills do have a side effect of decreased libido.

  • Female sexual response

    There are four stages of sexual response: excitement, plateau, orgasm, and resolution. Sexual arousal involve a complex interaction of thoughts and feelings, sensory organs, nerve responses, and hormonal reactions occurring in many parts of the body.

    1. Excitement/Desire
    The first sign of female sexual excitement is the moistening of the vaginal walls.

    A low level or lack of sexual desire is sometimes called a low or lagging libido. This may be due to physical or emotional or relationship problems – and sometimes a combination of all. The major contributor to low libido is stress and fatigue. This is usually temporary and situational – a little vacation or a nicely planned evening out is often the only thing that is needed for you need to rekindle the flame.

    More troubling situations to remedy are problems related to grief, separation, divorce, and loss of a job or other major life events that may affect libido, due to elements of depression or feelings of loss. Relationship problems may affect desire, especially when underlying anger and hurt affect your willingness to be vulnerable and share intimacy. Women with poor body image, low self-esteem, and a history of sexual trauma or abuse may also experience low libido. Physical causes of low libido include side effects from medications, recovering from surgery, trauma and childbirth, certain chronic illnesses (e.g. diabetes) and hormone deficiencies.

    Short spells of low desire usually work themselves out – stress management may be important to learn. If the situation continues, discuss this with your health care provider so that the appropriate medical considerations can be reviewed and referrals made when necessary.

    2. Arousal
    The clitoris and labia swell and the inner two-thirds of the vagina lengthen. Breathing and heart rate increase. The nipples harden and breasts may enlarge. As excitement increases, the clitoris contracts. The vaginal opening shrinks and the inside becomes more congested.

    Changing hormone levels as in pregnancy, postpartum, breastfeeding, and menopause (surgical or natural) may especially impact your sexual responsiveness and lubrication. While the mood may be right and the partner may be perfect, bouts of slow arousal are frustrating. The good news is that they are usually short-lived.

    Causes of slow arousal may be:
    • side effects of medications (see antidepressant medication and sexual dysfunction)
    • chronic illnesses which decrease the blood supply to the pelvic area (diabetes, heart disease)
    • alcohol and drug abuse
    • relationship/situational issues

    3. Orgasm
    Continued stimulation brings orgasm, rhythmic contractions of the vagina, uterus, and pelvic muscles, accompanied by very pleasurable sensations. Women are often able to be orgasmic following a previous orgasm if they continue to be stimulated.

    Problems with orgasm may also be due to a variety of physical and emotional problems, such as:
    • Stress
    • Fatigue
    • Drug and alcohol abuse
    • Side effects of medications
    • Relationship problems

    4. Resolution
    Eventually, the body returns to its unaroused state.

    Painful intercouse (dyspareunia)

    Pain with intercourse is a signal that something is wrong. There are a variety of things to consider when this symptom occurs – the most common things are included below:

    • first time having sex
    • uncomfortable position (the wrong angle of penetration)
    • too forceful movements
    • inadequate lubrication
    • irritating condom material (e.g. nonoxynol-9)
    • irritating creams, lotions or oils used in the genital area
    • bladder spasm, infection or full bladder
    • vaginal infection
    • STI
    • prolapse (weakened areas in the pelvic floor)
    • hernia

    Anytime painful intercourse is a regular problem or if it’s accompanied by bleeding or deep pelvic pain, do not delay in having these symptoms evaluated by your OB/GYN health care provider.

    Vaginismus

    Vaginismus is a condition where involuntary spasms of the pelvic muscles make vaginal penetration uncomfortable and tense. This problem varies in severity, and many women find the issue troublesome but manage to cope and even enjoy sexual activity with adequate lubrication.

    An unfortunate cycle of apprehension, tension and spasm may become an expectation in sexual relations. In some cases, any vaginal penetration (intercourse, tampon use or pelvic examination) is not possible without relaxant medication. This is a frustrating problem in a sexual relationship because the affected woman feels she can’t control her body and the partner feels rejected and inadequate.

    This condition may arise from a variety of problems; often there are psychological and emotional factors. By far, it is seen in women who have a fear of sex, or who’ve been molested or traumatized. However, this is not always the case. Infections and irregular skin condition in the genital area may also cause this problem.

    The good news is that treatment is available. Counseling is often helpful, especially when used in conjunction with pelvic muscle training and biofeedback. As women make progress with these symptoms, vaginal dilators may be used (at home) to practice muscle relaxation while the patient controls the size and depth of penetration. A series of different sizes of vaginal dilators may be prescribed.

    Vulvodynia

    This condition causes soreness and discomfort in the vulvar area. It is often described as a burning, irritated rawness in the perineal area, but the degree of discomfort, the location and the duration of the symptoms vary among women. Diagnosis is made when the symptoms have persisted for more than 6 months with negative testing for infection, STI, and yeast. The shrinking and drying of vaginal tissue that occurs with decreasing levels of estrogen may contribute to this problem – but don’t confuse this with midlife dryness – it is a less frequent and more painful condition.

    Vulvodynia often impacts sexual activity by causing painful intercourse. This is more problematic when the soreness is most exquisite in the vaginal vestibule, the ring of tissue that surrounds the vaginal opening.

    Treatment is directed toward symptom relief and may include topical steroid medication to reduce inflammation, nerve blocks, biofeedback (to train muscle spasm control), and diet modifications. There are other treatments to consider if these interventions don’t work – consult with your women’s health physician for further advice and medical management. Don’t suffer in silence – your health care provider can help.

  • Female sexual anatomy

    The following is a brief definition of common sexual anatomy in the female.

    The external female genital area is known as the vulva. It includes the:
    • mons pubis - a pad of fatty tissue that covers the area of the pubic bone and is covered with pubic hair.
    • clitoris - a center for sexual arousal in the female.
    • labia majora - two folds of skin extending from the mons pubis and protecting the external genitals.
    • labia minora – smaller and smoother skin folds that meet above the clitoris.
    The internal female reproductive organs include the:
    • vagina - a flexible muscular body cavity that leads from the outside of a woman’s body to the cervix.
    • uterus - a hollow, thick-walled, muscular organ. The lining of the uterine walls, the endometrium, is built up, then shed and expelled through the cervical os (opening) during menstruation.
    • cervix - the tapered end of the uterus, extends downward and opens into the vagina.
    • fallopian tubes – these uterine tubes are at the top of the uterus, and extend toward the ovaries but are not attached to them. The funnel-shaped end of each tube fans out over the ovary.
    • ovaries - on each side of the uterus is one of a pair of ovaries, they are responsible for producing follicles (eggs).
  • Sexual intercourse during your period

    Unprotected intercourse during a woman’s period has risk. In addition to the obvious hazards of sexually transmitted disease (including HIV), pregnancy is still a possibility. The menstrual period begins on day 1 of the menstrual cycle and continues through days 5 – 7. Ovulation occurs around day 14, and is the most fertile time in the cycle. Because sperm can live in the body for several days, and an ovulation MAY occur several days early in a particular month, there is a slim chance that viable sperm may be present if intercourse occurred late in the menstrual period.

    Perhaps, a larger concern is for women with irregular cycles or mid-cycle spotting. They may think a day or two of light bleeding is their period, when actually it is around the time of ovulation – an extremely risky time to have unprotected intercourse.

  • Signs of Sexual Dysfunction

    The term “Sexual Dysfunction” covers a wide variety of problems, including spasms of the vagina, pain with sexual intercourse, problems with sexual desire (libido) and sexual response. Decreased sexual desire is the most common complaint among women, affecting up to 43% of women. The problem may be psychological, physical, or a combination of both.  Sexual dysfunction can be temporary or long-lasting and may be caused by hormonal changes, drug use, depression, anxiety or other medical, psychological or neurologic conditions.  Most sexual dysfunction can be treated, and your Ob Gyn provider will help determine the best treatment options for you.

    Common Signs and Symptoms:
    • Pain during sex
    • Lack or loss of sexual desire or the inability to stay aroused
    • Lower urinary tract symptoms
    • Difficulty having an orgasm
    • Vaginal dryness
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