From last title

FEAR

Fear of intercourse, especially the first time round, may affect one's outlook towards one's future sex life. If the first penetration proves to be extremely painful and traumatic, phobia of intercourse may result. Fear can also be of pregnancy, infection and guilt to name a few.

SUGGESTION : A couple should try to find out more about sex before starting, especially concerning contraception, hygiene and prevention of infection. Enough foreplay and lubrication is important.

TIGHT INTROITUS ( VAGINA )

Some people are born with tight pelvic bone and vagina. While one cannot do much about bones, a tight vagina can be treated easily. Many such patients have a thickened band on the floor of the vagina, giving rise to pain during intercourse, resulting in the female refusing penetration ( Vaginimus ).

SUGGESTION : A simple surgery, which can be done as a day procedure, can be done to either release the tight band ( using laser or burning called diathermy ), or to make a small cut to widen the outlet of the vagina ( called Fenton's operation ).

RETROVERTED UTERUS

Retroverted uterus ( womb ) occurs in about 10 to 15 % of patients, naturally. In such cases, the womb rests on the back or the spine area. Some will complain of pain during intercourse.

SUGGESTION : A change in the sexual position may be all that is needed. The rear entry ( doggy style ) tends to move the womb away from the spine and relieve much of the backache. Surgery is available to correct this problem but this is a major surgery and is used only as a last resort.

ENDOMETRIOSIS

This is when menstrual blood back flow out of the lining of the womb to implant on the ovaries, womb or outside the womb. Endometriosis is associated with painful periods, painful intercourse, heavy periods and subfertility.

SUGGESTION : Please consult your gynae regarding further management. A laparoscopy ( key-hole surgery ) where a scope ( TV ) is put through the naval to look at the womb may be necessary for diagnosis. Treatment can be with medication or keyhole surgery depending on the severity.

VAGINAL INFECTION

This often presents with vaginal discharge which could be white and curdy ( fungal infection ) or yellow / green ( bacteria or parasite infection ). If left untreated, the patient may experience lower abdominal pain and of course painful sex.

SUGGESTION : See your gynae to clean off the infection, send the discharge for examination and for medication.

MENOPAUSE

This covers one large group of patients. In my practice, i routinely ask my patients about their sexual health. It may be due to the Asian culture, but the sad truth is that many menopaused women will divulge that they have little or no sex after menopause. There are many reasons , but a common one given is that of feeling old and tired. This may one reason for us reading reports of older men going over to Batam in search of sex. This has led some to believe that " WOMEN MENOPAUSE, MEN NO PAUSE ". Well, men actually has andropause, but this comes much later than women's menopause. The menopause is associated with loss of hormones called Oestrogen as the ovaries stop working and stop producing hormones when a patient is menopaused. This results in vaginal dryness, clitoris losing its protective covering, loss of tissues elasticity and the vaginal lining becomes thin. There is also a decrease in sexual responsivity and decreased libido. All these will lead to painful sex.

SUGGESTION : Vaginal hormones will help to improve vaginal dryness, thicken vaginal tissues and improving the elasticity of the vagina. The men have Vigra, Levitra and Cialis. Now a product approved for use in females in the USA, has been brought to Singapore. This is " ZESTRA ", a cream manufactured to help in lubrication and increasing libido in females. Application of Zestra to the vulva and vagina area 5 to 10 minutes before intercourse can leak to improving sexual arousal for the females.