ON 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 premenstrual tension? RYes, oral contraceptive pills do relieve premenstrual tension in about 50 percent and painful periods, i.e. dysmenorrhoea, in 90 percent of the 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 need to understand the risks involved  before  undergoing surgery.

Does disparity in breast size require  treatment?Disparity in the size of the breasts  may be due to various  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 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 hair 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?Some women report that they get  enough clitoral stimulation during  normal sexual intercourse.  Some  prefer gentle stimulation along with a little pressure.  For some women, intercourse is enough to reach a climax while for others additional clitoral stimulation is essential.

What is the G-spot and how can one stimulates it?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 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, 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. The 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 does of an antihistamine may prove useful.

Do women have different degrees of lubrications?Yes, women differ in the amount of  vaginal lubrication produced.  Even in the same woman, the lubrication may 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 trough 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 a 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 if there is a 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 foetus.  In the last trimester, i.e., from the seventh month to labour, one many 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 foetus

It must be understood  that whenever, because  of 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  are 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 foetal malformation.

When can a woman resume sexual  intercourse  after delivery?  One should not indulge in sexual intercourse..

  • If the epistomy scar (the cut made to ease the birth of the baby) has not  healed properly.
  • If there is bleeding from vagina.

Usually, after three weeks    of delivery, a woman  can comfortably resume  sexual activity.

Is epistomy necessary during normal delivery?Epistomy facilitates delivery of the  foetal 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 string the epistomy, the obstetrician should take one or more stitches, known as 'husband's  stitch', to ensure  adequate  apposition which help 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  child birth.  It can be best  prevented by proper management of labour 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 contractions of the perennial muscles- a phenomenon akin to holding  the urine and releasing it.  Twenty such contractions and relaxation's, three times a day,  may help increase the  muscle tone.  If this does not  work, one may consider vaginal reconstructive surgery. 

What conditions can make  a woman frigid?Distraction disturbed  interpersonal  sexual relationships , anti-hypertensive drugs, tranquilizers, and  sedatives, hypnotise 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 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 of 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, then 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 to she  is not attractive to him any more, 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 a situation anxiety   that may impair his response and performance.  Even if the male is  able to perform  properly in thee circumstances, the minimal or deliberately subdued response of his  partner due to traditional misconceptions will leave him with the fleeing 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 expectation, 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 situations   demands.

Where are the psychological  sequel of a rape  case?The psychological trauma experienced  in 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; the 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.  Det4ection 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  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 beast, starting at the breast bomb  and going outwards 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 the  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 the 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.