Tampon – worse cramps?

A question from a patient: “it seems to me that tampons make my cramps worse – can it be?”

Answer: menstrual cramps are the contractions of the uterus as it expels the extra lining that developed in preparation for conception, which did not materialize.   That said, a tampon cannot regulate your cycle nor affect the body’s natural process of thinning out the uterine wall in preparation for next month’s cycle.

(To subscribe to our Blog, follow the subscription link is on the right, at the top of the navigation column)

Reluctant to Use Condoms?!

We’ve been shocked lately by the large number of female patients who expressed reluctance to use condoms with their partners despite the risk of exposure to STIs (Sexually Transmitted infections, the current terminology).

At first we thought they were not informed of the risk — but they were.  Then we thought it only happened once, but were told that it goes on regularly…

Aha, you may say, these must be silly young adults who are under the surge of sex hormones, flushed with lust (still, no excuse!).  No, no, no — they were ladies in their 50s and 60s, educated, bright, and sexually experienced!

So we posed our standard question: do you know where his penis was before it visited your vagina???  We heard different replies:

• “But he is a clean, good, responsible guy!”
• “He was only with 2 other women before me…”
• “I am uncomfortable talking to him about using condoms…”
• “He says he doesn’t like to use condoms…”
• “I don’t want to lose him by insisting on it…”
• “He says he is okay and I want to believe him…”
• “It will affect the spontaneity of our sex…”
• “Should I talk to him about STIs?  Is it really important?”

And so we continue to treat women who contacted STIs from unprotected sex.

Apparently, the road to female sexual equality and self-protection from STIs is still long and bumpy.

(To subscribe to our Blog, follow the subscription link is on the right, at the top of the navigation column)

Penis too big?

While nature created us suitable for copulation, there are times when size matters.

She says: “He feels too big to fit inside my vagina.  When we try, I feel that I am being torn and the vaginal opening will often bleed.  Try as we may, he cannot get inside me for normal, comfortable intercourse.”

He says: “Yes, I am thicker than average and some past partner said so too but we always managed to have vaginal intercourse somehow.”

So, is it her vaginal size? Is it his penis’ size? What is going on?

The penis has two dimensions, length and girth (thickness).

• The length will fit in as deep as the vaginal canal will allow: most men will fit in completely, while some may have the base of their shaft sticking out.  Some positions may afford greater vaginal depth and you may want to experiment to find out.
• Girth (thickness) poses a problem because a thicker-than-average penis will challenge the vaginal opening, often to the point of tearing and suffering when trying to get in.  A ‘very thick’ penis (yes, they do exist!) will make vaginal intercourse impossible with altogether.

The vagina is rarely too small in structure.  It may react in nervousness and appear smaller/tighter in some situations but typically speaking, it is suitable for the average to slightly-thicker-than-average penis.

The woman should not be blamed for being ‘too small’ or for having vaginismus or dyspareunia before ascertaining that the penis is of functional girth.

In situations when the vagina needs just a little extra stretch, women can try to ‘warm up’ with a thick dildo before the penis enters in the hope that it will open it up enough for intercourse.

Overall, women should not feel inadequate nor a failure if he is too thick, nor seek surgical expansion (yes, you read it right) just to please him at the expense of their own genital and emotional health!

 

Rx and Sexual Arousal

A common concern among women and clinicians is the potentially adverse affect of medications on sexual arousal (libido), especially the SSRI group of anti-depresant/anti-anxiety medications.

Clinically speaking, we do not find that SSRI medications interfere with libido, unless the woman is on the high end of dosage for very severe anxiety and/or depression.  Of course, it does not take much for the woman to kill her orgasm, but that should not be attributed to the medications as the cause.

A new study (see below) just published points in the same direction within the non-depressed 40-62 years old female population who are taking a typical dose of 10 or 20mg of escitalopram (Lexapro). 

The study: Sexual Function in Nondepressed Women Using Escitalopram for Vasomotor Symptoms.

Intercourse – how often?

The frequency of intercourse depends on the woman’s preferences, on having an available partner, on the style of the relationship, on medical/religious involvements, etc.

The vagina itself, being the sturdy body part that it is, can handle frequent intercourse as long as the woman listens to it = ‘vaginal management:’

• Lubrication: use lubricants if/when you feel the slightest of chafing/heat spot sensation to avoid irritation and/or emotional distress;
• Arousal: not mandatory for sexual intercourse to take place as penetration should be available regardless.
• Repeat intercourse in the same day/hour: go for it if you’d like but mind your comfort and use lubrication as needed.
• Preferences: say NO if you do not want to do it again so soon!  With the penis being a visitor in your vagina, it is about your choice.

 

Our new Facebook page

You are invited to visit our new Facebook page, and while there – don’t forget to Like it.

As always, your comments and suggestions are always welcome.

Thanks!

 

No G-spot?!

So, where is the G-Spot? I can’t seem to find it…

The Gräfenberg Spot, commonly known as the G-Spot has been described as a bean-shaped area in the vagina and presumed to be an erogenous zone for the female.  There were many research studies about it, books written, and men and women looking for it…

A Holy Grail?  The existence of the G-Spot has always been controversial and only now, with advanced sophisticated imaging devices, can we be closer to a definitive conclusion.

In their recent study titled, “Is the Female G-Spot Truly a Distinct Anatomical Entity?” Kilchevsky  and colleagues assert that  “…Objective measures have failed to provide strong and consistent evidence for the existence of an anatomical site that could be related to the famed G-spot. However, reliable reports and anecdotal testimonials of the existence of a highly sensitive area in the distal anterior vaginal wall raise the question of whether enough investigative modalities have been implemented in the search of the G-spot.”

(To subscribe to our Blog, follow the subscription link is on the right, at the top of the navigation column)

 

 

The Pill, Childbirth, & Texting

Updates from the January 2012 issue of Obstetrics & Gynecology:

• In his Editorial, John T. Queenan, MD reminds all that while “…breastfeeding offers short-term contraceptive, many mothers do not breastfeed exclusively and want a practical means of contraception that does not hinder their ability to breastfeed.”  Furthermore,  Dr. Queenan highlights the controversy surrounding when is it safe to start taking the Pill considering that the earliest ovulation occurs around 25 days postpartum in non-breastfeeding women.
• Espey and colleagues address the question of ‘when’ in their research titled, Effect of Progestin Compared With Combined Oral Contraceptive Pills on Lactation and assert that oral contraceptive, whether combined hormonal or progestin-only, administered 2 weeks postpartum did not adversely affect breastfeeding continuation.
• Consequently, since there is still a widely-accepted concern for venous thromboembolism (blood clotting) associated with the Pill, further research is needed to ascertain the safe timing of starting it following childbirth.  However, says Dr. Queenan, “…the findings… are a positive contribution to expanding the family-planning aspects of breastfeeding and to encouraging breastfeeding for all women.”

Another research article in the same issue titled, Effect of Daily Text Messages on Oral Contraceptive Continuation by Castano and colleagues concludes that daily text messaging to women taking the Pill improved their staying on it.  This article brings to mind our own clinical observation of patients typically programming their mobile device to alert them to take their Pill.  It is nice to see medicine and techy-ness working together.

(To subscribe to our Blog, follow the subscription link is on the right, at the top of the navigation column)

Newlywed Guide to physical intimacy

We would like to recommend a fantastic new book, The Newlywed Guide to Physical Intimacy, which was just published.

Although originally written for the (Jewish) observant couple, we found it suitable for any reader of any faith who is a beginner when it comes to physical intimacy and sexuality.

Furthermore, we had the pleasure of personally meeting with the author, Dr. David Ribner, whose professional knowledge and personal kindness are sensed in every word he wrote.

Click here to buy from Amazon.com

 

Female Sexual Dysfunction

In January 2010, ACOG District II (American College of Obstetric and Gynecology, New York District) formed a task force of women’s health experts to create this educational resource guide focusing on female sexual dysfunction (FSD).

The goal of this guide is to heighten ob-gyns’ awareness of FSD, proper assessment methods and treatments, as well as the importance of sensitive and honest patient- provider dialogue.  The educational content for this guide was shaped by a recent survey of ob-gyns, literature review and task force consensus.

We were privileged to be members of this very important project and are delighted to make it available to all.

Click here to read the entire Guide.

(To subscribe to our Blog, follow the subscription link is on the right, at the top of the navigation column)