Cleaning the clitoris

Is there a need to clean the clitoris, and how should it be done?

Typically speaking, there is no need to clean the clitoris beyond the basic genital hygiene practice.  However, women often find ‘stuff’ accumulating under the clitoral hood that is bothersome, and which may at times cause irritation: dry skin, dried up lotion, residue of topical medication/s, genital powder, etc.

If you want to clean it beyond the just-rinse-the-area method, take a bath: add a few drops of baby oil to the water and let the warm, oily water take care of it.  Make sure to place a towel at the bottom of the tub to avoid slipping.

If you need to go one step farther, dip a Q-tip in baby oil or in Aquaphor healing ointment and VERY GENTLY swipe under the clitoral hood.  Be cautioned to not force it and not to rub hard — you want to avoid injury to this sensitive area.

Still bothered by it? Can’t clean it? Ask your OBGYN provider to help.

A hug is just a hug?!

Why can’t a hug just be a hug, instead of his hands and mind going in the direction of sexual engagement???

This is one of the most common of sentiments expressed by (frustrated) women, which highlights a fundamental difference between female and male:  women thrive on affection (hugging, kissing, cuddling, soft verbalization, massage, romantic gestures, etc.)  whereas men receive their validation and love and connection from a sexual act.

Now, hold off your hate comments for the following disclaimer: many men cherish affection and enjoy giving and receiving it.  However, take away sexual connection, and they will feel incomplete.

For women, thinking and feeling sexual is nice and normal but it may not be acted on for hours, days or years on end.  However, take away affection and you can easily have frustration and negativity.

So, can a hug just be a hug?  Make sure to openly discuss with your partner if he gets the ‘wrong message’ from your affectionate gesture; you would not want to begin avoiding affectionate contact in anticipation of sexual expectations from him.

Why suffer in silence?

The body is built for intercourse and women are typically able to handle it just fine.  Still, why do so many women suffer in silence during (painful, unwanted) intercourse, instead of speaking up?

  • Is this an inherent trait in women?
  • Is the partner at fault?
  • Is society to be blamed? Or culture? Religion?

Apparently, the causes are deeply rooted in the woman’s psyche and include

  1. The sense of “I do not deserve any better…”
  2. The feeling of “I am the only one who is struggling so I may as well just keep quiet…”
  3. The fear of “Partner will leave me if I speak up… I do not want to be alone…”
  4. A statement like “In my culture women submit, quietly; speaking up will have negative repercussions…”
  5. Some religions where women are expected to be subservient to the husband’s sexual wants regardless of their own feelings.
  6. The woman’s inability to say NO, to speak up her preferences!

Regardless of the reason, this suffering will typically lead to a deepening sense of victimization and/or to developing vaginismus.  After all, it is against human nature to be made helpless, hopeless, forced-upon.

Important: the vagina is a hostess to the penis! Its owner – the woman – determines if to invite the penis in, how long it can stay in, and when it is time to leave.  Have you ever thought of that in such terms?  And, did you realize that the thrusting during intercourse is a rapid, powerful physical action inside the vagina, easily felt throughout the woman’s pelvis and body?  Ouch.

Unfortunately, many women will continue to suffer in silence. We hope and pray that enlightenment will come about sooner than later.

Penis & thrusting

Thrusting during intercourse is the rocking movement of the penis in the vagina, done rhythmically as per the male’s arousal.  It is the flip-side of rubbing the penis to arousal during manual sex or oral sex.

How deep does the penis thrust during intercourse? As deep as the vaginal depth allows, as deep as the male’s desire guides him, and most importantly: as deep as it is comfortable for the woman.

Does the penis come out of the vagina during thrusting, as in going in & and coming all the way out, in & out, in & out?  Most of you will say a definite NO, the penis does not come out of the vagina but rather stays inside during thrusting.

Surprisingly enough, there are quite a few who struggle with ‘what is normal’ and who will expect the vagina to endure their repetitive, rhythmic in & out powerful motions.  For the woman, these quick, ongoing penetrations will activate the tightening reflex of the vaginal ring (introitus), giving her discomfort and painful intercourse (dyspareunia) or even vaginismus.

Gentlemen, please respect vaginal endurance and stay inside when you thrust.  And ladies, do not suffer in silence!

About stirrups

During gynecologic exam, the woman is asked to slide down to the edge of the examination table for best visualization of the area and to accommodate the use of the speculum.  This position is medically known as the dorsal lithotomy position.

Stirrups were invented by Bert H Simpson in 1908 and patented in March 1909 – only 100 years ago.  See photo below.

Many women would rather not use stirrups because they cause them embarrassment and much distress.  Are they mandatory?

Apparently not: a 2006 study suggests an alternative to discuss with your doctor: keeping feet on bed.  The study is worth reading.

stirrups_shrouded

Vaginismus, returns?

Vaginismus is a common condition that affects women worldwide regardless of their culture, religion, education, sexual orientation, or family status.  Vaginismus is a somatic (body-mind) reaction to fear/apprehension of vaginal penetration.  It happens instantaneously and involuntarily.

Women with vaginismus tend to suffer in silence and shame, thinking they are the ‘only one’ with this problem, which is why prevalence is not available.  A certain measure of anxiety is typically associated with this condition, ranging from minimal to severe, the latter may also include panic and OCD (obsessive compulsive disorder).

Vaginismus is curable and the cure should be life-long as long as the woman follows discharge instructions, which should include specific management of the residual anxiety/panic/OCD.  In other words, once the woman can have vaginal penetrations without a problem, why fear them any longer?

Does vaginismus come back? It can, if the woman did not follow up on discharge instructions and is again ‘allowing’ the anxiety/panic/OCD to regain control and interfere with vaginal function.  Sad, isn’t it? To have gone through a treatment process only to then be non-compliant.

On a good note, it is rare that the woman will regress to a complete vaginismus: she will typically be able to have (some) penetration/s but with trepidation and under the effect of her un-managed anxiety.  In some cases, the vaginismus could remain cured but other somatic reaction/s may appear, such as IBS (irritable bowel syndrome), neck or back aches, TMJ (jaw joint pain), headaches, etc.

Bottom line (no pun intended): vaginismus is a body-mind phenomenon and both aspects must be properly resolved for a life-long cure, a joint effort between a skilled clinician and a responsible patient.

Fingering?

When women are being asked if they masturbate, they typically associate it with their ability/desire for ‘finger in vagina.’

The truth: female masturbation is about clitoral stimulation regardless of vaginal action.  In other words, inasmuch as vaginal penetration may enhance the arousal, it is not mandatory nor the key to sexual excitation.

Furthermore, even women with vaginismus (inability to have vaginal penetration) can be quite satisfied sexually because the clitoris is not inside the vagina!

So, ladies and gentlemen: let us not assume that fingering is desired by the woman, nor expect fingering to be an integral part of the sexual act.  It is a woman’s choice to be fingered, or not.  Some women like it, others just do it (in neutrality, no adversity) for their partner.

Soft penis?!

Most of our vaginismus patients never experienced intercourse before undergoing treatment so they do not have a perception of what a penis at full erection feels like upon penetration.

Some men ‘feel’ that their penis is at full erection (hard enough for penetration = functional erection) yet it may not be.  A bit of a sensory confusion.

The problem? The inexperienced woman is now ready for intercourse, the man is trying to penetrate, things just don’t happen, both are frustrated and upset…

The answer: one cannot stuff a soft penis into the vagina…

Vaginismus or Vestibulitis?

It is common to group vaginismus and (vulvar) vestibulitis into one and it takes a proficient clinician to know the difference.

Generally speaking,

  • Vaginismus = unable to have vaginal penetration/s, or able to have them but with pain and distress.
  • Vulvar vestibulitis = penetrations are usually available but the pain/burning/discomfort surrounding the area may complicate matters.

Unfortunately, vaginismus remains an elusive diagnosis while (vulvar) vestibulitis has become the (quick) answer to vulvogenital problems.

Vaginismus on Facebook

We started a chat group on Facebook for the exchange of information regarding vaginismus.

  • Name of the group: Vaginismus, a private pain
  • Participants: former patients of ours, women with vaginismus and/or their partner, clinicians who treat vaginismus, etc.
  • Our goal: to offer a positive exchange about vaginismus, its impact on life, treatment options, etc.   Our former patients will be available for questions and input having ‘been there.’

To join, login to Facebook and search for  Vaginismus, a private pain

We look forward to hearing from you.