Long considered a taboo subject, women’s sexuality is now openly discussed and portrayed on television, in magazines, and on the internet. Most importantly, women are becoming increasingly aware of their sexuality and their sexual health nowadays. Nevertheless, many young adults are still ignorant of important facts about sexuality and related studies have proved that despite awareness raising and exposure to television programs on sex, some young people, especially girls from very conservative backgrounds, still think that even kissing or touching can lead to pregnancy.The Nation asked Family Planning Association (FPA) Sri Lanka Medical Director Dr. Sumithra Tissera about the common sexual problems that women face.
Q. What sexual problems do women face?
Sexual problems or sexual dysfunction can be classified as:Loss of desire or libido: Inability to become aroused - insufficient vaginal lubrication, anxiety and inadequate stimulation.Lack of orgasm (anorgasmia): could be due to sexual inhibition, inexperience, lack of knowledge, guilt, anxiety, or past sexual trauma or abuse, certain medications and disease.Painful intercourse: could be due to vaginismus, endometriosis, pelvic lump, vaginitis, poor lubrication, sexually-transmitted infections, presence of scar tissue from previous surgery, (vaginismus - involuntary spasm of the muscles surrounding the vagina – due to fear, sexual phobia, previous traumatic or painful experience).
Q. What causes such problems?
There can be several causes such as personal wellbeing; relationship issues; male sexual problems; childbirth; menopause; surgery such as hysterectomy and oophorectomy; vaginal or pelvic pain - prior surgery; endometriosis; infections; bladder and pelvic support issues; medical issues such as cancer, heart disease, arthritis, diabetes, alcoholism; taking in anti-psychotics, anti-depressants, anti-hypertensives (beta blockers) and emotional factors such as stress, anxiety and depression.
Q. Are they the same for young and older women or do they change with age?
The causes for women’s sexual problems can vary with age. For example, sexual problems due to childbirth, relationship issues are mainly observed at young age while problems due to menopause (dryness of the vagina and loss of desire due to hormonal imbalances), medical issues, bladder and pelvic support issues are mainly seen at older age.
Q. What could be the reasons for pelvic disorders that cause pain during intercourse?
Having severe vaginal discharge with smell and itching can cause the vaginal area to be red and swollen making sexual intercourse painful. Also Pelvic Inflammatory Disease (PID) can cause pain during sex. Prominent pubic bone and a very thick hymen are also reasons that they may avoid sex just after marriage. All these can be solved by consulting relevant family doctor, or a gynecologist.
Q. Does hormonal imbalance interfere with sexual satisfaction?
Perimenopause and menopause surgeries that remove bilateral ovaries that secrete the sex hormones can result in vaginal dryness, causing painful sexual intercourse which may make women avoid sex completely.But this can be prevented by using a lubricant or an estrogen containing gel around the vaginal area or using Hormone Replacement Therapy (HRT). But before using any of them, consulting a gynecologist is advisable.
Q. Is pregnancy a cause for sexual dysfunction?
A lot of pregnant women worry about having sex thinking that it will harm the fetus. But this is not true. They can continue having sexual intercourse, but may sometimes need to change the positions so they can avoid pressing on the protruding abdomen.
Q. Do Non-Communicable Diseases (NCDs) like diabetes, hypertension, cancer and heart disease interfere with sexual activities?
Yes, they can interfere with sexual activity by reducing the desire. Cancer can cause discomfort and fatigue due to the disease as well as medication. Breast surgery for cancer results in changes in body image. Diabetes impairs arousal and ability to experience orgasm. Arthritis and heart disease may reduce the physical ability to engage in sex and psychiatric problems due to disease or medications can affect a person’s sexual relationships.
Q. What about medications?
Some medications also can reduce the sex drive and make the vagina dry thereby reducing the desire to have sexual contact (anti psychotics and anti depressants).
Q. How do Sexually-Transmitted Infections (STIs) affect a person’s sexual activities?
STIs can cause sexual problems due to discharge, small lesions and redness on the vaginal area. Women avoid intercourse when they have such conditions because of the pains they experience during the intercourse.
Q. How do male impotency and other problems in men during sex affect women?
Male sexual dysfunctions may also have some negative effects on women’s sex lives. In the case of premature ejaculation (ejaculating too early) the woman may feel unsatisfied. Some men due to their inability to get an erection may avoid having sex or postpone it daily where the women may also, after sometime, avoid sexual activities or may look to other men.
Q. What about attitudes to sex? Some women, because they are brought up in conservative households or due to bad experiences think sex is shameful or bad, your comments.
This is sometimes observed in relationships. Especially if women had a bad experience during their childhood, they would perceive sexual relationships negatively. They may also experience pain during sexual intercourse. Some such women get vaginismus and they do not allow their partners to have sex with them even after many years of marriage.
Q. How important is knowledge about sex in minimizing women’s sexual problems?
Just knowledge is not enough. They need to have accurate knowledge to understand sex and sexuality. They must know the difference between men and women not only physically, but also psychologically and the way they are aroused and way they act.
Q. what is the role of cultural beliefs about sex, especially with reference to Lankan and Asian women?
In Asian cultures, sex is seen as a taboo subject. The kids are not even taught the physical and psychological changes taking place in their body. Most start learning this after marriage or during a relationship. As this subject is not spoken about openly, particularly women are very shy even to talk about it with their partners. Specially what they like and dislike and what they want from a relationship as they feel speaking openly may brand them a woman with ‘bad characters’. This sometimes inhibits the woman even more in showing her desires.
Q. How can sexual problems be resolved?
For solving all sexual problems, medicine is not essential. Simple counseling and discussions between partners is enough to identify the problems and come up with solutions. There are doctors in Sri Lanka trained on psychosexual medicine as well as sexual health specialists and psychologists. If any women feel that she has a change in her sexual behavior or relationship, she should seek help soon rather than waiting till it escalates.
Q. What supports do Lankan women have by way of 1) accessing correct knowledge 2) counseling and any other? What role does the FPA play in these interventions?
There are many books written on relationships, sexuality and sexual behavior of men and women by eminent consultants and psychologists. They are available from many book shops. FPA Sri Lanka clinic - Centre for Family Health - provides consultations and referrals with people who need specialized care and counseling.
Q. Are they available to all and where can they be obtained?
These services are available for all women, sometimes even through their family physicians. But if they do need specialized care they may need to go and talk to a Consultant Psychiatrist in their own area.
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