FAQ - Female Sex Problems

Q What is labioplasty?

Ans - Labioplasty is cosmetic surgery for female genitalia to correct the deformities & irregularities. it restores the normal & aesthetically  good shape. This surgery is available at our centre.

Q What is Hymenoplasty?

Ans - Hymenoplasty is also known as Revirgination. It is operation to restore Hymen, if it damaged or lost due to any reason?

Q What are the types of sexual problems in female?

Ans - Female sexual dysfunction is generally divided into four categories:

1. Low sexual desire. You have poor libido, or lack of sex drive. This is the most common type of sexual disorder among women.

2. Sexual arousal disorder. Your desire for sex might be intact, but you're unable to become aroused or maintain arousal during sexual activity.

3. Orgasmic disorder. You have persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and ongoing stimulation.

4. Sexual pain disorder. You have pain associated with sexual stimulation or vaginal contact.

Most sexual problems in women overlap more than one category. With increased information about the complicated nature of female sexual response, a new view has emerged one that focuses on sexual response as a complex interaction of many components affecting intimacy, including your physiology, emotions, experiences, beliefs, lifestyle and relationships. If any one of these components is affected, sexual drive, arousal or satisfaction may be affected.

Q What are treatment options for female sexual disorders?

Ans - Treatment may involve treating the underlying medical or hormonal condition contributing to sexual dysfunction, as well as addressing emotional and relationship issues that result or contribute to the dysfunction. In some cases,
Female sexual dysfunction can be treated by taking specially prescribed medications. But quite often, successful treatment requires no medications.
Nonmedical treatment for female sexual dysfunction
Improve your sexual health by making healthy lifestyle choices and enhancing communication with your partner.

1. Communicate with your partner. Open and honest communication with your partner can enhance your emotional and sexual intimacy. Some couples never talk about sex, while others are less inhibited. Even if you're not used to communicating about your likes and dislikes, learning to do so and providing feedback in a nonthreatening manner can set the stage for greater sexual intimacy. It may be difficult to resolve differences in sexual desire with your partner. Communicating your feelings can help in this matter.

2. Make healthy lifestyle changes.

3. Avoid drinking excessive amounts of alcohol, stop smoking,

4. Exercise regularly

5. And make time for leisure and relaxation.

6. All the abovemeasures are as important for your sexual health as for your overall health. Too much alcohol blunts your sexual responsiveness. Cigarette smoking restricts blood flow. Decreased blood flow to your sexual organs can lead to decreased sexual arousal or orgasm. Regular aerobic exercise can increase your stamina, improve your body image and elevate your mood. Learning to relax amid the stresses of your daily life can enhance your ability to focus on the sexual experience and attain better arousal and orgasm.

7. Strengthen pelvic muscles. Pelvic floor exercises can help with some arousal and orgasm problems. Doing Kegel exercises strengthens the muscles involved in pleasurable sexual sensations. To perform these exercises, tighten your pelvic muscles as if you're stopping your stream of urine. Hold for a count of five, relax and repeat. Do these exercises several times a day.
Your doctor also may recommend exercising with vaginal weights. By using a series of five weights, each increasingly heavier, that you hold in place in your vagina, you can strengthen pelvic floor muscles. You gradually work up to heavier weights as your muscle tone improves.

8. Seek counselling. Talking with a sex therapist or counsellor skilled in addressing sexual concerns can benefit you whether your condition is due to emotional factors or not, since even sexual problems that are hormonal in origin can affect your emotional health and intimacy with your partner. Evaluation with a sex therapist typically includes a review of your sexual identity, beliefs and attitudes; relationship factors including intimacy and attachment; communication and coping styles; and your overall emotional health. Therapy often includes education about sexual response and techniques, ways to enhance intimacy with your partner, and recommendations for reading materials or couples exercises.

Medical treatment for female sexual dysfunction

Effectively treating sexual dysfunction often requires addressing an underlying medical condition or hormonal change that's affecting your sexuality.
Medical conditions that can contribute to sexual dysfunction include depression or anxiety, diabetes, cardiovascular and neurological diseases, pelvic or abdominal surgery, and cancers. Vulnerable hormonal times in a woman's life occur during pregnancy and the postpartum period, while using hormonal birth control methods, and during perimenopause and menopause.
Therefore, to treat the underlying condition, medical therapy for sexual dysfunction might include:

9. Adjusting or changing medications that have sexual side effects

10. Treating thyroid problems or other hormonal conditions

11. Optimising treatment for depression or anxiety

12. Strengthening pelvic floor muscles

13. Trying strategies recommended by your doctor to help with pelvic pain or other pain problems

If your doctor feels you might benefit from a hormonal treatment, possible therapies include:

1. Estrogen therapy. Estrogens are important in maintaining the health of vaginal and external genital tissues. Replacing estrogen can improve sexual function in a number of ways, including increasing the tone and elasticity of vaginal tissues, increasing vaginal blood flow, enhancing lubrication, and having a positive effect on brain function and mood factors that impact sexual response. Localized estrogen therapy in the form of a vaginal cream, gel or tablet can help with sexual In some changes due to menopause.

2. Progestin therapy. Progestins generally are prescribed to balance estrogen's effect on the uterus and not to treat sexual dysfunction.

3. Androgen therapy. Androgens include male hormones, such as testosterone. Testosterone is important for sexual function in women as well as men, although testosterone occurs in much lower amounts in a woman. Androgen therapy for sexual dysfunction is controversial. Some studies show a benefit for women who have low testosterone levels and develop sexual dysfunction, for instance after surgical menopause due to removal of the ovaries. In these women, testosterone therapy reportedly improved libido, arousal and sexual thoughts. No standard, FDA-approved testosterone preparation exists for treating female sexual dysfunction. Testosterone therapy may be given as a cream or gel patch applied to your skin. Sometimes, testosterone is given as a pill or injection.

Possible side effects for women on testosterone therapy include acne, excess body hair (hirsutism), enlargement of the clitoris, and mood or personality changes such as aggressiveness or hostility. Also, excessive amounts of testosterone can decrease high-density lipoprotein (HDL) cholesterol (the "good" cholesterol) or cause an abnormal rise in liver enzymes in the blood.

Hormonal therapies won't resolve sexual problems that have other causes beyond those factors related to hormones. Because the issues surrounding female sexual dysfunction are usually complex and multifaceted, even the best medications are unlikely to work if other emotional or social factors remain unresolved.

Emerging treatments

Research is on to assess the effectiveness of sildenafil (Viagra), tadalafil (Cialis) and other drugs in female sex disorders.

FAQ Male Sex Problems

QWhat types of sexual problems are seen in males?

Ans - Men may have various problems related to sex.
1. Low desire (low libido)
2. Problems of erection (Erectile Dysfunction) or Impotence.
3. Problems of Ejaculation - Early, Delayed or Absent ejaculation.
4. Sexual Pain Syndromes.

Q What is Premature Ejaculation & What can be done about it?

Ans - Premature ejaculation ia condition where a man ejaculates during intercourse sooner than he or his partner wishes.

Causes

Premature ejaculation is commonest sexual problem in males.
It is often caused by Psychological &Social factors. It is only rarely caused by a physical or structural problem of the body( Organic cause).
Premature ejaculation early in a relationship is most often caused by anxiety and overstimulation. Other psychological factors such as guilt may also be relevant. The condition usually improves without formal treatment if cause is Psychogenic .

Symptoms

Ejaculation happens before the individual or couple would like ,that is prematurely.
This may range from before penetration to a point just after penetration, and may leave the couple feeling unsatisfied.

Signs and tests

Abnormal findings are unlikely to be found on examination.Lab reports are also usually normal. Useful information is more likely to be obtained by discussion between person or the couple & healthcare provider.

Treatment

Practice and relaxation will help you deal with the problem. Some men try to distract themselves by thinking non-sexual thoughts to avoid becoming excited too fast.

Some helpful techniques include the following:

The "stop and start" method:

1. This technique involves sexual stimulation until the man recognizes that he is about to ejaculate. The stimulation is then removed for about thirty seconds and then may be resumed. The sequence is repeated until ejaculation is desired, the final time allowing the stimulation to continue until ejaculation occurs.

2. Can be done by man himself or with the help of his partner.

The "squeeze" method:

This technique involves sexual stimulation until the man recognizes that he is about to ejaculate. At that point, the man or his partner gently squeezes the end of the penis (where the glans meets the shaft) for several seconds, till urge to ejaculate passes away.Withhold further sexual stimulation for about 30 seconds, and then resume stimulation. The sequence may be repeated by the person or couple until ejaculation is desired. The final time allowing the stimulation to continue until ejaculation occurs.

Drugs

Antidepressants such as Fludac and other selective serotonin reuptake inhibitors (SSRIs) may be helpful because they have a common side effect of prolonging the time it takes to achieve ejaculation.

Local anesthetic creams,such as Xylocaine, may be applied to the penis to decrease stimulation. Decreased feeling in the penis may prolong the time before ejaculation.

Condom use may also have this effect for some men.Initially double condoms may be used.

Evaluation by an andrologist,urologist,surgeon, sex therapist, psychologist, or psychiatrist may be required for some couples.

Prognosis

In most cases, the man is able to learn ejaculatory control through education and practice of the simple techniques outlined. Chronic premature ejaculation may be a sign of anxiety or depression, both of which could be helped by psychiatric intervention.

Complications

1. Inferility - Very early ejaculation, occurring prior to entry into the vagina, may prohibit a desired pregnancy.

2. Marital Discord - A continued lack of ejaculatory control may lead to sexual dissatisfaction on the part of either or both partners and may be a factor in sexual tension or discord in the relationship.

Professional help

Call for an appointment with your health care provider if premature ejaculation is causing a problem and does not respond to techniques such as those described above.

Dont fall prey to Quacks.

Dont be misled by wellmeaning but uninformed relatives & friends.

Prevention

There is no prevention for this disorder, though relaxation can reduce the likelihood of its occurrence.

Q What is Erectile Dysfunction (Impotence)?

Male erectile dysfunction is defined as "the inability to achieve or maintain an erection sufficient for sexual intercourse. It is one of the most common sexual dysfunctions in men. Although erectile dysfunction can be primarily psychogenic in origin, most patients have an organic disorder, commonly with some psychogenic overlay. Some men assume that erectile failure is a natural part of the aging process and tolerate it; for others it is devastating. Withdrawal from sexual intimacy because of fear of failure can damage relationships and have a profound effect on overall wellbeing for the couple.

Erectile dysfunction often accompanies chronic illnesses, such as diabetes mellitus, heart disease, hypertension, and a variety of neurological diseases, physicians from many medical disciplines may be required for management of these patients

Q How common is Erectile Dysfunction?

The Massachusetts male aging study, studied men aged 40 to 70 years and found some degree of impotence (Erectile dysfunction) was present in 52 per cent of the men studied. Mild in 17.1%, moderate in 25.2%, and complete in 9.6%
5% of men at 40 years of age and 15% at 70 years of age reported complete impotence;
However, a higher prevalence of complete impotence was seen in men with concomitant illnesses. Erectile dysfunction is more common with advancing age, and since the aged population will increase, its prevalence will continue to rise

Q What is required for Erection?

In the flaccid state, the smooth muscle cells of the penile arteries and the corpora cavernosa are in a state of tone (contraction). Relaxation of the smooth muscle (arterial and cavernosal) causes increased inflow of blood into the lacunar spaces of the corpora cavernosa (fig 1).6 The arterial pressure expands the relaxed trabecular walls, thus expanding the tunica albuginea with subsequent elongation and compression of the draining venules. This mechanism of veno-occlusion restricts the outflow of blood through these channels. After ejaculation or cessation of the erotic stimuli, the smooth muscle surrounding the arteries and the lacunar spaces contracts. The inflow of blood is reduced and the venous drainage of the corporeal spaces is opened, returning the penis to the flaccid state. Erection of the penis is thus a haemodynamic event under the control of the autonomic nervous system.7 Coordination of the neuronal activity from psychogenic stimuli occurs in the hypothalamus while reflexogenic erection involves a polysynaptic coordination in the sacral parasympathetic centres.8

Fig 1. Hypothetical mechanism of penile erection, adapted from Krane et al2

Several neurotransmitters are involved in penile erection. A principal neural mediator of penile smooth muscle relaxation, and therefore of erection, is nitric oxide.The importance of this pathway is shown by the clinical finding that selective inhibitors of phosphodiesterase-5 (which breaks down cyclic guanosine monophosphate) facilitate erection.11

Normal erectile function requires the coordination of psychological, hormonal, neurological, vascular, and cavernosal factors. Alteration in any one of these factors is sufficient to cause erectile dysfunction. Not uncommonly, a combination of factors is involved.

Q What are the causes of Erectile Dysfunction (Impotence)?

Chronic systemic illness

Diabetes mellitus, heart disease, and hypertension are all commonly associated with erectile dysfunction. Complete impotence has also been observed to increase with the severity of depression; almost 90% of severely depressed men report complete impotence. Peripheral vascular disease leading to insufficient arterial blood supply is another common cause. In addition, an association between low plasma concentrations of high-density lipoprotein and erectile dysfunction has been found. Other diseases such as peptic ulcer, arthritis, and allergy are also associated with an increased prevalence of erectile dysfunction.

Hormonal factors

The fall in free serum testosterone and increases in concentrations of sex hormone binding globulin with aging may be associated with loss of libido and reduced frequency of erection, but restoration of normal testosterone concentrations does not usually improve sexual function.
Patients with hyperprolactinaemia, frequently associated with low testosterone values, can develop low libido and erectile dysfunction by unknown mechanisms.

Local conditions

Poor blood supply as a result of congenital malformations or trauma is a less common cause of erectile dysfunction that can affect the young male.

Peyronie's disease is a specific condition of the penis in which the development of fibrous plaques in the tunica albuginea, sometimes extending into the erectile tissue, may cause pain (in the early inflammatory stage) and penile deviation, making coitus impossible.

Inability to retain pressurised blood in the corpus cavernosum follows disruption of the veno-occlusive mechanism, which can be caused by Peyronie's disease, congenital, or the result of trauma or surgery.

Drug induced erectile dysfunction

Around 25% of erectile failure seen in clinic patients is caused by medication. Erectile dysfunction may affect 10-20% of patients taking thiazide diuretics, and to a lesser extent, patients who are using blocking drug (Propanolol, Atenolol etc)

Erectile dysfunction commonly complicates antidepressant treatment with both monoamine oxidase (MAO)inhibitors and tricyclic antidepressants. Benzodiazepines and selective serotonin reuptake inhibitors(SSRI) have been reported to cause erectile failure, decreased libido, or ejaculatory problems.

Cimetidine, digoxin, and metoclopramide cause erectile dysfunction, as do anabolic steroids, either through a direct effect on penile tissues or through suppression of normal androgen production.

Up to 75% of patients in alcohol rehabilitation programmes have erectile dysfunction. In chronic alcohol abusers erectile failure may be the result of a combination of psychogenic and organic factors (for example, neuropathy).

Psychogenic causes

Psychogenic influences are the most likely causes of intermittent erectile failure in young men. Anxiety about "performance" may result in inhibitory sympathetic nervous system activity, and anticipatory anxiety can make the condition self-perpetuating. A psychogenic component is often present in older men, secondary to an organic cause. Underlying relationship problems are a common cause of erectile failure

Q How is Erectile Dysfunction diagnosed?

Your medical and sexual history should be told, and details of any concomitant medication, tobacco and alcohol consumption, and the presence of risk factors for erectile dysfunction (for example, vascular or surgical) should be informed. Preservation of nocturnal and early morning erections generally means that there is no organic basis for erectile dysfunction. The quality of erections during sleep can be assessed with portable home devices (such as Rigiscan) that measure changes in penile girth and rigidity, or in a sleep laboratory.

Measurement of blood pressure, palpation of peripheral pulses, and a neurological examination will be undertaken, including the bulbocavernous reflex and anal sphincter tone. The secondary sexual characteristics will be examined for signs of hypogonadism and any local abnormality in the external genitalia will be noted. The penis will be palpated for Peyronie's plaques and the testes examined for size and consistency. Further investigations are likely to be guided by the clinical findings, but should include measurement of free testosterone and prolactin concentrations. Vascular assessment may also be required.

Q How is Erectile Dysfunction treated?

Ans--Treatment modality chosen in a given case depends on the cause of the problem. One or more of following may be required.

Psychosexual counseling

Patients who have a sizeable psychogenic component require psychosexual counseling. Since an organic element is present in most patients, this approach is increasingly being used in conjunction with drugl treatment.

Hormonal therapy

Testosterone may improve erectile dysfunction in some patients with diagnosed hypogonadism. Transdermal formulations of testosterone and dihydro-testosterone, or as oral formulations of testosterone are used.

Hyperprolactinaemia is usually managed with bromocryptine or similar drugs. Less commonly, surgery is used to remove tumours secreting prolactin.

Drug treatment

Drugs that are currently available have limited effectiveness.Some of the drugs given orally are

Trazodone, given as a single agent, has been effective in some studies, but not others. Side effects such as sleepiness and gastrointestinal discomfort are common and limit its use.

Yohimbine has a modest effect on psychogenic, but not on organic, erectile dysfunction.

New drugs, such as inhibitors of phosphodiesterase-5 that affect the breakdown of cyclic guanosine monophosphate are more effective. Trials of one such drug, Sildenafil, have shown a response rate of around 90% in men with erectile dysfunction of no known organic cause. In diabetic subjects with clear organic erectile dysfunction, sildenafil showed a 50% response rate. This drug is generally well tolerated, and has no appreciable effect on pulse rate or blood pressure. The dopaminergic agonist, apomorphine, produced a 60% response rate after subcutaneous injection in men with psychogenic erectile dysfunction. However, patients reported a large number of side effects. Recent formulations (a sublingual, sustained release tablet), minimise these side effects. Phentolamine, widely used for intracavernosal injection treatment, has been tried orally. A buccal preparation with a shorter onset of action has also been used with a success rate of 30-40%. Injectable drugs In those patients who show inadequate response to tablets injections may be used. The most common treatment is self-injection of prostaglandin E1 into the corpora cavernosa (fig 2).

Fig 2. Vasoactive drugs such as Papaverine or alprostadil can be injected into the penis or administered by applicator

This treatment is highly effective approximately 80% of impotent men benefit from it. It is relatively safe, with only a small risk of priapism and formation of painless penile fibrotic lesions (8-9% after two years).16

Alprostadil (prostaglandin E1) has also been administered into the urethra in men with erectile dysfunction from several causes (fig 2). Erection sufficient to allow intercourse was achieved by more than 40% of men, and home treatment reports indicate a good safety profile. This treatment will probably be tried as an initial step, and those who fail will then be managed with intracavernosal injections.

Mechanical devices

The simplest and least expensive treatment is a vacuum constriction device shown in figure 3. Air is pumped out of the cylinder with the hand held pump to create a vacuum and cause an erection. The constriction band is then pulled off the cylinder onto the base of the erect penis and the cylinder is removed. This treatment is reliable and has few adverse effects when used properly It is often accepted by older patients in a longstanding relationship, whereas younger patients may prefer to try other treatments.

Penile prostheses are surgically implanted devices that provide penile rigidity (fig 3)

With the two piece inflatable prosthesis, the pump and reservoir are in the scrotum and are used to inflate the cylinders into the erect position. The cylinders are then deflated by pressing a valve at the base of the pump to return the fluid to the reservoir.

In a three piece inflatable prosthesis, the pump is in the scrotum and the reservoir is in the abdomen. Penile prostheses are usually recommended when other treatments fail.

Semirigid, malleable rods can also be inserted into the penis to provide penile erection.

Fig 3. Vacuum Device and Penile prostheses to produce erection

Vascular surgery

Arterial reconstructive surgery is sometimes indicated in men with arterial occlusive disease,The best results are obtained in young patients with isolated arterial lesions following trauma.

Venous surgery, with extensive ligation of the veins that drain the corpora cavernosa, is sometimes used as the last resort before the implantation of a penile prosthesis in young men with veno-occlusive disease. The results are generally poor as only 30% of patients report long term improvement.

Conclusions

Although the ideal treatment for erectile dysfunction has not yet been found, important advances have been made. Greater openness in society has stimulated research and made it easier for patients to seek help. However, doctors are generally reluctant to discuss the topic with their patients.So if you have any sexual concerns bring it to notice of your doctor.