Common Sex Problems Female

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Common Sex Problems Female

  1. 1. <ul><li>Common Sexual Problems In Females & Solutions </li></ul><ul><li>Dr.Dhananjay Gambhire </li></ul><ul><li>MD(Psychiatry) </li></ul>
  2. 2. Talking about sex <ul><li>Doctors or Parents </li></ul><ul><li>Non-judgmental, understanding approach </li></ul><ul><li>Start with general enquiries </li></ul><ul><li>Acknowledge the difficulty in talk </li></ul><ul><li>Encourage the person to talk about sex </li></ul><ul><li>No assumptions </li></ul>
  3. 3. Myths <ul><li>Sex = Intercourse. </li></ul><ul><li>Man should be sexual leader. </li></ul><ul><li>Women should not initiate sex. </li></ul><ul><li>Respectable people should not enjoy sex too much, should not masturbate. </li></ul><ul><li>If sex is not good something is wrong with the relationship. </li></ul>
  4. 4. <ul><li>Sex with virgins increases sex power </li></ul><ul><li>Once homosexual always homosexual </li></ul><ul><li>Suhagrat should be red </li></ul><ul><li>No approved aphrodisiacs </li></ul><ul><li>Size does matter </li></ul><ul><li>No sex in pregnancy, menses </li></ul>
  5. 5. Common triggers <ul><li>Psychological </li></ul><ul><li>Relational problems </li></ul><ul><li>Life stressors </li></ul><ul><li>Anxiety </li></ul><ul><li>Depression </li></ul><ul><li>Fear of pregnancy or STD </li></ul><ul><li>Lack of knowledge of sex </li></ul><ul><li>Negative sexual history </li></ul>
  6. 6. <ul><li>Environmental - </li></ul><ul><li>Space, Children, Physical discomfort </li></ul><ul><li>Physical - </li></ul><ul><li>Pain, Illness, Drugs, Alcohol, Childbirth </li></ul><ul><li>Partner problems- </li></ul><ul><li>Non-responsive partner, Preference problems, Disinterest </li></ul>
  7. 7. Defining sexual dysfunctions <ul><li>Inability to participate in activity </li></ul><ul><li>Sexual dysfunction in all occasion </li></ul><ul><li>Duration of six months </li></ul><ul><li>Significant stress or interpersonal difficulties </li></ul><ul><li>No h/o drug use, physical disorder, mental disorder </li></ul>
  8. 8. Stages Of Sexual Activity Excitement Resolution Desire orgasm
  9. 9. Stage 1:Desire: <ul><li>Characterized by Sexual fantasies & desire to have sex </li></ul><ul><li>Reflects persons Attitude towards sex </li></ul><ul><li>Motivation </li></ul><ul><li>Drive & Personality </li></ul><ul><li>Biological drive </li></ul>
  10. 10. <ul><li>Previous good experience with sex </li></ul><ul><li>Availability of partner </li></ul><ul><li>Good overall relationship with partner </li></ul><ul><li>Adequate self esteem </li></ul><ul><li>Ability to accept oneself as a sexual person </li></ul>
  11. 11. Hypoactive sexual desire <ul><li>Deficiency or absence of sexual fantasy & desire of sexual activity. </li></ul><ul><li>F(40%)>M(30%) </li></ul><ul><li>Frequency of sex not important –lack of desire is distressful </li></ul><ul><li>Chronic stress, anxiety, depression, abstinence of sex, deteriorating relationship </li></ul>
  12. 12. Stage 2:Excitement: <ul><li>Subjective sense of sexual pleasure and accompanying physiological changes, </li></ul><ul><li>Penile erection, </li></ul><ul><li>Nipples of both sexes become erect, </li></ul><ul><li>Increased blood circulation in vagina, </li></ul><ul><li>Voluntary contractions of large group muscles, </li></ul><ul><li>Heartbeat and respiration increases, BP rises, </li></ul><ul><li>Heightened excitement lasts for 30 sec to 30 min </li></ul>
  13. 13. Female Sexual Arousal Disorder <ul><li>Persistent inability to attain ,maintain an adequate lubrication – swelling response of sexual excitement </li></ul><ul><li>60% </li></ul><ul><li>Discomfort in sexual activity </li></ul>
  14. 14. Dyspareunia <ul><li>Recurrent or persistent pain occurring in men/women before, during or after intercourse </li></ul><ul><li>F(15%)/M(8%) </li></ul><ul><li>Organic (Infection) / Psychological (Stress) </li></ul>
  15. 15. Vaginismus <ul><li>Involuntary muscle contraction of outer third of vagina that interferes with penile insertion & intercourse </li></ul><ul><li>Educated women </li></ul><ul><li>H/O sexual trauma </li></ul><ul><li>Strict religious upbringing </li></ul><ul><li>Battered relationship </li></ul>
  16. 16. Stage 3:Orgasm: <ul><li>Peaking of sexual pleasure, </li></ul><ul><li>Release of sexual tension, </li></ul><ul><li>Rhythmic contraction of perineal muscles & pelvic reproductive </li></ul><ul><li>organs, </li></ul><ul><li>Emission of semen, </li></ul><ul><li>lasts for 3 to 25 sec. </li></ul>
  17. 17. Female orgasmic disorder <ul><li>Women’s inability to achieve orgasm by masturbation or coitus </li></ul><ul><li>35% </li></ul><ul><li>Presentation-Lower abdominal pain, itching, vaginal discharge, irritability, fatigue </li></ul><ul><li>Lifelong/Acquired/Situational </li></ul><ul><li>Psychological-fear of pregnancy, hostility toward men, damage to vagina, guilt </li></ul><ul><li>Masturbation, G-spot stimulation </li></ul>
  18. 18. Stage 4:Resolution: <ul><li>A sense of relaxation ,well being Disgorgement of blood from genitalia, body back to resting stage </li></ul><ul><li>No orgasm resolution take 2 to 6 hrs </li></ul><ul><li>Females can have multiple orgasms </li></ul>
  19. 19. Postcoital headache & Dysphoria <ul><li>NSAIDS-Over the counter pain killers. </li></ul><ul><li>Rest. </li></ul>
  20. 20. Investigation <ul><li>Local examination for injury </li></ul><ul><li>Investigate for sugar blood pressure </li></ul><ul><li>Infection </li></ul><ul><li>Constipation </li></ul><ul><li>Serum prolactin, Testosterone,Thyroid hormones </li></ul><ul><li>All routine blood investigation </li></ul>
  21. 21. Rx <ul><li>Dual Sex Therapy- </li></ul><ul><li>Establish communication in marital unit, Misconceptions dealt </li></ul><ul><li>Foreplay as an enjoyable alternative to intercourse </li></ul><ul><li>Imagery </li></ul>
  22. 22. Sensate focus exercises- <ul><li>Heightening sensory awareness </li></ul><ul><li>Stage1-partners touch each other </li></ul><ul><li>Stage2-partners touch each others genitals </li></ul><ul><li>Stage3-Mutual touching </li></ul><ul><li>Stage4-women on top </li></ul>
  23. 23. Kigels exercises <ul><li>Pelvic floor muscles, Vaginismus </li></ul><ul><li>Breath normally-Quickly contract and relax </li></ul><ul><li>Contract muscle count three relax </li></ul><ul><li>Inhale slow contract three, hold three, relax three </li></ul><ul><li>Muscle relaxed bear down </li></ul>
  24. 24. <ul><li>Vaginismus- Vaginal dilations with fingers, dilators </li></ul>
  25. 25. <ul><li>Antianxiety & Antidepressant Medicines- </li></ul><ul><li>Escitalopram,Sertaraline,Imipramine. </li></ul><ul><li>Hormone Therapy- </li></ul><ul><li>Testosterone (sex drive in both male and female), Hormone Replacement Therapy </li></ul><ul><li>Water based lubricants, Saliva </li></ul><ul><li>Antibiotics </li></ul>
  26. 26. Key for Maintenance of Sexual Activity <ul><li>Availability of partner </li></ul><ul><li>Consistent sexual activity </li></ul><ul><li>Absence of vascular disease (Blood Pressure) </li></ul>
  27. 27. Masturbation <ul><li>Normal activity common in all stages of life from infancy to old age </li></ul><ul><li>4 times in a wk in adolescence </li></ul><ul><li>2 times a wk in adulthood </li></ul><ul><li>Abnormal when only type of sexual activity </li></ul><ul><li>Reassurance for teenagers </li></ul>
  28. 28. Child sex education <ul><li>Age old topic </li></ul><ul><li>Start as early as possible </li></ul><ul><li>Give books to read about sex education by doctors </li></ul><ul><li>Children's will experiment but will be safe </li></ul><ul><li>Studies have shown sex education has not increased incidence of sexual activities </li></ul>
  29. 29. <ul><li>THANK YOU </li></ul>

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