Sex and Sexual Health
Sex and sexual health is a natural and important component of an individual's overall wellness.
An individual's perspective about sex and sexual health may be influenced by societal, familial, religious and cultural norms. This allows and facilitates many diverse views and practices.
Sex can be used as an expression of love, a form of intimacy and of an act for procreation.
Adult partners must be willing and give consent to engage in sex.
What is dyspareunia?
This refers to pain during sexual intercourse.
How do you manage dyspareunia?
- Change in position – penile cushioning
- Using lubricants and/or moisturizers
- Treatment of medical conditions that may cause pain e.g. endometriosis, chronic pelvic pain
- Pelvic floor physical therapy
- Pelvic floor osteopathic manipulative treatment
- Medication
What is vaginal stenosis?
This is narrowing of the vaginal opening and canal. Vaginal stenosis is a common contributor to pain during intercourse.
This may occur after:
- Repair of vaginal tears or laceration after a vaginal birth or repair for a vaginal injury or after vaginal surgery
- With menopause
- After pelvic radiation therapy.
How do you manage vaginal stenosis?
Patients should seek evaluation and management by a women's health clinician. Treatment options include pelvic floor exercises, physical therapy, use of dilators, radiofrequency treatment etc.
Sex after Menopause
Menopause is a normal part of aging and menopausal changes are most likely to impact sex. The decrease in female hormones contribute to changes in the urinary and genital system leading to vaginal dryness, decreased skin elasticity, loss of fat and thinning of pubic hair. These in turn cause pain or discomfort with intercourse, increased risk of skin tears, vaginal stenosis, increased urinary tract infections, decreased libido etc. These symptoms may cause women to avoid intercourse or forgo intercourse altogether.
Women should seek out evaluation by a woman`s health clinician as many of these conditions can be effectively treated or managed.
Sex after Cancer
Women diagnosed with breast and other gynecological cancers (e.g vaginal, vulvar, uterine, ovarian, cervical) also encounter changes in sex after diagnosis and treatment of their cancers. Post treatment, some women are reluctant to engage in intercourse because:
- They are self-conscious about their bodies and are unwilling to show or share with their partners
- Surgical scarring
- A woman may be ashamed of her cancer diagnosis.
- Absence of desire for intercourse or intimacy
- Pain
- In some pelvic cancer treatments – surgery may require complete removal of genitalia leading to significant distortion of the anatomy.
- Other medical conditions including mental health diagnosis
Discussions regarding post-surgical or post treatment recovery is a significant part of the counseling that women with cancer receive. These sessions are important for all women to plan for upcoming changes as well as allow the woman to address her questions and concerns. Part of these discussions involve providing resources to the woman and her partner about sex and sexual health. Post-surgical care and counseling is another space to discuss concerns with sex and sexual health.
Sex with Prolapse
Women with prolapse may find sex to be difficult or painful and some women may choose to discontinue sex altogether due to embarrassment or poor body image. Women with prolapse may engage in penetrative sex by wearing a pessary (device that sits in the vagina, used to treat prolapse and/or urinary incontinence). They may also modify positions during intercourse – laying on the back or elevating the pelvis during intercourse reduces the prolapsing or protruding organ. Generous use of lubricant will also help decrease pain and discomfort.
Sex and Urinary Incontinence
Women with prolapse or urinary incontinence may encounter leakage of urine during intercourse. These episodes of leakage may be decreased by emptying your bladder prior to sex, treating the underlying cause of urinary incontinence, pelvic floor exercises.
What are sexual dysfunction disorders?
Female sexual disorders refer to conditions that arise during sex and cause persistent distress to the woman.
What are the types of sexual dysfunction?
- Pain
- Arousal
- Desire
- Orgasm
Pain Dysfunctions include vaginismus – which is caused by spasm of the pelvic floor muscles. This can be mild, moderate or severe. Women with this condition may be unable to or poorly tolerate pelvic exams, are unable to utilize tampons or have penetrative sex.
Arousal Dysfunction – a woman is unable to experience excitement.
Desire Dysfunction – a woman has no or low interest in sex.
Orgasm dysfunction – unable to reach orgasm. Can be primary or secondary.
- Primary anorgasmia – woman has never had an orgasm.
- Secondary anorgasmia - previously able to reach orgasm, but no longer can.
Notes:
- Women of reproductive age who do not desire pregnancy should use contraception.
- Contraception does not protect against sexually transmitted diseases.
- All sexually active individuals should obtain STD testing at least once in their lifetime.
- Individuals who have multiple sex partners should consider taking PrEP (Pre-exposure prophylaxis. Medications intended for use by individuals who are HIV negative but are at high risk of getting infected with HIV).
- A woman may use intimacy enhancing tools such as toys, literature, clothing to add to the experience. Devices may also be used to aid in treatment of some of the sexual dysfunction disorders.
