Your Sexual Health

What are the safest, most effective, birth control options on the market?
There are many birth control options on the market and what is best for someone else may not be what is best for you. Your choice of birth control has to be able to work with your body and lifestyle. Birth control pills are 99.9% effective when used properly, but if you're not a good pill taker, this may not be the best method for you. Talk to your doctor about choosing the best birth control method for you. However, always remember that condoms are the ONLY method of birth control that protects you from STDs.

Will my sex life change after having a baby?
Most likely yes, but it doesn't have to. After bringing home a new baby your whole life will change, which will take some adjusting. One of those adjustments will be dealing with a decrease of time and energy that you used to have for your sexual relationship. Keep open communications with your partner and make time to keep your sex life alive- find ways to make it creative and fun.
-Dammun Pierce, M.D., Hilton Head OB/GYN

Where did my libido go? Can I get it back?
This is one of the most common questions that a gynecologist hears. The first thing to do to help get your "groove" back is talk about it with your doctor. Helping improve libido involves a multi-faceted approach due to the complexity of the female libido.
Hormones: Balancing hormones can make sex easier and enjoyable again.
Medications: Some medications may decrease your libido, including certain anti-depressants and anti-seizure medicines. Depression, if untreated, can also diminish desire. Other physical conditions, like hip or back pain, arthritis, or recent surgeries, can make intimacy difficult. Physical therapy can help a woman be more flexible and able to be intimate with her partner.
Life's ups and downs: Job, economical, and relationship stresses all play an important role in libido. Alcohol and recreational drug use can also negatively affect libido, as can weight gain or self-esteem issues. A woman needs to be well rested, have a healthy diet, and good self-esteem. To be comfortable with sex, you must first be comfortable with yourself!
-Tracy Blusewicz, M.D., Advanced Women's Care

I feel embarrassed discussing sexual issues with my gynecologists. Help me overcome this! "I can almost guarantee that you can't say anything that we haven't heard before! We talk about sexual issues all day long with women of all ages (and sometimes with their partners)." I can't do anything about it if you don't tell me what is going on!"
-Katherine Coley, M.D., Advance Women's Care
"First thing is do not feel embarrassed! We are very used to talking about how your body works in great detail and sexual details are no different. My other piece of advice is to address these problems openly in your visit. If you save these questions until the end of the visit, or spend a lot if time on other issues that may not be as important to you, then we may not have a chance to give these issues the time they deserve."
-Meredith Mitchell, M.D., Coastal OB/GYN

Sex after menopause: Does menopause have to mean "men on pause"?
Many women will notice a change both in desire for sex and comfort during sex. These are very normal things that happen with changes in hormone levels. As the ovaries slow in making testosterone, many women will have less desire for sex. This can be treated with testosterone replacement (with or without estrogen replacement) generally through a transdermal cream. Side effects include unwanted hair growth and elevations in cholesterol. Many women do not want to use hormones and can try lifestyle changes. The most important thing that women can do as they age is to keep up good communication with their partners. Men also are going through significant sexual changes as they age. Many couples will find other ways to be intimate other than penetrative sex. Working through these challenges together can actually bring you closer together.
-Meredith Mitchell, M.D., Coastal OB/GYN

What's happening if sex hurts?
There are a lot of reasons for sex to hurt, depending on what stage of life you are in. The problem can arise from either the vagina itself or from deeper in the pelvis. Vaginal issues could include inflammation from infections such as yeast, bacterial vaginosis, or an STD, such as genital warts, trichomonas, herpes, gonorrhea or chlamydia. Another vaginal issue is dryness from lack of lubrication. Often using a lubricant is helpful, but for the postpartum woman who is still breastfeeding or the peri- or postmenopausal woman, using a topical estrogen cream in the vagina can help the vaginal walls be more "elastic" and make sex more comfortable. Some pelvic issues that can cause pain include endometriosis, ovarian cysts, interstitial cystitis, fibroids or pelvic congestion. Some of these conditions can be seen on ultrasound, and some are diagnosed through history. Discussing your pain with your doctor can help to pinpoint what the problem is and aid in fixing it.
-Katherine Coley, M.D., Advanced Women's Care

I don't feel attractive anymore. How can I bring my sexy back?
Every women has something beautiful about her. Play up your strengths! If you have nice hair, great legs, or beautiful eyes wear clothes that highlight them. Use that strength to feel more confident. Confidence=sexy!
-Meredith Mitchell, M.D., Coastal OB/GYN

Am I the only one feeling like I never have sex? What is a "normal" frequency of sex?
There is no one right answer to this question! Every couple has to come up with their own right answer. And that is the key...it's something you have to come up with together. If he wants it all the time and you want it rarely, you will both be unhappy. Women dealing with the strain of trying to balance career, kids, family, and being a wife often don't have the time and energy to also feel like a sexual person. Making time to be with your partner, and doing things together that you both enjoy, helps engender those feelings of closeness that many women need in order to want to have sex. Sometimes even scheduling times to have sex can not only give you the time you need to unwind and get into the mood, but anticipation can make that time better.
-Meredith Mitchell, M.D., Coastal OB/GYN

What other health factors can affect my sex life?
Health problems, including being overweight, diabetes, and high blood pressure, affect one's sex life by decreasing libido and endurance. Both estrogen and testosterone levels are affected in a negative way, decreasing the benefits they are responsible for. Hormones in the body are a symphony, each playing a role important in sexual health. The above stated medical conditions disrupt their perfect concert, and thus, create undesirable sexual performance. Lab evaluation of levels, followed by supplementation, along with treating disease with the right drugs, will lead to a satisfactory sex life.
-Gaston O. Perez, M.D., FAAFP, Global Family Medicine

What is an orgasm? How do I maximize my chances of having orgasm during sex?
An orgasm in a female is defined as the sudden discharge of accumulated sexual tension during the sexual response that results in involuntary rhythmic muscular contractions of the pelvic floor, and is accompanied by characteristic changes in heart rate, blood pressure and respiratory rate.
Between 70 and 80 percent of females require direct clitoral stimulation to achieve orgasm. The clitoris has over 80,000 sensory nerve endings, well more than any other part of the human body. The clitoris in females is the equivalent to the penis in males. It is the small bulb structure that sits at the very top of the vagina and urethra where the labia minora (inner lips) meet.
Difficulty reaching orgasm in females is significantly more common than in males. The time required for a man to reach orgasm is, in general, four minutes, while for a female it is 10-20 minutes with a partner and four minutes when masturbated (which makes an argument for the communication comment to follow). Communicating with your partner about what you want and need to reach orgasm is very important, as men tend to generalize a woman's trigger for orgasm based on sexual experiences with other women, and one shoe does not fit all. Lack of foreplay and feelings of sexual inadequacy or guilt on the part of either partner are other major inhibitors to reaching orgasm.
PET scans of the brains of females demonstrate over and over that the brain regions associated with behavioral control, fear and anxiety shut down with orgasm which means that deactivation or "letting go" of all fear and anxiety might be the most important, or even necessary, thing to achieving orgasm.
-Kristi Blessitt, M.D., Bon Sain OB/GYN

My friends use sexual "aids" and a prescription cream to help heighten orgasm. I'm interested, but where do I start?
Some women use sexual aids to increase sexual enjoyment and heighten orgasm. There are topical agents, that can be applied directly to the clitoris, that enhance sensation by increasing blood flow and engorging it so that it is more sensitive. Start by trying some over the counter ointments/aids. Believe it or not, many are sold in your local super store in the feminine hygiene/condom isle.
Other women choose to use vibrators alone or with their partners for clitoral stimulation. Viagra, which has traditionally been used for male erectile dysfunction, can be used orally or compounded into a topical cream applied to the genitals. It works by increasing blood flow to the vaginal region and clitoris thereby increasing lubrication and sensation.
-Kristi Blessitt, M.D., Bon Sain OB/GYN

*Be sure to make an appointment with your practitioner to discuss whether the prescriptions available would be appropriate. There are many health factors that determine whether you are a candidate.