The Sex Talk: You've Got Questions..We've Got Answers
April 2023 Issue — Pink Prescriptions
The Sex Talk: You've Got Questions..We've Got Answers
You can’t welcome spring without talking about the
birds and the bees. So, here it is: The sex talk.
Tracy Blusewicz, M.D. — Advanced Womens Care of the Lowcountry
I used to love sex, but now it’s painful. What can I do to revive my sex life?
If your sex life went from “Oh my!” to “Oh no!” there are a few common reasons and ways to try to revive the connection. Childbirth and pregnancy change the vagina and can result in painful sex for at least the first year after delivery. The weight of the uterus during pregnancy stresses the pelvic floor and can cause weakness and lack of support. This can change the angle of the vaginal canal and clitoris, which then changes sensation for both partners. If the beautiful new baby came through the vaginal route, there can be resulting tears or episiotomies which can cause long term scar tissue and pain during sex. Even C-section moms have changes in the pelvic floor due to the pressure of the baby’s weight during pregnancy. Imagine this change happening to the pelvic floor with multiple pregnancies over the years, the results are compounding and can create lack of sensation, pain with penetration and urinary incontinence.
Kegel exercises, pelvic floor physical therapy, RF (radiofrequency) and laser devices that heat the tissue and cause remodeling of the support of the vaginal canal all help. Toning devices that have EMS (electrical muscle stimulation) or MMS can strengthen the pelvic floor, think of these as a gym for your vagina. I have personally conducted studies that show RF increases the amount of elastin in the vaginal tissue (think of getting your stretch and bounce back), and EMS helps with the muscle tone of the pelvic floor (think of support and ability to respond to penetration). Two examples of these devices are the Forma V and V tone by Inmode.
Menopause and change of hormone levels are also a huge factor in diminishing pleasure with sex and painful sex. Using oil-based lubricants, like coconut oil or vitamin E, can help with the friction and tearing of the dry vaginal tissue. Prescriptions like estradiol cream, suppositories, pills, and rings also help with the natural lubrication and “stretch” of the vaginal surface. In cases of severe vaginal dryness and tearing, laser and RF devices can save a couple’s sex life.
If sex suddenly becomes painful, or if there is bleeding involved with attempted sex, there may be a pelvic reason like an ovarian cyst, uterine fibroid, vaginal infection, endometriosis, or a cervical polyp, and you should go to a gynecologist for an ultrasound and further evaluation.
If sex has never been enjoyable or you have never been able to place a tampon, there could be reasons like vaginismus, a vaginal septum, or an imperforate hymen and you should see a gynecologist or pelvic floor specialist for further evaluation and treatment.
I often hear women say they are frustrated and ready to give up on being intimate and the ability to enjoy sex, but listen up, you don’t have to! I want to reassure you there are multiple available solutions for you to try. Talk to your gynecology provider; the topic of painful sex is not taboo, and the solution is here.
Tracy Blusewicz, M.D. of Advanced Womens Care of the Lowcountry is a Cosmetic Gynecologist and Vaginal health expert. She is a national and international trainer and speaker for EmpowerRF Platform.
By Dr. Eve Ashby — Beaufort Memorial Hospital
What are the most effective forms of birth control?
Sexually active women should know that there’s still chance of pregnancy even if they are using birth control. For this reason, it’s sometimes considered safer to combine a hormonal method with a barrier method to be sure there isn’t an unplanned pregnancy.
The most effective form of contraception is sterilization (tubal ligation/vasectomy), followed by LARCs (long-acting reversible contraception) such as the IUD and subcutaneous implant. These do not require too much patient compliance, so they are the best. Pregnancy rates are less than 1 per 100 women using these methods each year.
In the middle on the effectiveness scale are birth control pills, injections, patches, rings, and diaphragm, which have 6-12 pregnancies for every 100 women per year.
The least effective method is fertility awareness (or “rhythm” method), spermicide alone, and barrier methods alone (condoms, cervical cap and sponge). Pregnancy rates for these methods are 18 per 100 women per year.
The best method is the one you feel you can remember and doesn’t have any bothersome side effects. Keep forgetting your pill? Try something longer acting like the ring or IUD. There are many choices now!
I’ve been single awhile, and now that I’m seeing someone, I’m considering becoming sexually active again. Birth control is no longer an issue. What should I be concerned about instead?
If you are not at risk of becoming pregnant due to menopause or a hysterectomy, birth control may not be an issue, but sexually transmitted infections (STIs) still are. Therefore, it’s important to protect yourself from gonorrhea, chlamydia, hepatitis, syphilis, herpes, and HIV.
While condoms are not 100 percent foolproof in protecting from these STIs, they drastically reduce your risk. Also, consider getting the HPV vaccine, which is now approved up until age 45, especially if you have never had a history of having HPV.
Ideally, talk to your partner about getting STI screens before entering into a sexual relationship and consider starting to use products that will help with vaginal lubrication a few weeks to months before becoming sexually active.
Eve A. Ashby, DO, FACOOG, is a board-certified gynecologist with Beaufort Memorial Lowcountry Medical Group in Beaufort and Okatie. Dr. Ashby is also an Assistant Professor and Regional Director of Medical Education for A.T. Still University School of Osteopathic Medicine.
By Katherine Coley, M.D. — Advanced Women’s Care of the Lowcountry
My partner thinks about sex all the time, but it seems to never be on my mind. Does this mean I have low libido?
Libido for women is complex, but at the base of it all is your testosterone level. Women produce three main hormones from the ovaries: estrogen, progesterone and testosterone. Even before menopause, one of the first hormones to drop is your testosterone level, affecting your libido. After menopause, forget it, there is none, and additionally, you have low estrogen which causes vaginal dryness and lack of elasticity. So now you not only don’t have any desire for sex, but it hurts, too! There is a solution. Most gynecologists offer targeted hormone testing and a variety of hormone replacement options, regardless of what stage you are in. Our happiest patients are our hormone replacement patients on testosterone supplementation (with or without the other hormones.) My patients tell me all the time we have saved their marriages, renewed their relationships, and helped them with a part of their lives they thought was gone forever. Get an evaluation and discuss what your options are for your specific hormone replacement needs.
Dr. Katherine Coley is a Board Certified Ob/GYN at Advanced Women’s Care with 13 years of experience. She graduated residency from New York Presbyterian hospital/Weill-Cornell program. Call for more information: 843-301-0718.