Sexual Health – Page 3 – DR DICK SEX ADVICE

Experiencing pain during or immediately after sexual activity—known as dyspareunia—is a condition affecting many women, yet it remains a topic often shrouded in silence. This medical issue, which can affect both physical and emotional well-being, is more common than many may realize. Understanding and addressing this condition is crucial for promoting overall sexual health and quality of life.

Dyspareunia can affect men and women, but it’s more common in women. Pain during or after sex can affect about 10–20% of women in the U.S. This may be a low estimate, though, as many women don’t seek medical help for painful sex and therefore underreporting is likely.

It happens during or after sex

“Dyspareunia is any time women report pain with intercourse,” Dr. Savells said, noting it can also “be defined as anytime there is pain with sexual activity because that doesn’t always involve a partner.”

It is typically painful during sex but can also “include time immediately following that, so in the next several minutes, not a day or two later. That would be something else,” she explained.

Keep an eye out for these symptoms

“Symptoms can be external irritation—around the clitoris or around the opening of the vagina—but a lot of the time it is inside the vagina,” Dr. Savells said. “And that can be with initial contact or foreplay, or it can be with penetration.

“Some patients can even specifically differentiate the difference between pain that occurs as soon as a partner tries to enter versus that which occurs from deep thrusting,” she added. “Being able to provide these kinds of details to your doctor can help them determine the cause.”

Menopause is a main cause

“The causes of dyspareunia include the thinning of skin and lack of estrogen that both occur with aging as women go through menopause,” Dr. Savells said. “This is very common. Probably about 40% of all menopausal women say they have difficulty with their intercourse, their intimacy.

“That can be due to both vaginal atrophy—which is thinning of the skin—and it can also be due to vaginal dryness,” she added. “A lot of women have both of those, but they are two distinct problems.”

There are other causes

“Patients who have pain with intercourse can also have muscle spasms in the muscles around the vaginal wall. These muscle spasms can cause pain with sex but can also be a cause of chronic pelvic pain that is unrelated to intimacy,” Dr. Savells said. “If they’ve had a painful intercourse experience in the past, it can cause them to be tense because there’s fear that pain will occur again.”

“It can be due to just stress and anxiety. Or it can be due to post-traumatic stress disorder from a previous traumatic event, such as assault or rape,” she said. Vaginismus, which is an involuntary tensing of the vagina that is often experienced at the start of sex, while inserting a tampon or while getting a pelvic exam, is another reason.

“Some patients can also have pain with sexual activity due to a skin condition called vestibulitis, which is an irritation of the skin at the posterior portion of the vaginal opening,” Dr. Savells added. “Unlike several of the other skin changes which can cause sex to be painful, this condition is often treated with surgery instead of topical creams.”

“Less commonly, some patients can have scar tissue from previous surgeries to their labia or their vagina. And yet another cause for dyspareunia can be an enlarged uterine fibroid, which can also cause pain with intercourse,” she said. “There are even some bladder conditions that can cause pain with intercourse.”

Additionally, “some patients as they get older will have something called vaginal stenosis or vaginal narrowing and the same vagina that worked with that partner 10, 15 years ago is now too small,” Dr. Savells said, noting patients will say, “I’ve got the same partner, why don’t we fit together anymore?”

“It’s because the vagina is actually getting smaller,” Dr. Savells said.

Dyspareunia is also common for women post-pregnancy if they had a traumatic vaginal birth or issues with prolapse.

Vaginal dryness is a concern

“Stress, anxiety and depression can all cause patients to have difficulty with the arousal component of their sexual function,” Dr. Savells said. “But as far as pain goes, a lot of times that’s due to the dryness.”

For example, “a lot of patients with cancer will have dryness due to their chemotherapy or other treatments they’ve had,” she said. “If patients have had pelvic radiation for uterine cancer or cervical cancer, they may have dryness and pain due to that.

“They may have scar tissue due to that, but even patients who’ve had chemotherapy for nongynecologic reasons can have a lot of vaginal dryness as a side effect of their medication,” Dr. Savells said.

Treatments vary depending on cause

“There are a lot of things that we can do to help patients who are having pain with sex. I don’t ever want anybody to feel like it’s their fault or they’ve created the problem,” Dr. Savells said. One of the most- common causes is “when a woman is having problems because they are estrogen-deficient. Lack of estrogen is the definition of menopausal and for most women, that is about 50 years old.

“But there are also much younger women who are also estrogen-deficient; if they have had an early hysterectomy or if they have had breast cancer and had to have their ovaries taken out,” she added. “For most women who are estrogen deficient, the primary thing we start with is estrogen cream. There are women with contraindications to estrogen therapy, however, so it is essential for patients to consult with their physician about whether or not this is appropriate for their individual situation.”

“If your vagina is out of estrogen, you just add back more estrogen. And for a lot of women that is very effective and fixes their problem,” Dr. Savells said. “There are also nonhormonal therapies for vaginal dryness and vaginal atrophy, so we have options even for those women who cannot take estrogen replacement too.”

For example, Dr. Savells’ practice has a MonaLisa Touch laser, which she said is “super effective.”

“Mona Lisa Touch treatments include lasering of the vaginal tissue and the tissue that surrounds the vaginal opening on the outside. As a result, all the skin in the treated area becomes thicker and stronger. This helps those women lubricate more-naturally when they become aroused, and also reduces the microscopic tears which cause many women to feel a burning sensation after sex,” she said. “For both pre-menopausal or estrogen deficient women, these treatments can be very beneficial. For patients who have vaginal spasms, pelvic floor therapy is helpful for them.

“But therapy is not a quick fix,” Dr. Savells added. “For immediate help, sometimes those patients will get injections into the muscles around the vagina to help relax those muscles so that they don’t spasm and have so much pain.”

“We also utilize compounding pharmacies to make vaginal suppositories that have muscle relaxers in them to help relax those muscles,” she said. “And sometimes patients will insert a vaginal suppository with a muscle relaxer in it a little while ahead of when they anticipate intercourse might happen. That will help relax them a little bit so that they don’t have as much discomfort.”

“For someone who has a condition called vestibulitis, which is a specific type of irritation in the skin at the posterior portion of the vaginal opening, surgery is necessary. Fortunately, this is a relatively minor procedure and simply involves excision of superficial skin in the affected area,” Dr. Savells said. “Sometimes I’ll see patients who just need a little bit of help, they’ve just had a little bit of narrowing and a very short course of dilator therapy, from four to six weeks, gets them back to where they want to be.”

Dilator therapy is a treatment that is used to gently stretch and expand your vaginal tissue over time. This improves its elasticity and reduces the pain you may feel during sexual intercourse.

“If your pain with intercourse is due to uterine prolapse or the uterus falling down, then a hysterectomy may be necessary,” she said.

It can affect your mental health

“Lots of women feel insufficient in their relationship at home. A lot of women feel less sexy or attractive and it causes significant relationship conflict in some households,” Dr. Savells said. “So, it’s kind of the chicken-and-the-egg discussion.”

“For some people, the anxiety, stress, a previous trauma, history of PTSD can lead to pain with intercourse,” she said. “And then for some patients, some other medical condition was the initial culprit of the pain with intercourse.

“But because of that, now they have anxiety or depression or feel like they’re less than,” Dr. Savells added.

Try pelvic floor physical therapy

“I’m a huge fan of pelvic floor physical therapy,” Dr. Savells said, noting that “physical therapy is great for patients whose pelvis floor muscles have gotten too relaxed as they get older and they may be having urine leakage, some stress incontinence, things like that.

“But it’s just as helpful for patients whose muscles are too tight, which is really where it plays into this discussion,” she added. “So, those patients with vaginismus—where they have lots and lots of tension in their pelvic floor muscles—a physical therapist is good at helping them learn to relax those muscles.”

“We don’t pick how we exhibit our anxiety or our stress or our attention and some patients just tend to have a lot of tightness in their pelvic floor muscles just like other patients report neck tightness or stiffness,” Dr. Savells explained. “A physical therapist can help patients learn to isolate those muscles—it’s not intuitively obvious—and help them learn to be intentional about relaxing those pelvic floor muscles.”

Continue treatment to prevent return

If dyspareunia is treated appropriately, the pain “shouldn’t recur as long as the patient is continuing their treatment,” Dr. Savells said. “Patients have had really good success. If they get the right diagnosis and the right treatment, most of them don’t have problems again as long as they maintain their therapy.”

For example, some “menopausal women will use their estrogen cream, get better and then feel like they are cured, and they will quit using their cream. Then a year later the problem comes back,” she said. “In the beginning it’s hard to convince people this is a chronic thing. This is your new normal.”

Set realistic expectations for sex

“If you surveyed thousands of women, about 40% of them across the board will say that they have concerns about their sexual function,” Dr. Savells said. “But a lot of times, especially in younger women, they have concerns that their body isn’t quite normal because of what they’re comparing themselves to or their partner is telling them that their sex drive is not as good as it should be, that their frequency of intercourse is not as good as he would like for it to be.”

“A lot of their concern about their sex life has to do with setting realistic expectations for them, reassuring them that their anatomy is normal, that their sexual frequency is in fact normal despite what television or social media tells them,” she said. “So, about 40% of women will say that they have sexual concerns, but only 15% of women have true sexual dysfunction, which means it’s interfering with their ability to perform—they can’t have intercourse, they don’t enjoy intercourse.”

Include your partner in the process

“If someone’s doing dilator therapy, that can involve a partner. If you’re doing marital therapy or sex therapy, obviously those involve a partner,” Dr. Savells said, noting “sometimes partners are affected by a woman’s treatment course in other ways, although not directly involved. If a patient requires gynecological surgery for her painful intercourse, then she will be required to abstain from sexual activity for a period of four to six weeks. This is a great opportunity for a partner to be emotionally supportive of her feelings and sexual health.”

“It’s important to include them in the communication so that they understand why this is hurting. A lot of times, it’s often important for patients to reassure their partner that it’s not you,” she said. “Men are often very affected by this problem as well because as soon as the woman is feeling pain, she’s withdrawing a little bit and not as eager to initiate sexual contact. … So, it very much becomes a problem for both of them.”

Don’t be embarrassed

“This should be something that your gynecologist is super comfortable having a conversation about,” Dr. Savells said, noting that “I probably have this conversation multiple times every day, so don’t be embarrassed.”

“Your gynecologist should be super comfortable talking to you about your sex life, the parts that are good, the parts that are bad, the parts that need improvement,” she said. “We have lots of options for how to help.”

Complete Article ↪HERE↩!

August 29, 2024May 13, 2026

How a survey of over 2,000 women in the 1920s changed the way Americans thought about female sexuality

In the 1920s, many women became more comfortable in their skin. But the facts of life remained in short supply.

By Anya Jabour

American women still have fewer orgasms than men, according to new research that suggests that decades after the sexual revolution, the “orgasm gap” is still very much in effect.

One of the study’s lead authors at the Kinsey Institute for Research in Sex, Gender, and Reproduction told The New York Times that the gap persists because many Americans continue to “prioritize men’s pleasure and undervalue women’s sexual pleasure.”

As my research shows, these attitudes toward sexual pleasure have a long history.

But so do efforts to push back against them.

Almost a century ago, a pioneering American sex researcher named Katharine Bement Davis challenged the prevailing view that respectable women did not – and should not – experience sexual desire or have sex, except to please men or to have children.

Davis’s 1929 book, “Factors in the Sex Life of Twenty-Two Hundred Women,” completely upended this thinking.

By surveying everyday American women, she was able to show that it was completely normal for American women to have sex for the sake of pleasure.

An unlikely advocate for sexual liberation

Davis spent the first half of her career policing women’s sexuality, not promoting it.

In 1901, after earning her Ph.D. at the University of Chicago, Davis became superintendent of the New York State Reformatory for Women at Bedford Hills. While there, she studied the women in her care. Most female convicts, she concluded, were “immoral women.”

Davis’ efforts to enforce sexual morality drew the attention of philanthropist John D. Rockefeller Jr. In 1917, he invited her to lead his private agency, the Bureau of Social Hygiene, founded to study and combat prostitution and venereal disease.

During World War I, Davis promoted sex education to curb sexually transmitted infections among soldiers and civilians. Through this work, she became convinced that sexual ignorance – not sexual immorality – posed the greatest danger to women’s welfare.

Davis had long criticized the sexual double standard, which condoned men’s sexual experimentation but condemned women’s sexual experience.

Now, she also recognized that this double standard promoted women’s chastity at the expense of knowledge. She complained that discussions of women’s sexuality were “taboo,” which resulted in “distorted views, baffled speculation, and unfortunate experiences.”

Tackling a taboo topic

Insisting that Americans needed accurate information to achieve “a sane outlook on all matters pertaining to sex,” Davis made it her mission to teach women about sex.

But first, she needed to learn about women’s actual sexual experiences. Davis decided to undertake a large-scale study of what she called “the sex life of normal women.”

Davis’ approach was a dramatic departure from existing studies of “abnormal” sexuality focused on institutionalized populations. “Except on the pathological side,” she remarked, “sex is scientifically an unexplored country.”

Woman in white blouse seated in chair posing for a portrait next to a bouquet of flowers. — Katharine Bement Davis was frustrated by the double standard that celebrated men’s sexual experiences and condemned those of women.

By contrast, Davis explained, she wanted to understand “the woman who was not pathological mentally or physically.”

To that end, Davis distributed a detailed questionnaire to what she called “women of good standing in the community” from 1921 to 1923. The resulting study sample of 1,000 married women and 1,200 unmarried women was not representative – it skewed white, well-educated and well-to-do. But their responses allowed Davis to redefine female sexuality.

America’s first sexual revolution

Davis launched her study of women’s sexuality during what historians now refer to as America’s first sexual revolution. The second – and more well-known one – would take place in the 1960s.

In the 1920s, as one commentator noted, a “revolution in manners and morals” was underway. Sex suffused popular culture. Contestants in beauty pageants displayed their charms in skimpy bathing costumes and short skirts. Actresses flaunted their sex appeal on stage and screen.

New attitudes about sex affected the daily lives of average Americans, too. Young women throughout the nation adopted the sexy look of “flappers,” the term used for women who sported short skirts, rolled stockings and bobbed hair.

Prior to the 1920s, courtship often took place in the home, allowing parents to closely supervise couples. But the ubiquitous automobile – which one juvenile court judge had dubbed “a house of prostitution on wheels” – rendered adult chaperonage obsolete and granted young people unprecedented sexual freedom.

Meanwhile, birth control activists like Margaret Sanger and Mary Ware Dennett distributed contraceptive devices and disseminated sexual information in defiance of the Comstock Act of 1873, which had defined birth control and sex education as “obscene” and made circulating such materials a federal crime.

Sex, secrecy and shame

Even amid the nation’s first sexual revolution, the facts of life remained in short supply.

According to surveys Davis distributed to married women, only about half of the respondents believed that they had been “adequately prepared … for the sex side of marriage.”

After expanding her study to include unmarried women, Davis found that fewer than one-third of all participants received sex education from their parents.

Many women didn’t know how pregnancy occurred. Some had been unprepared even for menstruation. One recalled that when she experienced her first period, “I naturally thought I was bleeding to death.”

In place of information, many women imbibed shame. “Having acquired the feeling as a small child that any sex pleasure was shameful and a great sin,” as one respondent put it, some could never overcome their discomfort with sex. Another woman regarded all sexual thoughts as “something to be shunned like the devil.”

One response succinctly summarized the problem: “Our present secrecy, fear, and repression are responsible for most of our sex ills.”

Challenging the conspiracy of silence

Many women were eager to challenge what one called a “conspiracy of silence” surrounding female sexuality.

Study participants ended up providing Davis with over 10,000 pages of handwritten responses. She used this information to produce the nation’s first major study of women’s sexuality, a 400-plus page book brimming with both statistical data and personal stories.

“Factors in the Sex Life of Twenty-Two Hundred Women” covered a wide range of topics, ranging from sex education to sex play. Running throughout the entire work, however, was one central idea: Women liked sex.

Davis included data on birth control, same-sex relationships and masturbation. At the time, these practices were universally stigmatized and often criminalized. Yet significant proportions of study participants engaged in all these activities.

Nearly three-quarters of married respondents reported using contraceptives. Many probably took advantage of state laws allowing physicians to prescribe diaphragms to protect patients’ health. Surprisingly, nearly 1 in 10 women admitted having abortions, even though the procedure was illegal in every state.

More than half of unmarried women and nearly one-third of married women stated that they had experienced “intense emotional relationships” with other women. In each group, approximately half described those relationships as sexual. This was a remarkably high figure, given prevailing views of homosexuality as sexual deviance and state laws criminalizing homosexual acts.

Nearly 65% of unmarried women and more than 40% of married women reported masturbating. Since nearly all physicians and pastors condemned the practice, Davis assumed the actual numbers were even higher.

Davis’ data demonstrated that “normal” women experienced what one called “natural sex feeling.” In short, her study showed that many women enjoyed sex for its own sake.

Davis believed that reliable data would lead to “more satisfactory adjustments of the sex relationship.” In other words, better information would lead to better sex.

Davis paved the way for future studies that validate women’s sexual pleasure. While researching female sexuality, she established the National Research Council’s Committee for Research on the Problems of Sex. The Rockefeller-funded committee later subsidized Alfred Kinsey’s studies of human sexuality.

Davis’ legacy lives on. The findings from the Kinsey Institute’s latest study show that discussing sexual pleasure still matters, particularly for women. It also suggests that Americans’ understandings of sex have improved over the past century.

When Davis conducted her study in the 1920s, she found it “advisable” to define “orgasm” for participants who were unclear on the concept. Now, a generation of better-informed Americans ponder how to address a persistent “orgasm gap.”

Complete Article ↪HERE↩!