Sexual wellness

[And role of Cosmetic gynecology procedures in promoting it]

A female lives a lifetime enjoying the warmth of multiple relationships as a daughter, sister, mother, aunt, friend and colleague and later in life a granny who dotes over her grandchildren, but relationship with a man is a different from all these because of the implied sexuality. The same applies equally to a man. Sex is the keystone in any long, happy and fulfilling relationship between a man and a woman. The guy who said that a way to a man’s heart is through his stomach missed the target by good 12 inches south. Suffices to say that it behooves all couples to invest their time and energy in developing a mutually satisfying sexual relationship which can become the bedrock of a happy married life.

Now that you acknowledge the importance of healthy sex in marriage, let us define ways and means to make it better.

First things first. A thorough knowledge of the structure and functions of human genitalia is imperative to get started. In this time and age such knowledge would be taken as granted for any normal adultbut there are exceptions. If you have any doubt you will do well to back to the basics. A detailed description of the male and female genitalia and sexual organs as well as their functions is beyond the scope of this article but such information is easily attained.

The discovery of female sexuality

For ages, the prevalent culture of patriarchal society meant that sex was always a male bastion. Sexual gratification was considered a male thing. The females in Victorian era were told that sex for them is to be endured and not be enjoyed. Their job was to make their males happy in bed. In an Indian marriage the bride was blessed at the time of matrimony ‘go and bear him sons’. The implication was females were just there to bring their progeny to the world and then rear them to youth for the whole cycle to be repeated. Each act of sex was for the pleasure of the male and ended with his orgasm. Female orgasm and satisfaction was never an issue.

Studies by Kinsey [Kinsey Institute, Indiana, USA] in 1940s and 50s exploded a number of myths about the sexual practices of American adults. The study was conducted by interviewing thousands of volunteers. Masters and Johnson made the first scientific investigation into the realm of female sexual function and brought it into public focus. They used a method of direct observation of individuals performing masturbation or engaged in sex with a partner. In addition, their vital parameters including muscular and vascular responses were measured. They concluded that female sexual response can be divided into four stages –

  1. Arousal – It causes many changes in women including increase in muscle tone, a rapid rise in pulse and blood pressure and rate of breathing, clitoral swelling, expansion and opening of the vaginal lips, vaginal lubrication, and nipple sensitivity
  2. Plateau – women reach the plateau phase in which they continue to experience increases in pulse and breathing, as well as a tightening of the vaginal entrance.
  3. Orgasm – The shortest phase of sexual arousal is the orgasm, in which women undergo rhythmic contractions of the vaginal and uterine muscles described as waves of pleasure.Involuntary muscle contractions, including spasms of the feet, flushing of entire body, increase in heart rate and breathing along with sudden release of tension in body muscles
  4. Resolution – Physiological changes return to normal levels. There is a general feeling of well-being, intimacy and fatigue.

The refractory period occurs during the male’s resolution phase. It is a length of time during which a male cannot become more aroused from any kind of sexualstimulation.

Differences in male and female sexual response

  1. Females take longer to arouse.This implied that whereas males become ready to perform sex almost immediately, females need time to get ready. Therefore, foreplay becomes an important part of the act without which a female may not be physically or mentally ready for the act. Greater the emotional bonding, lesser is the time needed for arousal and vice versa.
  2. Females have longer orgasms.
  3. Females can have multiple orgasms or even status orgasmus.
  4. Females do not have a standard refractory phase. They can go on to have the next orgasm although they may not feel like doing it.
  5. Many perfectly normal females find it impossible to achieve normal orgasm during penetrative sex and need some clitoral stimulation unlike males.
  6. Many researchers have argued about the existence of 2 types of orgasm in females- a clitoral orgasm and a vaginal orgasm. Clitoral orgasm is achieved by physical stimulation of clitoris and vaginal orgasm may achieved by penetrative sex. Others argue that there is no vaginal orgasm and penetrative sex also produces orgasm due to indirect stimulation of clitoris by the male organ.
  7. Some people have suggested the presence of a g spot on the anterior vaginal wall in the females which is intensely sensitive and whereas others have denied the presence of any such entity.

Female Sexual Dysfunction[FSD]

FSD is defined by the World Health Organization as ‘the various ways in which a woman is unable to participate in a sexual relationship as she would wish’

It can be classified into

  1. Lack of desire. [HSDD -hypoactive sexual desire disorder]
  2. Difficulty in arousal {FASD- female sexual arousal disorder]
  3. Painful/ uncomfortable intercourse [dyspareunia]
  4. Inability to orgasm- It has been found out that 50-60 percent women were unable to achieve vaginal orgasms in a sexual intercourse due to psychological factors. In some, the disorder was so severe that they had no orgasm in their lifetime even on self-stimulation and masturbation.
    Many females put up a pretense of enjoying sexual act and even fake an orgasm to please their partners. In one study it was is estimated that up to 80 percent females had faked an orgasm at some time in their lives.

Incidence of FSD – It is estimated that It is estimated that at least 40 per cent females are afflicted with FSD. Some studies have quoted a much higher incidence.Up to 75 million women in the US alone continue to suffer mentally and physically from sexual problems. The numbers in our country could be mind boggling.

Scope of the problem of FSD – Human sexual function is not just important for procreation, it is an important determinant of quality of life. Most females are too reserved or shy to discuss the issue of sexual dissatisfaction with their partners, friends, leave only going to a counselor or doctor for expert help. They simply accept it as a way of life and move sex lower down in their list of priorities in life, submitting themselves to their partners’ periodic demands for sex only to keep the marriage going. But such an attitude of stoic indifference only leads to poor self-esteem, depression, ill health and poor creativity and poor productivity at work.Lack of respect for the partnerpaves the way for couples living ‘unhappily ever after’, extra marital affairs, ugly separations and bitter divorce battles fought in court rooms. The upbringing of children in an environment of bickering, quarreling and fighting parents threatens to bring forth a generation of children who are sick physically and scarred mentally. The hidden cost of ignoring this basic issue are enormous for the individuals, family and the society.

General tips for healthy and fulfilling sexual relationships

  1. Plan it- donot leave sex for the last part of the day when your energies are zapped and you are exhausted physically and mentally. Early morning is a good time to do it if you have the time as male hormones peak in the morning in their diurnal rhythm and you are fresh after a night’s sleep.
  2. Too much planning also kills romance. Be spontaneous and natural and respond to your partner’s cues.
  3. The use of lubricating jellies like KY jelly can make up for poor or inadequate secretions and heighten the pleasure for both partners and reduce chances of pain for female.
  4. Be imaginative- Consider use of sex aids like, vibrators, handcuffs edible undergarments to spice up the act. Such stuff is easily available online. More advanced sexual practices like sado-masochism, bondage or oral sex need to with consent of both partners.
  5. Tips for Males-There is nothing manly about forcing yourself on your partner. Never force apartner to have sex. Donot take your partner for granted even if she is your wife. Consent for sex should be earned every single time. A female should feel loved and wanted for her to give herself whole heatedly and the man should endeavor to do that in a relationship. A man who considers his partner just a piece of meat and flesh to be enjoyed loses it all.
    Foreplay is important for females. In an ideal relationship the foreplay for the next session begins immediately after one session is over.
  6. Tips for Females-It is not always the duty of the male to initiate sex. Nothing turns a male on more than when females make the first move. It need not be direct, innuendos work equally well, it is an art which every female has she just needs to hone her skills to ‘kill’.
    It is alright to be bashful at the outset but in a sustained relationship, males like females who discuss sex, offer suggestions and are proactive and vocal.
  7. There is no substitute for a close emotional bonding which is the basis for a mutually fulfilling sex. Each partner should strive to please the other and ‘give’ rather than focus on self- gratification and ‘take all’.

Treatment of female sexual dysfunction

Treatment of FSD is plagued y a number of problems

A] Lack of proper understanding- unlike male sexual dysfunction, female sexual function has not been extensively studied.

B]Females even in developed countries have a certain reticence to come forward and discuss their sexualproblems.

C] lack of therapeutic options-unlike males, the options for females are severely limited.

Treatment modalities

Sexual function results from a complex neurovascular process that is controlled by psychological and hormonal inputs which requires a coordinated physiological response from multiple systems.

  1. Psychotherapy, sexual education and counselling were the mainstay in treatment of FSD until recently.
  2. Drugs- Males have access to about 20 drugs for sexual dysfunction but there are few options for females.

    A] Testosterone- only used in treating HSDD in postmenopausal women. It is effective only at high supraphysiologic doses and its long-term safety profile is not well understood. Its use in women is not approved by the US FDA.
    B] Flibanserin- It is the first drug ever to get approval for female sexual dysfunction It is recommended for use in females with low libido or HSDD[ hypoactive sexual desire disorder] represents the most common and frustrating sexual dysfunction in women.
    Neurotransmitters have important effects on the sexual response. While dopamine and norepinephrine can enhance sexual desire, serotonin can cause inhibition. Flibanserin which initially had been investigated for its antidepressant qualities, appears to modulate neurotransmitters and increase sexual desire.
    The medication, taken as a 100-mg daily tablet taken at bedtime, is not effective in all premenopausal women with HSDD. The effects are seen after the first 4 weeks, unlike the rapid effects of Viagra like medications for male erectile dysfunction, with results peaking at 8 weeks. Flibanserin is not known to affect sexual arousal or orgasmic function.
    Side effects include drowsiness, hypotension, and syncope. It should be used cautiously in liver disease. Concomitant use of alcoholor strong CYP3A4 inhibitorslike oral antifungals, antibiotics, and antiretrovirals can increase the risk of adverse side effects.

  3. Treatment of local organic disease like retroverted uterus, endometriosis, cervicitis etc.
  4. Treatment and control of systemic diseases like diabetes mellitus and peripheral vascular disease. The role of these diseases in FSD is not fully understood unlike male sexual dysfunction.

It must be understood that there cannot be a single treatment for some ting as complex as female sexual response.

Role of Cosmetic Gynecology Procedures

[why should boys have all the fun……]

S. No. Procedure Benefit Downtime/Side Effects Cost
1. Laser Vaginoplasty- OPD procedure. Painless. Short & quick. Tight vagina, Better secretions, also Improves stress incontinence nil 10000/ sitting. Can be repeated on demand
2. Laser Labiaplasty – Generally combined with laser Vaginoplasty. Done after applying anesthetic cream. Procedure time one hour only Improved appearance of Vulva 3-5days. There can be post op pain and skin changes 5000/ sitting. Can be repeated at monthly intervals
3. Hymenoplasty- Surgical recreation of damaged hymen. Local/ regional/ general anesthesia Lost hymen restored [Revirgination] 3-6 weeks of abstinence 30,000-60,000 [ cost depends on anesthesia choice and room category]
4. Surgical labiaplasty Trimming of Labia minora Autologous fat injection labia majora 3-6 weeks of abstinence 30,000-60,000 [ cost depends on anesthesia choice and room category]
5. Surgical Vaginoplasty Correction of vaginal laxity 2-3 months 50,000
6. O Shot Improves sensations & secretions in clitoris. Better and more intense orgasms nil 10,000/ Can be repeated on demand