Sex Made Easy (6 page)

Doctors and scientists are currently researching effective treatments for PGAD. In one study, physical therapy exercises were found to be helpful. For some women, masturbation to orgasm helps. Other times, women find that applying an ice pack to their genitals helps relieve the feelings of genital pressure or arousal. Women who experience a great deal of anxiety, shame, or embarrassment about their genital arousal symptoms may be helped by meeting with a sex therapist—again, while PGAD isn't “all in their heads,” counseling or therapy can be helpful in aiding women to relax and focus on things other than their bodily sensations (which may exacerbate their discomfort).

If a woman's symptoms started after she began taking a certain medication, she should mention this to her health care provider, as there may be another medication or another type of treatment available without such side effects. And while a minority of patients with PGAD felt that their symptoms started while they were taking SSRI antidepressants, a larger number of these patients have felt that their symptoms improved while taking antidepressants.

If you experience PGAD, please know that there is reason to be hopeful that your condition can be treated so you can feel better and more comfortable in your body. If your health care provider isn't knowledgeable on the topic, try to find a doctor in your community who specializes in sexual medicine (see
Resources
) or bring your health care provider copies of some of the research articles listed in the back of the book so that they can become familiar with PGAD and help you to manage it effectively. Consider, too, whether it's possible to reframe your situation. Although some women are bothered by feelings of constant arousal, others are not. Might there be a way to look at your situation from a different perspective?

Vaginal dryness typically kicks in on a more regular basis as women approach menopause (commonly in their mid-to-late forties or early fifties, although some women reach menopause at younger or older ages). However, there are a number of reasons why even younger women may experience vaginal dryness. In our recent National Survey of Sexual Health and Behavior, my research team found that about one-third of American women (even very young women) report having experienced vaginal lubrication difficulties during their most recent sex act.
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More specifically, 35 percent of women ages eighteen to twenty-four reported lubrication difficulties during the most recent time they had sex as did 28 percent of women ages twenty-five to twenty-nine, 31 percent of women in their thirties, 36 percent of women in their forties, and nearly half of women in their fifties. This is striking. It suggests a few things to me. Perhaps many young women and their partners are rushing into sex without adequate foreplay.
Or the sex they are often having lasts a long time, or is quite vigorous and rough, thus drying the vagina. Or Mother Nature built the vagina to make enough lubrication to be “sufficient” for sex that is kind of, sort of comfortable, but that “works,” and if we want sex to be wetter, we have to take matters into our own hands through foreplay and store-bought lubricants.

Insufficient vaginal lubrication is different from vaginal dryness. Not having enough vaginal lubrication can happen to any woman and is more often a result of rushing into sex without much foreplay, having sex after a shower or bath (warm water dries the vagina out), or having a tight genital fit (for example, if your partner or sex toy is very big, or your vagina is quite small).

Vaginal dryness is a whole different ball game. It's more chronic and ongoing and is typically caused by low levels of estrogen. Remember: estrogen plays an important role in producing vaginal lubrication. This is why it's more common among postmenopausal women whose ovaries have stopped producing estrogens.

So which young women are candidates for ongoing vaginal dryness? Women who are breastfeeding, as their estrogen levels are typically low, may experience uncomfortable vaginal dryness. Also, women who have had their ovaries removed, for example as part of a hysterectomy or as part of surgical treatment for cancer, may experience vaginal dryness (this is sometimes called “surgical menopause,” meaning that by surgically removing the hormone-producing ovaries, the woman has effectively gone into menopause). If your vagina feels uncomfortable, such as feeling dry or sandpaper-ish during sexual activities as well as daily activities, let your health care provider know. She or he may recommend a vaginal moisturizer that you can apply at home, and it can make a world of difference.

This is another case for a vulvovaginal expert. It's also an instance in which you may want to connect with a sex therapist. Often, when women feel that they absolutely cannot go through with vaginal penetration or intercourse, there's a lot of fear and panic that surrounds the issue—and sometimes a good deal of strain on the relationship. A sex therapist who
has experience treating women with vaginismus (a name for a condition that describes women who feel unable to experience vaginal penetration, often with a great deal of fear or anxiety, even though they want to and have tried to) or vulvodynia (unexplained vaginal pain) may be a helpful guide on your journey to getting better. A medical doctor or nurse is instrumental in checking to make sure that there are no health conditions causing the pain or difficulty with penetration. A therapist can be helpful in terms of coaching you (and your partner if you have one) through attempts you make at home, and in private, to have sex. Your doctor, nurse, or therapist may recommend the use of vaginal dilators (see sidebar on page 35).

You're in good company. Many women release significant amounts of fluid during sexual arousal or orgasm. This is sometimes called “female ejaculation,” although not all sexual health professionals like or use this term because women's sexual fluids are not precisely the same as male ejaculate (semen).

Scientific research is lagging in this area so the percentage of women who experience female ejaculation is not known. What we do know is that the fluid comes out of the urethra, but if you're worried that you're peeing during sex, you can relax. Female ejaculation is not the same as urine (pee), and the chances of that are very, very low. Researchers who have conducted chemical analyses of female ejaculate have found that it is distinct from urine, and that it is composed of creatinine, prostate specific antigen, glucose, fructose, and other substances.
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That said, if you accidentally release urine when you laugh, cough, or sneeze, or if you have to pee so often throughout the day or night that it bothers you, let your health care provider know. In one study my research team conducted at Indiana University, we found that women's incontinence symptoms were among the biggest predictors of less pleasurable sex. If you can get your urinary concerns addressed and, if needed, treated, you may feel more confident in bed.

But back to female ejaculation: as far as scientists can tell, there is nothing unhealthy about this experience. It happens to millions of women.
Although it surprises some women and their partners at first, many grow to enjoy it as part of their sexual experience. I like to think of female ejaculation as a “beauty's in the eye of the beholder” kind of thing; some people aren't thrilled with female ejaculation, while others are. A friend of mine who often experiences female ejaculation looks to it as a sign of great sex. And a man I know who's come across it a few times says it's always a surprise when he encounters it, but he loves pleasing women so much that it's never a bad surprise. It just is what it is.

A few words about prep work: as with men's “wet spots,” some women lay a towel down on the bed, or other sex surface, before they have sex to minimize the post-sex cleanup. Others just let it flow. It's totally up to you and your partner.

Easy: pause for a moment during sex and pull them out. If one or both labia are pushed in in such a way that you need your male partner to pull out so you can remove them (rare, but possible), ask him to gently pull out for a moment. And before you go blaming your labia size for your discomfort, let me reassure you that labia of any shape or size can get pushed inside uncomfortably during sex. Labiaplasty (surgery to resize and reshape the labia) is definitely not a guarantee against this experience, as even women with itsy bitsy inner labia (less than one or two centimeters long) have this happen to them at times. Trust me on this one.

I think of tearing during sex as falling into one of three categories. Each type is important and requires a different strategy.

The first kind of tearing is quite common and can be thought of as very tiny tears—invisible to the naked eye—that occur inside the vaginal canal or around the vaginal entrance. These tears are the result of friction between a woman's vagina and the penetrating fingers, penis, or sex toy. They're more likely to happen if a woman is not well lubricated during penetration (such as during sex in the shower, when her natural vaginal lubrication may have dried, making sex feel rough and uncomfortable).
These kinds of tears also sometimes happen if her male partner's penis is larger than average, or if sex is vigorous or rough or lasts a long time. If you experience this kind of vaginal tearing (and many of us have), you might not feel any pain or discomfort during sex. Later on, however, when you go to the bathroom, you might notice a small amount of light-colored blood on the toilet paper after you wipe yourself, or you might notice a trace of blood on your underwear. This has certainly happened to me before, and spending more time in foreplay or using a water-based lubricant has done the trick for me. This kind of vaginal tearing is usually not serious and often heals on its own within two to four days, particularly if you avoid sex or masturbation while it heals. If you repeatedly experience this kind of vaginal tearing, try using a water-based lubricant during sex to see if this reduces the frequency of tearing. You might also mention it to your health care provider, as sometimes there are health reasons (such as low levels of estrogen) for women being prone to vaginal tearing.

A second kind of tearing isn't in the vagina, but on the vulva. These are also very small tears that you might not be able to see with the naked eye; they're just differently placed. Instead of being inside the vaginal canal, they may be on the vestibule (the area around the vaginal entrance), the labia, or just below the vaginal entrance. If you repeatedly experience pain, discomfort, or bleeding on your genital skin, let your health care provider know. Some skin conditions, including one called lichen sclerosus, can make a woman's genital skin more vulnerable to tearing during masturbation or sex with a partner. Treating the skin condition, such as with a cream prescribed by a doctor, can strengthen the skin and reduce the risk of tearing. Women who are breastfeeding or in menopause, or who otherwise have low levels of estrogen, may also be more prone to vulvar tearing. Again, this is something that should be brought to your health care provider's attention.

The third and most serious type of tearing during sex is an accidental tear or injury. Sometimes women tear pretty badly during sex. This can result in significant pain and can be noticeably bloody. If this happens to you, call your health care provider immediately and/or go to the emergency room. Sometimes the cut can be treated at home. However, your health care
provider may recommend that you use a prescription antibiotic cream or ointment to reduce the risk of infection (after all, the vagina and vulva are close to the anus, so there's some risk of getting bacteria near the cut). Other times, genital cuts are severe enough that they require stitches and other kinds of medical treatment. I once experienced a sex cut from vaginal intercourse and it was certainly no picnic (having my boyfriend at the time put on his glasses and inspect my vagina under full bright lights was also no picnic, but it gave us something to laugh about later). However, I was fortunate that my health care provider felt I didn't need to come in to the office or get stitches. Based on our conversation on the phone, she felt the cut sounded small and shallow enough that I could treat it at home with a prescription antibiotic ointment. That said, I've had friends and students who have had more severe cuts that required trips to the emergency room and stitches. It's not your fault if you get a sex cut and if you do, don't let embarrassment get in the way of getting good health care. Always do your best to take care of your vulva (and the rest of your body too).

Many genital lumps and bumps are completely harmless (such as moles or other natural skin bumps) and are benign, meaning not cancerous (read
The V Book: A Doctor's Guide to Complete Vulvovaginal Health
for an entire chapter on the many lumps and bumps that occur on women's genitals). Some are moles. Other lumps and bumps are the result of infected hair follicles, or are genital warts caused by certain strains of the human papillomavirus (HPV).

In rare cases, however, a lump or bump on the genitals may be a sign of cancer, which is more effectively treated with higher survival rates when detected early. It's better to be safe than sorry and tell your health care providers about your new discoveries down there rather than keeping them to yourself. Sometimes women notice other sorts of genital changes, such as an enlarged clitoris, that may be a sign of other health problems, including some cancers. Remember: all genital changes should be mentioned to your health care provider. And if you feel that your questions or concerns aren't being addressed by that person, switch doctors or get a second opinion.