Pain with intercourse, otherwise known as dyspareunia is not an uncommon complaint, although it should never be ignored. There are several possible explanations for your discomfort such as vaginal dryness due to depletion of natural hormone levels, a pinched nerve from a trauma or spinal curvature, vaginal muscle spasms, irritation and inflammation at the opening of the vagina, or even cervical tenderness due to infection. It is important that you schedule an appointment ASAP with a sexual health clinician to determine the exact cause of your discomfort. Also discuss your pain with your partner and reassure him that you do love and care for him. If you feel comfortable enough, invite your partner to attend the appointment with you so he will understand your situation better.

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I am a healthy 42 year old and I have been happily married for 15 years. In the past year I have lost all interest in sex and I have no idea why. What could be causing this?

Many women experience HSDD (Hypoactive Sexual Desire Disorder) or decreased libido for a variety of reasons. First, you need to evaluate your sexual relationship with your husband. Is there still a sense of intimacy and romance? Are you able to communicate what pleases you and turns you on? Do you take time for date nights and make sure to change up your sexual scenarios? It is important to remain open and honest with your partner and continue discovering new ways of pleasing each other. If you try all of these tactics and you still have a low desire, you may be experiencing a decrease in natural hormone levels or decreased vulvar sensitivity. There are also many medications that can negatively impact libido. A thorough health history and physical examination by a sexual health clinician will help to decipher the true cause. True HSDD is often a multifaceted issue that can be dealt with in multiple ways and often with more than one specialist.

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My husband who is 65 and I (62) have had a wonderful marriage and sex life for most of our marriage. Due to some health issues my husband suffered erectile dysfunction for the last 2 years. He is now better and on Viagra. But now I am having pain with intercourse. Can anything be done?

Unfortunately, this is a very common scenario. When women, especially menopausal women, do not experience physical arousal and intercourse for a prolonged period of time, the vagina loses its natural elasticity and lubrication. If intercourse is then initiated with vaginal penetration, dyspareunia, or pain with intercourse, can occur due to irritation or tearing of the vagina and vulva. Just like your husband sought care from a clinician for Viagra, it is important that you seek care from a sexual health clinician. Most commonly, low dose estrogen creams, pills, or rings can be applied directly to the vagina and/or vulva as a first line therapy to help regain elasticity and lubrication. Be open with your husband and explain to him your physical pain. Assure him that your difficulty with intercourse is not a result of your relationship, but rather something that does require patience and a gentle approach. Invite him along to your appointment and encourage him to be a part of this process.

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I am a 35 year old single mother.  Motherhood and working a full time job keep me very busy and on the move.  However, I find myself thinking of and wanting sex at some unusual times throughout the day, almost every day.  Is this normal or am I “oversexed”? 

First of all, you are not oversexed and there is nothing wrong with your desiring sex at any time.  There is no rule or guide designed to outline when thoughts or desires for sex is or is not warranted.  Unless your thoughts are keeping you from your parenting, work, or interfering to such a degree that you feel unproductive, enjoy your healthy sexual desire.  Embrace your fantasies and do not be uncomfortable using them to aid in masturbation. Self-pleasuring is a very normal, healthy, and safe way to express your sexuality. Now, if you do find your thoughts are deterring you from your daily routine or causing you to partake in risky sexual behavior, you may find it helpful to meet with a sexual health clinician to discuss this issue. There is a disorder referred to as Persistent Sexual Arousal Disorder (PSAD) that involves spontaneous, intrusive and unwanted genital arousal. Women with PSAD can experience hundreds of orgasms per day but they feel no subsequent fulfillment. The fact that you “want” sex tells me that you do not have PSAD. 

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My partner and I have a healthy relationship and we are both very open with our communication, although we recently hit a “rut” in the bedroom.  What can we do to refresh our sex life and make things more exciting?

Most couples will experience the infamous “rut” in the bedroom.  It is a natural occurrence in a stable relationship.  Be assured that your sex life is not over.  Discuss ways to explore your sexuality together such as incorporating sexual aids (toys) or visual stimulation such as erotic videos or DVDs into your routine, or just simply rediscover each other’s bodies. Try to reinvent your personal art of seduction with fantasy and role play. It is up to the both of you as to how you choose to enhance your sexual relationship, but know that making the effort together and enjoying the outcome will truly enhance not only your sexual relationship, but overall, your trust and intimacy.  For more tips on how to spice up your love life, go to www.bettersex.com. Good luck and have fun!

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I am a newlywed of 8 months.  I really do enjoy sex and find it very easy to get excited.  However, I cannot seem to reach orgasm.  My husband is concerned that I have lost interest in him and that he is not fulfilling my needs.  Does this mean something is wrong with me physically?

This is probably the most common complaint that I hear from the women in general. Most likely there is nothing wrong with you. Ask yourself first, if this causes distress for you. If not, then you can simply assure your husband that sex is exciting and fulfilling for you. Many women gain satisfaction more from the emotional closeness that occurs during and after sex than from orgasm. If you are distressed, or even curious about why you are not experiencing orgasms with intercourse, then ask yourself if you are capable of having an orgasm with means other than intercourse, i.e. masturbation, oral sex, manual stimulation, etc. If so, then you are like many women and we simply need to talk about how you and your husband are having intercourse. Skipping foreplay and having intercourse in the missionary position for three minutes is not going to do it for most women. Foreplay is essential to arousal, lubrication and ultimately orgasm. Oftentimes, couples engage in foreplay with oral sex so that the female experiences an orgasm, and then they move on to intercourse, which culminates in male orgasm. Some couples routinely incorporate the aid of a vibrator to enhance clitoral arousal during intercourse. (A variety of vibrators can be discreetly purchased online at www.goodvibes.com).Other problems that can cause anorgasmia, or lack of orgasm, include premature male ejaculation, pain, hormonal imbalance, neurological disorders, medication use, and/or relationship issues. Only your sexual health clinician can diagnose and properly treat the cause of your anorgasmia.

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My gynecologist has placed me on several hormone creams to help me with lubrication.  I am not comfortable using hormones.  Do I have other options?

Topical treatments such as creams, vaginal pills, and/or vaginal rings do not have the same systemic effect as oral pills, meaning that very little hormone absorbs into the bloodstream. Topical treatments usually have a localized effect on the area where it is placed. This works well when your only problem is lubrication. By simply applying a cream, or inserting a pill or ring, lubrication often returns without increasing your risk for heart disease and certain cancers as much as with an oral pill. If you are adamant about not using hormones, there are some alternative therapies that you can try including acupuncture, non-hormonal lubricants, clitoral suction devices (http://www.eros-therapy.com/), and/or arousal fluids. A complete health history and physical exam by your sexual health clinician is important in order to identify the appropriate therapy for you.

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I am a 25 year old college student with a sexually transmitted disease that I contracted from my unfaithful ex-partner.  I recently started a new relationship with a wonderful man who is aware and accepting of my diagnosis.  However, I am insecure about sex now and am also afraid of passing this disease to him.   How can I move past this and enjoy my life again?

While it is easy to understand your insecurities about sex since your diagnosis, having a sexually transmitted disease (STD) should not keep you from having a productive and healthy sex life.  Educate yourself regarding your diagnosis and be certain to understand the risks and precautions associated with it.  The Centers for Disease Control and Prevention provides STD information at http://www.cdc.gov/std/default.htm. Certain STDs such as gonorrhea, Chlamydia, and syphilis can be cured if diagnosed and treated appropriately. Others, such as HPV (Human Papilloma Virus commonly referred to as genital warts), HSV-2 (Herpes Simplex Virus type 2), and HIV (Human Immunodeficiency Virus) can be treated but never completely cured. It is a common misconception that if you do not have visible warts or lesions on your genitals, then you cannot pass the virus to your partner. Unfortunately, the virus is continuously shedding. While you are more likely to pass the virus when you have an outbreak, you can infect your partner at any time. It is fortunate that you have a very understanding partner. Although he may be aware of your diagnosis, educate him as well. It would be beneficial for the both of you to meet with a sexual health clinician or counselor to discuss your questions and concerns.  Until then, rest assured that you can enjoy a wonderful sexual relationship as long as you and your partner completely understand your STD and the precautions needed to prevent transmission.

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I am a 56 year old woman who is wheelchair bound due to degenerative disk disease.  My husband and I have always had an exciting and fulfilling sex life.  Although as my disease progressed, I have found it more and more difficult to enjoy intercourse due to my limited mobility. I miss my husband and our intimacy. Please tell me there are options that will enable us to enjoy each other again.

There are many options for couples dealing with sexual problems due to disabilities but it is imperative that you first consult with a health care provider so that safety can be assessed regarding sexual intercourse and your particular disability. If your problem is simply lack of mobility, a sex swing might help to alleviate pressure on your neck, back, and hips, but also any strain your husband might endure trying to support you during intercourse. I suggest that you and your husband start researching your options by visiting www.bettersex.com. You may want to check with your local medical supply company to inquire about the different styles and models. It is possible your insurance may cover the expense. If your problem is decreased arousal and/or orgasm there are also options for you. The EROS device, a clitoral suction device, can help to increase sensitivity and lubrication when used consistently. You can learn more about this at http://www.eros-therapy.com/. Please do not give up on your sexual relationship with your husband. Intimacy can be obtained in many ways, not just through intercourse. Non-demand pleasuring, outercourse, and mutual masturbation are alternatives to intercourse that can bring mutual pleasure back into your bedroom.

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