Sexual health is an important part of your overall wellbeing. Sexual concerns are much more common than is acknowledged. Medical studies have shown up to 50% of women have some sort of sexual function concerns. That is not to say men do not have sexual concerns also. Since my target audience is women, this article will address women's sexual health. Not only can sexual problems affect relationships, they can cause distress in the form of guilt, stress, worry anger, embarassment, frustration, unhappiness, and depression. Sexual function is multi-factorial - it is affected by hormones, medications, state of physican and mental wellbeing, body self-image, relationship with your partner, and stress.

"You are the only physician I have ever felt comfortable with talking about sexual concerns." This was a comment from a patient recently seen for her annual examination - who, by the way, did have major sexual concerns. As with any medical condition, your physician should have expertise in diagnosing and treating the particular problem. Equally important is the physician must be "approachable;" you should feeel comfortable discussing your concerns with your physician. Sexual function is perhaps the most intimate and personal part of your life - not the easiest thing to talk about, but something having a major impact on who you are and how you feel.

What is normal sexual function? Many years ago the team of Masters and Johnson originally described a sexual function cycle for both men and women. The first phase, excitement, can be divided into desire and arousal. Desire begins prior to actual sexual contact and continues until orgasm. Desire has several components including: drive, expectation, and emotion. Arousal begins with foreplay. Women experience vaginal lubrication during this inital phase. Another important result of arousal in the female is that the top of the vagina balloons out and lengthens. Penetration without adequate foreplay can result in pain on deep penetration. As a generalization, the arousal phase takes more time in women than in their male counterparts. The plateau phase lasts varying lengths of time depending on the length of time devoted to foreplay prior to orgasm. During plateau the level of arousal is maintained but not increased. Orgasm or climax results in ejaculation in the male with fairly rapid loss of erection of the penis. Subsequent orgasm in the male can only occur during another separate arousal cycle. Women have the ability to have one orgasm or multiple orgasms with episodes of heightened arousal. Women can also stay on the plateau phase and be sexually satisfied without having orgasm with every sexual encounter. Resolution follows orgasm and lasts varying lengths of time. During this phase arousal is not possible.

All of this sounds very scientific but is not meant to take away from the very personal and intimate nature of a sexual relationship. It is intended to provide information that will possibly enhance your understanding of sexual function. It is also important to realize another major difference between sexual function in females and males - libido or sex drive in males is spontaneous and in females is more responsive. In practical terms, a woman is more likely to want sexual closeness when she is in a pleasant, relaxed environment with "loving touches" - such as candlelight, nice music, good conversation, and perhaps a glass of wine.

Female Sexual Dysfunction (FSD) can be divided into 6 categories including:
1. hypoactive sexual desire - a diminished or absent desire for sexual activity or occurrence of sexual fantasies
2. sexual aversion - an aversion to and avoidance of genital sexual contact with a sexual partner
3. sexual arousal disorder - inability to become sexually excited with associated vaginal lubrication and swelling of the vulva and vagina (due tio inflow of blood to the area)
4. difficulty reaching orgasm - a delay or absence of orgasm after appropriate arousal
5. vaginismus - involuntary contraction of muscles at the entrance to the vagina - this may cause pain on penetration or may prevent penetration altogether
6. dyspareunia - pain with intercourse due to inadequate lubrication or due to pelvic pathology such as endometriosis, infection, or an ovarian cyst - dyspareunia may also be caused by inadequate stimulation (love making) prior to penetration; adequate stimulation is necessary to allow the vagina to lengthen to minimize the risk of the penis hitting the top of the vagina and causing pain

Other medical conditions, medications treating medical conditions, and substance abuse can affect sexual function. A classic example is depression and the medications used to treat the condition. Many women with depression have no desire for sexual activity, and SSRI's (medications used to treat depression) affect sexual desire. A very common cause for hypoactive sexual desire is stress - probably the most common sexual function concern and cause I see in my practice.

Sexual aversion is less common than the other froms of female sexual dysfunction. It may be due to a traumatic event as a child or an upbringing or religious background that paints sexual intimacy as something that is forbidden and dirty. A previous sexual assault can result in sexual aversion.

Sexual arousal disorder may be a functtion of inadequate foreplay or prior pain with sexual activity. As noted above, most women are better able to respond sexually with "loving touches."

Difficulty reaching orgasm, decreased desire for sex, and difficulty becoming excited are frequently connected to one another. Stress in today's world is a very common cause for these forms of sexual dysfunction. Various medical studies show that most women do not reach orgasm with every sexual encounter.

Vaginismus can cause painful sex. Vaginismus is usually a conditioned response to something that was previously unpleasant. An example would be a woman who has no sexual function problems and develops a vaginal yeast infection that causes severe irritation and burning during sex. The next time she has intercourse, she unconsciously "remembers" that the last encounter was painful; the muscle at the entrance to the vagina contracts in an attempt to prevent penetration, and she has pain. Repeated attempts simply make the problem worse.

Dyspareunia or painful sex (other than vaginismus) is frequently caused by a treatable condition such as endometriosis (see my website www.endometriosistherapy.com). On the other hand, painful sex may be caused by something as simple as a yeast infection.

Treatment of sexual function concerns first requires an accurate diagnosis. Understanding sexual function is the first step to a normal, enjoyable sex life. If you have questions regarding your sex life, you should discuss this with your physican and your partner.

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      On A Lighter Side

On a lighter Side, it is hot! The recipe below is a good one for the summer. Like many people, I tend to do more grilling during the spring and summer. I am consistently asked how long I tend to practice gyn. My original plan was to retire several yewars ago, but when the time came I asked myself why I wanted to stop doing something I enjoyed. Bottom line, my health is good, I enjoy what I do, and I intend to continue working probably for another 10 to 15 years. We are always happy to see your family and friends. Contact us at Advanced Healthcare for Women, telephone 912-355-7717, for an appointment. My websites are www.womensdoctor.com and www.endometriosistherapy.com. Have a great summer!

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  In The Kitchen with Dr. B. - Summer Salad with Quinoa

With good tomatoes available, this is a summertime hit that will go with most entrees. When preparing foods, I always think about the varieties of color, taste/smell, texture, and quality of the ingredients. One of the ingredients in this dish is quinoa (pronounced keen-whah). Quinoa is a grain-like vegetable grown primarily for its edible sees. It originated in the Andean reegion of Peru over 6,000 years ago. The protein content (12-18%) is very high, and it contains a balanced set of essential amino acids. It is a good source of fiber, phosphorus, magnesium, and iron and is gluten-free. Natural quinoa has a coating of saponins which in most boxed products has been removed by pre-soakiong. Saponins can be mildly toxic and cause a bitter taste and numbness of the lips and tongue. Quinoa makes a nice (and more healthy) alternative to rice.

2 cups water
1 cup quinoa
1 15-oz can of black beans, rinsed and drained
1 cup frozen, shelled edamame (baby soy beans), thawed
1 cup chopped, seeded tomato
1/2 cup finely shopped red or Vidalia onion
3 Tbs extra virgin olive oil
2 Tbs red wine vinegar
Salt and Pepper to taste

Bring the water to boil, add salt sparingly, add the quinoa, cover and simmer for 15 minutes. Transfer the quinoa to a large bowl and let cool. Combine the remainder of the ingredients with the quinoa. You may choose to lightly saute' the onion ahead of time or leave it raw. The edamame may also be cooked lightly in boiling water - try cooked and uncooked and see what you like. Another ingredient you may want to add is chopped, seeded cucumber - so good this time of the year. Enjoy!