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   Sexual Health
Dr. Massoud, my question might sound simple but it is of quite interest to me. I am a 45 years old woman, that have been on a blood pressure medication for almost 6 months, and since then I feel my sexual drive became nil. What happened? What should I do to get it back on track?
 

The medications you are taking belong to the family of anti-hypertensive. These medicinal drugs that treat high blood pressure, decrease women libido and impair their sexual arousal along with orgasmic disorders. However, the percentage of affected women depends on the dose administered. For instance, 15% to 20% of women have these side effects when put on low dosages, and 50% to 60% of them feel alike when administered high dosages.

Nowadays, there are a large set of anti-hypertensive drugs that can be prescribed to treat this silent killer called “hypertension”. Talk to your physician about trying these drugs, or a combination of them till you find the appropriate one(s) that do not affect your sexuality.

Below is a list of the anti-hypertensive that are associated with low libido, sexual arousal impairment and orgasmic disorders in women, and that cause erectile dysfunctions in men.
 
Drug Type

Brand Names

Prescribed for

Beta-Adrenergic
Blocker
Inderal, Lopressor, Corgard,
Blocadren, Tenormin
High Blood
Pressure
Calcium Channel
Blocker
Adalat, Procardia, Calan,
Isoptin, Verelan, Cardizem,
Dilacor XR, Triazac
High Blood
Pressure

Dear Dr. Beaini, I am a 50 years old man that suffers from anxiety. I have been on a medication (Xanax) for two years during which I did not have sexual activity with my wife. My wife suffers also from chronic hypersensitivity and is, most of the times, on anti-histaminic medicines. Even though we do love each other well, we are feeling lately ourselves distant from each other and intimacy is there no more. Are there any advices you can give us? What should we do?

My dear I have to say I was impressed by that fact that love is still there, and you both really care to maintain it for lifetime. First of all, let me point out that what you are passing through is quite normal while taking your medicinal drugs that are classified as sedatives. These tranquilizers such as Valium, Xanax, Lorazepam, and Diazepam are prescribed in order to relieve anxiety and are pretty well helpful; however, they cause low libido and erection problems in men, and I assume this is your case.

As for your wife, also note that Anti-histamines used to treat allergies and sinus ailments can result in drowsiness and a reduction in vaginal lubrication. Drowsiness will result in a decreased ability to stay awake for sex. Reduced lubrication can be perceived as vaginal pain during intercourse.

Do not panic, what you are passing through both of you is normal; however you need these medicines for your own health. Be sure that your treatment on this sedative will not last forever, as your physician will start decreasing the dosage once he notices it is time to do so. By that time, if everything is normal with you, your sexual drive will gradually resume, and you can ask your partner to use some lubricants to make your sexual activity go smoother since her chronic hypersensitivity will ask a longer treatment. 

Till this moment comes, note that sex is an important part of your life as a husband and wife; it does not make up everything that will keep you on. Cuddles, kisses, hugs, romantic moments can still be of quite importance to you. Your life as a couple is much more beyond sex and orgasm. Try to spend much more time together and back up each other in every single moment of the day. Your intimacy is the most important after all, and it goes far beyond simple physical contact. 

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Dear Dr. Massoud, I am a 35 years old woman, married since 10 years and have two lovely children. As my physician said, I am suffering from a depression, and I was consequently put on an anti-depressant for two consecutive years. Since then, I feel no interest for sex, and if I do have sex with my husband (actually just for his pleasure), I rarely feel a delayed orgasm. My sexual drive is never like before, and this is annoying me and affecting somehow our relation. Can you give me further explanations about this issue? Any tips that can be helpful regarding our relation especially that I feel intimacy vanished....
 

Anti-depressants such as Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), and Serzone (sertraline) are all "selective serotonin reuptake inhibitors (SSRIs). Up to 25% of people using SSRIs report some sexual impairment that varies differently between them. For instance, Zoloft has the lowest reported side effect, while Paxil has the highest one. Under your physician supervision, you might need to try one or more of these anti-depressants to find one that doesn't adversely affect your sexuality. Antidepressants may improve a woman's desire and enjoyment of sex as she will feel less depressed and more in the mood for it. Antidepressants that belong to the class MK869 are as effective as Paxil without the sexual side affects. Tricyclic antidepressants like Anafranil, causes sexual dysfunction in nearly 50% of the patients who take it. Anafranil has actually been used for premature ejaculation in men because it delays orgasm. Other tricyclics, like Elavil, Tofranil, Sinequan, and Pamelor can cause dry mouth, dizziness, constipation, and lethargy. For these reasons, many people prefer Prozac, the first of a new generation of enormously effective antidepressants that have fewer unpleasant side effects. Prozac is a selective serotonin reuptake inhibitor, or SSRI, and works by enhancing the action of the brains chemical serotonin. But Prozac, like the SSRI Zoloft, causes sexual dysfunction - usually delay in reaching orgasm, or an inability to reach orgasm - in as many as 60% of patients. Paxil, another SSRI, can cause a loss of libido. Consequently what you are feeling during your treatment is normal.

Please note that since you can no longer achieve full arousal and orgasm it may be best not to attempt to achieve this, as difficult and undesired as this may be. You may need to explore pleasure rather than orgasm, and avoid activities that result in sexual frustration. Communicating this to your partner may be quite helpful, and more important than the need and means of experiencing orgasm, as orgasm is not always a measure of completeness and successfulness of a sexual experience. As this point out, sex can be fun and enjoyable even in the absence of orgasm, for both of you. Placing too much emphasis on orgasm can have an adverse affect on you as an individual and both of you as a couple. Sex is much more than just orgasm. Cuddles, kisses, hugs, romantic moments are primary to you now.  

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Dr. Massoud, despite these medicinal drugs, how do the “bad drugs” affect male and female sexuality?
 

Alcohol can impair female sexual arousal even before intoxication takes place. In men alcohol delays ejaculation hence orgasm.

Addictive narcotics such as heroin and morphine caused female orgasmic dysfunction, and decreased sexual interest since narcotics act directly on the brain and the mood of the person.

Amphetamines and cocaine can cause sexual dysfunction in men when used in large doses or over long periods of time. One would have to assume women would also experience sexual dysfunction under these conditions; due to similar anatomy and sexual physiology.

Marijuana caused some women to report temporary vaginal dryness resulting in painful intercourse. Retarded ejaculation was also noticed in men. 

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Dear Dr. I am a 38 y.o. mother, I have been on contraceptive pills for the past 6 months and I feel I am enjoying sex more. Some of my friends are feeling the opposite; they simply do not like sex as they used to do. How can you explain that? Am I a “sex bomb” or my friends became “cold in sex”?
 
Many women taking birth control pills enjoy sex far more than before because they have been freed from their fear of pregnancy. But some women who take progestin-dominant pills complain of a loss of libido and vaginal dryness because of the hormone shifts caused by the pills. Women taking oral contraceptives have four times as much SHBG (Sex Hormone Binding Globulin) in their blood as those that do not take oral contraceptives. SHBG attaches itself to the testosterone circulating in a woman's body making it ineffective, and possibly causing a decrease in sexual desire and sensitivity. This might be the case of your friends.
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Hey doc!  My name is Sarah and I am a 17 y.o. I would like to know what the best rules for my personal hygiene are as I have a lot of vaginal secretions and I feel my vagina is always dirty. So… any tips?
 

Your vulva and vagina are not “dirty” as you said in your question so they do not need “cleaning” in the true meaning of this word. Naturally speaking, air and plain water are the only things that should come in contact with your vulva because everything else is a potential irritant.

Below, you can find a list of 10 recommendations for caring for your vulva and vagina. It is a list of what NOT TO DO, as many women and girls have been misinformed about their body and commonly do things that may harm it.

    a)      Do not use soap: Scented and unscented soaps may irritate and dry out the delicate mucous membranes of your vulva. Antibacterial soaps will kill all bacteria, not just the harmful ones; it is not recommended to use them over a long period of time. Anti-bacterial soaps are recommended for a short-term use especially if a woman has excessive vaginal secretions. Be aware that the water out of your faucet often contains chemicals like chlorine or other chemicals that may irritate your vulva, especially if you have sensitive skin. For that, I recommend you use filtered water along with FEMINIK especially designed for women genitalia hygiene.
    b)      Do not use scented products: Scents, perfumes, and deodorants all contain chemicals that might irritate your vulva. Deodorant pads and tampons contain chemicals that are unnecessary and they can cause irritation. If you are concerned by your genitals’ odor, just change your pad or tampon more often.
    c)      Do not use colored or scented toilet paper: Use only plain white toilet paper, though rinsing your vulva with plain water would be better, as is simply air drying. Europeans are more likely to have and use bidets.
    d)      Do not use panty liners: While panty liners may absorb moisture and protect your under garments they prevent air from getting to your vulva and the moisture and bacteria are trapped in the pad positioned directly against your warm vulva.
    e)      Do not wear undergarments made of synthetic materials: Your panties should be made of 100% cotton to allow moisture out and air in. If you cannot go without make sure they do not trap moisture or body heat. Wash your undergarment in detergents meant for delicate skin or infants. In some women, chemicals in regular detergents may irritate the vulva.
    f)       Do not wear damp or wet clothing: Do not wear wet clothing like bathing suits and gyms cloths. As soon as you are done swimming or exercising change your cloths and undergarments.
    g)      Wear as little as possible: The more layers of clothing you wear covering your vulva the harder it will be for excess moisture and heat to escape your body. At night, sleep nude or wear a nightshirt to allow your genitals to breath freely.
    h)      Regular unscented pads and tampons can also be a source of irritation: The synthetic materials many of these products are made of can irritate the vulva and vagina and may contain chemical residues. The Always brand of sanitary napkins has been found to cause irritation in some women. It is recommended that women use pads and tampons made from natural products, as they are gentler on the body.
    i)        Do not douche: Douching washes away the natural body fluids and destroys your body's own natural defenses, causing infections. If your vulva or vagina has an unpleasant odor or discharge, time to see a doctor.
    j)        Do not self diagnose: Using over the counter antifungal, yeast, treatments can damage your vulva and vagina if you do not actually have a yeast infection, or have a resistant form. Teens and young women may misdiagnose the cause of their vaginal fluids and/or irritation. In such cases, you have to refer to your doctor.
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Dr. Beaini, is it true that women vaginal secretions are acidic? What are the nature and the functions of the liquid that the vagina secretes during intercourse?  Are these secretions women’s pheromones?
 
In spite their various chemical composition, vaginal secretions contain sweat, sebum (57.5% glycerides and free fatty acids, 26% wax esters, 12% squalene, 3% cholesterol esters, and 1.5% cholesterol), and secretions from Bartholin's and Skene's glands at the vulva, endometrial, and oviductal fluids, cervical mucus, exfoliated cells, and secretions of the vaginal walls themselves, which increase with sexual arousal. All women's vaginal secretions include pyridine, squalene, urea, acetic acid, lactic acid, complex alcohols (including cholestrol), glycols (including propylene glycol) ketones, and aldehydes. For all women, the vagina is acid and its acidity varies with the menstrual cycle, rising from day one after menstruation and peaking mid-cycle, just before ovulation. The figure below shows the location where these secretions take place.
 
 

Based on the types of acids of vaginal secretions, women are classified into two groups.

  • Women whose vaginal secretions contain acetic acid, which is the case of all women.
  • 35% of women have vaginal secretions containing short-chain aliphatic acids in addition to acetic acid. The short-chain aliphatic acids that come from the metabolic processes of resident bacteria, including Lactobacilli, Streptococci, and Staphylococci, do include propionic acid, isovaleric acid, isobutyric acid, propanoic acid, and butanoic acid. These acids belong to a pungent class of chemicals which other primate species produce as sexual-olfactory signals. Some researchers have referred to these vaginal secretions in women as "copulins" and "human pheromones."
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I heard my friend at school telling me she uses a tampon during her menstruation period. What is a tampon? What is the difficulty at using it? Is it healthier than using disposable menstrual pads? Does it affect virginity somehow since it is inserted into the vagina as my friend told me? Thank you Dr.!
 
A tampon is a plug of cotton or other absorbent material inserted into a body cavity or wound to absorb fluid. The most common type in daily use is a usually disposable plug that is designed to be inserted into the vagina during menstruation to absorb the flow of blood. A tampon has different sizes and different absorbencies as shown below.
 
 

Absorbency

= 6 grams 6-9 grams 9-12 grams 12-15 grams 15-18 grams
Type of tampon Junior Regular Super Super plus Ultra
 

Unfortunately the tampon affects virginity (hymen) as it stretches the hymen overtimes. This is why virgins are not advised to use tampons if they do not intend to loose their virginity in a way or another because of their religious and/or background educational believes.

The difficulties that most women face when using a tampon are:

    1.      Difficulty to pain in inserting the tampon: The walls of the vagina and the pelvic muscles are normally in contact with each other and are made of many muscle fibers. When something enters the vagina it must make room for it, no matter how small it may be: a finger, tampon, or penis.
    2.      Hymen: that can be stretched when using a tampon. Sometimes a little bleeding is observed indicating defloration.
    3.      Unfamiliarity with the vagina: It is a mystical place for most women since social and religious rules made it off limits. For that, a woman should know her vagina and its angle of penetration. Kegel exercises are also advised for young daughters to be familiar with their pelvic and vaginal muscles.
    4.      Lack of communication mother-daughter: A mother should discuss all the anatomy and biology of menstruation when her daughter nears the time of her first menstrual period. Budding breasts is a visible indicator that it is time for this discussion, as on average, her menstrual periods will begin about a year later. Take a tampon, unwrap it, take it apart, show her all the different parts, and explain what they do and tell her how it is used. Use a relaxing language in a relaxing atmosphere.  The following figure is helpful for explanations.
 
 
    5.      Lack of lubrication: In order to reduce the friction of the tampon against your vagina during insertion, use a water based lubricant like K-Y Jelly near or in the vagina. Petroleum based lubricants adhere to the vaginal walls and may result in vaginal infections. If a water based lubricant isn't available the applicator can be lubricated with saliva. The tampon applicator is sterile prior to use so it is safe to insert into the mouth to lubricate it.
    6.      Vaginal dryness: Is the main problem during tampon removal. Prevent this problem by using the suitable tampon for you: for instance do not use Supers if your menstruation is not heavy because the tampon will be difficult to remove as it swells after blood absorption. To remove it, try squirting some water based lubricant up into the vagina. Then insert a lubricated finger into the vagina to spread the lubricant around. Try to work the lubricant around the sides of the tampon. Masturbating may also help lubricate the vagina, if you are able to relax enough to do so. Squatting down on the floor with knees spread while pushing out, like during a bowel movement, may help to move the tampon toward the vaginal opening. If lubrication and gentle pressure doesn't extract the tampon, a visit to the doctor or gynecologist is advisable.

The information presented by tampon manufacturers is usually too vague to be of much use to young women wanting to know how to insert a tampon. If a young teen should experience difficulty inserting a tampon she usually has nowhere to turn for guidance. Below are some instructions related to the correct use of a tampon:

 
 

Disposable menstrual pads are easier and healthier to use, however some women prefer tampons because they got the habit to use them and do not show if they wear stretch clothes. Tampons do have health risks:

  1. Vaginal irritation and/or infection: The blood that collects in a tampon while it is inside the vagina can serve as an incubator for bacteria. In the warm moist environment of the vagina the blood provides nourishment for bacteria to expand. Switch to sanitary napkins if vaginal irritation appears.
  2. Toxic Shock Syndrome (TSS): The toxic bacteria that causes TSS is often present in the vagina and becomes active only if the tampon is left for a long period of time (generally more than 4 hours. Switch to sanitary napkins at night).
  3. Vaginal scrapping and scratching: While inserting the tampon, some small injuries in the vagina may take place and can make it easier for bacteria to enter the blood stream increasing a woman's chances of developing a vaginal infection.
  4. Odor: Never use a deodorant on a bad smelling tampon, clean yourself and change it frequently if you smell bad.
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Doctor, when I am in period, I feel I need more sex than usual. Is it OK to have sex during menstruation or is masturbation preferred instead and why? Thx!!!
 

Sexual activity is not the same in all women and it fluctuates during the cycle based on the hormonal changes: for instance, it is maximal during ovulation and it is less beforehand. Some women experience a marked increase in their libido during their menstrual period and as a result crave partnered sex. While some postpone sex until after their period because they feel they have something to hide from their partner and that their partner should naturally find them undesirable at this time, others aggressively seek out a partner. This increased sex drive is the result of hormonal changes and perhaps because a woman knows she is not pregnant, and is much less likely to become pregnant during her period. Many women have found experiencing orgasm(s) during their menstrual period relieves menstrual cramp as muscle contractions allow a faster flow of the menstrual fluid and relieves some of the muscular tension caused by the hormone prostaglandin.

Many women also rely on masturbation to produce their orgasm(s), feeling they are or should be unattractive to their partner at this time, while others just are not in the mood for partner sex, in an active role, but like to have an orgasm. Masturbating during your period is technically fine, but it is worth to ask yourself if you are willing to touch your genitals while you know that blood might pop up at anytime?!!

As for sex, I would say that it is not wise for couples to engage in all forms of sexual activity during menstruation because there are a lot of pathogens that are transferred from one person to another when bodily fluids are exchanged even between faithful partners. In outer-marriage sex diseases like hepatitis and AIDS are more easily transmitted when the blood of a woman comes in contact with the body and particularly the blood stream of a man. If the blood of one partner comes in contact with an open cut or wound on another, the transfer of these harmful pathogens is more likely to occur. These are real risks with severe consequences.

Couples engaged in a short-term relationship, such as dating, should not exchange body fluids. In a casual dating relationship the only safe form of sex during a woman's period, or anytime, is mutual masturbation, since no physical contact takes place there is no exchange of body fluids. If a couple is not already exchanging body fluids then barriers need to be used to prevent this from occurring. This can be accomplished by using condoms. Keep in mind that during most normal sexual activities minor injuries and bleeding occur and as a result there is always some risk involved when body fluids are exchanged. Sexual activity during a woman's period just increases that risk.

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