Sex Problems and Stds

Sex Problems and STDs

Most Can Be Prevented and Cured

You've tried for years to have an orgasm to no avail. You've battled painful urinary tract infections and vaginal dryness.

Now you're worried about losing your sex appeal in a society that lusts after the beauty and bloom of youth. And all this talk about AIDS is making you wonder, for the first time, if your sexual practices might lead to a sexually transmitted disease.

And you thought sex was supposed to be fun.

It is, and it can be. But the reality is sexual difficulties and sexually transmitted diseases can strain your intimate relationships, destroy your self-
esteem and, in the case of AIDS, kill you. At the very least, sexual problems can make you feel as if age is finally catching up with you--sapping your sex appeal and making sex seem as exciting as a church supper.

"In our culture, sex is viewed as very important and the territory of the young. So when a woman starts viewing herself as less sexually attractive or senses that something is going wrong in her sexual relationship, it can undermine her sense of self and make her feel like she's getting older," says Beth Alexander, M.D., sex counselor and associate chairperson in the Department of Family Practice at the Michigan State University College of Human Medicine in East Lansing.

Every year, about six million American women get sexually transmitted diseases. Untreated, these illnesses can lower sexual drive, trigger acute arthritis and some chronic diseases and disrupt the central nervous system. Some diseases cause dementia and even death.

"When a woman finds out she has a sexually transmitted disease, she can feel psychologically dirty. It affects her sexuality, often to the point that she loses all interest in sex," says Michael Brodman, M.D., professor of obstetrics and gynecology at the Mount Sinai School of Medicine of the City University of New York.

But fortunately, there are many ways that you can prevent sexual problems and sexually transmitted diseases from developing in the first place, doctors say. Even so, most sexual difficulties or diseases can be remedied, meaning you'll have a lifetime of active and fulfilling sex to look forward to.

Heading Off the Problem

Many women have or will have sexual problems sometime during their lives, including painful intercourse, urinary tract infections and inhibited sexual desire, says Domeena Renshaw, M.D., director of the Sexual Dysfunction Clinic at Loyola University of Chicago Stritch School of Medicine.

Some of these problems are caused or complicated by ailments such as diabetes or heart disease and require medical attention. But doctors say most of us can head off the heartache of sexual disorders and improve our chances of having vigorous sex lives if we follow these basic guidelines.

Stomp on your cigarettes. "If you're in your thirties or forties and want to continue having a wonderful sex life until you're 70 or 80, you better stop smoking now," Dr. Alexander advises. Smoking constricts blood flow to the sexual organs and inhibits arousal in women.

Stow the booze. Sure, a glass or two of wine or beer can loosen sexual inhibitions, but more than that can hamper your ability to have an orgasm, says Dr. Alexander. Alcohol can also trigger hormonal changes that will decrease sexual desire.

Ask about medications. "A lot of drugs can affect your sexual response," Dr. Alexander says. Medications for high blood pressure, antidepressants such as fluoxetine hydrochloride (Prozac) and lithium (Lithotabs, for example), steroids, ulcer drugs and beta-blockers such as timolol (Timoptic, for example) are among the hundreds of drugs that can adversely affect sexual response. If you suspect a medication is interfering with your sex life, ask your doctor if the drug can be changed or the dosage reduced.

Slow down, you're going too fast. If you're constantly rushing around and working 50-plus hours a week, you may be heading for a sexual problem, Dr. Alexander says. "If you can change things that are stressful to you, do it, because lowering your stress and taking more time for yourself will improve your sexual performance," she says. Find ways to make sure you relax regularly--take an evening walk around the neighborhood or unwind with a good novel before tumbling into bed.

Sleep on it. Avoid having sex when you're tired; you're less likely to encounter a sexual frustration if you do. "You shouldn't feel like you're expending your last bit of energy to have sex at the end of a long day," says Shirley Zussman, Ed.D., a sex and marital therapist and co-director of the Association for Male Sexual Dysfunction in New York City. "I recommend that you put time aside for sex. That sounds unspontaneous, but in the long run it adds something to your relationship. Not only can sex happen that way, but you can do it with a certain zest."

Give yourself a break. Every woman, no matter how experienced she is in bed, will have an occasional sexual frustration. When it happens, you should avoid dwelling on it. Otherwise, you might be setting yourself up for a chronic sexual disorder, says Marty Klein, Ph.D., a licensed marriage counselor and sex therapist in Palo Alto, California, and author of Ask Me Anything: A Sex Therapist Answers the Most Important Questions for the '90s.

"If you believe it's going to happen to you at some point, when it does happen, it's no big deal," he says. "It's like getting a rash. Everyone gets rashes sometime in their lives. But if you believe that you never will, and then one day you do, you'll totally freak out. This could even set the stage for it happening again and again in the same circumstances."

DifÞculty Achieving Orgasm

Nature can have a warped sense of timing. Take orgasms, for instance. It takes women up to four times as long as men to reach climax, says Dr. Renshaw. It's little wonder, then, that only 20 to 30 percent of women regularly have orgasms and up to 10 percent say they've never climaxed during intercourse. Here are a couple of suggestions that can help.

Do Kegel exercises. These can help women achieve orgasms by increasing the body's awareness of sexual sensations, says Cynthia Mervis Watson, M.D., a family practitioner in Santa Monica, California, and author of Love Potions. Kegels strengthen the pubococcygeus (PC) muscles around the genital area. To find these muscles, try to stop your urine flow. Spread your legs apart so that your thighs don't touch. As you attempt to clamp off your urine flow, you'll feel like you're pulling upward with your pelvis and sense a tightening around your anus. That's how Kegel exercises are done. Once you master the technique, squeeze those muscles, hold, then release for three seconds at a time. Work up to a set of 30.

Don't dwell on it. Simply tell your lover that you're not going to try to have an orgasm for the next two weeks. Doing that should relieve any of the pressure you may feel to climax and allow you to enjoy sex more, says Dr. Klein. Of course, the more relaxed you are, the more likely it is that you will have an orgasm.

Urinary Tract Infections:
Flushing Out UTIs

During intercourse, the penis can drive bacteria up into the bladder and cause a urinary tract infection (UTI). One in five women has at least one encounter with this annoying disorder that causes frequent urges to urinate, a burning sensation during urination, pain above the pubic bone and occasionally blood in the urine. Here are some things you can do to prevent it.

Don't hold it in after sex. Urinating after intercourse will reduce your risk of a UTI, says Thomas Hooton, M.D., associate professor of medicine in the Division of Infectious Disease at the University of Washington School of Medicine in Seattle. "If you urinate right after sex, you'll flush any bacteria that could cause an infection in the bladder back out," he says.

Wipe carefully. "After urinating, wipe yourself from front to back, toward your rectum," Dr. Brodman says. Wiping the other way can drag bacteria from the rectum into the urethra and increase your chances of getting a UTI.

Re-examine your birth control method. If you have frequent, recurrent UTIs and use a diaphragm with a spermicide, consider switching to a different form of contraception. In studies at the University of Washington, urine samples taken after sex revealed that women who used diaphragms with spermicide had a much greater risk of having the Escherichia coli bacteria that cause UTI. The combination of spermicide and diaphragm apparently kills off good bacteria that protect the vagina and urinary tract from infection and encourages E. coli bacteria to flourish.

Low Sexual Desire:
Rekindling the Flames

When you first got together, you and your mate counted the hours between your sexual interludes. But gradually, as your passion cooled, hours turned into days, then weeks, and now you actually find yourself trying to avoid sex.

Up to 48 percent of American adults lose interest in sex at least temporarily at one time or another, researchers estimate. About 70 percent of people who seek treatment for low sexual desire are women. Depression, alcoholism and chronic diseases such as liver disease are some of the physical causes that can accelerate that process, Dr. Alexander says. But physical problems rarely inhibit sexual desire in women younger than 55.

"The problem isn't necessarily that one person is unhappy or uncomfortable with her own desire for sex. The problem is that she usually wants more or less of it than her partner," says Michael Seiler, Ph.D., assistant director of the Phoenix Institute in Chicago and author of Inhibited Sexual Desire. "If you want less sex than your partner, you can feel weird, abnormal and certainly older."

Here are a couple of ideas for rekindling the passion in your relationship.

Talk about it. If your lover wants sex four times a week and you feel like it four times a month, you should talk about your needs and reach a compromise. Otherwise the problem will intensify. "A couple needs to talk about their feelings," Dr. Seiler says. "If they can't connect emotionally, the likelihood of them getting together in other ways is remote."

If you feel that your partner is losing interest in sex, avoid saying things such as "This is a major problem" or "You have this bad hang-up," suggests Anthony Pietropinto, M.D., a psychiatrist in New York City and author of Not Tonight, Dear: How to Reawaken Your Sexual Desire. Instead, try saying "I've noticed that you haven't seemed too interested in sex lately; is there anything I can do?" The important thing is to keep the pressure off your partner.

Dream on. "Learning to fantasize and playing sexually in your mind can rekindle your sexual desire," Dr. Seiler says. To do it, take five minutes each day to conjure up any sexual image that excites you. It could be a movie star, your spouse or even a former lover. Make a mental note of it. Then when you're in a sexual situation, recall it and see if it arouses you.

Headaches Before and After

A good romp in bed occasionally cures a headache, but more often sex actually triggers one, says George H. Sands, M.D., assistant professor of neurology at the Mount Sinai School of Medicine. Most common is the explosive type of headache that feels like a grenade has gone off in your head as you near orgasm. Any headache that occurs during sex should be checked out by a doctor, since it could be a symptom of a serious condition, such as a cerebral aneurysm.

Coping with Vaginal Dryness

It ranges from an occasional dull ache to frequent severe pain that makes sex virtually impossible. Although painful intercourse can be caused by genital herpes, premenstrual syndrome, pelvic or vaginal infections, emdometriosis, pregnancy or recent childbirth, often the culprit is vaginal dryness. And vaginal dryness is a common complaint of women going through menopause. Here's how to fight it.

Take it easy. Ask your partner to slow down and take more time during foreplay. Keep in mind that as women age, there is often less lubrication.

Rub it in. You might consider using a water-soluble, over-the-counter vaginal lubricant such as Astroglide, says Lonnie Barbach, Ph.D., a sex therapist and psychologist in San Francisco and author of The Pause: Positive Approaches to Menopause. Some women prefer petroleum-based gels, but remember, you shouldn't use these products with latex condoms because the oils can weaken the latex and increase the chances of leaks.

When Sex Is a No-Go

Take your finger and move it slowly toward your eye. Just when it seems you're about to touch your finger to your eyeball, your eyelid slams down to protect it.

That's basically the same reflex that causes vaginismus, an involuntary clamping down of the muscles surrounding the vagina that makes intercourse impossible.

About 2 in every 100 women have this condition, triggered by painful intercourse, extreme fear of pregnancy, feelings of guilt or shame about sex or other psychological causes.

Overcoming vaginismus often requires the help of a sex therapist or
psychiatrist.

Doing without STDs

If every American who has a sexually transmitted disease moved to Canada, it would more than double the population of our northern neighbor. About 40 million Americans have sexually transmitted diseases, or STDs. Each year there are 12 million new cases, 6 million of them women.

"We have a tremendous epidemic on our hands," says Peggy Clarke, president of the American Social Health Association in Research Triangle Park, North Carolina.

Most STDs can be cured, although the longer you go without treatment, the more likely you are to have lingering and possibly permanent physical and mental disabilities as a result of these diseases. You should also be aware that STDs are often symptomless and can hide in a body for years while the person unwittingly infects others.

Short of abstinence, having your lover wear latex condoms is your best insurance policy against acquiring an STD, Clarke says. If you have or have ever had a lesion, discharge or rash in the genital area, see your doctor.

The federal Centers for Disease Control and Prevention in Atlanta has identified more than 50 sexually transmitted organisms and syndromes. Here's a look at some of the more common ones.

Genital herpes. Nearly 31 million people--one in six Americans--have genital herpes. Herpes, caused by the virus herpes simplex type 2, is a lifelong infection that produces genital sores as often as once a month in some women. Other women never develop symptoms, although they are infectious. Acyclovir (Zovirax), an oral prescription drug, can ease the symptoms but won't cure the disease. Sores from herpes or any other STD also increase your risk of contracting AIDS, since the virus can easily enter the body through open blisters.

Syphilis. Known as the Great Imitator because its early symptoms mimic a horde of other diseases, syphilis often begins with a painless sore in the genital area and progresses in three stages that can last more than 30 years. It can make a woman's life miserable, because it can induce heart disease, brain damage and blindness. Untreated, it can also cause death. About 120,000 people get syphilis each year. Antibiotics can cure it but cannot reverse the damage it has caused.

Gonorrhea. Known since ancient times, gonorrhea today strikes about 1.5 million Americans annually. This bacterial menace can cause painful urination and discharge from the vagina within two to ten days of infection. Untreated, it can lead to infertility, arthritis, skin sores and heart or brain infections. Gonorrhea can be passed on to a baby during childbirth. Antibiotics can cure it.

Chlamydia. This condition has symptoms similar to gonorrhea, although it, too, can be symptomless. The most common curable STD in the United States, chlamydia infects about four million people annually. A leading cause of infertility among women, it can permanently damage the fallopian tubes. It can also be cured with antibiotics.

Genital warts. Nearly a million new cases of genital warts are reported each year. This STD is caused by the human papillomavirus, some types of which have been linked to cervical cancer. There is no cure, although the warts can be removed surgically or burned or frozen off. Recurrences are common.

Hepatitis B. This disease can lead to cirrhosis of the liver or liver cancer. Up to 200,000 cases are reported annually, despite the fact that vaccination can prevent it.

For more information about STDs or referrals to self-help groups in your area, phone the Centers for Disease Control National STD Hotline (1-800-227-8922) or write the American Social Health Association, a nonprofit organization that offers educational information on STDs, at P.O. Box 13827, Research Triangle Park, NC 27709.