ASK THE DOCTOR - Sexual Intercourse After a Long Gap

We are married for eight months. Whenever we have sexual intercourse after a long gap, my wife suffers from urine infection. We both keep good health and are quite particular about cleanliness. Why is this happening?
- Palat

Mechanical rubbing during intercourse can cause urethral inflammation in females. In spite of all the so-called hygienic precautions, infection can enter the inflamed urethra and bladder causing urinary infection. This is a common complaint known as ‘honeymoon urethritis’. Whenever there is a ‘gap’, excitement levels are high. This causes aggressive movements and harder rubbing of organs. An aggressive mechanical rubbing during intercourse causes this problem. Try to be gentle during intercourse. Women enjoy it better that way. Also engage in prolonged (20-25 minutes) and mutually satisfying foreplay. This will produce adequate lubrication in her vagina for an enjoyable intercourse. Lack of lubrication (which is likely to be either due to a lack of interest, lack of relaxation during the act or lack of adequate foreplay) can also be the cause of urethral (or even vaginal) injury and inflammation.

ASK THE DOCTOR - Postponing Sexual Intercourse in Teenagers

QUESTION:
As parents, what kind of messages can you give your teenager about postponing sexual intercourse that won’t sound preachy, or like you are living in the dark ages?
- H Pawar

ANSWER:
Most parents hope their teenagers will wait to have sex till they are psychologically mature and are able to have emotional resources to manage relationships. It is important for parents to be able to convey this hope while communicating accurate information about sexual health and consequences. While we may encourage teenagers to postpone intercourse, the present reality is that, most young people become sexually active when they are in the clutches of their hormones. Because of this, they must be prepared to protect themselves when they decide to engage in sexual activity. Information about preventing pregnancy and sexually transmitted diseases is vital to help young people make informed decisions. And parents can help their kids understand the value of selfrespect, assertiveness, and responsible decision-making in postponing sexual activity.

‘Everybody is doing it’ is an age-old pressure tactic that applies to experimenting with drugs and alcohol as much as it does to experimenting with sex. Encourage your children not to be taken in by it. Teenagers often say they have intercourse the first time because they are curious. Open family communication about sexuality can satisfy your teenager’s curiosity, and help him/her behave more responsibly while exploring his/her sexuality.

You can communicate to your teenager that anyone can have good intentions of abstaining from intercourse. However, to translate this intent into responsible behaviour may not be as easy because of the high levels of arousal experienced due to raging hormones. And yet one needs to remember at the right time the consequences of irresponsible sexual behaviour in order to practice responsible sexual behaviour.

ASK THE DOCTOR - Unsuccessful Attempt at Sex

QUESTION:
I have been married for the last two years after a passionate-but-no-sex six month affair. In these two years, my husband and I have attempted sex exactly six to seven times, but because it was so painful and unsuccessful, it was a total turn-off. Now my husband feels so repulsed at the very mention of sex, also he says he that has to force himself to feel attracted towards me. I still feel attracted and turned on by him. His private area is a ‘prohibited zone’ when it comes to me. He is addicted to masturbation and he says he’s quite comfortable relieving himself this way. I’ve totally lost interest in relieving myself on my own. He doesn’t help either. He has also begun calling me a child-wife although I’m nearing 30. Please help.
- Manju

ANSWER:
It is sad that your sexual relationship is in a mess today. It seems that it all started with painful and unsuccessful attempts at the initial stage of your relationship. That has put your husband totally off towards you, as far as a sexual relationship with you is concerned. You seem to have carried the fear of penetration, which resulted in a clenching up of your body during intimacy, and when one is tense, the lubrication is insufficient, and thus the pain, which merely serves to reinforce the fear of penetration. This becomes a vicious cycle. Your husband on the other hand was afraid of causing you pain when you might have resisted, and his fear due to your apprehension kept him away resulting in his seeking sexual release through masturbation which he now finds as a comfortable outlet as he does not want to have to encounter your apprehensions and be responsible for causing you any pain. Neither of you can be blamed for this situation completely. It happened due to a lack of proper knowledge (sex education) on the part of both of you. Both of you were either uninformed or ill-informed about the physical as well as psychological (emotional) aspects of a healthy sexual relationship. That made both of you commit major mistakes during your early attempts at intercourse. This situation can now be rectified through a series of ‘sex counselling’ sessions for both of you. This requires a willingness on the part of both of you to attend such counselling sessions together. Do consult a senior sex counsellor as a couple for professional help. Strictly avoid more attempts and self-help. That may worsen the situation.

ASK THE DOCTOR - ‘I’m Unable to Achieve Orgasm’

QUESTION:
I am a 31-year-old married woman. I am unable to experience orgasm during intercourse. We have tried ‘everything’ but have not succeeded. Even a senior sexologist was of no help. Can you help us? - Ashwini

ANSWER:
Inability to reach orgasm is quite common amongst women. Probably, it is the result of age-old sexual repression of women, forced by religious and cultural beliefs. It either stems from your own deep rejection of your sexuality, or as a result of a moralistic upbringing. A woman is as capable of experiencing an orgasm as a man. All it needs is her true and complete acceptance of her sexuality, love for the partner, a relaxed atmosphere, complete privacy and an uninhibited passion. In such circumstances, one simply discovers the technique to reach to one’s orgasm.

You say that you have tried everything. In that case you need to look into your own inhibiting factors. If you find it difficult to see them all by yourself, you may take the help of a professional sex counsellor.

ASK THE DOCTOR - ‘Will an IUD Hamper Sex?’

I delivered my first child four months ago. My family doctor has advised me to use an IUD as a contraceptive. Kindly give more information about IUDs. Will an IUD come in the way of enjoying sex?
- Nilima

An IUD (Intra-uterine device) is a small object made of plastic, copper or stainless steel. Copper T is one such IUD that is shaped in the form of a ‘T’. Your doctor places it inside the uterus. The arms of the Copper T contain some copper, which stops fertilisation by preventing sperms from making their way up through the uterus into the fallopian tubes. If fertilisation does occur, the IUD would prevent the fertilised egg from implanting in the lining of the uterus. The IUD can stay in your uterus for up to 3 to 10 years. The IUD is 90-99 per cent effective at preventing pregnancy. It requires visits with your doctor to have it inserted and to make sure you are not having any problems. The upside is that once a doctor places it inside your uterus, you cannot feel it and can forget about it for 3 to 10 years. Moreover, they are cost-effective. The downside of IUDs is chances of pelvic infections, excessive menstrual bleeding and a higher risk of contracting STDs. An IUD does not interfere in any manner in enjoying sexual intercourse as it is within the uterus and not in the vagina. 

ASK THE DOCTOR - It is normal for children to play ‘doctor’ with each other?

QUESTION:
I was disturbed when I noticed that my five and half year old nephew was playing “doctor” with my 4-year-old daughter and another friend. The ‘game’ involved the showing private parts to each other. What should I do if I catch them playing “doctor” again? Is it normal? I am afraid that my daughter might be a victim of sexual abuse if I do not take action now.
- R Chopra

ANSWER:
Children from three to six years of age are most likely to play “doctor.” Many parents overreact when they witness or hear of such behaviour. Heavy-handed scolding is NOT the way to deal with the situation. Nor should parents feel this is promiscuous behaviour or will lead to promiscuity. Often, the presence of a parent is enough to interrupt the play. You may wish to direct your child’s attention to another activity without making a lot of fuss. Later, sit down with your child for a talk.

Explain that although you understand her interest in her friend’s body, she is getting  to be a big girl and people are generally expected to keep their bodies covered in public. This way you have set limits without having made the child feel guilty. This is also an appropriate age to begin to talk about good and bad touch. Tell your child that her body is her own and that she has the right to privacy. No one should touch her if she doesn’t like it or want it. Tell her that if anyone ever touches her in a way that feels strange or odd, she should tell that person to stop it and then tell you about it. Explain that you want to know about anything that makes her feel odd or uncomfortable. 

ASK THE DOCTOR - Sex and hysterectomy?

QUESTION:
I am a 44-year-old married woman. Two years ago I had my hysterectomy done. Even my ovaries were taken out. The gynaecologist told me to take Premarin pills after the operation. Six months ago a doctor friend told me to stop these tablets immediately as they can cause harm. Since I stopped the tablets, my sex desire has gone down drastically. My BP has been going high too. I get crazy mood swings. Why is all this happening?
- Mathur

ANSWER:
Ovaries produce female hormones (estrogen and progesterone). If the ovaries are surgically removed, it causes a rather abrupt ‘surgical menopause’ as the female hormones are now not produced in your body. It is due to this reason that your gynaecologist advised you to take hormone

supplements. On the advice of your doctor friend, when you stopped taking the hormone tablets, you started producing menopausal symptoms which are inevitable for every menopausal woman due to withdrawal of female hormones. The loss of interest in sex, mood swings, fluctuating BP are the symptoms of menopause. Menopausal symptoms can be managed successfully with treatment. I advise you to consult a gynaecologist for the management of your menopausal symptoms. 

ASK THE DOCTOR - My wife lacks an interest in sex?

QUESTION:
I am a 55-year-old man in good physical health and married happily for the last 30 years. I have a good sex drive and desire to have sex as often as I can with my wife of fifty years. However since the last few years, I find that my wife is not taking an interest in sex. After her menopause, she complains of dryness in her vagina which makes it difficult to enjoy sex. Apart from this physical issue, I find that she doesn’t take any initiative in sex and avoids the same on some or the other pretext. As a result, we have sex only once in a fortnight, whereas I desire sex at least twice a week.
- XYZ

ANSWER:
Menopause is invariably wrongly blamed for declining interest in sex in women. The cause for lack of matching interest in sex in partners could be physical, psychological, situational or even out of a so-called religious belief. It is necessary to find out the cause of such sudden loss of interest in sex. Only after knowing the cause, therapy can be planned.

For your information, a woman’s interest in sex depends on the following factors:

Integration of Love and Sex:
A woman operates through her heart. Her sex-life is not separate from the rest of her life. She sees everything in her life as inter-related. As against this, man tends to compartmentalise. He can mentally put aside stressful aspects of his life and separate it from sex. A woman needs good feelings and experiences during the day to have satisfying sex. How her husband treats her out of bed, greatly influences her response in bed. Inattentiveness, harsh language, a rude tone, hurting words, and criticism can make it difficult for a woman to get involved, to feel enthusiastic and to be passionate during sex. It is important for a couple to be loving even when they are not in the sex act. Sexuality and affection cannot be compartmentalised. Good sex is a continuum of affection and closeness during the day.

Lack of Love: This lack of love cannot be blamed on only one partner. Love happens between two sensitive human beings. Both of you need to deeply examine your relationship, either on your own or with the help of a good counsellor. Ask yourself what you can do to bring more depth into your relationship and make it more than sex — a sharing of intimacy.

Satisfaction: The level and frequency of satisfaction that she has experienced in her sexual life. If sex has been a one-sided activity by the man without bothering much about the needs of the woman, then over a period of time, she may lose interest in sex.

Foreplay: If foreplay is not done correctly and adequately, female partners do not feel aroused enough to have intercourse. Many husbands are impatient and want to go for intercourse after a short and hurried foreplay. Such repeated experiences of unsatisfactory sex gradually make the woman lose interest.
It will be better if both of you speak freely on this subject with each other and try to understand each other.

Erectile Dysfunction after surgery

QUESTION:
I am 62-years-old. I got myself operated for prostate last year. After the operation I have almost lost the ability to get an erection. My erection was satisfactory before this operation. Will I ever get my ability to get erection back? What can be done to get my erectile function as it was before the operation.
- A Shah 

ANSWER:
A prostate removal surgery such as ‘Radical Prostatectomy’ can cause injury to the pelvic nerves resulting into neurogenic erectile dysfunction. The incidence of erectile dysfunction after Radical Prostatectomy depends on whether a ‘nerve-sparing’ surgical procedure was performed. Reported rates of Erectile Dysfunction after bilateral nervesparing radical prostatectomy range from 18 to 82 per cent. Other factors related to disease or surgery can also affect erectile function. It will be worthwhile discussing your post-operative erectile dysfunction status with the surgeon who operated on your prostate. I think your surgeon is the best person to guide you through your present dilemma.