Sex and sexuality involve the mind and the body. Any problem with either can have an effect on your sex life. Depression, which is one of the most common mental illnesses, tends not to affect the sex drive but often diminishes the pleasure experienced. Bipolar disease, also known as manic depressive disorder, has been reported to cause an increase in sexual activity and some promiscuity when those afflicted are in the manic phase. Very often, medications used to treat mental disorders can decrease your sex drive. Alcohol or other recreational drugs can also cause increased or decreased desire for sex and can cause problems with maintaining an erection, as well as arousal issues for women. Addiction to these substances can cause prolonged sexual problems. On occasion, people will sometimes replace one of these addictions with an addiction to sex.

The short answer is yes, absolutely! The slightly longer answer is that the type of sexual activity will often vary slightly depending on the type of disability. In fact, each persons medical condition should be reviewed individually by a healthcare provider so that specific recommendations can be made. The most important thing to remember is that EVERY person, regardless of the disability they possess, is capable of some level of participation in a sexual relationship. This may take a bit more patience and creativity than a so-called normal relationship, but can be a fulfilling part of a healthy partnership.

A certain amount of vaginal discharge is normal. It is a result of the hormones that are produced by your body. Normal vaginal discharge does not have a strong odour and is usually clear, white, or slightly yellow. If you find that the discharge is smelly, has changed color, or is itchy or irritating to your skin, see a healthcare provider.

It is very common for women to have a vaginal discharge, but it can be bothersome or concerning for some women. Under the influence of estrogen, the vagina and cervix secrete mucous which results in a discharge. This is completely normal, and starts when a girl begins to go through puberty. A normal discharge is usually clear, white or pale yellow, but can vary widely between individuals, as well as changing throughout a womans lifetime with her menstrual cycle, with pregnancy, after having a baby, or on different hormonal medications.

When women notice a discharge, they often worry about infection. If the discharge suddenly increases in amount, becomes yellow-green, has a foul odour, or if you are experiencing fever, chills or abdominal pain, you should see your health care provider, who will examine you and take swabs to rule out infections. If you have been sexually active, a sexually transmitted infection such as gonorrhea, chlamydia, or trichomonas is a possibility. Women who have never had sex can still get a yeast infection, or an imbalance of the normal vaginal bacteria (called bacterial vaginosis). If you think it may be a yeast infection, but have never had one before, it is a good idea to see a professional the first time to be diagnosed correctly before trying an over-the-counter treatment.

Even if an infection has been ruled out, vaginal discharge can be embarrassing or annoying for some women. If there is a lot of discharge, this can contribute to odour, itching and irritation in the genital area. Having a bath (not just a shower) every day in plain water can help keep the vulva clean. Other simple measures can include wearing cotton underwear during the day, going without underwear at night, and avoiding thongs and pantyliners.

Yes, there are glands which lubricate the vagina that will often secrete small amounts of fluid during sexual excitement or orgasm. But some women do not experience female ejaculation.

This fluid is a normal part of the female sexual response. It is mostly water and other proteins that help lubricate the vagina and make intercourse easier. You can not stop it from being made, and in fact intercourse would be quite uncomfortable without the fluid being there.

If the discharge is there at other times and particularly if it is associated with a foul odour, itch, or skin irritation, it could be due to a sexually transmitted infection (STI). In that circumstance, it would be important to see a health care professional to get this checked out.

Bacterial vaginosis (BV) is the most common cause of mal-odorous vaginal discharge. However up to 50% of women with BV have no symptoms. It occurs when the normal bacteria of the vagina (lactobacilli) are replaced with other types of bacteria (gardnerella vaginalis, mycoplasma, or prevotella for example).

BV is not felt to be a sexually transmitted infection. Risk factors however do include multiple sexual partners, douching, and lack of vaginal lactobacilli.

This bacterial overgrowth can be diagnosed by a speculum examination where you health care provider will do a swab of your vaginal discharge.

Women that have a foul smelling vaginal discharge, found to have BV, should be treated with an antibiotic (recommended regimens are metronidazole 500mg orally twice a day for 7 days, or metronidazole gel 0.75%, one applicator full intravaginally once a day for 5 days, or Clindamycin cream 2%, one applicator full intravaginally at bedtime for 7 days, MMWR STD Treatment Guidelines, 2002)

Women without symptoms may not require treatment. Routine treatment of sexual partner is not recommended.

A certain amount of vaginal discharge is normal. It is a result of the hormones that are produced by your body. Normal vaginal discharge does not have a strong odor and is usually clear, white, or slightly yellow. It may change in amount throughout your menstrual cycle.  If you find discharge that has an odor, different color, or is itchy or irritating to your skin, see a healthcare provider.

A douche is a liquid, which some women use to clean the vagina. In fact, the vagina keeps itself clean, and douching is nor really necessary. So the answer to “what is the best douche to use” is none!

The vagina contains a variety of bacteria. It may sound strange, but the balance of bacteria in the vagina is an important part of keeping it healthy. If one bacteria or yeast takes over, you can develop an infection like bacterial vaginosis or a yeast infection. Douches can destroy the balance of bacteria in the vagina which may result in an infection. Douches can also irritate the vagina, possibly putting you at higher risk of other sexually transmitted infections.

If you notice an unpleasant odour or discharge, you should see your health care provider to be checked for an infection, instead of trying to douche and cover it up. You should never douche before visiting your doctor, even for your routine check up and especially before your Pap smear. It will make your test results unreliable.

Some women use a device called a menstrual cup during their menses. There are two menstrual cups available, the Keeper and the DivaCup . The Keeper is a rubber cup (and so cannot be used by women with latex allergies), while the DivaCup is made from silicone.

The cup is inserted into the vagina during menses. It holds one ounce (30 ml) of menstrual fluid. Unlike tampons, the menstrual cup is non-absorbent and simply collects the menstrual flow. Depending on the amount of menstrual flow, the cup should be emptied at least 2-3 times per 24 hour day, washed and reinserted. It can be worn up to 12 hours at a time. For removal, pull on the stem until the base of the cup is reached. The contents can then be emptied in the toilet, the cup washed with hot water and soap, rinsed and re-inserted. The cup can also be sterilized by boiling it in water for 2-5 minutes.

The keeper cup is marketed as “The DivaCup” and is made in Canada. It is available in 2 models: one for women under the age of 30, who have never delivered a child, and model 2 (slightly larger) for women over 30 years old, or who have had a child.

As the cup is reusable, it provides women with an environmentally friendly alternative to tampons or pads. It has been approved for use by Health Canada since 2002. It is available in some health food or environmental stores, or through order.

About 10 years ago, high-absorbency tampons were developed so that women with heavy flow would not have to change tampons as often. Unfortunately it was discovered that when high-absorbency tampons were left in place too long, a local infection could develop from a bacteria called staphylococcus. This bacteria is not carried on the tampon but is normally present on everyone’s skin. The staphylococcus could produce a toxic substance that entered the blood stream and made the tampon user sick - a condition called toxic shock syndrome. The symptoms were high fever, a red rash (like a sunburn), vomiting, diarrhea, muscle aches, and feeling generally unwell. Tampons have been redesigned so that this is very rarely seen as long as the tampon is changed at least every 4-8 hours. If you ever experience these symptoms while using tampons, you should remove your tampon and see a doctor immediately to get checked. Don’t be embarrassed to tell the doctor that you have been using tampons. If she or he doesn’t know this, they might just think you have the flu.

Using a tampon is a good way to learn more about your own anatomy and if you are able to insert and remove it easily it makes it more likely that you have adequate room and no partial blockage of the vaginal opening by a remnant of the hymen. The tampon itself does not really stretch the vagina or create more space, but if you have been able to successfully use a tampon, you will probably not have pain with your first sexual intercourse.

First of all, if you think you might have a tampon left inside, “a few months” is way too long to wait!

Toxic Shock Syndrome is a very rare but potentially serious condition caused by toxins released from the common (and usually friendly) skin bacteria Staphylococcus aureus. Staph aureus infections can occur in other circumstances, but when a foreign body like a tampon is left in the vagina for days, these bacteria can multiply, especially in the presence of nutrient-rich blood, and release their toxins, causing the syndrome.

The symptoms of toxic shock syndrome include a high fever, a diffuse rash that can include peeling skin when more severe, feeling unwell, nausea, vomiting or diarrhea, fast heart rate, dizziness or fainting from low blood pressure, and confusion. If severe and not treated, this can progress to shock, organ damage or even death.

Again, this syndrome is very rare (about 1 in 100,000 women) but you will notice that all tampon boxes have warnings about it. To reduce your risk, do not leave your tampon in for more than 8 hours, use the minimum absorbency needed for your flow, and always remember to remove the last tampon at the end of your period.

When you have a “lost” tampon, try not to panic. Your vagina is a closed space. The tampon cannot move anywhere else; it is either inside your vagina within reach, or it has already fallen out. Try to get it yourself by reaching into your vagina with clean fingers to see if you can pull it out or feel it. If you can’t, but suspect it is still there, you should see a health care professional within a day or two for help.

Toxic shock syndrome (TSS) is a rare but serious infection caused by a bacterial toxin. It may be caused by different bacteria but is usually due to streptococci and staphylococci. Toxic shock syndrome (TSS) is the bodys response to a toxin produced by a bacterium called Staphylococcus aureus. We all have bacteria throughout our bodies, and in fact we need them to have our bodies function properly. Up to 50% of people will carry this particular strain of bacteria at any given time. Most of the time, it does not cause us any harm, and many of us have natural resistance to the toxin it produces. However, if you have a break in your skin (like a cut from shaving, a surgical wound, or an abrasion in your vagina from using a tampon) and your immune system does not respond, an infection can develop from this bacteria. This is very rare, but can be life threatening.

Once the bacteria enter the wound and multiply, they begin to release the toxin. This toxin can cause a high fever, rash, muscle pains, vomiting and diarrhea, and leave you feeling generally unwell (like a severe bout of the flu that does not go away). As time passes, it can cause the blood pressure to drop dangerously, and the kidneys can fail. There are some people who die from this infection.

Although a Staph aureus infection can be caused by several factors, it became more known to the general public because of its association with tampon use. In the 1970s and 1980s, reports describe a number of women who developed Toxic Shock Syndrome (TSS). They all had their period at the time and many were using a particular super-absorbent tampon that is no longer available. When tampons are used for a prolonged time, they can irritate the surface of the vaginal skin, creating microscopic breaks in the skin that allow bacteria to enter your system. The bacteria then produce the toxin that makes you sick. We now know that this infection can be caused from other sites of damage to the skin, and can also happen in men.

The number of reported TSS cases has decreased a lot in recent years. About half the cases of TSS reported today are associated with tampon use during menstruation, usually in young women. Studies have shown that using the super plus tampons and leaving tampons in the vagina for long amounts of time increase the risk of developing TSS. Tampons made with rayon do not appear to have a higher risk of TSS than cotton tampons of similar absorbency.

TSS also occurs in children, men, and non-menstruating women. TSS symptoms appear quickly and are often severe. Not all cases are exactly alike, and you may not have all the symptoms. Symptoms include a sudden high fever, vomiting, diarrhea, fainting, aching muscles, dizziness, or a sunburn like rash. Later, the skin on the palms of your hands and soles of your feet may flake or peel. A first episode may be so mild that you don’t connect the symptoms with TSS, but the next time, the symptoms may be severe. Once you’ve had TSS, you’re more likely to get it than someone who never has had it.

TSS is usually treated with antibiotics, and drugs to lower temperature, and large amounts of fluids to keep your blood pressure up. Antibiotics are given to help prevent recurrence. Patients often are hospitalized and severe cases require intensive care. With proper treatment, patients generally recover within three weeks.

While TSS is rare, it’s an important health concern for menstruating women. It is important to know how to prevent it and how to recognize its symptoms. This will help to reduce its dangers and continue to keep its incidence low. Early diagnosis and speedy treatment are crucial to avoiding the most serious effects of TSS.

The best way to avoid getting this infection is to keep your hands clean. These bacteria live on the skin and can be passed from person to person through contact. Also, use tampons with the lowest absorbency that will handle your menstrual flow and change them often (at least every 4-6 hours). Wash your hands well before inserting a tampon. Consider alternating tampons with sanitary pads to allow the vaginal skin to heal. If you develop symptoms that suggest TSS during your period, even if you are not using tampons, you should see your health care provider right away.

No, a tampon cannot get lost inside your body. The opening at the end of your vagina (the cervix) is much too small for a tampon to fit through. The tampon is held in place by the walls of your vagina until you pull on the cord to remove it. If you feel definite resistance when you pull on the withdrawal cord, try to relax. You may want to leave the tampon in a little longer as it may not have absorbed enough menstrual fluid to become soft and pliable. It may be too early to remove it, if it’s been in place less than 4 hours.

A tampon cannot get “stuck” inside you. The vagina is a potential space that can expand, and the tampon can get lodged near the back. It will stay there until you find it. Sometimes the string may become twisted behind the tampon, or pushed way back in the vagina, making it difficult to reach. When this happens, it takes some time for the vagina to relax and change position so that the tampon will return to its usual place, or at least a place where it can be reached. Try to “fish around” for the tampon or string with a clean finger. If you’re not able to find it, ask your partner to try.

If neither you nor your partner can find the tampon, see your health care provider (as a last resort, you can go to the emergency room). It is important to do this not only for peace of mind, but because the tampon will begin to smell bad and because there may be a small risk of infection (including toxic shock syndrome) if the tampon is left in for too long.

Many women go faithfully for their annual exam without knowing exactly why they are important!

One reason is to review your health history and any medications, in case there have been any changes. This is a good time to review your birth control method, to be sure it is still working well for you. Your doctor may ask about your periods, mood, or any sexual concerns, and review other habits that can influence your health such as smoking, alcohol or drugs. Your doctor may check your blood pressure, or perform a breast exam to check for any lumps. You may be sent for blood tests such as thyroid, sugar or cholesterol tests, depending on your age and situation. Women over 50 are sent for mammograms (breast x-rays) every two years to screen for breast cancer.

With regard to the pelvic exam, the purpose is to do a Pap test, screen for sexually transmitted infections if needed, and to make sure your reproductive organs are normal and healthy. The Pap test is designed to pick up pre-cancerous changes in the cervix so that they can be treated if necessary, to prevent development of cervical cancer. A speculum is used to hold your vaginal walls apart so your cervix (the entrance to the uterus or womb) can be seen at the top of the vagina. A sample of cells is brushed from your cervix, spread onto a glass slide and sent to a laboratory where specially trained technicians carefully examine the cells under a microscope to see if there are any abnormal or pre-cancerous cells there. The Pap test has been proven effective at preventing cervical cancer, if women get tested every one to two years.

At the same time, cervical secretions can also be sampled with a Q-tip to look for gonorrhea or chlamydia, two common STIs that often have no symptoms in women. Many health care professionals check for these infections as a routine, but you can ask for them to be done if you would like to be sure. There is no test to screen for herpes or genital warts, but if there are sores or warts seen, these can be sampled to confirm the diagnosis. Other infections like HIV, Hepatitis B and syphilis are diagnosed with a blood test; ask your doctor if you would like to be tested.

The final part of the pelvic exam is the “bimanual” exam where the position, shape and size of your uterus and ovaries are felt with 2 fingers in your vagina and the other hand on your lower abdomen, to ensure that they are normal.

You can access the web pages for the College of Physicians and Surgeons relevant to the province where you live. On that webpage you can access a doctor search for any specialty in any city. To see a specialist, you usually need to get a referral from your family physician. Ask your family doctor to refer you to a gynecologist in your area. You can give them a name that you found or they can find someone for you.

Silicone-based lubricants are an alternative to water-based lubricants. Unlike oil-based lubricants, they are safe to use with latex and polyurethane condoms. They are not recommended for silicone sex toys. This synthetic product retains its lubricant properties longer than water-based lubricants, thus is preferred by some people. As it is not water-soluble, it can be more difficult to wash off. Silicone-based lubricants are not absorbed through the skin epithelial layer of the vagina. Other than potential skin sensitivities, it does not carry any known health risks.

Masturbation (also called self pleasuring, “jerking off”, or “playing with yourself”) is a personal choice. Some people are comfortable touching themselves and some are not. Both are okay. Masturbation is a normal activity that people may do alone or with a partner. It involves rubbing or touching your or your partner’s body in a way that arouses sexual feelings and might produce an orgasm. Males and females of any age can masturbate.

Masturbation is not harmful. Most people see it as a normal part of sexuality. It can give pleasure, can be relaxing, help you sleep and is an outlet for sexual tension. Masturbating may help to teach you about your own body and learn about where you like to be touched. You may choose to share this information with your partner. If a woman doesn’t have orgasms easily, masturbation can help her learn how. Women more commonly experience orgasms through masturbation than through intercourse alone.

Some people do not masturbate because they don’t get pleasure from it, or because they are uncomfortable touching their bodies. In some religions, masturbation is not acceptable. All of these choices are normal. Masturbation is not acceptable if it is done in front of a person who has not wanted or permitted it.

There are a few things to keep in mind to make masturbation safer. Touching genitals with clean hands helps avoid spreading germs. Avoid putting a sharp or unclean object into a vagina or anus because it can cause tearing or infection. Any sex toys that are used during masturbation should not be shared with a partner without being cleaned first.

Being gay, lesbian or bisexual is also called having “same sex feelings” or a “same sex orientation.” No one knows for sure why some people are attracted to people of the same sex. Sexual orientation is a complex issue. Different people may be attracted to the same sex for different reasons. Some people who are gay, lesbian or bisexual say that they have always felt attracted to members of the same sex. Others say they became aware of these feelings when they were teenagers or young adults. Some scientists believe there may be biological or physical factors. People are not attracted to the same sex because they were raised a certain way by their parents, are mentally ill or are abnormal in some way.

Gays, lesbians and bisexuals may have feelings of confusion or fear. They worry that family and friends will reject them or keep them at a distance. It is important to remember that people with a same sex attraction can and do lead happy healthy lives. If you are lesbian, gay or bisexual, you may find it helpful to meet others with a same sex orientation. For example, you can join a gay or lesbian club or organization. You may also check with social services to see if they offer support services that are gay, lesbian, and bisexual positive. Building these relationships can make you feel less alone. You may also be a source of support to someone else.

Unfortunately there is no test. Sexual orientation is a reflection of your feelings towards other people, be they same or opposite gender, or both. It may be obvious from the start that you are attracted to people of your own gender. However many people do experience a period of confusion. Sexual orientation does become clearer with time. The important point is not to fear your own feelings. Having had feelings toward a person of your own gender, or an actual encounter, does not label your orientation. Homosexuality is not a choice, but part of who you are as a person.

Roofies is a nickname for ROHYPNOL. Other nicknames include rophies, ropies, ruffies, la rocha, roofenol, roche, Mexican Valium, rib and rope. It is a very potent tranquilizer and is not legally available in Canada or the USA. It has a sedative effect including muscle relaxation and amnesia (memory loss). It takes effect in 20 to 30 minutes after dosage and lasts approximately 8 hours. It is used as a cheap alternative to alcohol and as a cure for hangovers. Most often, it is used in combination with alcohol and other drugs. When used in date-rape crimes, it has the effect of sedating the victim and often there is very little memory of the event. The drug, produced as a pill, can be crushed up and quickly dissolved into a drink. Unlike other drugs used in date-rape crimes, Rohypnol is colourless, odourless and tasteless when dissolved in liquid. It is a dangerous drug and can be addictive. Withdrawal symptoms include headache, muscle pain, confusion, hallucinations and convulsions.

This is a controversial area. Some people believe that men don’t have a menopause equivalent and others feel very strongly that they do and have in fact labeled it the andropause. Those who believe andropause exists suggest that males undergo a decrease in their sex hormones. They suggest there are visually apparent physical changes such as sagging of the chest. There might also be less urgency about sex, more time required to become aroused and a reduced need for orgasm. Sexual activity might change to become more gentle and less centred on performance. The bottom line is that both men and women can be (and often are) sexual in old age.

Medications and their effects on sex is a difficult subject to study. Despite this, there are entire books dedicated to this topic. It is probably safe to assume that any drug may increase, decrease or have no effect an individual’s sexuality. Having said this, we know there are some drugs which are commonly used that tend to negatively affect sex drive and performance. Many heart disease drugs are believed to decrease sex drive. You would be best served by checking with your doctor to see which of the medications that you are taking might affect your drive. Some cancer agents may also cause a decrease in desire, but emotional and physical factors would also have to be considered. Medications used for heart disease are also associated with erectile dysfunction. On occasion, the underlying disease might also be adding to the difficulties. It is important to note that - while there is an association - this does not mean that everyone taking medications for heart disease will have these problems. Association in this context does not imply that the drug is the cause.

Guys like sex for the same reason that almost everyone likes sex - because it feels good! Society portrays men as being sex-obsessed, and this is an image some guys feel they need to live up to. Sex plays an important role in a lot of relationships, but not everyone is obsessed with sex. Some men and women may be more interested in open and honest communication, touching, hugging and other expressions of affection that don’t involve intercourse.

A person’s HIV test may be negative for up to three months following the time of contact (viral transmission). For this reason, it is recommended that you always use a condom for the first 3 months of a monogamous relationship. After three months, if you and your partner both test negative for STI’s and HIV, then you may consider not using condoms provided you are using an appropriate method of birth control and that you both remain monogamous.

One thing to think about: not everybody is 100% truthful. If you stop using condoms and either you or your partner has an extra-relationship affair, you may be at risk for STI’s/HIV and the need for condoms may arise again. Some couples find it better for their own peace of mind to continue using condoms throughout a relationship - for ongoing STI/HIV protection and pregnancy prevention.

No, it is not wrong to fantasize during sex. In fact, it’s healthy if it heightens your pleasure. Fantasy is exactly thata fantasy or daydream or sexual activity confined to the mind. It is not reality and only you have the choice of making it real or keeping it a private act. Most people fantasize. What you choose to fantasize about is entirely your business. Most people do not share their fantasies with other people. If the fantasy becomes an obsession that is disruptive in any way, then obviously it is not healthy. This tends to be a problem for only a very small group of people. As for whether to share your fantasy with your partner, it’s a matter of personal choice. If you think sharing will improve your sex life, and your partner is secure enough to accept your fantasy, then go ahead and share. If you think that sharing might be threatening to your partner and might affect your relationship then keep it to yourself and enjoy it. You might be surprised about the fantasies your partner is having.

No. Males and females have an equal ability to enjoy sex. A satisfying sexual relationship relies on both partners to be considerate of each other and to explore what types of sexual touching and activities feel best.

Underwater sex - whether in the pool, hot tub, ocean, lake, river, shower, or bath - isn’t considered a safer sex option. Here’s why:

1. Spermicide is likely to “wash off” or wash away in water.
2. Water containing chemicals, salt, or bacteria can be forced into the vagina or rectum during sex, possibly causing irritation, infection, or temporary dryness.
3. Since it’s recommended to store latex condoms away from direct sunlight, it’s possible that heated water may have a similar effect on latex.
4. Water can seep between the condom and the penis, possibly causing the condom to slip off.
5. Oil-based products - such as sun block, tanning lotion, shampoo, conditioner, and soap - and possibly even chlorine cause latex condoms to deteriorate.
6. Condoms aren’t typically tested in pools or hot tubs, or with chemicals found in these hot, wet places. Of course, using a condom in a pool or hot tub is better than not using one at all.

Anal sex is when a penis (or dildo) is inserted into someone’s anus.

Anal sex is healthy, but it does pose more risks because it can be easier to contract disease. A condom should always be used, with plenty of water-based lubricant. Many couples prefer to have anal sex because a woman can’t become pregnant through anal sex. For both partners, it also feels very different from vaginal sex.

Some women are prone to developing bladder infections when they have sex. This is due to bacteria that normally live in the vagina being introduced into the urethra (the tube draining the bladder) during intercourse. One of the ways to help prevent infection is to urinate (pee) within a few minutes after having sex. This helps flush out any bacteria that may be there.

Some women who are trying to become pregnant may avoid going to the bathroom because they want to prevent semen from leaking out of their vagina. They stay in bed or put a pillow under their hips. However, leakage of part of the semen is normal and there is no medical evidence that suggests preventing leakage makes any difference to pregnancy rates. Most of the ejaculate gets released at the top of the vagina during intercourse and sperm are often in the uterus within minutes of ejaculation. There is no need to stay in bed for a prolonged time after intercourse before going to the toilet.

There have been a few medical studies on this subject but the results are somewhat confusing. The largest study on non-alcoholic women found that ‘female-initiated sexual activity occurred twice as often without alcohol versus with alcohol.’ This seems to be the opposite of what you would expect. Another study found that ‘the higher the blood alcohol level the greater the depressant effect on the orgasmic response, including longer time needed to achieve orgasm and diminished intensity of the feeling.’ The same study found that with alcohol there was greater arousal and pleasure associated with orgasm. Obviously, this is somewhat contradictory. Common sense would suggest that since most of your inhibitions are diminished with alcohol, your sexual inhibitions should not be any different.

It certainly does sound like too much of a good thing. It is common in relationships for one partner to want sex more than the other, and this can wax and wane throughout the relationship. And it can be a big problem when the sex drives are very different.

One thing you didn’t mention is whether or not you are having orgasms with your husband. If you are not, that could explain why you are still so aroused. Or maybe you need more than one orgasm now. After (or during) sex with your husband spend some time showing him how you like to be touched, and what turns you on. Many women do not have an orgasm from vaginal penetration alone, and need extra digital or oral stimulation to climax. Communication is key. While he is no doubt enjoying this for himself, remember he wants to satisfy you as well.

If he truly can’t keep up with you, or even if he can, consider masturbating to take the “edge” off your newly revved-up sex drive. Having an orgasm before bed can help you sleep, and first thing in the morning it may help you to focus on your busy day without being distracted. You may want to buy a vibrator; these have become much more mainstream now and there are many models available. You can buy them discreetly on-line, or in upscale boutiques.

There are also some hormonal changes going on. When a woman becomes menopausal, the ovaries stop producing estrogen. Ovaries continue to produce testosterone into menopause, and although the amount differs between individuals, it tends to decrease as we get older. (Many women complain of a reduction in sex drive after menopause.) Testosterone, a “male” hormone, is thought to be largely responsible for libido. The actions of estrogen and testosterone tend to oppose each other, so now that you’re not producing estrogen, this could mean that your testosterone now has relatively more influence. Some signs of testosterone excess include oily skin and acne, excess hair growth on the face, rapid loss of scalp hair, voice deepening or muscles becoming bulkier. If you have any of those symptoms, see your doctor who can check your testosterone level to make sure it is within normal limits.

Menopause can also bring about changes in your life that can contribute to you feeling sexier. You no longer have to worry about periods or pregnancy, which can be a big relief for some women. Many couples are more financially secure. And if your kids have recently moved out of your house, you are probably feeling a freedom you have not felt in years. Enjoy it!

You can also talk to your family doctor or gyneacologist about this - they will probably be more understanding than you think. One note of caution: if in the future you do end up having a new sex partner, use condoms to protect yourself from infection. Sexually transmitted infections are a lot more common now than when you got married, and even “nice” men your age may have one and not know.

There are a number of lubricants available, for example Astroglide, Aqua Lube, or KY-Jelly (which are water-based lubricants). If you are using latex condoms, a diaphragm, or a cervical cap, you should only ever use water-based lubricants. Petroleum-based lubricants such as Vaseline are NOT safe to use—they can degrade the latex in condoms and diaphragms.

Either partner may apply the lubricant directly to the penis, or it may be applied to the woman’s genitals, either externally or inside the vagina. The lubricant can be squirted on directly or can be poured into the hand or on the fingertips and then applied. Additional lubricant can be used as needed during intercourse.

There’s no right or wrong way to use lubricants. Experiment with what works best for you. Applying lubricant can even be a part of foreplay. Remember, though, that lubricants are not spermicides and therefore do not help to prevent pregnancy.

This is a really important question and one that does not have a simple answer. To know that answer, youll likely have to ask yourselves several more questions. The first thing to think about is Why am I thinking of having sex? Is it because of peer pressure? To impress your friends? To keep up with the crowd?

Sex should never be just because. So much of what is gossiped about at school or work is just that - gossip. What does your partner think about this? Do they want to have sex too? Do they feel like they are ready? Are you and your partner able to talk openly about your feelings about sex? Do you feel pressured by your partner? You should never feel forced to have sex with anyone. Although sex is great with the right person at the right time, there is always the possible consequence of pregnancy. Have you had an open discussion about birth control and pregnancy? Have you both been tested for sexually transmitted infections? If not, are you prepared to reduce your risk of STIs by the use of a condom?

As you can see, there are a lot of things should be discussed and understood before having sex. Sex can be a fantastic experience between you and your partner, but its still a big decision and one that shouldnt be taken too lightly.

We call this discrepant libidos. This is a common cause for relationship problems, particularly for people who have trouble communicating with their partner. It can be a win/ lose situation that inevitably turns into a lose/lose situation. That is, the partner who has the higher drive feels hurt and rejected when sex does not happen and the partner with lower drive feels pressured and resentful at having to perform when they don’t feel up to it. The best solution is usually for both partners to reach a compromise. The higher-drive partner should understand that each person has their own natural sex drive and should not feel rejected when their drive doesn’t fall in line with their partner’s. Finding non-sexual romantic ways to boost their partner’s libido may also prove helpful. Dealing with the libidinal feelings by masturbating or redirecting is another approach. For the partner with the lower drive, it is important to understand that their partner is not trying to pressure them. Responding to some of the non-sexual cues may help enhance their sex drive. Many times, simply being with their partner, holding them while they masturbate or masturbating them is an acceptable alternative that doesn’t require full-blown sexual involvement. If there is a large discrepancy, such as one partner wanting sex every night of the week and the other only once a week, they could agree to engage in sex twice or three times a week. Often this requires more of an attitude change than a physical change

It depends. If she feels really comfortable with the idea of having sex and feels relaxed and aroused, then it probably won’t be painful, providing her partner is gentle and listens to her needs. If a girl feels anxious about pregnancy or is scared or uncertain about her partner, these feelings may make her tense and it may hurt when the penis enters her vagina. Lots of couples use a water-based lubricant when they have intercourse, particularly for the first time.

No. In fact, the majority of women do not have bleeding when they first have sexual intercourse. It depends on your own body. If you can insert tampons or fingers easily, you probably won’t have problems, providing that your first sexual intercourse is gentle.

Yes, you can. And one doesn’t have to engage in full intercourse to get pregnant. Close genital contact without penetration could put you at risk of an unplanned pregnancy or sexually transmitted infections.

Children who haven’t reached puberty yet, or who have just begun puberty are likely to have a lot of questions about sex, their bodies and how things work.

For example, they may ask:

1. “How does the sperm get into the egg?”
2. “What’s an orgasm?”
3. “How big do penises get?”
4. “What do men and women do in bed?”
5. “What is oral sex?”
6. “What are homosexuals?”
7. “Does sex cause AIDS?”
8. “What is jerking off?”

Before talking with your children about contraception and sexuality, it’s a good idea to think about your own views on sexuality issues. This is important when a teenage son or daughter is asking you what you think. If you want your child to speak openly with you about how they’re feeling, you should probably be willing to do the same.

Be prepared to discuss with your children how you feel about these issues:

1. Dating (“going with”, “seeing someone”)
2 Contraception for birth control/safer sex
3. Sexuality in relationships
4. Teens having sex
5. Sexual behaviours (masturbation, petting, oral sex, intercourse)
6. Sexual orientation (gay, lesbian, bisexual)

Sometimes we think that if we load up our kids with all the proper information, they’re bound to make good decisions. It’s also easy to think that once our child has made a firm decision, they will always be able to follow through on it. Even if your teen has all the info on sex and is highly motivated to act on a decision you may have helped them to make, there may still be something missing. That something is the behavioural skill needed to act on their decisions.

Being able to communicate about sexuality isn’t always easy, but is really important. Let’s look at an example to illustrate. Suppose your 16 year-old son has decided that he’s not ready to have intercourse with his girlfriend. He may have a good understanding of why he’s not ready but he’s not sure about how he’s going to bring it up and talk about it with his girlfriend who’s sending him signals that she does want intercourse. He might be afraid that she will dump him or think that he’s not normal for being a guy who doesn’t want to have sex. He needs to know what he is going to say and how he’s going to say it.

That’s the behavioural skill - learning to communicate effectively. Often, young people end up doing things they didn’t intend to do because they don’t have the behavioural skills to follow through on their decisions. The same thing applies to a whole range of sexual health issues including birth control and condom use. If your son or daughter is going to be sexually active or already is, they need the communication skills to negotiate birth control and condom use with their partners. Perhaps this is something you can help them with by talking about the importance of effective communication. Schools are increasingly involved in helping young people deal with these issues.

There is a whole lot of information about contraception and sexuality that your child will need to know as they grow into fully mature adults. Does this mean that you need to become a “sex expert”, ready to provide your child with a wide range of detailed information about all aspects of sexuality? Not at all. Nobody expects you to become an encyclopedia of sexual health. The most important thing is to offer your guidance and to establish an environment of trust and support.

Your main goal at this point shouldn’t be to answer every possible question your child might have. Rather, you want to establish a line of communication with your child so that they can be comfortable talking with you, and so they feel that you are supportive rather than confrontational. If you don’t know the answer to a question your child asks, don’t hesitate to say so. Say you’ll find out and get back to them later. Still, it’s probably a good idea to try to have some basic knowledge about issues such as contraception, safer sex practices, sexually transmitted infections, and the male and female bodies so that you and your child can discuss sexuality.

There may be times when a parent will feel a little (or a lot) uncomfortable or embarrassed discussing sexuality with their children. That’s OK. Contraception and sexuality are sensitive topics, so it’s normal to feel nervous when talking about it, especially with your children. Your kids will probably be nervous and a little uncomfortable talking to you about it too.

If you’re reading this it is because you have realized that it’s important to talk to your children about contraception and sexuality, to offer them your guidance, and to make sure that they have the information they need to be happy, healthy, and responsible. If you and/or your child are nervous about it, acknowledge your feelings. In the years to come you will both laugh about how nervous you were when talking about sexual health issues. If your children are older, chances are you’ve already dealt with a lot of sexual topics already - things like body function, nudity, pregnancy, etc.

Here is a good way to start - “I’m really glad we’re talking about sexuality because it’s important stuff. I don’t know about you but I’m a bit nervous. But we need to talk about it. I want you to know what I think and it would be good for me to know how you’re feeling about it. I also want to make sure you have all the information you need.”

It’s helpful when talking to your teens about contraception and sexuality to remember that human beings engage in a wide range of sexual behaviours from holding hands, to kissing, hugging, caressing, mutual masturbation, oral sex, anal sex, and intercourse. Sometimes parents find themselves talking with young people about sex without being very specific about what they mean.

If you say to your son or daughter, “You’re too young to have sex, you shouldn’t do it until you’re more mature” you may be sending a very vague and confusing message.

Talking about the range of sexual behaviours can help your daughter or son to decide on which behaviours they are ready for and which ones they are not ready for. This is called “sexual limit setting”. It doesn’t have to be all or nothing. One area of discussion with your son or daughter might be where on this range of behaviours they want to set their limit. A young person with a clear sense of where their limits are in terms of their sexual behaviour may be less likely to do something they will regret later or end up doing something they really didn’t intend to.

It is not uncommon for some girls to have irregular menses for the first year or so after they start their period. However, if this does not improve, a visit to your health-care provider would be a good idea. There are some health conditions that are associated with irregular periods and should be ruled out. Your health-care provider will have some options to regulate your cycle if you wish.

For the first few years after starting their periods, many girls have irregular cycles. This can mean bleeding every 2-3 weeks or 2-3 months. The cause for this is anovulation (not releasing an egg), which is very common while the hormone system that regulates periods reaches full maturity.

If you are using birth control, such as the birth control pill, the patch, the ring, an IUD, or an injectable contraceptive, bleeding between your periods (breakthrough bleeding) is common in the first few months. Usually this problem will resolve on its own after three to six cycles. Long-term pill users may also have breakthrough bleeding if they miss pills or take them at irregular times. Women who smoke cigarettes are also more likely to experience spotting in between periods. Occasionally, sexually active women may experience spotting as a symptom of a sexually transmitted infection like chlamydia and gonorrhea. Using condoms properly, each and every time, greatly lowers the risk of getting these infections.

If you are pregnant, or think you might be pregnant, it is very important to see your health care provider to find out the cause of the bleeding. Several complications of pregnancy can cause irregular bleeding, including miscarriage or ectopic pregnancy (a serious condition in which the baby develops outside the uterus, usually in a fallopian tube).

The most common reason for sexually active women to miss 3 periods in a row is pregnancy. It is very important to have a pregnancy test to determine if you are pregnant. If the test is negative, there are several reasons why you have missed periods. It may be caused by a recent substantial weight loss or gain, a particularly large amount of stress in your life, or eating too little and exercising too much.  It can also be due to hormonal conditions like polycystic ovarian syndrome (PCOS). If you have been on the birth control pill for a long time, menstrual periods can get lighter and lighter until they actually stop. This is not a problem (in fact many women enjoy this relief from menstrual bleeding); however, it is still prudent to get a pregnancy test to be sure. If your periods have recently stopped you should see your health care provider to have this checked out

The first period can be a bit different for everyone, but it will always involve some kind of bleeding from your vagina. This bleeding may be a small amount of brown or bloody liquid containing slippery mucus, or it may be more like fresh blood. Sometimes, if the blood sits for a while in the vagina, it will appear clotted (lumpy). This is normal.

During your first period, you may feel cramps in your stomach area or lower back, or you may not have any cramping or pain at all for your first few cycles. Painful periods are usually related to the release of an egg a few weeks earlier (see the previous FAQ), and this might not happen for the first few cycles after you start your period.

You may notice some changes before your period comes. You (or your friends!) may notice that you have been moody or grumpy for the week before your period starts. During this time, your breasts may also feel tender or your stomach area may feel bloated. All of these changes are normal, and are caused by special chemicals in your body called hormones. These symptoms will normally go away once your period starts.

Pain during your period is called dysmenorrhea, and it is extremely common. It is usually associated with cycles that release an egg (ovulatory cycles). When young women first start to get their periods, they may not release an egg every month so their periods may not be as painful.

When your period starts (menstruation), chemicals called prostaglandins are released which cause your uterus to contract. The endometrial lining (the lining of your uterus), which has become thick, is shed from the uterus through the cervix during these contractions. Typically, these contractions are the most painful during the first day or two of your period, and then gradually get better. However, some women have pain throughout their entire period. Painful periods may also be accompanied by other symptoms, such as nausea, vomiting, dizziness, diarrhea, and headaches.

This pain may sometimes be treated with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, that help decrease the amount of prostaglandins your body releases. These drugs work best if you take them before the pain gets very bad. If you have a predictable cycle, you can start taking the medication the day before your period starts. Most of the time, you will only need to take the medication for a day or two to get over the worst of the symptoms. Some women find exercise or a hot shower or bath can also help to ease the pain. If this does not work, and you need more help with pain control, please see your health care provider for more information.

There are other, less common, causes for painful periods. These include endometriosis, problems with the development of the female reproductive tract resulting in a partial or complete blockage of menstrual tissue, and untreated pelvic infections. Again, if you have monthly pain that is not responding to basic treatment such as over-the-counter medications, please see your health care provider for help.

Cramps with a woman’s period are common, and are caused by chemicals called “prostaglandins” that are released as the uterine lining is shed. Prostaglandins cause the muscle of the uterus to tighten, causing little “contractions” which are often perceived by the woman as painful. Many women get mild cramps which are tolerable, and which can be treated by hot baths, hot water bottles or exercise, or by taking an over-the-counter medication such as ibuprofen (Advil or Motrin).

Ibuprofen is an example of a non-steroidal anti-inflammatory medication (“NSAID”). This type of medication prevents prostaglandins from forming, and thus reduces the cramping. If an over-the-counter NSAID is not strong enough, ask your doctor for a prescription. Some examples of NSAIDS available by prescription only include naproxen, mefenamic acid, celecoxib, and ketorolac. If taking it as you need it is not working, try taking your anti-inflammatory at the first sign of pain, or just before your period even starts, and take it regularly according to directions for the first 2 or 3 days of your period. The medication can work even better if you start to take it before the prostaglandins have had a chance to form, rather than waiting until the pain is severe.

Hormonal contraceptives like the combined oral contraceptive pill or patch, Depo-Provera injections, or the Mirena intrauterine system are also used to treat painful periods due to various causes. These work by stopping ovulation and/or reducing the amount or frequency of bleeding.

Severely painful periods are not necessarily normal, and can be treated. A visit to your health care professional may be helpful to help figure out why you are having the pain and what type of treatment would work best for you. A woman should not have to “suffer through” pain that interferes with her life. Some other causes of painful periods include fibroids (benign uterine tumours), endometriosis and adenomyosis (benign conditions where small patches of the uterine lining grow outside of the uterus or into the uterine muscle, respectively). Pain that occurs at other times in the month may also be due to these, or could be from ovarian cysts, or bladder or intestinal conditions, among other things.

Talk to your doctor if you are concerned, or if the pain is severe.

When a woman is not taking in enough calories to meet her energy needs, the body seems to recognize that there would not be enough energy to nourish a developing baby and thus stops ovulation. In other words, when there is an imbalance between the calories consumed and the energy needed, this stress acts on the hypothalamus in your brain to temporarily shut off your reproductive hormones. The result is that you do not ovulate (release an egg) which means that you dont have a period.

A woman in this situation usually has low levels of estrogen too. This often happens when a woman eats too little, exercises too much, or is too thin. Sometimes this takes place in athletes who train very hard and is often seen in gymnasts, figure skaters, and dancers. It also happens in women with an eating disorder like anorexia nervosa.

Anorexia nervosa is a disorder where a person has a distorted body image so that they think they need to lose weight, even though they are sometimes already dangerously thin. This is a serious condition with health effects like depression and suicide, electrolyte imbalances, heart rhythm problems and in extreme cases can lead to death! It can be treated with counseling and sometimes medication.

The main long-term effect of low estrogen is loss of bone mass, leading to osteoporosis. In a teen-age woman whose bones are still increasing their strength, this is especially a concern.

The lack of periods is not the problem, but what is causing it. You should see your doctor to look for other causes of not having a period. If it is too much exercise/too little food, the natural way to get back your period would be to either reduce your exercise level or increase the calories you take in to meet the demands on your body. It may help to gain some weight because a woman needs a certain percentage of body fat in order to ovulate and menstruate. You should think hard about your motivation for dieting and exercising so much. Could you have an eating disorder? This is something you should bring up with your doctor.

The birth control pill is one option. It does not correct the underlying problem, but it gives you a regular period, keeps the uterine lining thin, and acts as supplemental estrogen to help your bones. It also gives you reliable birth control (if you need it), among other non-contraceptive benefits.

The pregnancy tests that are available at the drugstores are very sensitive. By the time a woman has missed her period, if she is pregnant, it will be positive. If she has a delayed period for another reason, it will be negative. If a woman misses two periods in a row, she should consider redoing a pregnancy test and/or seeing a doctor for a more sensitive blood test to rule out pregnancy.

Yes, stress can definitely affect the timing of menstrual cycles. Some women can miss several months in a row with extreme stresses (like relationship breakup, loss of a loved one, school exams, etc). Physical stress can also cause skipped periods. Physical stress may include exercising for several hours every day, losing or gaining more than 10 lbs in a short period of time, or not getting enough calories to support the nutritional needs of both herself and a potential baby.

The short answer is no. Your period is the (usually) monthly sloughing of the lining of the uterus. During the early part of your cycle, the lining grows in response to increasing hormones. After ovulation, the lining matures and prepares itself for implantation of the fertilized egg (blastocyst). When conception does not occur, the drop in hormones causes the shedding of the uterine lining (your menses).

In pregnancy, some women experience some spotting at the time of implantation, approximately 6-7 days after fertilization. So if fertilization happens at mid-cycle, and the implantation is a week later, spotting could happen at the time a woman is expecting her period. The implantation bleeding is usually light and short in duration. Any other bleeding in pregnancy would not be considered normal. Medical attention should be sought.

A woman can get pregnant at any time of the month. Some women have even become pregnant from having sex during their period! The easiest time to get pregnant though is when you ovulate. This happens once a month when your body releases an egg from one of your ovaries. However, not all women ovulate at the same time of the month. Most women ovulate about 2 weeks before their period starts.

The days before, during, and just after ovulation are the easiest time of the month to get pregnant. Sperm can live in your body for 5-7 days. If you have sex a week before you ovulate, the sperm may still be able to fertilize the egg, resulting in pregnancy. The egg can survive for 1-2 days after ovulation. If you have sex on the days right after you ovulate, you could become pregnant.

It may be difficult to know exactly when you ovulate and unfortunately there is no perfect test for this. For a young woman whose periods are just getting started or who has irregular periods it is very, very difficult to know when she has ovulated. For this reason it is important to always use some form of birth control if you don’t want to get pregnant, regardless of where you are in your cycle.

If you have unprotected sex (no matter at what point in your cycle) but you do not want to get pregnant, talk to your health care provider about emergency contraception.

You can certainly have sex during your period, if you and your partner both want to. Some people don’t like having sex when there is bleeding, but that is a personal preference, or a religious belief for some; in the Jewish faith there is a rule against sex during menstruation. There is no medical reason to avoid sex during your period.

Theoretically, if you are having a normal period, and have regularly-timed cycles, there may be less chance of pregnancy. But women can and do get pregnant during their periods. If you bleed for a long time, or your cycles are short, ovulation could occur even though you are still bleeding. In addition, women sometimes get an episode of “breakthrough” bleeding at other times in their cycle when they may be fertile. You also need to consider that sperm can live in a woman’s reproductive tract for up to a week. Therefore, the safest thing to do is to always use a reliable method of contraception, unless you want to risk a pregnancy.

Having sex during your period does NOT reduce the risk of transmission of sexually transmitted infections so always use condoms to protect yourself unless you and your partner have both tested negative for STIs AND are in a monogamous relationship.

Unfortunately, pregnancies have occurred from unprotected intercourse at any point in a woman’s cycle. Though not a very reliable method of birth control, your fertile days can be calculated by the calendar method. Your first “possibly fertile” day can be determined by using the length of your shortest menstrual cycle, and subtracting 20. The last “possibly fertile” day is found by using the length of the longest cycle, and subtracting 10. Thus, if a woman’s cycle length varies from 22 to 29 days, her fertile period ranges approximately from day 2 to day 19 (day 1 being the first day of menses). If she has her menses for 7 days, she will be fertile for 5 days during her period!

Don’t worry if you have one or two irregular cycles because occasionally all women have variations in their periods. True irregularity persists over several months. So if you do notice wide fluctuations in your cycle, speak to your doctor about it.

Irregular periods can be troublesome when trying to get pregnant. Irregular or abnormal ovulation and menstruation accounts for 30% to 40% of all cases of infertility. Depending on the cause of your irregular period, getting pregnant sometimes needs the assistance of your doctor.  If you have periods that are unpredictable, irregular, or more than three months apart, see your health care provider for help.

Unfortunately, pregnancies can occur from unprotected sex at any point in a woman’s cycle. Ovulation may vary each month and with each cycle therefore you can ovulate even on your period if you have a short cycle.

Women who conceive after tubal ligation have an increased risk of tubal pregnancy because of tubal distortion resulting from the procedure. Ectopic pregnancies are usually secondary to utero-peritoneal fistula after unipolar electrocoagulation, inadequate coagulation or recanalization after bipolar procedures, or recanalization or fistula formation after Pomeroy, tubal ring or clip procedures.

The usual early signs of pregnancy are a missed period or a period that is not like your normal period; breast tenderness, swelling or tingling; frequent urination; nausea or vomiting; fatigue; changes in appetite (either increased or decreased); and mood changes. Missing a period does not become a reliable sign of pregnancy until it is more than 10 days late (and your periods are normally regular). Some women experience a small amount of bloody discharge just after conception, called “implantation bleeding”, and may mistake this for a period.

Other signs of pregnancy include enlargement of the abdomen as pregnancy progresses, softening of the cervix, and a bluish discolouration of the vaginal mucosa.

If you were not using a reliable form of birth control or were not using it properly or consistently and your period is more than 10 days late, you should consider performing a pregnancy test. A blood test or a urine test can be performed to diagnose pregnancy. The blood test must be ordered by your doctor, however urine pregnancy testing kits are available in most drugstores.

There is still a chance of pregnancy before a woman is menopausal, but it isn’t high. Ovulation and menses may be irregular in the few years leading up to menopause. By definition, a woman is menopausal once she has gone 12 months without a period. There are many excellent contraceptive options for women at this stage of life to ensure that accidental pregnancy does not occur. For most non smokers, hormonal methods of contraception such as the pill, patch and ring are still safe and effective. Barrier methods like the condom, diaphragm and intrauterine devices are also excellent choices for this age group. As women enter menopause, hormonal methods can reduce symptoms like unwanted hot flashes, and can regulate and reduce menstrual flow.

An important point to help preserve one’s fertility is to prevent acquiring STIs by using condoms. A woman who contracts chlamydia or gonorrhea can develop an infection in her tubes that will leave them permanently scarred. This could prevent egg and sperm from meeting, or increase her risk of having a tubal pregnancy (when the fertilized egg gets caught in the tubes and does not reach the uterus).

A woman’s ability to conceive begins to decrease by age 35, and becomes very low by age 42. Miscarriage rates also increase as maternal age increases. Previous use of the oral contraceptive pill and/or the contraceptive patch does not affect a woman’s future fertility.

After use of Depo Provera, it may take up to 1 year to return to regular cycles, with the monthly release of an egg. However, long-term fertility is unaffected by this progestin contraceptive.

An episiotomy can occasionally result in a scar that is tender and therefore makes intercourse uncomfortable or even painful. It is impossible to predict which episiotomies will result in a painful scar. The size or the location do not seem to matter. Most of these can be successfully treated with minor surgery, although there is a risk that the surgery can cause another painful scar.

The simple answer is - you can resume sexual relations when you start to feel like it again! Having sex too soon isn’t harmful, but can be uncomfortable! Theoretically, in the first week after delivery, while the cervix is still open, sex without a condom could increase infection in the uterus by normal vaginal bacteria. Most women wait a couple weeks to months. It will depend on the type of delivery, whether or not you have stitches in your vagina, and if so how bad the tear was. Breastfeeding can decrease a woman’s estrogen level, potentially leading to vaginal dryness and discomfort with sex. The first time you and your partner have sex, it is important to take your time and indulge in foreplay to ensure you are aroused and lubricated. Have some lubricant on hand in case this is necessary. Penetration should be gentle, as there may be some tightness or pulling from scarring around the vagina (even if your stitches have completely healed).

An important consideration will be birth control - unless you want to have another baby right away! A woman can get pregnant weeks after having a baby, even if her period has not yet returned. “Lactational amenorrhea” is a natural form of birth control for breastfeeding women but it is only effective in certain circumstances. If you are breastfeeding exclusively (i.e. no supplements), your baby is less than 6 months old, and your period has not yet returned, this method is more than 98% effective. Many women use condoms, at least temporarily until a more permanent method can be started. The contraceptive sponge should not be used if there is vaginal bleeding due to the rare risk of toxic shock syndrome. Other vaginal barrier methods such as the diaphragm or cervical cap cannot be properly fitted until 6 weeks postpartum when the pelvic structures have returned to normal. Likewise, intrauterine devices are generally not inserted until six weeks or later. Progestin-only methods like the injection (Depo-Provera) or the “mini-pill” are considered safe for breastfeeding women and their babies, although a small amount of the hormone does get into the milk. Combined hormonal contraceptives (pill, patch or ring) can be started after 3 or 4 weeks if a woman is not breastfeeding, or no earlier than 6 weeks if she is because these estrogen-containing methods can decrease the amount of milk.

Unless there are complications with the pregnancy, it is safe to have sex during pregnancy. However, both partners must be comfortable with this decision. Pregnancy may present challenges to sex and a couple’s enjoyment of it - hormonal changes, mood changes, nausea, physical discomfort, weight gain, and changes in energy levels may affect both desire and enjoyment of sex.

Some couples find that experimenting with different sexual positions is helpful while other couples find other ways to have pleasure if one of the partners does not want to have intercourse. It is important that a couple remains open with one another throughout the pregnancy and communicate their feelings. It is also suggested that you discuss this further with your health care provider to determine what is most appropriate for you.

Late in pregnancy, the weight of the baby might be uncomfortable for the woman when lying on her back. It might also be uncomfortable to lean forward in any way. Also, a woman might not be very mobile because of the extra weight. Positions with women on her side with the male partner approaching from the front or back are typically more comfortable. Using a comfortable inclined chair with the woman lying back and the male on his knees on the ground between her legs may also be comfortable. For the male partner it is probably more an issue of attitude toward healthy sex than actual positions. Some men express concern that their penis might be too close to their unborn child’s head. There may also be a concern that sex could harm the baby or cause the mother to go into labour early, but there is no evidence that any of this is true.

Yes it is possible to get pregnant even when ejaculation doesn’t occur in the vagina because sperm may be present in the pre-ejaculation fluid. Withdrawal of the male penis from the vagina prior to ejaculation (coitus interuptus) is associated with a high failure rate. Withdrawal does not protect against sexually transmitted infections or HIV thus condom use is strongly recommended.

The risk of pregnancy from anal sex is incredibly low. However, there is always a possibility of pregnancy when sperm are anywhere near the genital organs. It is less likely if the male partner ejaculates while in the rectum. However, if any semen leaks from the anus, it is possible to have some enter the vagina. Also, if the male pulls out and ejaculates near the vagina, some sperm may get inside. Again, using condoms with anal intercourse will decrease the chance of becoming pregnant, as well as decrease the chances of getting an STI. A second, more reliable form of birth control (like the birth control pill) should also be used for improved protection.

For many women, pelvic exams can be pretty stressful. Some women will even delay visits to the doctor for years to avoid them. This might be because of a fear of the unknown or bad news, or maybe just a fear of discomfort and embarrassment. If you are dreading your next pelvic exam, hopefully this answer can help dispel some of the bad vibes.

A pelvic exam is made up of two parts: taking a look at the cervix (and doing swabs for infection and a Pap smear) and feeling the uterus and ovaries. Because the walls of the vagina normally sits closed (kind of like a tube sock), an instrument called a speculum is used to gently hold the vagina open so the person doing the exam can see the cervix. For some women, this part of the exam is uncomfortable. Taking deep breaths and relaxing your muscles will help. It also helps to let the examiner know how your previous experiences with the exam have gone.

The cervix is the opening to the uterus. If you are sexually active, a swab may be taken from the cervix to check for infections like chlamydia and gonorrhea. A Pap smear checks for signs of pre-cancerous changes in the cervix. Most cervical cancers are started from a type of virus called human papillomavirus, or HPV, which is the same family of viruses that can cause genital warts.

Once you are sexually active, a pap smear should be done every year to monitor the cervix for these changes. This is done using a small wooden or plastic spatula (kind of like a Popsicle stick) that is wiped on the surface of the cervix to remove cells. The cells are placed on a slide and examined by specially trained people. This part of the exam should take 2-3 minutes at most and is usually not uncomfortable.

The speculum is removed at this time. The examiner will then place one hand on your lower abdomen and one or two gloved fingers into your vagina. By putting pressure between their hands, the examiner can feel for the uterus and ovaries. If there are abnormalities in the size or shape of these organs, they can usually be detected this way. This takes about 30 seconds. Thats it!

This exam should be done every year once you become sexually active. If you have not had sex yet, this exam is usually done around the age of 18. This exam is very important. Not only can it provide early detection of disease, but it also gives you an opportunity to ask questions and get answers about your reproductive organs and sexuality.

The white “granules” you describe are most likely plugged skin ducts. They are very common on the labia and are normal. If you have an itchy or smelly discharge as well, consider seeing your health care provider to rule out a sexually transmitted infection.

During sexual intercourse, the penis enters the vaginal opening. This can be occasionally difficult if a woman is not aroused, as the opening is neither relaxed nor well lubricated.

If intercourse has previously been painful, or if a woman is apprehensive, there may be an involuntary spasm of the muscles around the vagina called “vaginismus”. Women describe the feeling during intercourse as burning, or tearing. They may feel that they are “too small” or their partner “too big”. Often these women have the same sensation during insertion of any other object including fingers and tampons. Though it may feel difficult or embarrassing, talk to your physician or health care provider. They may be able to reassure you and offer suggestions. There are a number of simple strategies to eliminate the problem of vaginismus, and restore a healthy sexual relationship.

Initial steps in overcoming this problem could include:

1. Being comfortable with your partner, and sure of your decision to have intercourse
2. Wait until you are aroused prior to attempting penetration
3. Communicate with your partner. Until this problem is solved, there are other ways of having sex without penetration!
4. If vaginismus may be the problem, try exercises to relax your pelvic muscles called Kegel exercises

Breasts are formed of fat and fibrous tissue with glands that enlarge during pregnancy to allow for breast feeding the baby. If a girl gains weight, her breasts might get larger. Exercise can enlarge the look of the breasts not by adding fat to breast tissue but by enlarging the muscles (pectoral) beneath the breasts. There are no other effective non-surgical alternatives for breast enlargement. Surgical breast enlargement involves placing a prosthesis- an artificial device containing saltwater or silicone - into the space between the breast tissue and the underlying muscle through a small incision under the nipple or in the armpit.

The length of the vagina is variable. The depth from the vaginal opening to the tip of the cervix can range anywhere from three to seven inches when a woman is not in a sexually aroused state. The vagina does have the capacity to expand which it does during childbirth and during sexual arousal. When a woman is sexually aroused blood flows to the genital area causing the upper two-thirds of the vagina to lengthen by forcing the cervix and uterus to ascend. Sometimes during vaginal intercourse the penis may come in contact with the cervix. If this is uncomfortable for the woman, changes in position or depth of thrusting may be required.

Yes, it is normal for a woman to have labia that are different sizes. Sometimes, one can be quite a bit larger and can even be irritated by rubbing against clothes and underwear. A gynecologist is trained to examine this part of your body and can recommend treatment if needed.

No. There is only a small genetic (inherited) component to breast size. However, there is no absolute connection. It is common within one family to see sisters with very different breast sizes.

Women frequently have a difference in the size of their breasts. At puberty one breast may grow faster than the other. Inequalities often even out after completion of pubertal changes.

Hormonal treatments are not effective in correcting breast asymmetry. Mild to moderate inequalities could be modified by using bras with gel supports, added to the smaller breast side. Corrective surgery can be sought for significant asymmetries, if a woman so desires.

Breast size however can change over the course of a woman’s life. Adolescent breasts are mainly formed of glandular tissue. This tissue slowly changes, and by menopause is mostly replaced by fat. In a typical cycle, breasts retain water, and can feel firmer in the time leading up to menstruation. Breast pain and water retention improves during menses.

Early pregnancy will see growth of the glandular tissue, which will differentiate and begin secreting milk as the pregnancy progresses. Overall, breast size will increase. Changes in weight are also reflected in fluctuating breast size as breasts are partially formed of fat. If one breast starts to feel different from the other, changes its contour, or seems to be suddenly larger, a breast examination should be performed to detect any lumps or masses.

There is not much scientific data on this yet, but no doubt this will come as body piercing becomes more prevalent. One of the more common risks would be infection; the genital area is full of bacteria, even in people who are strict about hygiene. Most infections from piercing will be minor, and treatable with antibiotics and/or draining any collection of pus. It would be very rare to have a serious infection that kills skin cells or requires an operation to remove the infected tissue. Damage to sensitive skin by the piercing can cause scarring or nerve damage, possibly affecting sensation in the area, although proponents of piercing say it can enhance sexual sensation.

Depending on their location, piercings on women generally do not interfere with childbirth. However, it is possible for the baby to be scratched by the device, or for it to be pulled out during delivery. Piercings on the nipple may damage the few milk ducts they pass through, but are unlikely to affect milk delivery as there are many other ducts. The metal could damage the babys mouth and should be removed prior to feeding. Other risks could include injuries during sexual activity, or the piercing getting caught on something or lost. Though some of these scenarios may seem far-fetched, unpredictable and strange things do happen occasionally!

No. The belief that cutting hair makes it grow back faster is a myth. When boys cut facial hair by shaving it seems to grow faster but really it is just the stubble that gives the impression of thicker hair growth.

Yes. There is no danger to shaving pubic hair. Sometimes if you accidentally nick the gland opening that the hair arises from you may get a local inflammation like a pimple at that site.

Cum, or semen, is made up of fluids and sperm. It may have a salty or bitter taste but will not make you sick in small amounts. But you need to know that viruses can be present in the semen (including hepatitis B and HIV) and if these were to contact any open sores or cuts in your mouth they could cause infection. Herpes (cold sores) from the mouth can infect the penis (or vagina) during oral sex. Because of this risk of transmission of sexually transmitted infections, you might want to avoid getting semen in your mouth and/or use a condom, dental dam, or oral barrier during oral sex.

When an egg is released from the ovary (ovulation), it is usually picked up by the end of the fallopian tube. This occurs within minutes after ovulation. There are many tiny hairs inside the tube that help sweep the egg along its length. Muscle fibres in the wall of the tube also help move the egg. The egg is in the tube for approximately 80 hours (just over three days) before it enters the uterine cavity. It is while the egg is in the tube that it can be fertilized. If an egg has been fertilized in the tube, it may implant into the uterus 1-3 days after entering the uterine cavity.

The absolute length of time that an egg can be fertilized is unknown, but is thought to be between 12 and 24 hours. This means that even though the egg remains a living cell for longer, it is only able to create an embryo for a short period after being released from the ovary. By comparison, sperm have a life of up to 7 days, although they are most able to fertilize an egg for the first 2 to 3 days after they are released into the vagina.

The survival of sperm outside the body depends on many factors including the ambient temperature and what it comes into contact with.

In one study, where sperm was left at room temperature in a test tube, only 28% of sperm were moving by 12 hours. Another study found that sperm could survive up to 24-48 hours if left at 23 degrees C (room temperature).

Makler,A et al. Factors Affecting Sperm Motility. I. In Vitro Change in Motility with Time after Ejaculation. Fertlity and Sterility, 31, Feb 1979,147-54

Makler,A et al. Factors Affecting Sperm Motility. VIII. Velocity and Survival of Human Spermatozoa as Related to Temperatures above Zero. Int J Androl, 4, Oct 1981, 559-69

Sperm can however last longer if brought into contact with a woman’s reproductive tract (labia, vagina, cervix…).

Yes, sperm are definitely alive. They are single cells with a head, body, and tail. They contain half of the usual amount of DNA found in human cells so that when they combine with an egg both the sperm and the egg contribute equal amounts of genetic material to the embryo. Sperm can live for up to a week in the female reproductive tract. Outside the body, they can live for several hours if kept at body temperature. Sperm can be preserved by freezing. Donor sperm can be frozen for months to years to allow the donor to be screened for diseases that may appear slowly like HIV/AIDS. Once the sperm sample is known to be safe it can be used to inseminate a woman.

Guys always try to protect their groin in any situation where they could get hurt because their testicles are extremely sensitive to pain. This is probably nature’s way of protecting the sperm-bearing testicles from serious injury that could affect fertility. The skin over the penis is very sensitive to touch to trigger the muscle contractions necessary to achieve erection (when muscles at the base of the penis contract, they prevent blood from escaping from the blood channels of the penis resulting in an erection). Continued stimulation to the skin of the penis triggers the nerve reflex that leads to ejaculation. The penis is not overly sensitive to pain.

A flaccid (unaroused) penis size varies greatly among men. However, when penises are erect there is less variation in size because smaller penises enlarge more during an erection. The average length of an aroused penis is between 5 and 6 inches. Men often underestimate the size of their penis because a portion of it is covered by pubic hair when they are looking down at it. The penis is made of nerves, blood vessels, fibrous tissue, smooth muscle, and three cylindrical bodies of spongy tissue that fill with blood when a man has an erection. There is no bone, and there is some skeletal muscle at the base of the penis.

Penis pumps were developed to help men who have trouble getting and keeping erections. These erection devices are plastic cylinders that are placed on a penis, helping men get erections by drawing blood into the penis. This temporary effect is produced by means of a vacuum created by pumping air out of the device. When a satisfactory erection results, the cylinder is removed after placing a specially designed rubber band, or tourniquet, at the base of the penis. This holds the blood in the penis and keeps it erect during sex. (The constrictor band should not be kept in place for longer than 20 minutes.) Penis pumps do not permanently increase penis size.

Books and web sites talk about “ancient exercises” to lengthen the penis. These exercises are essentially basic masturbation techniques used by boys and men the world over that have no effect on penis size. “Jelq” is portrayed as an “Arabian” technique involving either wrapping the index finger and thumb around the base of the penis and pulling up, or just pinching the penis with the index finger and thumb and pulling up. “Jojido” is an “exotic Japanese” technique similar to Jelq. These exercises are all based on the idea that the penis is a muscle that can be toned and buffed similar to your biceps. However, the smooth muscle of the penis cannot be exercised. Work out all you please, but don’t expect anything bigger at the end of the month.

Using weights is talked about as a way to lengthen the penis, especially for men who’ve had penile enlargement surgery. The premise is that the weights stretch the tunica albuginea, the membrane surrounding the erectile chambers of the penis. It is the elasticity and overall size of the tunica albuginea that determines the length and the width of the penis. Hanging weights from the penis, however, has not been confirmed to be effective.

Penile enlargement surgery is a very new procedure, performed rarely by only a few specialists. It is still an investigational/experimental technique without reliable results.

Remember, size is not the most important thing—it’s what you do with what you have!

Medical treatments for enlargement of the prostate include alpha1 adrenergic blocking drugs such as prazosin and 5-alpha reductase inhibitors such as finasteride. The most important side effect with prazosin is lightheadedness when standing suddenly but occasionally men may report decreased ejaculate because the ejaculate goes backward into the bladder (so-called retrograde ejaculation).

Finasteride blocks the conversion of testosterone to the more potent dihydrotestosterone. This reduces the levels of male hormones that stimulate prostate growth. It has a very low risk of side effects and few interactions with other medications, but in clinical trials 2% of patients stopped using finasteride because of adverse sexual side effects which included a decrease in the volume of ejaculate, impotence and decreased libido.Surgery is the only alternative to medical therapy for benign enlargement of the prostate, however, it also carries risks for sexual side effects such as retrograde ejaculation.

Some medical reasons for an adult man to get a circumcision would include recurrent infections or injuries, a very tight foreskin (phimosis) or a foreskin that is stuck in the pulled-back position (this is called paraphimosis and is a medical emergency). Other non-medical reasons a man might consider this would be for personal, religious, or sexual reasons.

A urologist usually performs adult circumcisions, although some family doctors may do it as well. It is done as a day surgery with local anesthetic. The freezing is injected into the base of the penis so the entire penis is numb, and the excess skin is trimmed off. Any stitches used are dissolvable. The usual recommendation is to avoid erection or any genital stimulation for 4 to 6 weeks after the procedure. If you do not have a medical reason to be circumcised, you should consider whether the problems your foreskin is causing warrant the pain and risks of surgery. Make sure its what you want, as opposed to what your partner wants, and talk to your doctor.

The G-spot is also known as the “Grafenberg” spot, after the first physician who described the area. The term refers to an erogenous area on the anterior wall of the vagina, approximately one third upwards from the introitus. Though the G-spot is much described, its actual physical presence remains controversial.

Blowing air into the vagina, or vaginal insufflation, can cause serious problems in pregnant women, but it rarely harms those who are not. An air embolism occurs when the air gets into blood vessels through the lining of the uterus. This complication can be fatal, so a sexual partner should never blow into the vagina of a pregnant woman.

Vaginal insufflation can also cause problems when air under pressure travels from the vagina through the cervix, uterus and fallopian tubes into the abdominal cavity. Air irritates the abdominal cavity and can cause serious pain and a phenomenon called “free air”-but that is more commonly associated with a hole in the gastrointestinal tract, a problem that generally requires surgery for treatment. Free air from vaginal insufflation only requires observation rather than surgery, but there have been multiple cases of women receiving unnecessary surgeries because the history of their sexual activities was not known.

Sexual activity, including orgasm, is influenced by body and mind. On certain occasions, your body might be present but your mind is absent. In other words, you might not always be as excited as you could be. If you are distracted by other events in your life or are having relationship problems, you may not achieve orgasm as easily or you may not be able to have one at all. This happens to both males and females. Occasionally, there may be a physical problem that prevents you from attaining orgasm, but this happens very rarely. When this is the case, it is usually accompanied by other signals such as pain or difficulty during the actual act of intercourse. Medications might also affect your drive for sex and as a result make orgasm more difficult to achieve. Some people may never have experienced orgasm, but - often with some guidance - almost all of those people find they can.

 There are many causes for pain during intercourse including vaginismus, the involuntary muscle spasms in the vagina, infection, insufficient lubrication, and endometriosis. There are effective treatments for all of these problems and you should ask your family doctor. The doctor may be able to determine what the problem is and treat it, or they can refer you to a gynaecologist who can help.

There are many different opinions about this question. Often a uterus that is tilted backwards rather than forwards (as the majority tend to be), is blamed for many problems. Some physicians feel that this ‘tilting’ does not cause pain during intercourse. Others do believe it can cause pain, and in the past we would even have done surgery to try and correct the position. These days, that surgery is extremely uncommon. Some women find the penis bumping against the cervix to be pleasurable and others find it uncomfortable or even painful. If you are experiencing pain, a doctor’s exam can tell you which way your cervix is tilted and then it is simply a matter of finding positions that reduce the amount of penis to cervix contact. Often, having intercourse with the male behind the female can prevent the penis from touching the cervix. Also, when the woman is very aroused the vagina tends to balloon out and this might be sufficient to keep distance between the cervix and penis.

Lack of control over the timing of ejaculation is a common problem for men. It affects 30% of men under the age of 25 and 10% of men over the age of 25. These men consistently ejaculate more quickly than they or their partners want them to during intercourse, thus the term rapid or premature ejaculation. Ejaculation may occur immediately prior to or just after insertion of the penis into the partner, without any sense of voluntary control. Causes of premature ejaculation include over-stimulation, anxiety over sexual performance, and stress. It may also be due to a male’s lack of awareness of the preliminary sensations that lead to orgasm, making him unable to control the process leading to ejaculation.

There are several possible solutions to dealing with premature ejaculation:

1. The stop-start method works to make a man more aware of his sensations as he is approaching orgasm. His partner manually stimulates his penis while he focuses on his sensations. When he feels that orgasm is approaching, he has his partner stop the stimulation. The extreme sexual tension will be diffused, and then the partner can begin restimulation. Once the couple becomes proficient at this, then the procedure is applied to intercourse.

2. The squeeze technique is commonly performed with the premature ejaculator laying down. His partner stimulates the genital area until the penis is erect, then squeezes the penis for 3-4 seconds by holding the penis with the thumb on the ridge between the head and shaft, and the first two fingers situated on either side of the ridge opposite the thumb. This squeeze eliminates the desire for ejaculation. This technique should be repeated several times during genital stimulation, so that foreplay can continue without ejaculation. Once mastered, this method can be used in intercourse when the man’s partner inserts his penis and sits on top of him motionless. When he feels close to ejaculation, his partner lifts off of his penis and administers a squeeze, then returns to the sitting position. Over time this results in ejaculatory control.

3. Condoms provide protection against pregnancy and sexually transmitted infections. However, they may also help to delay ejaculation in males who have trouble with premature ejaculations.

4. A sex therapist may be able to help men and/or couples work on the problem of premature ejaculation if these techniques are not helpful.

The skin of the foreskin and scrotum can have little lumps and bumps, like any other part of our body. In a flaccid (not aroused) penis, these areas may seem more prominent. If these bumps are small, do not change in size or color, and do not hurt, they are likely normal, particularly if they have been present for a long time. However if you find new bumps, particularly after having had a new sexual partner, or if there is discharge from the area, you should see your doctor to rule out a sexually transmitted infection (STI). Condyloma (warts) can look like bumps. They are usually few in number, and can grow in size. Your doctor can confirm the diagnosis, and treat them.

Bumps on the skin can be a harmless skin condition or a sign of infection. The short answer is: see your doctor to be sure.

The skin on the penis, or more commonly the hair-bearing skin around the penis, can get skin tags or clogged pores or glands. Tiny, fine bumps can also be perfectly normal (called pearly papules or papillomatosis). These are seen more commonly in the moist mucous skin under the foreskin in uncircumcised men.

Molluscum contagiosum is a harmless viral infection that causes small round pearly bumps. Molluscum can be seen on any area of skin, not just the genitals. They can be spread to wider areas of skin through shaving or spontaneously.

Herpes infection may show up at first as blisters (fluid-filled bumps; but quickly progress to highly contagious sores.

The most common infectious cause of a bump is human papillomavirus (HPV), also called genital warts. These are usually uneven, fleshy, cauliflower-like lesions, though sometimes they can be more flat.See hpvinfo.ca.

Other possibilities include a mole or other coloured lesions that can be seen anywhere on the body. Another possibility is cancer. Penile cancer is extremely rare, especially among young men, and usually looks like a sore rather than a skin-covered bump. If you notice a lump in your testicles (as opposed to your penis) however, you should see your doctor because testicular cancer is not uncommon in young men.

As you can see, there are a variety of conditions that can show up as a bump on your penis. As a general rule, something that has been there for a long time without changing is more likely to be a normal variation. If a bump is new, and especially if it shows up after unprotected sex, it is more likely to be an infection.

A yeast infection is a common type of vaginal infection caused mainly by an overgrowth of a fungus called Candida albicans. Candida albicans is often present in the vagina without causing any symptoms

Yeast cells are normally present in the vagina but can overgrow if the vaginal environment is disturbed. If the normal pH balance of the vagina changes, the yeast cells can multiply resulting in a vaginal yeast infection.

Certain factors may increase the risk of developing a yeast infection. These include: pregnancy; certain medications (steroids, antibiotics); some medical conditions (diabetes, immune disorders); tight synthetic clothing; sexual activity with a partner who has a yeast infection.

The most common signs of yeast infection are severe itching, burning, and irritation of the vagina. The inner and outer lips of the vagina may be swollen or inflamed.

There is usually a thick, odourless, cottage cheese-like discharge.

Intercourse and urination may be painful due to inflammation of the urethra.

If you have never had a yeast infection before, don’t try to diagnose or treat it yourself. The only way to know for sure is to see your doctor. If you have had a yeast infection before, you might recognize its symptoms: itching, burning, and a thick, white vaginal discharge that resembles cottage cheese.

Treatment: Yeast infections can usually be treated with over the counter antifungal medications available in the drug store/pharmacy (a prescription is not required). These creams or suppositories are inserted into the vagina. Alternatively, your doctor may prescribe a medication for you that you take by mouth.

It is important to get a professional diagnosis. Failure to correctly diagnose and treat a vaginal infection could have long term health effects. Vaginal discharge that is not white and does not resemble cottage cheese may indicate that you have something other than a yeast infection. If this is the case, consult your doctor.

Firstly, it is important to establish that they truly are yeast infections. Some women have a different vaginal discharge just before their period, and if this discharge is itchy or irritating, it may be perceived as a yeast infection. You should see your doctor when you have the symptoms to be sure.

Recurrent yeast infections can be seen if the immune system isnt working properly due to medical conditions like diabetes or when using certain medications like corticosteroids (used to treat asthma and other conditions). Overweight women get more yeast infections, presumably due to the increased moisture from sweat in the groin folds. The infection can also recur (or never really go away) if the yeast species is resistant to the treatment used. Your doctor can look for yeast under the microscope to confirm the diagnosis and can culture the yeast with a vaginal swab if the organism is resistant to treatment.

Some women do get cyclic yeast infections based on hormonal changes in the vagina. In this case, your options would include:

1. Continue to treat the yeast infection each month
2. Get the yeast infection pill (fluconazole) from your doctor and take it each month in the week before your period to prevent a yeast infection
3. Change your pill, go off the pill, or try another birth control method to change the hormonal environment in your vagina
4. Treating the vagina with boric acid or gentian violet can sometimes help with difficult cases.

Recurrent vulvovaginal candidiasis (yeast infections) affects 5-8% of pre-menopausal women. The diagnosis is made with four or more culture proven episodes of infection per year. Risks include: antibiotic use, oral contraceptive use, diabetes, sexual activity, douching, HIV infection, lupus, use of immunosuppressive drugs (e.g. steroids), and hormone replacement therapy.

A recent study looked at using oral fluconazole 150mg weekly for 6 months versus placebo, after both groups were initially treated with fluconazole every 3 days for 3 doses. The cure rate was statistically higher in the fluconazole group at the end of treatment, and at the 6 month follow-up. However the relapse rate was also higher at follow up in the treatment group.

Sobel, JD, Hillier, S, Smoleski, L, et al., 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy, San Diego, CA 2002; Abstract LB-8

A small study found less recurrence over 3 months in women using Depo Provera.

Dennerstein, GJ, Depo-Provera in the treatment of
vulvovaginal candidiasis. J Reprod Med 1986; 31: 801-3

Other treatments include: managing/changing risk factors, yeast-free diet, eating yogurt with active lactobacilli, and the application of gentian violet.

It is possible that this is a yeast infection. Typical yeast infection symptoms are thick, white discharge (kind of like cottage cheese), lots of itching, and the skin can look quite red and irritated. If you have consistent itching like this, it is a good idea to see your doctor to be tested for yeast. There are many other things that can make your vagina and external skin itch, and yeast creams may not fix the symptoms or can make them worse. Once the yeast infection is confirmed, it is usually easily treated by an over-the-counter treatment (typically a cream or tablet that is inserted in the vagina). Women who have confirmed recurrences of yeast infection in the week before menstruation each month can often get relief by taking a single tablet of a prescription medication each month about the time the infections have been recurring.

No, a yeast infection will not affect your fertility or make you sterile.

A yeast infection is not considered a sexually transmitted infection. It is caused when certain internal or external factors change the normal environment of the vagina and trigger an overgrowth of microscopic fungi called Candida albicans. These are the most likely fungi to cause yeast infections as well as infections in other moist areas of the body, such as the mouth (thrush), skin folds and fingernail beds.

Factors that increase the risk of yeast infections include:

1. Certain medications (antibiotics, steroids)
2. Menstruation
3. Pregnancy
4. Diabetes

Damp bathing suits, sweaty workout clothes, toilet seats, tampons, and spermicides do not cause yeast infections.

Some sexually transmitted infections are associated with infertility. Both chlamydia and gonorrhea may lead to pelvic inflammatory disease (PID) and this may damage the fallopian tubes, ovaries and uterus, including the cervix. These infections can cause scarring that may lead to infertility. Up to 40 percent of women who have untreated chlamydia develop PID and 20 percent of women with one episode of PID become infertile. Therefore it is very important that you protect yourself against sexually transmitted infections by using condoms every time you have intercourse.

Yeast or Candida Albicans can be in the vagina. There are many organisms in the vagina that live in balance. Changes in the acid/base balance in the vagina can cause any one of them to grow more than they usually would. This is often the cause of recurrent yeast infections. Many things can cause a change in this balance, including where you are in your menstrual cycle.

In most cases, recurrent yeast infections have nothing to do with STIs. Some people who have recurring infections of any kind or sores that do not heal are later found to have HIV, but these symptoms are not the cause of STIs. Epididymitis is an inflammation of part of the male genitals. On occasion, it is because of an infection such as Chlamydia or Gonorrhea, but it can also be caused by other problems that are not infections at all. Recurrent epididymitis should be checked out by your doctor. Frequent occurrences of these problem do not increase your chances of contracting an STI.