Female Sexual Dysfunction: Vaginismus, Kegel exercises

Kegel exercises

Kegel (KAY-gul or KEY-gul) exercises strengthen the pelvic floor muscles, which support the uterus, bladder and bowel. It takes diligence to identify your pelvic floor muscles and learn how to contract and relax them. Here are some pointers:

Find the right muscles

 

To make sure you know how to contract your pelvic floor muscles, try to stop the flow of urine while you're going to the bathroom. If you succeed, you've got the basic move. Or try another technique: Insert a finger inside your vagina and try to squeeze the surrounding muscles. You should be able to feel your vagina tighten and your pelvic floor move upward. Then relax your muscles and feel your pelvic floor move down to the starting position. As your muscles become stronger — and you become more experienced with the exercises — this movement will be more pronounced.

But don't make a habit of starting and stopping your urine stream. Doing Kegel exercises with a full bladder or while emptying your bladder can actually weaken the muscles. It can also lead to incomplete emptying of the bladder, which increases your risk of a urinary tract infection.

If you're having trouble finding the right muscles, don't be embarrassed to ask for help. Your doctor or other health care provider can give you important feedback so that you learn to isolate and exercise the correct muscles.

   

Once you've identified your pelvic floor muscles, empty your bladder and sit or lie down. Then:

• Contract your pelvic floor muscles.


• Hold the contraction for three seconds then relax for three seconds.


• Repeat 10 times.


• Once you've perfected three-second muscle contractions, try it for four seconds at a time, alternating muscle contractions with a four-second rest period.


• Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.

To get the maximum benefit, focus on tightening only your pelvic floor muscles or isolating your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Also, try not to hold your breath. Just relax, breathe freely and focus on tightening the muscles around your vagina and rectum.

Repeat three times a day

 

Perform a set of 10 Kegel exercises three times a day. The exercises will get easier the more often you do them. You might make a practice of fitting in a set every time you do a routine task, such as checking e-mail or commuting to work.

Vary your technique with one of these methods:

• Try sets of mini-Kegels. Count quickly to 10 or 20, contracting and relaxing your pelvic floor muscles each time you say a number.


• Visualize an elevator. Slow down the exercises, gradually contracting and releasing your pelvic floor muscles one at a time. As you contract, visualize an elevator traveling up four floors. At each floor, contract your muscles a little more until you reach maximum contraction at the fourth floor. Hold the contraction and then slowly release the tension as you visualize the elevator returning to the ground floor. Repeat 10 times.

Biofeedback training

If you have trouble doing Kegel exercises, biofeedback training may help. In a biofeedback session, a nurse, therapist or technician will either insert a small monitoring probe into your vagina or place adhesive electrodes on the skin outside your vagina or rectal area. When you contract your pelvic floor muscles, you'll see a measurement on a monitor that lets you know whether you've successfully contracted the right muscles. You'll also be able to see how long you hold the contraction.

Another technique uses electrical stimulation to help you feel the muscles contract. The procedure is painless, although you'll experience a buzzing feeling as a small electrical current is applied to your pelvic floor muscles, making them contract. Once you feel this sensation a few times, you'll probably be able to duplicate the exercise on your own. Because simpler methods work for most women, this technique is rarely used. 

 

Female Sexual Dysfunction: Vaginismus, Treatment

Vaginismus is considered one of the most successfully treatable female sexual disorder. Many studies have shown treatment success rates approaching nearly 100%. Treatment resolution follows a manageable, step-by-step process.

Vaginismus is highly treatable. Successful vaginismus treatment does not require drugs, surgery, hypnosis, nor any other complex invasive technique. Effective treatment approaches combine pelvic floor control exercises, insertion or dilation training, pain elimination techniques, transition steps, and exercises designed to help women identify, express and resolve any contributing emotional components. Treatment steps can often be completed at home, allowing a woman to work at her own pace in privacy, or in cooperation with her health care provider.

• The sexual pain, tightness and penetration difficulties from vaginismus are fully treatable and can be completely overcome with no remaining pain or discomfort.
• Women experiencing sexual tightness/pain, penetration problems, or unconsummated relationships can expect remarkable resolution of their vaginismus, allowing full, pain-free intercourse.
• Treatment steps can usually be completed at home using a self-help approach, allowing a woman to work at her own pace in privacy, or in cooperation with her health care provider or specialist.
• Vaginismus treatment exercises follow a manageable, step-by-step process.

Treatment involves extensive therapy that combines education, counseling, and behavioral exercises. Such exercises include pelvic floor muscle contraction and relaxation (Kegel exercises).

Vaginal dilation exercises are recommended using plastic dilators. This should be done under the direction of a sex therapist or other health care provider. Such therapy should involve the partner, and can gradually include more intimate contact, ultimately resulting in intercourse.

Educational resources should be provided. This includes information about sexual anatomy, physiology, the sexual response cycle, and common myths about sex.

Female Sexual Dysfunction: Vaginismus, Types and Symptoms

Vaginismus: 

is a condition which affects a woman's ability to engage in any form of vaginal penetration, including sexual penetration, insertion of tampons, and the penetration involved in gynecological examinations. This is the result of a conditioned reflex of the pubococcygeus muscle, which is sometimes referred to as the 'PC muscle'. The reflex causes the muscles in the vagina to tense suddenly, which makes any kind of vaginal penetration -- including sexual penetration -- either painful or impossible.

Vaginismus has two major classifications:

Vaginismus can be experienced by women at any age or time in life. It has two major classifications; primary vaginismus and secondary vaginismus.

Primary Vaginismus

Primary vaginismus usually refers to the experience of vaginismus with ‘first-time’ intercourse attempts. Typically, primary vaginismus will be discovered when a woman attempts to have sex for the very first time. The spouse/partner is unable to achieve penetration and it is like he ‘bumps into a wall’ where there should be the opening to the vagina and entry is impossible or extremely difficult. Primary vaginismus is the common cause of sexless, unconsummated marriages. Some women with primary vaginismus will also experience problems with tampon insertion or gynecological exams.

  

Secondary Vaginismus

Secondary vaginismus usually refers to the experience of vaginismus a little later in life, after a period of pain-free intercourse, and typically following temporary pelvic problems. A woman may have had a number of years of being able to have normal, pain-free intercourse and then experience a temporary pain-causing problem such as a yeast infection (or any of a wide range of physical problems). The initial pain problem may have been addressed medically, healed, or been managed, and yet the woman continues to experience ongoing troubles with sexual pain. In some cases, the severity of secondary vaginismus could escalate to the level that penetration becomes difficult, painful, or impossible. It can also impede a woman’s ability to experience orgasms, as a sudden pain spasm may abruptly terminate the arousal buildup toward orgasm. Some women with secondary vaginismus will also experience difficulty with gynecological exams or tampon insertion due to involuntary tightness.

Vaginismus is involuntary - not intentional

It is important to note that vaginismus is not triggered deliberately or intentionally by women. It happens involuntarily without their intentional control and often without any awareness on their part. Vaginismus has a variety of causes, often in response to a combination of physical or emotional factors. The mystery of the problem can be very frustrating and distressing for both women and their partners.

Female Sexual Dysfunction: General Treatment Guidelines

Provide education

Provide information and education (e.g., about normal anatomy, sexual function, normal changes of aging, pregnancy, menopause). Provide booklets, encourage reading; discuss sexual issues when a medical condition is diagnosed, a new medication is started, and during pre- and postoperative periods; give permission for sexual experimentation.

Provide distraction techniques**

Encourage erotic or nonerotic fantasy; recommend pelvic muscle contraction and relaxation (similar to Kegel exercise) exercises with intercourse; recommend use of background music, videos or television.

Encourage noncoital behaviors***

Recommend sensual massage, sensate-focus exercises (sensual massage with no involvement of sexual areas, where one partner provides the massage and the receiving partner provides feedback as to what feels good; aimed to promote comfort and communication between partners); oral or noncoital stimulation, with or without orgasm.

Minimize dyspareunia "painful sexual intercourse"

Superficial: female astride for control of penetration, topical lidocaine, warm baths before intercourse, biofeedback.

Vaginal: same as for superficial dyspareunia but with the addition of lubricants.

Deep: position changes so that force is away from pain and deep thrusts are minimized, nonsteroidal anti-inflammatory drugs before intercourse.

Male Sexual Dysfunction: Erectile Dysfunction, over view

The term impotence has been used to indicate the inability of the male to attain and maintain erection of the penis sufficient to permit satisfactory sexual intercourse. Erectile dysfunction (ED) is the preferred term.



ED is a common problem, especially among older men. Perhaps a more precise term for ED is that used to signify inability of the man to achieve an erect penis as part of the multifaceted process of male sexual function.

In the United States approximately 10 million men have ED.While erectile function may not be the most important indicator of sexual satisfaction, ED may contribute to mental stress that affects interactions with family and associates.



While many advances have occurred in the diagnosis and treatment of ED, other aspects remain poorly understood by the general population and even health care professionals. ED is frequently

assumed to be a physiological event associated with aging, but that is not entirely accurate.



The incidence of ED can be as high as 50% in men aged 40 to 70, with the percentage increasing with age. Other risk factors associated with ED include chronic illnesses, medications, cigarette smoking, heavy alcohol consumption, sedentary patterns, and obesity.



ED can be due to vasculogenic, neurogenic, hormonal, and/or psychogenic factors. It can also be due to changes in biochemical pathways.



Most cases of secondary ED are related to arteriosclerosis. ED is also associated with hypertension, antihypertensive therapy, and diabetes mellitus, particularly in the older diabetic. Other chronic diseases, such as psychogenic disorders and Peyronie’s disease,may be associated with ED.



Several therapeutic agents, especially those that affect neurotransmitter activity are often associated with ED. Many such reports have been anecdotal, although 25% of ED may be drugrelated.



Several classes of drugs have been associated with ED :

Drug Class That May Cause Erectile Dysfunction

Antihypertensives Thiazide diuretics,B-blockers, clonidine,

methyldopa

Antidepressants SSRIs,MAOIs

Antipsychotics Phenothiazines, thioxanthenes

Antianxiety agents Benzodiazepines

Hormones Estrogens, antiandrogens

Miscellaneous Alcohol, metoclopramide, opioids

SSRI, selective serotonin reuptake inhibitor;MAOI "monoamine

oxidase inhibitor".

The mechanism or mechnisms of drug-induced ED may be neural, endocrine, or idiopathic. ED seems to be most frequently associated with antihypertensive medications, particularly B-blockers and thiazide diuretics. Estrogen therapy and the use of antiandrogens can lead to changes in the endocrine system resulting in ED. Paradoxically, selective serotonin reuptake inhibitors (SSRIs) can be associated with ED while also being useful be for the treatment of premature ejaculation.



Erection involves a coordinated action of the autonomic nervous system, and certain drugs may interfere with either the sympathetic division (e.g., A1- receptors) or the parasympathetic division (e.g., noncholinergic neurotransmitters).

Prevention, Symptoms and Treatment of sexual dysfunction

**Prevention:



1- Open, informative, and accurate communication regarding sexual issues and body image between parents.



2- Review all medications, both prescription and over-the-counter, for possible side effects that relate to sexual dysfunction.



3- Avoiding drug and alcohol abuse will also help prevent sexual dysfunction.



4- Couples who are open and honest about their sexual preferences and feelings are more likely to avoid some sexual dysfunction. 



5-One partner should, ideally, be able to communicate desires and preferences to the other partner.



6-People who are victims of sexual trauma, such as sexual abuse or rape at any age, are urged to seek psychiatric advice.Individual counseling with an expert in trauma may prove beneficial in allowing sexual abuse victims to overcome sexual difficulties and enjoy voluntary sexual experiences with a chosen partner.





**SYMPTOMS:

• Men or women:
  
  
  
  
  
  
  • Lack of interest in sex (loss of libido)
  
  
  • Inability to feel aroused
  
  
  • Pain with intercourse (much less common in men than women)
  
  


• Men :
  
  
  
  
  
  
  • Inability to attain an erection
  
  
  • Inability to maintain an erection adequately for intercourse
  
  
  • Delay or absence of ejaculation, despite adequate stimulation
  
  
  • Inability to control timing of ejaculation
  
  


• Women:
  
  
  
  
  
  
  • Inability to relax vaginal muscles enough to allow intercourse
  
  
  • Inadequate vaginal lubrication before and during intercourse
  
  
  • Inability to attain orgasm
  
  
  • Burning pain on the vulva or in the vagina with contact to those areas
  
  

**TREATMENT:





Treatment depends on the cause of the sexual dysfunction. Medical causes that are reversible or treatable are usually managed medically or surgically. Physical therapy and mechanical aides may prove helpful for some people experiencing sexual dysfunction due to physical illnesses, conditions, or disabilities.





For men who have difficulty attaining an erection, the medication sildenafil (Viagra), which increases bloodeni flow to the ps, may be very helpful, though it must be taken 1 to 4 hours prior to intercourse.

Men who take nitrates for coronary heart disease should not take sildenafil. Mechanical aids and penile implants are also an option for men who cannot attain an erection and find sildenafil isn't helpful.





Women with vaginal dryness may be helped with lubricating gels, hormone creams, and -- in cases of premenopausal or menopausal women -- with hormone replacement therapy. In some cases, women with androgen deficiency can be helped by taking testosterone.

Vulvodynia can be treated with testosterone cream, with use of biofeedback and with low doses of some antidepressants which also treat nerve pain. Surgery has not been successful.





Behavioral treatments involve many different techniques to treat problems associated with orgasm and sexual arousal disorders. Self-stimulation and the Masters and Johnson treatment strategies are among the many behavioral therapies used.





Simple, open, accurate, and supportive education about sex and sexual behaviors or responses may be all that is required in many cases. Some couples may benefit from joint counseling to address interpersonal issues and communication styles. Psychotherapy may be required to address anxieties, fears, inhibitions, or poor body image.

**PROGNOSIS AND OUTCOME:





The prognosis (probable outcome) depends on the form of sexual dysfunction. In general, the probable outcome is good for physical dysfunctions resulting from treatable or reversible conditions. It should be noted, however, that many organic causes do not respond to medical or surgical treatments.





In functional sexual problems resulting from either relationship problems or psychological factors, the prognosis may be good for temporary or mild dysfunction associated with temporary stress or lack of accurate information. However, those cases associated with chronically-poor relationships or deep-seated psychiatric problems typically do not have positive outcomes.









**COMPLICATIONS:





Some forms of sexual dysfunction may cause infertility. Persistent sexual dysfunction may cause depression in some individuals. The importance of the disorder to the individual (and couple, when applicable) needs to be determined. Sexual dysfunction that is not addressed adequately may lead to conflicts or potential breakups.

Sexual Dysfunction "U.S sex study"

CHICAGO (CNN) -- Thirty-one percent of men and 43 percent of women regularly suffer from some form of sexual dysfunction, warranting recognition as a significant public health concern, according to a new comprehensive U.S. sex study.

February 9, 1999
Web posted at: 9:40 p.m. EST (0240 GMT)

"I think it gives us a base for explaining why we had this enormous response to Viagra," said the study's lead author, University of Chicago sociologist Edward Laumann.

Researchers are calling the findings the first of their kind since a 1948 report by Dr. Alfred Kinsey on human sexual behavior.

The study, published this week in the Journal of the American Medical Association, was based on data from the 1992 National Health and Social Life Survey, a collection of interviews with 1,749 women and 1,410 men aged 18 to 59.

Information from the national probability sample concerning sex was reviewed in the wake of Viagra's popularity in treating male impotence since it was put on the market last year.

Survey participants were asked if they had experienced sexual dysfunction over several months during the previous year, including lack of sexual desire, difficulty becoming aroused, inability to climax or ejaculate, premature orgasms, pain during sex, anxiety over sexual performance and not finding sex pleasurable.

Lack of interest in sex was the top problem for women. A third said they regularly didn't want sex, 26 percent said they regularly didn't have orgasms and 23 percent said sex was not pleasurable.

For men, about one-third said they had reoccurring problems with climaxing too early, 14 percent said they had no interest in sex and 8 percent said they regularly experienced no pleasure from sex.

In all, 43 percent of women and 31 percent of men said they had one or more reoccurring problems with sex. Sexual problems were most common among young women and older men.

In both women and men, sexual dysfunction was related to emotional and stress problems including poor health, poor quality of life and prior traumatic sexual experiences.

Researchers, who were surprised by the findings, said the study offers hope and comfort for those with sexual problems.

"Often they don't even admit it to their partners. It's the old 'I've got a headache' instead of, 'I don't feel like having sex,'" Laumann said.

Recent study of "Female Sexual Dysfunction"

A recent study published in the July 22 issue of the Journal of the American Medical Association, revealed that women, who have lost their sexual desire as a side effect of using antidpressants, can gain it back by taking Pfizer's Viagra.

98 women, taking antidepressants, were examined in the study conducted by 7 research centers in US, between September 2003 and January 2007. The average age of these women was 37 years and they were divide in two groups - half of them were given Viagra and half were given placebo (fake drug), but no one knew which pill they are taking.

After eight weeks, the researchers found that 73 percent of the women on placebo, had no improvement in sexual functioning, while 73 percent women given Viagra showed improved ability to reach orgasm and increased orgasm satisfaction.

But according to Harry A. Croft, MD, medical director of the San Antonio Psychiatric Research Center in Texas and co-author on the study, "Viagra only increased the orgasm and the time to orgasm, but it didnt't increase drive and desire."

Also, Dr. Irwin Goldstein, MD, director of sexual medicine at Alvardo Hospital in San Diego and editor-in-chief of The Journal of Sexual Medicine said, "Viagra engorges the clitoris of women with normal testosterone levels, which allows them to have orgasm. That is the same effect of Viagra on Mens' penis."

On the other hand, Sally Beatty, Pfizer's spokesperson, said that the company is not planning to go for FDA approval to use Viagra as a treatment for female sexual dysfunction.

Previous researches have shown that Viagra was helpful for men suffering from erectile dysfunction, because of using antidepressant medicines.

Sexual Dysfunction

Sexual problems are defined as difficulty during any stage of the sexual act (which includes desire, arousal, orgasm, and resolution) that prevents the individual or couple from enjoying sexual activity.

Sexual difficulties may begin early in a person's life, or they may develop after an individual has previously experienced enjoyable and satisfying sex. A problem may develop gradually over time, or may occur suddenly as a total or partial inability to participate in one or more stages of the sexual act. The causes of sexual difficulties can be physical, psychological, or both.

**Emotional factors affecting sex include both:

1- interpersonal problems: marital or relationship problems, or lack of trust and open communication between partners.

2- psychological problems within the individual:epression, sexual fears or guilt, or past sexual trauma.

**Physical factors contributing to sexual problems include:

• Drugs, such as alcohol, nicotine, narcotics, stimulants, antihypertensives (medicines that lower blood pressure), antihistamines, and some psychotherapeutic (drugs that treat psychological problems "Antidepressants") drugs
• Injuries to the back
• An enlarged prostate gland
• Problems with blood supply
• Nerve damage (as in spinal cord injuries)
• Disease (diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis)
• Failure of various organs (such as the heart and lungs)
• Endocrine disorders (thyroid, pituitary, or adrenal gland problems)
• Hormonal deficiencies (low testosterone, estrogen, or androgens)
• Some birth defects

**Classified into 4 categories:

a-sexual desire disorders,
b-sexual arousal disorders,
c-orgasm disorders,
d-sexual pain disorders "Lubrication disorder".

Significant differences in mean domain scores among 18 women with complaints of sexual dysfunction and 14 control women with no complaints of sexual dysfunction responding to the ASFQ"Abbreviated Sexual Function Questionnaire".

Sexual desire disorders (decreased libido) may be caused by a decrease in the normal production of estrogen (in women) or testosterone (in both men and women). Other causes may be aging, fatigue, pregnancy, and medications -- the SSRI"Selective Serotonin Reuptake Inhibitor" anti-depressants which include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) are well known for reducing desire in both men and women. Psychiatric conditions, such as depression and anxiety, can also cause decreased libido.

Sexual arousal disorders were previously known as frigidity in women and impotence in men. These have now been replaced with less judgmental terms. Impotence is now known as erectile dysfunction, and frigidity is now described as any of several specific problems with desire, arousal, or anxiety.

There may be medical causes for these disorders, such as decreased blood flow or lack of vaginal lubrication. Chronic disease may also contribute to these difficulties, as well as the nature of the relationship between partners. As the success of Viagra attests, many erectile disorders in men may be primarily physical, not psychological conditions.

Orgasm disorders are a persistent delay or absence of orgasm following a normal sexual excitement phase. The disorder occurs in both women and men. Again, the SSRI antidepressants are frequent Causes -- these may delay the achievement of orgasm or eliminate it entirely.

Sexual pain disorders affect women almost exclusively, and are known as dyspareunia (painful intercourse) and vaginismus (an involuntary spasm of the muscles of the vaginal wall, which interferes with intercourse). Dyspareunia may be caused by insufficient lubrication (vaginal dryness) in women.

Poor lubrication result from:
1-Insufficient excitement and stimulation.
2-Hormonal changes caused by menopause, pregnancy, or breast-feeding.
3-Irritation from contraceptive creams and foams may also cause dryness, as can fear and anxiety about sex.

It is unclear exactly what causes vaginismus, but it is thought that past sexual trauma such as rape or abuse may play a role. Another female sexual pain disorder is called vulvodynia or vulvar vestibulitis. In this condition, women experience burning pain during sex which may be related to problems with the skin in the vulvar and vaginal areas. The cause is unknown.

Sexual dysfunctions are more common in the early adult years, with the majority of people seeking care for such conditions during their late 20s through 30s. The incidence increases again in the geriatric population, typically with gradual onset of symptoms that are associated most commonly with medical causes of sexual dysfunction.