Some women report an increase while others report a decrease in sexual desire at menopause. Increase in sexual desire may be because of relative freedom from pregnancy and hence one may respond and perform with greater abandon and enthusiasm. Some women harbor the misconception that menopause marks the end of their sexual career and this fear (about their waning sexuality) increases their sex drive so that they may reaffirm their femininity. A decline in sexual desire could be because of physical reasons.

During menopause (or even a few years earlier), a reduction in the secretion of the ovarian hormones may cause atrophy of the vaginal epithelium which leads to reduction in lubrication and hence pain at the time of sexual intercourse (which can be remedied by estrogen replacement therapy). This causes a decline in sexual desire and a woman avoids sexual overtures. Depression and anxiety are common features and they also tend to reduce the sexual desire.

An orgasm is like a sneeze - it is difficult to describe but once you have had one you know what it feels like. Orgasms may differ. Usually one experiences a heightened sexual ecstasy accompanied by rhythmic vaginal contractions in females and ejaculation in males, followed by a fooling of relaxation.

Is completion of the sexual response cycles always necessary for satisfactory sex?

Sex is a method for reaching a sensual objective, which, when achieved gives satisfaction. During sex what is important is to experience that sensual satisfaction, and it may not be necessary to go through every stage of the sexual response cycle.

Causes of Reduced Orgasmic Pleasures

Orgasmic pleasure is considerably reduced in drug abuse (brown sugar in particular), myopathy, alcoholics, neuropathy and anxiety disorders.

What is Tubectomy?

Tubectomy is a permanent method of contenception by female sterilization, involving the excision of the tubes to interrupt the passage of ova. Its contraceptive measure does not leave any residual effect on the female’s sexuality.

Is Tubectomy reversible?

Yes, Tubectomy is reversible by microsurgicat techniques, but, this is more difficult than reversal of vasectomy. The success rate depends upon the method of tubectomy and the skill of operating surgeon.

Does Tubectomy affect Estrogen Levels?

No. Ligation of the tubes merely interrupts the passage of the ova thus preventing conception. It leaves the hormonal levels unchanged and has no effect on the female sexual desire.

Is there any change in sexual enjoyment after Tubectomy?

In fact, it may enhance one’s sexuality as it offers contraception without decreasing local sensitivity, it unlike barrier contraceptives.

Does the Female Superior Position prevent pregnancy?

Alas! No!

Are there any complications after Vasectomy?

Yes, occasionally. They may be surgical, immunological or psychological. Surgical complications are the least serious. They consist of bleeding (scrotal haematoma) or infection. This usually occurs a week later.

Immunological complications are extremely rare and no cause and effect relationship is known. Psychological complications occur chiefly because of inadequate counselling prior to the operation.

What preparations should one take after Vasectomy to prevent Surgical Complications?

An athletic supporter or a tight fitting jockey type underwear should be worn for a week t help relieve swelling and to support the scrotum to relieve the discomfort. The small gauze bandages protecting the incisions should be changed every two days.

What happens to the residual sperms?

The residual spermatozoa are phagocytosed (swallowed and destroyed) by the lymphatics of the testicle and epididymis and are rapidly disposed off.

Does the male hormone (Testosterone) level go down after Vasectomy?

No. Vasectomy has no effect on testosterone levels. A study was carried out by my colleagues and myself at the Institute of Research in Reproduction (ICMR), Bombay, on 45 vasectomised males with sexual dysfunctions. The duration of vasectomy was from fourteen days to fourteen years and revealed no significant change in the testosterone levels.

Is sexual desire and potency affected by Vasectomy?

No. The testes have two varieties of cells. One variety secretes testosterone that goes directly into the blood stream and is responsible for sexual desire and potency. The sperms are produced by the other variety of cells and they pass through a tube known as the vas. Thus, tying or ligation of the vas will have no effect on desire or potency. Sex life will remain unchanged. Erections, ejaculations and pleasure at orgasm will be as before.

What conditions can make women frigid?

Distraction, disturbed interpersonal relationship, anti-hypertensive drugs, tranquilisers sedatives, hypnotics and sometimes oral contraceptives can all lead to decline in sexual desire. Any pain at the time of coitus, whether it is vaginitis, pelvic infection or different uterine position, may lead to frigidity of sudden onset.

What is female circumcision?

It is a barbaric custom of female genital mutilation that varies in the extent of mutilation perpetrated. Its most disfiguring form — the Pharonic circumcision practiced in Sudan and Kenya; involves cutting off of the clitoris, labia majora and labia minora followed by close apposition of the tissue that remains leaving only a tiny hole at the bottom for the passage of urine. This severe local mutilation makes sex, a painful encounter. In its mildest form, it involves excision of the clitoris or the clitoral hood alone. It is performed due to the misconception that unless it is performed a woman will become overtly promiscuous.

Do women ejaculate?

Few women do report squirting of fluid at the time of orgasm, but this is rare. Female ejaculation is an entity that remains to be proven.

What is the G-Spot and how can one stimulate it?

The G-spot or the Grafenberg spot is an area of increased sensitivity with maximum potential for arousal. It is located on the anterior vaginal wall about two inches from the introitus. After sliding the fingers in that position and with forward, backward or side-to-side movement, the female will be able to pin point the spot where she appreciates increased sensitivity. With increased stimulation, the G-spot swells like a nodule, and becomes firm. Simultaneously clitoral stimulation can enhance sexual pleasure.

What is the most common female sexual problem?

As per my observation, painful sexual intercourse leading to vaginismus is the most common sexual problem.

What could be the cause of excessive vaginal lubrication during sexual intercourse?

Physiologically, lubrication occurs in the vaginal walls during sexual arousal. This could increase in certain conditions of heightened sexual excitement and vaginal infection/allergy. The best thing is to find the cause and treat it. At times, a small dose of an anti-histaminic may prove useful.

Do women like breast stimulation?

Most women enjoy stimulation of the breasts as they form an important erogenous zone of the female anatomy. But, enjoyment depends upon the way in which they are stimulated. Also there are times when the breasts are tender and an attempt to stimulate them causes pain. This usually occurs premenstrual and during pregnancy and in women using oral contraceptive pills, when the breasts are engorged due, to hormonal influence. Hence, it is best to ask the partner about whether "to do, or not to do".

Is the breast size important?

No. Large breasts are not more sensitive to stimulation than smaller one's.

Are there any medicines or creams to enlarge the breasts?

No.

Can the breast size be increased?

Certain exercises can help develop the Pectoralis Major muscles that would add a little bulk to the chest (but not the breasts themselves) and this may help to apparently increase the breast size. Plastic surgery may also prove beneficial.

Are there any exercises for sagging breasts?

There are no exercises that can help sagging breasts because there are no muscles in the breasts except the smooth muscles in the nipple. Wearing of a proper brassiere can help minimize sagging.

Does disparity in breast size require treatment?

Disparity in the size of the breasts may be due to various reasons - physiological and pathological. Disparity due to any pathological cause must be thoroughly investigated and treated. For physiological disparity, no treatment other than counseling and reassurance is required. For cosmetic reasons, if the difference is minor, padding the brassiere cup of the smaller breast would suffice. If the difference in size or contour is large then an enhancement! Enlargement mammoplasty of the smaller breast or a reduction mammoplasty of the larger one may be carried out after evaluating each case on individual merit.

What s the difference between a transvestive and a transsexual?

A transvestite is an individual who becomes sexually aroused by donning the apparel of the opposite sex, and a transsexual is one who strongly fools that he or she belongs to the opposite sex.

How can one diagnose transsexualism?

Transsexualism is an overriding feeling of discomfort with one’s anatomic sex and a constant desire to be rid of one’s genitals to become a member of the opposite sex. In other words, a male mind in a female’s body and vice versa. The diagnosis is made only if the disturbance has been continuous for at least two years; if there is no evidence of psychological disorder like schizophrenia; and is not associated with physical intersex or genetic abnormality. The differential diagnosis must be made among true transsexuaiism, transvestism and homosexuality. Physician should be aware that Gender transposition might occur in cases of severe personality disorganization associated with psychosis. A behavioral sex change may emerge even later in life in certain rare cases of temporal lobe epilepsy or as a consequence of senile dementia.

Are eunuchs transsexuals?

No. Eunuchs are not necessarily transsexuals. They are castrated males, who have had their testicles removed prior to puberty so that the secondary sexual characters do not develop. As against this, transsexuals are individuals who have an overwhelming desire to be the opposite sex.

What should one tell children about sexual abuse?

One should approach the subject directly and objectively giving appropriate and honest information without communicating unnecessary anxiety. This will make the child aware of sexual abuse and enable him to recognize sexual abuse and potential sexual abusers, when he encounters them. School children may be warned not to accept favors from strangers.

In adolescent years, a more frank discussion can take place. A trusting parent-child relationship encourages children to report unusual incidents with other persons, to their parents. In fact, public recognition in the area of child molestation is absolutely essential. Specific incidents, which have already occurred, should be reported and discussed in newspapers and on television. This will help in proper handling of sexual molesters.

Can the incidence of sex crimes be reduced by sex education?

Yes. Occasionally when sexual desire becomes intense, and a partner is not available, the only release left is masturbation. Rampant myths about masturbation (that it leads to impotence, homosexuality, tuberculosis etc.) often discourage individuals from indulging in it. In such circumstances, the intensity of sexual desire outweighs moral bindings and one may resort to sexual activity by force i.e. rape. This leads to an increase in sexual crimes. Rapes are also committed due to a common prevalent myth; that a man would be cured of venereal diseases if he has sexual intercourse with a virgin. Sex education, by eradicating these misconceptions, can orient an individual to direct his sexual impulses in a socially acceptable manner.

Is it harmful if the parent’s answers are a little more than what a child can understand?

Parents worry a great deal as to whether this knowledge will harm the child. Though we live in a conservative society, scientific knowledge appropriate to the age of the child will not harm the child while ignorance may.

It is better to give the child the basic information asked for in a simple, factual and loving manner. Even if the parent occasionally replies a little more than what the child can understand, there is no harm because this will help in leaving the door open for further questions.

Does giving sex education stimulate urges and sexual desires leading to increase in unwanted pregnancies and venereal diseases?

No. Sex education does not stimulate urges and sexual desire. In fact it satisfies one’s curiosity with appropriate and correct information enabling one to recognize one’s sexuality and sexual orientation. As mentioned by Milton I. Levine at Cornell University Medical College in New York “There is no evidence whatsoever that sex education is harmful, that it excites curiosity or stimulates sex urges and desires. On the contrary, there is ample evidence that it does help in gaining a wholesome attitude towards sex and understanding of the normal sex attitudes, roles and relationships”. He further states that “ it may aid our boys and girls to learn to direct their sex impulses with more knowledge and intelligence, to make a correct choice between operating codes of heterosexuality and homosexuality and to recognize and understand those men and women with sex desires and urges which are deviant”. In fact, it has been observed that in countries where proper sex education is given, the number of cases of unwanted pregnancies and venereal diseases have reduced considerably.