DYSPAREUNIA OR WHEN SEX HURTS

DYSPAREUNIA OR WHEN SEX HURTS

Pretty girl Rena came to see me in my office upon return from her honeymoon, she was in tears, this honeymoon was a total disaster, as they could not enjoy or have any sexual entertainment or pleasure.
Dyspareunia means painful sex, and the word is derived from Greek, which means (Badly Mated).
When you cannot have sex at all is called Apreunia.
Vulval pain is in fact quite a common condition, more often occurring in women, almost one in four  women suffer with Dyspareunia during there life span.

Historically it was described in 1880 as hypersensivity or super sensitivity of the vulva. It was in 1975 that the Vulvovaginal Disease Society gave it a name , burning vulva syndrome.
We have come a long way in understanding the problem , however we do not totally understand what causes it. In the past the condition was considered to be psychological, however luckily for the modern women the current diagnostic and therapeutic approach is integrated with some psychology.
Dyspareunia is a complex problem and frequently has a multifactorial aetiology. A new way has been recently suggested to define dyspareunia by dissecting it into primary, secondary, and tertiary sources of pain. It is also defined into superficial or deep depending on the origin of the pain and these will be discussed in future blogs.

We are talking about pain in the female external genitalia which lies between our thighs, and it is called the Vulva.

The picture shows all the female genital organs. The vulva consists of Labia Majora on both sides and in side this is Labia Minora on both sides. On the top is the Urethra and just above is the Clitoris not seen in the diagram. The little opening leads to the Vagina and the area around is called the vestibule. It is in this area that the pain is called Dyspareunia.
As a result of the pain the muscles of the area go into a spasm, and this is then called vaginismus.
Vaginismus can often happen before the sex is initiated, due to fear or psychological reasons.
Dyspareunia can be superficial, due to the visible structures or deep within the vaginal area.

In this post we will concentrate on some of the superficial causes of pain. We will not talk about the skin conditions, such as infections, dermatitis, herpes, human papilloma virus, congenital abnormalities such as the vaginal septum's, tough hymen, absent hymen or even absent vagina. Hymen is a membrane with a small opening in the centre , through, which the menstrual blood flows. At the time of commencement of sexual activity, the penis goes through the hymen, enlarging the opening.
Sometimes if this is not possible a medical procedure is necessary to enlarge it.

This type of difficulty along with painful infections or fear, disparity between the size of the mans penis and vagina, the vulva goes into a muscular spasm, this is very painful and some times extends into the women's legs.
Women coming from very conservative families , lack of education and abuse as a child, along with
local operations on the vulva and traumatic child birth, also get vaginismus.
So as medical practitioners after taking a detailed history and clinical examination should then advise the treatment accordingly.
The simplest thing to start with is to give basic education on sexual intercourse, reassurance, and some antidepressants.
Physiotherapy of the pelvic floor is useful.
It the vaginismus is not to severe you can help, by teaching the patient how to dilate the vagina. The vagina should be well lubricated, watery lubricants should be used. In my experience I have found Olive Oil to be a very good lubricant. The women should avoid using off the counter preparations, such as strong soaps, talcum powder or perfumes. The best thing to wash is with plain clean water.
The dilators are available as a set of gradually increasing size and the women can lubricate it slowly in the shower.
In very severe cases of vaginismus where the sex is totally impossible the treatment has to be taken.

One of the best treatments was described by Master and Johnson in 1970, still makes great sense to me. There advise that the couple should have a peaceful time to have relationship, initially they should touch each on non sexual organs, taking it in turns as to who starts first. There is total ban on sexual activity until the women is totally relaxed. There should be a fair bit of foreplay until she is well lubricated. The sexual activity should start with regular gentle stretching.
This condition is almost always reversible.

The next important condition causing superficial Dyspareunia is currently named Vulvodynia and we will talk about this in the next blog.
        

OSTEOPOROSIS

Osteoporosis
Osteoporosis is a very common condition in the present world , perhaps because we are living longer. Osteoporosis in simple language means fragile bones. It is more common in females. One in Five females suffer from this after the age of fifty, the recent study done in Australia showed that there were 1.3 million osteoporotic women in Australia compared with 50 million women in USA in 2010. 80 thousand women each year in Australia, suffer from a fracture from minor trauma, usually in the arm , hip and spine.
Billions of dollars are spent on health budgets to look after these women and men.
And the misery they suffer from the complications are immeasurable.
Osteoporosis is a preventable disease and we can save so much pain and suffering and cost if we act early.
This prevention really should be started in childhood, its like the foundation of a house, the better , the longer the house will stand. Like the repair of the house , the body also needs constant care to prevent osteoporosis.
The four important factors that are adequate nutrition, calcium, vitaminD and physical activity. 
In very young children up to the age of 4 you need 500mgs of calcium per day, then in adolescents about 700mgs and teenagers about 1000mgs. In older women the need increases again to 1300mgs per day.
Five to ten minutes of sport in the sun each day is enough to keep their vitamin d levels up to around 50units.
So as you can see it is very simple to maintain your bone health.
The best bone health is around late twenty's and it is called peak bone mass.
So if you have your best bone density at that age, your risk of osteoporosis is 30% less in old age.
There are some risk factors which increase the risk of osteoporosis , the most important being genetics, a frail figure, smoking, long term use of steroids, for example in Asthma, early menopause, poor gonadal activity(poor development).
The diagnosis is best made by bone density scan, called "dexa scan".
More tests are performed in complicated cases to study the calcium metabolism, and hormones involved in bone formation.
The treatment is simple, keep your calcium, Vitamin D and exercise up. 
The drugs required fall in to two categories' one is to stop the bone destruction, and the other is to make the bones remodel. The bones get repaired all the time by the process of absorption and remodelling .
Hormone replacement in women is the best treatment for prevention and management of osteoporosis, except where this cannot be given. 
It is very useful to take HRT in early menopause preferably before the age of sixty.
DO NOT BE AFRAID of HRT or MHT, do not suffer and enjoy life.
There are many other drugs available, for the management of osteoporosis, and they fall under the group of drugs called anti absorptive, they are called Bisphonates.
Nothing is worse than lying in a hospital with a broken hip, hanging in a sling, counting days, don't let it happen, do not be anti HRT, you cannot treat osteoporosis by calcium , vitamin d only.
To build a house you need a builder which is the HRT and you need concrete which is Calcium and Vitamin D.

"HOT FLASHES" Timing is everything in managing them. So how old are you today?. and you couldn't sleep all night yesterday because of them. So now is the right time to start HRT (Hormone Replacement Therapy), take the real diamond (the proper commercial drug) not naturopathic or homeopathic. They have not been scientifically tested and they do not really help. While all HRT carries some risks, but they are very useful in giving you a new lease of life, no hot flashes, good sleep, and happy sexual interludes. It prevents the long term side affects of menopause such as Osteoporosis , Bladder control, and newly diagnosed Diabetes. If you are between 45 and 60, now is the best time to start to enjoy life. See a doctor who is familiar with all forms of HRT and have it tailored to your needs. Use of custom-compounded bio identical therapy is not recommended. Special care has to be taken if there is risk of venous thromboembolism, stroke, ischemic, heart disease. The risk of breast cancer in women over fifty years is a complex issue and needs very special attention. In women with premature or surgical menopause HRT, should be given up to the age of normal menopause. There is a lot more to menopause than this brief summary. DO NOT BE AFRAID of HRT or MHT, do not suffer and enjoy life.

it is getting important to study vitamin d levels in pregnant women these days , although no rickets is seen as was seen 100 yeara ago. roughly 3 percnt of women required manupulation for delivery. many had obstructed labour, still birth and a fistula. it was a sad state of affairs unfotunately some of it still goes on . In my working life in 1968 1 had to deliver a very severely ricketty woman . almost doubled up . i wondered how she ever got pregnant. i was unable to examine her . the baby was alive . I decided to do a caesarian . the normal lower caesirian could not be performed . a classical caesarian was done. this can be dangerous for future . this was in the city of new delhi. The god was not kind to them , the baby was grossly malformed incompatible with life. I hope this will never ever happen again I am pleased to note that a lot of work is being done with reference to women and vitamin D.

Tongue Tie

Underneath the tongue there is a string of tissue that attaches the tongue to the mouth. If this tissue is short then there is difficulty for the tongue to move around and then this causes difficulty in breast feeding,and later on maybe speech. The baby has trouble latching on to the breast and slips off while feeding. The baby may not gain weight. The mother gets frustrated and gets painful nipples. The diagnoses is usually made at the routine intial examination of the newborn baby,by putting the finger in the mouth and feeling the cord like structure below the tongue. It occurs in 4 to 11 percent of babies. Some doctors do not believe that this needs any treatment,however if there are feeding diffuculties it is easier to snip it. A very fine scissors is used and the baby is supported so it does not move. No anesthesia is required. There is no bleeding. Sometimes there is a blood vessel in this and you have to be careful to watch this. I have generally found that there is immediate improvement after the tongue tie is snipped. Mostly a frustrated mother leaves my office with a big smile.

vitamins and minerals

We are all familiar with words about vitamins and mineral. Are they really needed, in the societies where we have plenty of food and a wide variety of vitamins and minerals are organic compounds required in very small quantities for cell function and also for growth developement and body metabolism . This keeps us in good health.

there are 13 types of vitamins that we know so far they can be divided into two groups fat-soluble and water-soluble. The fat-solubl A,E,D,and K.The water-soluble ones are B group and these contain B1 B2 B3 B5 B6 B9(folic acid) B12.

Normally if you have milk green leafy vegetables fruits legumes meat fish nuts all your vitamin needs are met.Some of these vitamins are synthesised within over body for example vitamin K it is synthesised in the large intestines by microbes. Bile salts are needed for this absorption you may have heard how newborn babies are given vitamin K at birth this is because their gut is sterile and therefore they cannot synthesise vitamin K.

Vitamin K is required by the liver for production of clotting factors and its deficiency can lead to bleeding problems. Babies born with vitamin K deficiency can get the bleeding disease of the newborn and therefore it is recommended that newborn babies are given vitamin K in the dose of 1 mg at birth.

The other important vitamin is Folic acid in pre pregnancy stage in the dose of the 400 µg per day from three months prior to getting pregnant and 12 weeks during pregnancy. This has been shown to prevent fetal abnormalities particularly of the nervous system in the newborn.

Besides these two special needs if we eat a healthy diet including fruits and vegetables it meets all our requirements of vitamins and minerals we need not to spend hundreds of dollars.

SAY A PRAYER

Say a prayer to lord Ganesh as in Hindu mythology, it stops all the obstacles in your progess.
lets me ask for his blessings as I start my blog today . you will hear from me again . bye for now .
Asha