Treatment for Painful Intercourse in Women

Treatment for Painful Intercourse in Women

Medical Treatment

Treatment of pain during intercourse depends on the cause.

Pain at initial penetration may be treated when the cause is identified.

Atrophy (thinning of the vaginal walls): Entrance pain caused by atrophy is common among postmenopausal women who do not take hormone replacement medication. Blood flow and lubrication respond directly to hormone replacement. The most rapid relief of atrophy comes from applying topical estrogen vaginal cream directly to the vagina and its opening. This cream is available by prescription only. Over-the-counter lubricants and moisturizers can also be helpful. An oral drug taken once a day, Osphena, makes vaginal tissue thicker and less fragile, resulting in less pain for women during sex. The FDA warns that Osphena (ospemifene) can thicken the endometrium (the lining of the uterus) and raise the risk of stroke and blood clots.

Urethritis and urethral syndrome: With this condition, a woman may urinate frequently with urgency, pain, and difficulty, but a urinalysis can find no identifiable bacteria. These symptoms may be caused by chronic inflammation of the urethra (the tube through which urine exits the body) from muscle spasms, anxiety, low estrogen levels, or a combination of these causes. Using a special instrument, the doctor may dilate the urethra. The doctor may prescribe low-dose antibiotics. At times, antidepressants and antispasmodics may also be prescribed.

Inadequate lubrication: Treatment of inadequate lubrication depends on the cause. Treatment options include water-soluble lubricants (for use with condoms; other types of lubricants may damage condoms) or other substances such as vegetable oils. If arousal does not take place, more extensive foreplay might be needed during sexual relations.

Vaginismus: Painful spasms of muscles at the opening of the vagina may be an involuntary but appropriate response to painful stimuli. These spasms may be due to several factors, including painful insertion, previous painful experiences, previous abuse, or an unresolved conflict regarding sexuality. For a woman with vaginismus, her doctor may recommend behavioral therapy, including vaginal relaxation exercises.

Vaginal strictures (abnormal narrowing): Doctors commonly see vaginal strictures after pelvic surgery, radiation, or menopause. Estrogen, or special surgical techniques may be used to treat these strictures.

Interstitial cystitis: This chronic inflammation of the bladder has no known cause; however, pain with intercourse is a common symptom. It can be diagnosed with a potassium leak test or a cytoscopy. A cystoscopy is a procedure to look inside the bladder and may distend (stretch) the bladder to examine the bladder wall. These procedures often work to clear the condition. Other treatments include amitriptyline, nifedipine, Elmiron, or other prescription drugs. Other options include bladder washings with dimethyl sulfoxide (DMSO) or other agents or transcutaneous electric stimulation (TENS) and acupuncture. Surgery is a last resort.

Endometriosis: Endometriosis occurs when some of the tissue that lines the uterus is found outside the uterus. Pain during intercourse caused by endometriosis is not uncommon.

Vulvovaginitis (inflammation of the vulva and vagina): Whether recurrent or chronic, this problem is common despite the rise in the number of over-the-counter treatments. If not responsive to self-treatment with lubricating gels or initial treatment by a doctor, a woman may need a more thorough evaluation to identify the cause.

A doctor may ask the woman if she uses antibiotic or antifungal medication or if she douches. If so, these practices should be stopped to help determine whether a specific disease-causing organism is present.

Treatment is based on the presence of bacteria or other organisms. Often, no single organism is identified. The doctor may talk to the woman about proper hygiene.

If recurring symptoms are shared with a sexual partner, both individuals should be tested for sexually transmitted diseases (STDs).

A doctor considers the possibility of intermittent urethral infection with chlamydia, an STD, as well as a more obvious urinary tract infection, and then treats with the appropriate antibiotics.

Treatment for deep thrust pain includes two strategies.

Pelvic adhesions (tissue that has become stuck together, sometimes developing after surgery): Pain with intercourse caused by pelvic adhesions can be relieved by surgically removing the adhesions.

The health care provider may find physical causes of the pain, including ovarian cysts, pelvic inflammatory disease , endometriosis, uterine prolapse, or retroversion of the uterus (uterus is tilted backward instead of forward).

Home Remedies for Painful Intercourse

Applying lubricating gels to the outer sexual organs, including the vulva and labia, and in the vagina may be helpful to women and ease pain during intercourse. Sex toys, such as vibrators, may also be useful. A woman should talk with her health care provider before attempting to use a vaginal dilator.

What does sexual activity do for our Health

WHAT DOES SEXUAL ACTIVITY DO FOR OUR HEALTH?

After all is said and done, much has been said about the health benefits of sexual activity with your spouse.  But as it turns out, your weekly frequency is an important factor when determining which health benefits you actually get.

Once a week:  Good for your weight

“Sexual activity guides the brain to release oxytocin that often improves your quality of sleep”, says Helen Fischer, a Doctor of Biology.” And since sleep regulates our hunger hormones – Ghrelin and leptin, good sleep leads to reduction of weight.

Twice a week: Good for a cold

People that have sex twice a week have 30% more hemoglobin A, proteins that are part of the immune system and provide protection from infection, bacteria and parasites that cause diseases. So claims a study made by Wilkes University.

Three times a week:  Good for the heart

Sex increases not only the heart beat but good blood flow, so says a study from Bristol University. The researchers claimed that “People who have sexual intercourse at least 3 times a week can reduce their risk of fatal heart attack by as much as 50%.

Four times a week: Good for the skin

People that have sex 4 times a week look 4 – 7 years younger.  So says a group of researchers from Royal Hospital, Scotland. The reason is that sexual activity, increase the rate of growth hormones while reducing fat mass and softening the skin, which gives you a younger look.

Five times a week: Good for performance

“Having sex often is tied to increased optimism, energy, focus and creativity,”  says Dr. Helen Fischer, “and you don’t have to stay inbed to enjoy the benefits of the relationship.  In addition, focus and motivation will help you at work, as well.”

Six times a week: Good for the brain

People that have sex 6 times a week pump more blood to the brain, which increase the rate of hormone production, the same hormones that improve cognitive function.  Some claim it may even help the production of new brain cells.

Seven times a week:  Good for the mood

“Frequent sex lowers tension and anxiety,” says Jonathan R. Cole, an expert on internal diseases from California, “and this is usually attributed to the rise in endorphin production.”

Ways to boost your orgasm

Ways to boost your orgasm

  1. Your brain is your most important sexual organ. So to enhance orgasm focus on what’s happening in your mind. Fantasise. Have erotic and sexual thoughts. Read erotic literature.
  2. Make sure you are not thinking of the 10 things you have to do before tomorrow…
  3. Make sure you are in your body and that you are not dissociated. In other words that your body is there, but that you are somewhere on another planet.
  4. Focus on the sensations in your body.
  5. Focus on yourself and not on what you need to do for him or on your thighs or stomach fat.
  6. Know what you like in bed. Know your body and own your power as a sexual being. Become comfortable with your body and sexuality.
  7. Most women need at least 20 minutes of clitoral stimulation to reach orgasm. Foreplay is very important and there is nothing wrong with reaching orgasm during foreplay and not penetration.
  8. Relax, take a few deep breaths and enjoy!
  9. Women need different kinds of stimulation of the breasts, vulva, ears, clitoris, neck, mouth and other erogenous zones.
  10. For some women being on top can boost an orgasm because you have control over the depth and angle of penetration.
  11. Don’t forget sexual aids like a vibrator. You can also stimulate the clitoris with a vibrator during penetration.
  12. Try being blindfolded. All your other sense will heighten.
  13. The coital alignment (CAT) technique can also boost orgasm. Put a pillow underneath your buttocks. Let him penetrate you and lie on top of you. Instead of thrusting he should move backwards and forwards stimulating the clitoral area.
  14. Do Kegel Exercises (see other attachment)
  15. Try and close your legs during the missionary position.
  16. Deeper penetration can lead to stimulation of the cervix. Try being on top with your back towards him or the missionary position with your legs pulled up.

ORGASM: The latest …

ORGASM: THE LATEST…

Dr Elmari Mulder Craig

EFS/ESSM Certified Sexologist and Relationship Expert

‘That moment during sexual experience where my body completely takes over and is out of my conscious control, moving and feeling according to its own pleasure and taking my mind for a wonderful ride’. Anonymous

The big O…

It is a powerful feeling of physical pleasure and sensation, which includes a discharge of accumulated erotic tension. Orgasms have been defined in different ways using different criteria. Medical professionals have used physiological changes to the body as a basis for a definition, whereas psychologists and mental health professionals have used emotional and cognitive changes. A single, over-arching explanation of the orgasm does not currently exist.

Psychological Definition of Orgasm

Psychologists, psychiatrists, and other mental health professionals and researchers define orgasm based on subjective experiences of satisfaction, release, and other emotional and/or cognitive changes. By these measurements, someone has had an orgasm either when they say they have or when they describe an experience that matches what some expert proposes orgasm to be.

Medical/Physiological Definition of Orgasm

Medical researchers have tried to define orgasm based on what happens in our bodies.

They’ve measured increase in heart rate, body temperature, skin flush, hormonal changes and changes in sensitivity, muscle contractions, ejaculation, and more. Research can tell us the “average” measurements for orgasm, but we always need to remember that these are only “average” for people who can get into a lab and have an orgasm. Even though there are no universally agreed upon measurements or limits for orgasm all of these measurements have been used to “prove” that an orgasm has occurred. By these definitions, if you’re body responds in a certain way, you’ve had an orgasm.

Anal sex correlates with orgasm

It is suggested that women who have anal sex more often reaches orgasm. As sexologists we are also aware of the fact that more women are having anal sex than ever before. New research described by William Saletan suggests that since 1992, the percentage of women aged 20-24 who say they’ve tried anal sex has doubled to 40 percent. The percentage of women aged 20-39 who say they’ve done it in the past year has doubled to more than 20 percent. And 94 percent of women who received anal sex in their last encounter said they reached orgasm—a higher rate of orgasm than was reported by women who had vaginal intercourse or received oral sex. Women who engage in anal sex are often also open to, and comfortable with other sexual acts including vaginal intercourse, cunnilingus and the use of sexual aids like vibrators and anal stimulators and partnered masturbation. Couples who have consensual, playful and open-minded sex lives tend to do things that result in the women in these relationships having orgasms AND to experiment with (and possibly find they enjoy) anal sex. It’s not one causing the other, but a common cause that results in the two being correlated.

It is important to note that anal sex does not necessarily mean anal penetration with a penis, but more often anal sphincter stimulation and the use of a finger or anal toy and often with simultaneous stimulation of the clitoris. We should always also keep in mind that sex is complex and people and their preferences differ.

Orgasms Facts

  • Greater behaviour diversity is related to ease of orgasm
  • Women who are sexually empowered, in touch with their bodies and open to asking for what they need, find it easier to reach orgasms regularly
  • Love, trust feeling safe emotionally and physically leads to easier orgasms
  • Researchers estimate that 10-15% of women have never experienced an orgasm
  • 47% of women reach their first orgasm through masturbation at the average age of 18
  • 70% of women need clitoral stimulation in order to reach orgasm
  • Many women find it easier to reach orgasm if they use the ‘women on top’ position as they can control the angle and level of penetration
  • Less than a third of women regularly orgasm through penetration alone
  • Women need on average 21 minutes of foreplay to reach orgasm
  • Women who’s pelvic floor muscles are strong find it easier to achieve orgasm and also find those orgasms to be more intense. Do your Kegal Exercises!
  • Research has found that orgasms are also not widely considered to be the most important aspect of sexual experience. One study reported that many women find their most satisfying sexual experiences involve a feeling of being connected to someone else, rather than basing their satisfaction solely on orgasm.
  • The clitoris has 8000 nerve endings and stretched 7 centimeters into the pelvic floor
  • The hypothalamus, the middle brain, the hippocampus and the cerebellum gets activated during orgasm.

Influential Research

Alfred Kinsey’s Sexual Behavior in the Human Male (1948) and Sexual Behavior in the Human Female (1953) sought to build ‘an objectively determined body of fact and sex’, through the use of in-depth interviews, challenging currently held views about sex. The spirit of this work was taken forward by William H. Masters and Virginia Johnson in their work, Human Sexual Response (1966) – a real-time observational study of the physiological effects of various sexual acts. This research led to the establishment of sexology as a scientific discipline and is still an important part of today’s theories on orgasms.

Orgasm models

Sex researchers have defined orgasms within staged models of sexual response. Although the orgasm process can differ greatly between individuals, several basic physiological changes have been identified that tend to occur in the majority of incidences.

The following models are patterns that have been found to occur in all forms of sexual response, and are not limited solely to penile-vaginal intercourse.

Master and Johnson’s Four-Phase Model:

  1. Excitement
  2. Plateau
  3. Orgasm
  4. Resolution

Kaplan’s Three-Stage Model:

Kaplan’s model differs from most other sexual response models as it includes desire – most models tend to avoid including non-genital changes. It is also important to note than not all sexual activity is preceded by desire.

  1. Desire
  2. Excitement
  3. Orgasm

Health benefits of sex and orgasm

  • Several hormones that are released during orgasms have been identified, such as oxytocin and DHEA, and some studies have suggested that these hormones could have protective qualities against cancers and heart disease.
  • After orgasm the body produces a quadruple amount of Oxytocin (the bonding hormone)
  • Oxytocin and other endorphins released during orgasm have also been found to work as relaxants. It is ten times more effective than Valium
  • It is a good sleeping pill
  • It is good for your hair and skin
  • It is a natural light anti-depressant
  • It relieves pain, headache, sinusitis and hay fever
  • It is good exercise and firms all the muscles in your body

Types of orgasms

Today sexologists agree that an orgasm is an orgasm and that there is no difference between a vaginal or a clitoral orgasm.  Although their might be a distinguished between mild, normal and intense orgasms.

The male orgasm

The following description of the physiological process of male orgasm in the genitals utilizes the Masters and Johnson four-phase model.

Excitement

When a man is stimulated physically or psychologically, they can get an erection. Blood flows into the corpora – the spongy tissue running the length of the penis – leading to the penis growing in size. The testicles are drawn up toward the body as the scrotum tightens.

Plateau

As the blood vessels in and around the penis fill with blood, the glans and testicles increase in size. In addition, thigh and buttock muscles tense, blood pressure rises, the pulse quickens and the rate of breathing also increases.

Orgasm

Semen – a mixture of sperm (5%) and fluid (95%) – is forced into the urethra by a series of contractions in the pelvic floor muscles, prostate gland, seminal vesicles and the vas deferens.

Contractions in the pelvic floor muscles and prostate gland also cause the semen to be forced out of the penis, in a process called ejaculation. The average male orgasm lasts for between 10 to 30 seconds.

Resolution

The man now enters a temporary recovery phase where further orgasms are not possible. This is known as the refractory period, and its length varies from person to person. It can last from a few minutes to a few days, and this period generally grows longer as the man ages.

During this phase, the man’s penis and testicles return to their original size. The rate of breathing will be heavy and fast, and the pulse will be fast.

The female orgasm

The following description of the physiological process of female orgasm in the genitals utilizes the Masters and Johnson four-phase model.

Excitement

When a woman is stimulated physically or psychologically, the blood vessels within her genitals dilate. Increased blood supply leads to the vulva swelling and fluid passing through the vaginal walls, making the vagina wet. The top of the vagina expands.

Heart rate and breathing quicken and blood pressure increases. Blood vessel dilation can lead to the woman appearing flushed, particularly on the neck and chest.

Plateau

As blood flow to the introitus – the lower area of the vagina – reaches its limit, it becomes firm. Breasts can increase in size by as much as 25% and increased blood flow to the areola – the area surrounding the nipple – causes the nipples to appear less erect. The clitoris pulls back against the pubic bone, seemingly disappearing.

Orgasm

The genital muscles, including the uterus and introitus, experience rhythmic contractions around 0.8 seconds apart. The female orgasm typically lasts longer than the male at an average of around 13 to 51 seconds.

Unlike men, most women do not have a refractory period and so can have further orgasms if they are stimulated again.

Resolution

The body gradually returns to its former state, with swelling reduction and the slowing of pulse and breathing.

What causes orgasms

It is commonly held that orgasms are a sexual experience, typically experienced as part of a sexual response cycle. They often occur following the continual stimulation of erogenous zones, such as the genitals, anus, nipples and perineum.

Physiologically, orgasms occur following two basic responses to continual stimulation:

  • Vasocongestion: the process whereby body tissues fill up with blood, swelling in size as a result
  • Myotonia: the process whereby muscles tense, including both voluntary flexing and involuntary contracting.

However, an article published in 2011 examined the occurrence of exercise-induced orgasm in women; when orgasms occur during physical exercise such as climbing and lifting weights. The findings of this study among others challenge the belief that orgasms are purely a sexual experience.

There have been other reports of people experiencing orgasmic sensations at the onset of epileptic medicine and foot amputees feeling orgasms in the space where their foot once was. People paralyzed from the waist down have also been able to have orgasms, suggesting that it is the central nervous system rather than the genitals that is key to the experiencing of orgasms.

Orgasm disorders

There are a number of disorders that are associated with orgasms. These disorders can lead to distress, frustration and feelings of shame, for both the person experiencing the symptoms and their partner. Although orgasms are considered to be the same in all genders, health care professionals tend to describe orgasm disorders on gendered lines.  Orgasm disorders can potentially cause feelings of distress, shame and frustration for anyone involved.

Male orgasmic disorders

Delayed Ejaculation/Inhibited male orgasm

Also referred to as inhibited male orgasm, male orgasmic disorder involves a persistent and recurrent delay or absence of orgasm following sufficient stimulation.

Male orgasmic disorder can be a lifelong condition or one that is acquired after a period of regular sexual functioning. The condition can be limited to certain situations or can generally occur. It can occur as the result of other physical conditions such as heart disease, psychological causes such as anxiety, or through the use of certain medications such as antidepressants.

Premature ejaculation

Ejaculation in men is closely associated with an orgasm. Premature ejaculation is a common sexual complaint, whereby a man ejaculates (and typically orgasms) within one minute of penetration, including the moment of penetration itself.

Premature ejaculation is likely to be caused by a combination of psychological factors such as guilt or anxiety, and biological factors such as hormone levels or nerve damage.

Female orgasmic disorders

Female orgasmic disorders center around the absence, or significant delay of orgasm following sufficient stimulation.

The absence of having orgasms is also referred to as anorgasmia. This term can be divided into primary anorgasmia, when a woman has never experienced an orgasm, and secondary anorgasmia, when a woman who previously experienced orgasms no longer can. The condition can be limited to certain situations or can generally occur.

Female orgasmic disorder can occur as the result of physical causes such as gynecological issues or the use of certain medications, or psychological causes such as anxiety or depression.

Common misconceptions

It is probable that the high importance that society places on sex, combined with the incomplete nature of what is currently known about the orgasm, has led to a number of common misconceptions. Sexual culture has placed the orgasm on a pedestal, often prizing it as the one and only goal for sexual encounters.

However, orgasms are not as simple and as common as many people would suggest. It is estimated that around 10-15% of women have never had an orgasm. In men, as many as one in three reports having experienced premature ejaculation at some point in their lives.

Another misconception is that penile-vaginal stimulation is the main way for both men and women to achieve an orgasm. While this may be true for many men and some women, many more women experience orgasms following the stimulation of the clitoris.

In fact, orgasms do not necessarily have to involve the genitals at all, nor do they have to be associated with sexual desires, as evidenced by examples of exercise-induced orgasm.

The journey to an orgasm is a very individual experience that has no singular all-encompassing definition. In many cases, experts recommend avoiding comparison to other people or pre-existing concepts of what an orgasm should be.

Some of the above information from James McIntosh, published in Medical News Today.

Premature Ejaculation

 

 

PREMATURE EJACULATION

The definition for premature ejaculation has been debated over the years but many experts in the field currently rely on the International Society of Sexual Medicine (ISSM) definition which identifies the following criteria:

  • Ejaculation which occurs always or nearly always before or within one minute of vaginal penetration.
  • Failure to delay ejaculation during nearly all episodes of vaginal penetration.
  • Personal distress, bother, frustration and/or the avoidance of sexual encounters.

Premature ejaculation may be classified as ‘lifelong’ (primary) or ‘acquired’ (secondary):

  • Lifelong premature ejaculation is characterised by onset from the first sexual experience and remains a problem during life.
  • Acquired premature ejaculation is characterised by a gradual or sudden onset with ejaculation being normal before onset of the problem. Time to ejaculation is short but not usually as fast as in lifelong premature ejaculation.

The European Association of Urology (EAU) points out that the ISSM definition only applies to men with lifelong premature ejaculation who have vaginal intercourse. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is due to publish a new definition in May 2013.

EPIDEMIOLOGY

  • The prevalence of premature ejaculation varies according to definition and is difficult to assess in view of many men not wanting to seek help or even discuss the problem.
  • The EAU reports a prevalence of 20-30% whilst a Cochrane review quoted a prevalence of 3-20%.

Risk factors:

  • Premature ejaculation may be anxiety-related. It is therefore more common in young men and early in a relationship. In these situations, the problem usually resolves with time.
  • Iatrogenic causes include amphetamines, cocaine and dopaminergic drugs. Although effective for the treatment of premature ejaculation in some men, sildenafil may also be a cause of premature ejaculation in others.
  • Urological causes – eg, prostatitis.
  • Neurological causes – eg, multiple sclerosis, peripheral neuropathies.

MANAGEMENT

Management should be tailored to the needs of the individual. The condition may be more of an issue in some relationships than others and patient expectation should be explored. Psychosexual counselling may be sufficient.

  1. General advice:
    • More frequent sex (or masturbation): premature ejaculation is more likely if there is a longer gap between sexual intercourse.
    • Using a condom to decrease sensation.
    • Using a cream with a numbing effect might also help. It should be applied to the head of the penis and especially the frenulum and carona (Dr. Rudolph/Serfontein would have pointed those out for you) about 10 minutes prior to penetration.  It usually does not affect the sensation of the partner and does not decrease the intensity of the man’s orgasm.
    • Sex with the woman on top reduces the likelihood of premature ejaculation.
    • Squeeze and stop-go techniques: stimulating the penis almost to the point of ejaculation and then stopping. These techniques are often effective but may take a few months to produce any benefit and relapse is common.
    • Behavioural treatments are useful for secondary premature ejaculation but are not recommended first-line for lifelong premature ejaculation. They are time-intensive and require commitment from the partner.
  1. Drug therapy:

Selective serotonin reuptake inhibitor (SSRI) antidepressants are the most commonly used (off-label use) but need to be taken daily for 12 weeks before the maximum effect is achieved. Paroxetineclomipramine, sertraline and fluoxetine have all been shown to be effective.

Dr. Rudolp/Serfontein usually prescribes Paroxetine (there are various brand names but this is the active ingredient). For the first   few days you will be asked to use half strength and then you will go up to full strength after that.  It might cause slight nausea and a dry mouth in the beginning.  Remember: these drugs work in your brain, so you might feel a bit strange in the beginning but it is usually quite easy to get used to it.  Please use it EVERY DAY, not only when you want to have intercourse.  It is much more effective if used every day and it is not good for you to skip dosages because you will experience withdrawal symptoms.  You will not get addicted to the drug, we will just have to taper the dosage if you would like to stop using it.  Stopping it abruptly can cause significant side effects and be dangerous.  It is possible that we might be able to use “as necessary” dosing later or even stop the treatment completely, but that will be assessed at your follow-up visit.  We usually request a follow-up visit within one month to six weeks.  Cheaper alternatives will also be discussed during your follow-up visit.

WARNING:  This drug should not be taken if you are trying for a baby – it might damage the DNA of the sperm.  You have to be off the drug for at least two months before you start trying for a baby.

  • In patients who cannot tolerate the side-effects of SSRIs, on-demand treatment with clomipramine may be a suitable alternative.
  • Daproxetine is an SSRI which has been specifically developed for the treatment of premature ejaculation. It is proving highly effective but is not yet licensed for use in the South Africa.
  • Sildenafil (Viagra) is an effective alternative, especially in older men and when associated with erectile dysfunction. Studies suggest that it improves intravaginal latency times, reduces performance anxiety and improves sexual satisfaction. It is thought to act by down-regulating the ejaculation threshold. There is some evidence that a combination of sildenafil with SSRI is better than SSRI monotherapy.
  • Anaesthetic creams may be effective and may show an additive effect when combined with sildenafil. Aerosol sprays are proving popular and novel preparations are being developed. Topical preparations may be the preferred therapy for some patients.
  • Tramadol has been found to have beneficial effect in the treatment of premature ejaculation but further studies of long-term safety are required before this treatment can be recommended as a viable option.
  1. Psychosexual therapy:
    • The evidence base for the effectiveness of psychological interventions is limited and randomised trials with larger sample sizes are needed.
  1. Surgery:
    • One study reported that a short frenulum was found in 43% of individuals affected by lifelong premature ejaculation. Frenulectomy was effective in relieving the problem and the authors recommended excluding short frenulum in all patients with lifelong premature ejaculation.

COMPLICATIONS

Premature ejaculation may have a significant adverse effect on both self-confidence and the relationship. One study reported that premature ejaculation can lead to sexual dissatisfaction, a feeling that something is missing from the relationship and an impaired sense of intimacy. If the condition remains untreated it can lead to increased irritability, interpersonal difficulties and deepening of an emotional divide.

Female sexual disorders.

Female sexual disorders: Treatment options in the pipeline

FEB 28, 2013

By: Michael L. Krychman, MD

Female sexual problems are best conceptualized from a biopsychosocial perspective that includes biological, psychological, sociocultural, and interpersonal factors. Treatment also follows a biopsychosocial model and options include psychotherapy, pharmacotherapy, physical therapy, and complementary approaches alone or in combination.

This article focuses on emerging treatment options for female sexual disorders. Currently, only 2 treatment options for female sexual complaints are approved by FDA: 1) The Eros clitoral stimulator, approved in 2000 for female sexual arousal disorder (FSAD); and 2) conjugated equine estrogen, approved in 2008 for treatment of moderate to severe dyspareunia.

Most of the research and development currently under way in this area is focused on pharmacologic options for treatment of hypoactive sexual desire disorder (HSDD)—the most prevalent female sexual disorder. Treatments primarily involve both steroid hormone and neurohormone mediators. The table provides a glossary of terminology related to female sexual disorders discussed in this article.

Central brain studies have shown that serotonin, norepinephrine, and dopamine are implicated in sexual function. Dopamine agonists and central melanocyte-stimulating hormone (MSH) analogs also are currently being investigated as possible mediators of female sexual function. In addition, estrogen therapy (ET) and testosterone replacement continue to be common treatments in female sexual medicine for vulvovaginal health and HSDD in postmenopausal women, respectively.

Clinicians and patients, however, are still somewhat hesitant to use ET, even locally, because of concerns about systemic risks of local ET. Off-label use of systemic testosterone for HSDD is associated with similar concerns. The following is an overview of investigational treatments of female sexual disorders, including drugs currently in phase 2 or 3 clinical trials and a thermal therapy.

Flibanserin

Flibanserin is a 5-HT(1A) agonist/5-HT2 antagonist for treatment of HSDD. Phase 3 pivotal trials have shown it to be effective, with mild adverse effects including nausea, dizziness, fatigue, and sleeplessness.

In a recent phase 3 trial in premenopausal women with HSDD, Katz and colleagues found that flibanserin 100 mg at bedtime was associated with clinically meaningful and significant improvement in the number of satisfying sexual events (SSE) and the sexual desire domain of the female sexual function index (FSFI).1 Significant differences also were demonstrated between treatment and placebo on the secondary end points of the Female Sexual Distress Scale-Revised total (FSDS-R total) and distress associated with low desire (FSDS-R item 13). In a trial of postmenopausal women with HSDD, flibanserin 100 mg at bedtime also was associated with clinically meaningful and significant improvement. The coprimary end points were SSE and sexual desire (FSFI-desire domain). Secondary end points for distress (FSDS-R total) and distress associated with low sexual desire (FSDS-R item 13) improved compared with placebo.2–4 To date, flibanserin has been studied in trials involving approximately 11,000 women.

Lybrido and Lybridos

Lybrido and Lybridos are novel combination drugs that are in development for treatment of HSDD. Lybrido combines testosterone with a phosphodiesterase inhibitor (PDE5 inhibitor) and Lybridos combines testosterone with a 5HT(1A) agonist (buspirone). Lybrido is designed for women with HSDD and low motivation, theorized to be a result of a relatively insensitive system for sexual cues. Testosterone is believed to improve desire, whereas the PDE5 inhibitor works to increase genital sensitivity. Because Lybrido is administered sublingually, the time of peak concentration of the PDE5 inhibitor coincides with the 4-hour delay in behavioral effect of testosterone.

Lybridos is designed for women with HSDD who also have sexual inhibition. Testosterone increases sexual motivation, and buspirone counters the sexual inhibition mechanism in the prefrontal area of the brain. As with Lybrido, administration of Lybridos is sublingual. The time frame for the pharmacologic effects of the buspirone coincide with the behavioral window for testosterone administration.5,6

LibiGel

LibiGel is a low-dose (300 µg) gel formulation of topical testosterone in development for treatment of HSDD in postmenopausal women. In recent phase 3 clinical trials, it did not demonstrate efficacy in primary end points, and the sponsor has announced plans to repeat this pivotal research.7

Coprimary end points of the efficacy trials were the change in the total number of days with a satisfying sexual event from baseline and the change in mean sexual desire from baseline. The Data Safety and Monitoring Board also made 9 “unblinded” reviews of all the data in the safety study and allowed the research to continue without changes. No specific safety signal has been observed with respect to cardiovascular disease or breast cancer.8

TBS-2: Tefina

TBS-2 is an intranasal low-dose nasal gel formulation of testosterone. It is being developed to offer women with female orgasmic disorder (inability to achieve orgasm despite adequate sexual stimulation) an on-demand treatment option.

Tefina is expected to have an attractive safety profile, with virtually no androgen-related adverse effects such as acne, growth of facial and body hair, or deepening of the voice that may be associated with other chronic regimens. Moreover, there is no expected risk of skin-to-skin transfer of testosterone to family members with the unit-dose nasal applicator currently under development. A phase 2 trial of Tefina is under way in the United States, Canada, and Australia.9,10

Alprostadil: Femprox

Alprostadil (prostaglandin E1-PGE1) is a naturally occurring, potent vasodilator that has an important role in regulating blood flow to the female reproductive tract. Alprostadil also potentiates the activity of sensory afferent nerves. Femprox is an alprostadil-based cream intended for treatment of FSAD. Nine clinical studies of Femprox have been completed to date, including a 98-patient, phase 2 US study and a 400-patient, phase 3 study in China. In a randomized clinical phase 3 trial of topical alprostadil 0.4% cream with a skin penetration enhancer, an ester of N,N-dimethylalanine and dodecanol (DDAIP), a 900-µg dose showed significant and clinically relevant improvements in primary arousal success and secondary efficacy outcomes (FSFI) and Global Assessment Questionnaire (GAQ) and FSDS.11

Apomorphine

Apomorphine is a dopamine agonist that has been used as a subcutaneous (SQ) injection for treatment of Parkinson disease and researched in oral form for treatment of arousal disorder. Research findings have been inconclusive, and apomorphine can be associated with emesis. In a small study of subjective or objective arousal in women with arousal complaints, changes in peak velocity of clitoral hemodynamics were significantly higher in patients given 3 mg apomorphine than in controls.12 This translated into changes in arousal and lubrication that were also significantly improved in the apomorphine group. The researchers concluded that the medication was beneficial in women with orgasmic problems or difficulties in the domains of subjective and objective complaints. Incidence of adverse events, which were mostly mild and transient, was low.

MSH Analog: Bremelanotide

Bremelanotide is a melanocortin receptor 4 agonist (MCR4 agonist) for treatment of HSDD and FSAD. It is a synthetic analog of a MSH and an agonist that activates the melanocortin receptors MC3-R and MC4-R in the central nervous system. Bremelanotide was initially delivered as a nasal spray. Phase 2 results with that formulation were promising, but development was stopped because of adverse effects on blood pressure.13 The drug has recently been reformulated in a lower dose for SQ injection and a phase 2b study is under way in premenopausal women with HSDD and FSAD.

Intravaginal DHEA suppositories

Intravaginal dehydroepiandrosterone (DHEA) is currently under investigation for treatment of vulvovaginal atrophic changes. Preliminary data are encouraging and suggest that this drug can reverse atrophic effects without increasing systemic estradiol levels. Intravaginal DHEA suppositories also may have an effect on HSDD. Phase 3 clinical trials of DHEA are under way, and more data
are forthcoming.14

Ospemifene

Ospemifene is a novel estrogen agonist and antagonist that has been studied as an oral agent for treatment of vulvovaginal atrophy (VVA) and, therefore, would be effective for VVA-related sexual pain. In phase 3 clinical trials, 826 women were randomized to 30 mg or 60 mg of this unique compound or to placebo for 12 weeks. The 60-mg dose was shown to be effective, well tolerated, and efficacious for vaginal dryness and dyspareunia.15 No proliferative effects on endometrium were seen, and adverse effects were minimal. The most commonly reported complaint was an increase in hot flashes.15

The Viveve procedure

Viveve (Sunnyvale, Calif.) has developed a monopolar radiofrequency (RF) thermal therapy to improve laxity of the vaginal introitus and sexual satisfaction in women after vaginal deliveries. To assess sexual satisfaction, sexual function, and distress associated with sexual activity, the FSFI and the FSDS-R scales were used in the clinical design. In addition, to discern effectiveness, patient-reported outcome questionnaires (Vaginal Laxity Questionnaire and Sexual Satisfaction Questionnaire) were used. In a pilot study in 24 women aged 25 to 44 years, reverse-gradient RF (energy range, 60 joules [n=3], 75 joules [n=3], and 90 joules [n=18]) was delivered through the vaginal mucosa. No adverse events were reported, and no topical anesthetics were required. Self-reported vaginal tightness improved in 67% of patients at 1 month posttreatment and in 87% at 6 months (P<0.001).  Mean sexual function scores improved, and FSDS-R score before treatment was 13.6 ± 8.7, declining to 4.3 ± 5.0 at month 6 posttreatment (P< 0.001). The office-based procedure is well tolerated and has shown excellent preliminary results.16

Summary

Only 2 FDA-approved treatments currently exist for female sexual disorders, but a wide range of oral, topical, and SQ formulations are being investigated. The etiologies of female sexual disorders are multifactorial, and a variety of treatment options are necessary to individualize treatment. Development of effective therapies is 1 important step for improving the sexual health of women. â–

References

  1. Katz M, DeRogatis L, Ackerman R, et al. Efficacy of flibanserin as a potential treatment for hypoactive sexual desire disorder in North American premenopausal women: results of the Begonia Trial. J Sex Med. 2011; 3(suppl 1):153.
  2. Simon J, DeRogatis L, Dennerstein L, et al. Efficacy of flibanserin as a potential treatment for hypoactive sexual desire disorder in North American post-menopausal women. J Sex Med. 2012;9(suppl 1):23.
  3. Goldfischer ER, et al. Continued efficacy and safety of flibanerin in premenopausal women with hypoactive sexual desire disorder (HSDD): results from a randomized withdrawal trial. J Sex Med. 2011;8(11):3160-3172.
  4. Derogatis L, et al. Treatment of hypoactive sexual desire disorder in premenopausal women: efficacy of flibanserin in the VIOLET STUDY. J Sex Med. 2012;9(4):1074-1085.
  5. van der Made F, Bloemers J, van Ham D, et al. Childhood sexual abuse, selective attention for sexual cues and the effects of testosterone with or without vardenfil on physiological sexual arousal in women with sexual dysfunction: a pilot study. J Sex Med. 2009;6(2):429-439.
  6. van der Made F, Bloemers J, Yassem WE, et al. The influence of testosterone combined with a PDE5-inhibitor on cognitive, affective, and physiological sexual functioning in women suffering from sexual dysfunction. J Sex Med. 2009;6(3):777-790.
  7. BioSante rises after ending LibiGel safety study. Businessweek.com Web site. www.businessweek.com/ap/2012-09-04/biosante-rises-after-ending-libigel-s…. Published September 4, 2012. Accessed October 3, 2012.
  8. BioSante Pharmaceuticals announces positive LibiGel phase III safety data review and decision to conclude the safety study [press release]. Lincolnshire, IL: BioSante Pharmaceuticals; September 4, 2012.
  9. van Gorsel H, Laan E, Tkachenko N, Dickstein J, Kreppner W. Pharmacokinetics and pharmacodynamic efficacy of testosterone intranasal gel in women with hypoactive sexual desire disorder and anorgasmia. Poster presented at: International Society for the Study of Women’s Sexual Health Annual Meeting (ISSWSH); February 19-22, 2012; Jerusalem, Israel.
  10. Efficacy and safety of TBS-2 testosterone gel in premenopausal women with acquired female orgasmic disorder. Clinical Trials Identifier: NCT01607658. www.clinicaltrials.gov/ct2/show/NCT01607658.
  11. Goldstein I, Bassam D, Frank D, Hachicha M, Fernando Y, Schupp J. Results of a phase 3 clinical trial for female sexual arousal disorder (FSAD) with Femprox, A topical alprostadil 0.4% cream with a novel transdermal delivery technology. J Sex Med. 2012;9(suppl 1):22.
  12. Bechara A, Bertolino MV, Casabé A, Fredotovich N. A double blind randomized placebo control study comparing the objective and subjective changes in female sexual response using sublingual apomorphine. J Sex Med. 2004;1(2):209-214.
  13. Levine SB, Brown C, Palace E, Fischkoff S, Schnorrbusch C. Bremelanotide study in pre- and post-menopausal women with female sexual arousal disorder.  Poster presented at: ACOG 56th Annual Clinical Meeting; May 3-7, 2008; New Orleans, LA.
  14. Labrie F, Archer D, Bouchard C, et al. Effect of intravaginal dehydroepiandrosterone (Prasterone) on libido and sexual dysfunction in postmenopausal women. Menopause. 2009;16(5);923-931.
  15. Bachmann GA, Komi JO. Ospemifene Study Group. Ospemifene effectively treats vulvovaginal atrophy in postmenopausal women: results from a pivotal phase 3 study. Menopause. 2010;17(3):480-486.
  16. Millheiser LS, Pauls RN, Herbst SJ, Chen BH. Radiofrequency treatment of vaginal laxity after vaginal delivery: nonsurgical vaginal tightening. J Sex Med. 2010; Sep;7(9):3088-3095.

Female orgasmic disorder

Research has showed that about 5% of women may experience a chronic inability to reach orgasm

Female orgasmic disorder results when a female cannot reach orgasm – even though her sexual desire is normal and she may be able to go through a normal sexual excitement phase.

Types of female orgasmic disorder

There are two types of female orgasmic disorder. It is, however, important to note that they are only considered to be disorders if you experience a significant amount of distress.

Partial female orgasmic disorder

This may occur when you are able to orgasm from some sexual experiences such as oral sex or clitoral stimulation, but not during intercourse. Possible factors for this could include taking medications that may have some side effects, being anxious about intimacy and early ejaculation in your partner. Be sure to discuss side effects of drugs with your doctor when medications are prescribed.

Total female orgasmic disorder Total female orgasmic disorder may result when a female is unable to reach orgasm during any sexual experience.

Chat to your doctor

Chat to your doctor about your symptoms and discuss your concerns with him or her. Your doctor may discuss the risks and benefits of changing your medication (if you are taking any), as well as the side effects.

Self help

You may find the following self-help measures useful.

Kegel exercises

It is believed that these exercises may help to increase orgasm during intercourse.

Masturbation

Masturbation may help you discover more about your body and what gives you pleasure.

Different sexual positions

Experiment with different positions during sex as this may help you to be more in control or more free in your movement.

Remember you can always ask your doctor to refer you and your partner to a sex therapist if you feel that you will be more comfortable talking to him or her.

Source: Women’s Health for Life, by Dr. Sarah Jarvis and a team of world class women doctors

Daily Tadalafil Effective for Men Regardless of Testosterone level.

Daily Tadalafil Effective for Men Regardless of Testosterone Level

By Reuters Staff

May 29, 2014

NEW YORK (Reuters Health) – Daily tadalafil improves sexual function in men who respond partially to on-demand phosphodiesterase type 5 inhibitor (PDE5I) therapy, regardless of their baseline testosterone levels, a new study from Eli Lilly shows.

However, men with normal testosterone levels had a significantly greater improvement in International Index of Erectile Function (IIEF) Erectile Function domain scores with daily treatment compared to men with low testosterone, Dr. Evan Goldfischer of Premier Medical Group of the Hudson Valley in Poughkeepsie, New York, and colleagues found.

Several studies have shown a lower response to PDE5I treatment in men with low testosterone, Dr. Goldfischer and his team note in their report in Urology, online April 10. And uncontrolled studies have found adding testosterone is more effective than PDE5I monotherapy in men with low levels of the hormone.

“However, additional data are needed to determine if TRT (testosterone replacement therapy) should be considered for all men with low testosterone levels who experience an inadequate response to PDE5I therapy,” they add.

About half of men have a return to normal erectile function with on-demand PDE5I therapy, the researchers note. They previously conducted a randomized trial in partial responders to on-demand PDE51, which found 39% recovered normal erectile function with 5 milligrams a day of tadalafil.

In the current study, the investigators conducted a post-hoc analysis of the treatment response in that study based on testosterone levels. A total of 503 men were included in their analysis, including 167 men on placebo and 336 on tadalafil.

IIEF Erectile Function scores improved significantly with treatment vs. placebo regardless of testosterone levels.

However, men with testosterone levels of 300 ng/ml or higher had a greater improvement in IIEF-EF domain score compared with men with lower testosterone (p=0.022). There were no differences between the low- and normal-testosterone groups in other IIEF domains or in confidence in their ability to maintain an erection.

“Additional studies should assess the impact of testosterone supplementation on response to tadalafil once daily in men with low testosterone levels who did not have adequate responses to optimized PDE5I therapy,” Dr. Goldfischer and colleagues conclude.

Eli Lilly designed and conducted the study and paid for assistance with writing and submitting the report. Dr. Goldfischer and his co-authors reported multiple financial ties to the drugmaker.

SOURCE: http://bit.ly/1gvmT9K

Urology 2014

Ten different “faces” of Sexuality …

By Sylvia Tamale

Introduction

As most of us know, Sexuality is one of the most complex and politicized issues on the African continent.  If Sexuality were to look in the mirror, she would see numerous faces.  In these brief notes, I map out ten different “faces” of sexuality as they have been manifested in Uganda, analyzing their intersections with human rights plus the de jure and de facto rules and norms that mould and paint their features.

  1. The Erotic Face

Wearing the shroud of silence and mystery, the face of Sexuality that most of us wish to focus on is the one that exhibits erotic desire and pleasure.  Most Ugandans would wish—if not openly, at least secretly in their deepest fantasies—that they were free to express their sexuality freely and derive maximum pleasure from it—provided those expressions and activities involve willing adult participants.  Alas, there is the legal face that squints at the erotic one, with significant implications for our right to desire, our right to pleasure, and of course, our right to love…

  1. The Legal Face

The powerful legal face of sexuality wears bold rules, restrictions, regulations and prohibitions on how, where and with whom we “do” sexuality.  The face would be attractive if the rules were confined to punishing those who inflict harm through sexual exploitation, assault and violence.  But they go beyond that—sometimes being patronising, at others controlling and at other points, even sexist.  In the process, these restrictions step on our rights to privacy, non-discrimination, autonomy, integrity and dignity.  Examples of such laws abound, including those on prostitution, criminal adultery, homosexuality, marital rape, pornography and abortion.  But, like a double edged sword, this face cuts on both sides and often its other face has been deployed by marginalized groups in Uganda to challenge its restrictive twin face.  Through strategic litigation, some of the stubbles and freckles on the restrictive legal face have been rendered unconstitutional.  For example, in a case filed by an NGO called Law and Advocacy for Women in Uganda (LAW-U), criminal adultery that targeted wives and not husbands was declared unconstitutional in 2010.

  1. The Reproductive Face

This brings me to the next face of sexuality, whose forehead wears the script of the roles of women and men in the continuity of life.  That is the face of reproduction which speaks both the language of health and the language of human rights.  The forehead is creased by restrictive abortion laws, and the mouth is contorted with practices which proscribe contraception.  The well-being of this face is further affected by underdevelopment and the lack of political commitment to its agenda.  In Uganda, the eyes of the reproductive face are generally closed most of the time or at best squinted.  While therapeutic abortion is legally permitted, the access to such a procedure remains a huge challenge, rendered more confusing by government policies that are more accommodating than the law.

  1. The Violent Face

The violent face of sexuality is angry and has a permanent snarl.  It is smeared with thick layers of damage and often recoils in utter stigmatised shame.  The violent face is typically feminine, with a lingering look of sadness that stems from loathing control.  It cannot escape the hurt in public or private spaces; in offices, schools, communities and homes; from acquaintances, from family members, from trusted individuals and from strangers alike.  It is a face we see both in times of peace and in situations of conflict.  This face is the ultimate persona of gender domination and it is a face acutely aware of infringements of the rights to sexual autonomy and bodily integrity.  Currently, the Ugandan laws that would potentially save its life are ineffective as they are coded through a patriarchal, phallocentric culture.  Sadly, a bill that was devised to improve the situation has been collecting dust in the corridors of power since the year 2000.

  1. The Cultural Face

The cultural persona of sexuality is also double faced, exhibiting both positive and negative aspects.  The positive side shows African traditional values that enhance sexual pleasure while the negative side exhibits practices geared to the control of women’s sexuality.  In that sense this face both enhances and violates human rights.  In Uganda the traditional institution of Ssenga among the Baganda, for instance, plays a significant role in promoting the right to sexual pleasure on the one hand, but on the other, despite the outlawing of the cultural practice of female genital mutilation, it is still practiced by some communities in the country.

  1. The Heteronormative Face

The heteronormative face of sexuality has big beautiful eyes that are deceptive because they hide a serious disability, that is, the fact that their central vision is exclusively binary.  This visual impairment means that she tends to categorize people in absolute terms as either heterosexual male or heterosexual female.  When the optometrist prescribed human rights lenses that would enable this face to clearly see diversity, the legal, cultural and religious faces conspired to conceal the prescription from her.  In Uganda, not only do these conspiratorial faces possess powerful platforms to promote the heteronormative ideal, stoking hatred and violence at every turn with homophobic and transphobic rhetoric; they also attempt to obliterate the rich diversity of Ugandan faces, particularly the homosexual and bisexual ones.  The draconian Anti-Homosexuality Act, which was invalidated by the Constitutional Court in 2014, was the latest attempt to reinforce legal support for this face.

  1. The HIV Face

From a distance, you can only see the epidemiological side of the HIV face.  However, on closer scrutiny you will notice the unmistakable gender and power wrinkle marks as well as the oppressive furrows of social class.  Access to the cheap affordable generic cream that the dermatologist recommended is becoming more and more difficult in the face of international intellectual property protections.  As if that’s not bad enough, last year, the Ugandan government passed the HIV and AIDS Prevention and Control Act (HAPCA), criminalising the sexual life and activities of this face.  The irony is that such a law that purports to be based on human rights principles in fact tramples human rights.  The socio-economic and cultural sides of this face clearly expose the complex dynamics between gender, human rights and HIV.  Not only does HAPCA contravene the Constitution and national policies on HIV/AIDS but it also violates several rights enshrined in international human rights treaties that the country has committed to.

  1. The Political Face

The contours of the political face of sexuality serve a specific socio-political purpose of outlining the criteria of sexual citizenship.  It is tinged with hypocritical rhetoric that wears the mask of “preserving traditional family values” “protecting our children” and “maintaining morality.”  It has the tendency to press panic buttons, to ahistoricize and otherize faces of other sexualities and to appeal to populist sentiments.  For example, the Anti-Pornography Act that was passed by the Ugandan government in 2014 emboldened vigilante groups and abusive government officials alike to maltreat women, including publicly undressing them.  In short, this face instrumentalizes sexuality for political ends and in the process, disenfranchises and inflicts untold damage to diverse minority groups in Uganda.  The political face, which is a close ally of the religious and cultural faces, usually rears its ugly head covered in partisan feuds, sectarian hatred, ageism, neoliberalism, patriarchy and militarism.

  1. The Religious Face

Closely resembling the political face is the religious one.  The message on this face tells us that sex that is non-genital, non-procreative, outside marriage, and between same-sex individuals, is sinful.  Its personality is heavily influenced by the Natural Law moral principle that makes it particularly attractive to the legal face.  But sexual morality is deployed based on double standards for men and women.  Examples of such laws include laws that govern criminal adultery and prostitution.  In Uganda, for instance, the offence of prostitution criminalizes sellers of sex (majority being women) without touching the buyers (most of whom are men).  Legal positivism and feminist jurisprudence have heavily criticised this face for its moral-based sexual laws in favour of rights-based laws.  In Uganda, this face is personified by Reverend Father Simon Lokodo, the Minister of Ethics and Integrity, who polices women’s sexualities with an iron hand.  This face is also in constant political struggle with the next one…

  1. The Subversive Face

The subversive face of sexuality wears a permanent wink!  It carries an undercurrent of rebellious, unrestrained sexuality.  Often characterised by great creative skills, subversive sexuality consciously breaks sexual taboos and crosses bright red lines.  It ignores norms and throws prejudice to the winds; it is not afraid to use four-letter words and to relish in the embarrassment that it causes, while knowing that what it is doing is exposing the innate hypocrisies of human beings: “F-them!” it tells the world, and knows that secretly, the world actually agrees.

This face organizes and plots in radical ways, constructs counter-“truths” about its realities, in an attempt to topple the lies peddled about its persona.  But the subversive face does all this at a huge price of swift and fierce backlash from the legal, political, religious, heteronormative and violent faces.  These faces gang up against her to squash all her sexual rights.  In fact they are not satisfied with simply plotting, but try to completely efface her image.  And the tools used range from acid to the sharp knife of the traditional genital surgeon.  Established in October 2009, the Civil Society Coalition on Human Rights and Constitutional Law is the most visible side of this face in Uganda, although the whole alphabet movement of sexual minorities (LGBTI), and of sex workers is really at the forefront in leading the way in this regard.

Conclusion

The diagnosis is simple: Sexuality suffers from a chronic case of schizophrenia!  The prognosis is not good.  Most of the time her condition inflicts huge human rights costs.  It causes profound disruption not only in her life but also in the lives of Ugandans who come face to face with her.  The prescription for stabilizing sexuality is to place her in a state of induced comatosia before undergoing major surgery that will provide her with a completely fresh and clean face.  The new face will be constructed from unblemished diverse threads of human rights and social solidarity that weave a complex web of justice, tolerance, equality, integrity, dignity, liberty and autonomy, safety, free choice, access to health services and most importantly to pleasure.  It will reflect the true complex social nature of sexuality.  But the challenge is a daunting one.  The fresh, reconstructed face must not be viewed as the end of the struggle; rather, as only one battle that will have to be joined by many kin, neighbors and acquaintances of sexuality.

About the Author

Sylvia Tamale is a Ugandan academic and the first woman dean in the Law Faculty at Makerere University.  She is the recipient of the Ford Foundation Fellowship, Fulbright-MacArthur Scholarship, University of Minnesota Award for International Distinguished Leadership and the Akina Mmama Wa Afrika Award for human rights activism in Uganda.

What is Sexual Health?

The World Health Organisation defines sexual health as “a state of physical, emotional, mental and social well-being related to sexuality; it is not merely the absence of disease, dysfunctions or infirmity. Sexual Health requires a positive and respectful approach to sexuality and relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.

For better sexual health:

  1.  Look after your general health as many medical conditions can have a negative effect on sexual functioning
  2. Get enough sleep as fatigue affects your sex drive.
  3.  If you smoke, stop, as there is a direct link between smoking and erection problems.
  4. Regular excessive alcohol intake has been shown to have a negative impact on sexual function. Restrict your alcohol intake to 2 drinks a day.
  5. Certain medications can cause sexual problems, ask your doctor if the medication he/she is prescribing for you is likely to have any sexual side effects.
  6. Educate yourself about sexuality as ignorance is one of the biggest causes of sexual problems in a relationship (there are excellent books, DVD’s and videos available on all aspects of sexuality)
  7. Be sensitive but honest with your partner about what works for you.
  8. Explore your body through self-touching so you know what works for you.
  9. Practice safer sex.
  10. Get help if you experience a sexual problem. Please send us an email(helpline.sasha@gmial.com)