Sexual Health and Wellness

 IMAGE 1: THE VAGINA

PARTS OF FEMALE REPRODUCTIVE TRACT

The mons pubis
The mons pubis is a rounded mound of fatty tissue that covers the pubic bone. During puberty, it becomes covered with hair. The mons pubis contains oil-secreting (sebaceous) glands that release substances that are involved in sexual attraction (pheromones).

Prepuce
Also called the clitoral hood is a fold of skin that surrounds and protects the clitoris. It develops as part of the labia minora and is comparable with the foreskin (equally called prepuce) in male genitals.

Clitoris
The clitoris, located between the labia minora at their upper end, is a small protrusion that corresponds to the penis in the male. The clitoris is very sensitive to sexual stimulation and can become erect. Stimulating the clitoris can result in an orgasm.

Labia Minora
The labia minora (literally, small lips) can be very small or up to 2 inches wide. The labia minora lie just inside the labia majora and surround the openings to the vagina and urethra. A rich supply of blood vessels gives the labia minora a pink color. During sexual stimulation, these blood vessels become engorged with blood, causing the labia minora to swell and become more sensitive to stimulation.

Labia Majora
The labia majora (literally, large lips) are relatively large, fleshy folds of tissue that enclose and protect the other external genital organs. The labia majora contain sweat and sebaceous glands, which produce lubricating secretions. After puberty, hair appears on the labia majora.

Vagina
The vaginal opening is the entryway for penetration during sexual intercourse and the exit for menstrual blood and vaginal discharge as well as the birth canal for a baby. When stimulated, Bartholin's glands (located besides the vaginal opening) secrete a thick fluid that supplies lubrication for intercourse.

Urethral Orifice
It is the opening to the urethra, which carries urine from the bladder to the outside and is located above and in front of the vaginal opening.

Length
8 – 10 cm

Position
The vagina lies between the bladder and the rectum and extends from the cervix to the body exterior.

Pubic Hair
The function of pubic hair is:

• visual indicator of sexual maturity;
• collection of secreted pheromones;
• reduction of external friction during sexual intercourse;
• and warmth (may be a side effect)

IMAGE 1: THE ANUS

PARTS OF RECTAL TRACT

External Sphincter
Opening and closing of the anus, generally closed.

Levator ani muscle
Conducting movement of feces towards anal opening.

Rectal mucosa
Protect the intestinal walls from harmful acids and gasses.

Columns of Morgagni (anal columns)
Aids in emptying the anal canal, holds the anal sinuses that exude mucus when compressed by feces to enhance movement.

IMAGE 1: THE BREASTS

Areola
The pigmented surface/area surrounding the nipple.  The areola helps to support the nipple and also contains Montgomery's glands which help to keep the nipple moisturized during breastfeeding.

Nipple
The nipple is the most front part of the breast, cone-shaped and surrounded by the areola.  The nipple is the most erogenous region in the breast of most women due to a very large number of nerve endings in the nipple.

Lactiferous duct
This is the canal carrying milk secreted by the mammary gland to the nipple.

Adipose tissue
Adipose tissue is the fatty tissue surrounding the mammary gland and covering the pectoral muscles that support the breast.

Mammary gland
An organ consisting of some 20 glands (lobes) ensuring secretion of milk.

An individual’s sexual response is psychophysiological of nature. Arousal is triggered by both psychological (e.g., fantasy and emotion) and physical (e.g., her gorgeous smile and sexy bum) stimuli; levels of tension are experiences both physiologically (e.g., heart rate increases) and emotionally (e.g., pleasant feelings); and with orgasm, there is normally a subjective perception of a peak of physical reaction (e.g., tense muscles).  Your psychosexual development, attitude toward sex and sexuality, and attitude towards your partner are directly linked to your sexual response.
 

What is exciting is unique to each woman.  Some women are aroused when their breasts are fondled; other women prefer other kinds of touch.  Learning what kind of physical contact you enjoy is an important part of learning about your sexual self.  The female sexual response cycle consists of four phases:

• Phase 1: Excitement;
• Phase 2: Plateau;
• Phase 3: Orgasm;  and
• Phase 4: Resolution.

You may not experience all four stages every time you are sexually active.  Most women find there are many times when sexual play involves only the first one or two stages.  Some women never or rarely have orgasms.  Both physical and social/emotional issues can be barriers to a woman’s sexual response.  What follows is a descriptive table of the phases (sourced from Womens Health Matters  www.womenshealthmatters.ca).
 

Scalp
The scalp can be very sensitive to stimulation.  Gently massaging or scratching a partner’s scalp and running your fingers through her hair releases endorphins which are feel good chemicals.  Thus, pay particular attention to stroking and playing with her hair when you're kissing.

Ears
Bundles of nerve endings are in and around the ears, making them ultra sensitive to touch.  Use the pads of your index finger and thumb to massage the outer ears with slow, firm movements.  Gently squeeze the earlobes.  Explore the area behind the ear with your lips and tongue, and then blow lightly.  Don't be shy about making noise while you're lingering, the sound of your breath and moans could be a huge turn-on.

Lips
It is very unlikely that a woman will not enjoy kissing her partner.  For many women this is their number one erogenous zone.  Variety and passion is the key to a good kissing experience.  Let your partner know that you want her, love and desire her; there is simply no better way to do this than with a passionate kiss.  Try varying the intensity of your kiss, kiss softly, more passionately, and then slow down, make sure you keep your partner surprised and tease her with your mouth and tongue.

Neck
The neck is always a great place to turn on your partner.  Cover different areas of her neck with tender kisses, using the areas behind the ears for extra stimulation (pay particular attention to this hot spot).  A variety and passion are the key, vary the intensity of your kissing, nibbling and licking and you will hear from her reaction how much she enjoys it.

Breasts
The breasts are an obvious zone, but try to avoid going immediately to the nipples.  The nipple is the most erogenous region in the breast due to a very large number of nerve endings in the nipple.  The whole breast area is sensitive from the bottom of the neck so start nibbling or touching her collar bone and then move on to start making small circles and gradually spread them out until you cup your hand gently under her breasts.  The nipples should be your eventual destination, not the first.  Remember to kiss and lick the entire breast and not just the nipples.  Another thing to keep in mind is that most women have two breasts, so give attention to both breasts, not just one.  This is a fun place to start teasing your partner.

Hands and arms
Not an erogenous zone that most think of, but the fact is most women love having their wrists kissed and nibbled by their partner.  Many women also like having their hands kissed (a traditional sign of affection) and their fingers sucked.  Other areas to target include the joint areas of the arm.

Back
The back is one of the most under rated female erogenous zones.  The back in particular, is rich in nerve endings and incredibly sensitive.  Start by massaging the back for a great way to set the mood for a night of passion.  Not only does massaging the back release tension and help to de-stress, it also increases the blood flow to the pelvic region and increases its sensitivity.  While massaging your partner’s back, don’t forget to kiss and lick it, you will find that most women love this and particularly love having their spine kissed and licked.  Running your tongue up and down this area is very erotic.

Navel
This is another one of those love/hate zones.  First find out if she fancies this before you try it.  If this fancies her, you can gently kiss, lick or suck her navel.  Remember you can use anything from your tongue to a strawberry …

Buttocks
Most women are self-conscious about their bottoms and deep down want them appreciated.  Squeezing and fondling this area by kissing and licking it will be appreciated by most women, who would simply love knowing their butt is liked and appreciated.

Genitals
The genital area is the top erogenous zone.  The clitoris, labia minora, labia majora and vagina become very sensitive during sexual stimulation due to increased blood circulation and nerve endings.  By stimulating your partner e.g., cunnilingus, you will drive her wild.  Remember the clitoris is very sensitive to touch, so be gentle and increase pressure as the need arise.

Inner Thighs
To touch the inner thighs are always a great place to turn your partner on, as they don’t get touched much during everyday life.  Whether it is touching, kissing, licking, or nibbling, virtually everything you do around this area will feel good.  It sounds obvious, but don't just use her thighs as an expressway to her genitals.  Spend some serious time caressing the inside of her legs and tease her by stopping just short of the mark.  The thighs are one of your best choices for massage oils or lotions.

Back of the Knees
The backs of the knees have a huge amount of nerve endings and are extremely sensitive.  Lightly kissing and licking in this area can be highly erotic.  Be careful not to be too rough since these areas are very sensitive.  Some women know enough to put perfume back there so make sure you take the time to notice.  It’s also a very ticklish spot for some, so you would do better to kiss her gently and work your way to the inside of her thighs.

Feet
They're a lot more sensitive than most people think.  In fact, a large area in the brain receives sensations and signals from them, so paying attention to them can be highly stimulating for most women.  Lightly kissing or passionately sucking them as well as massaging them with your hands are guaranteed to arouse your partner.  Because these zones can all be ticklish, the sensation of ticklishness can be exciting and pleasant for many women. 

Problems with your reproductive system can affect your fertility, for those women that do want to get pregnant.  Some women experience problems with their reproductive system.  Reproductive health problems can also be harmful to overall health and decrease your ability to have and enjoy a healthy sexual relationship.

Your reproductive health is influenced by many factors.  These include your age, lifestyle, habits, genetics, use of medicines and exposure to chemicals in the environment.  Many problems of the reproductive system can be corrected.

Participating in the following activities can impact your female reproductive health:

• Smoking;
• Alcohol and drug;
• Toxins; and
• Sexual history.

Smoking
Smoking can have a serious impact on your female reproductive health by interfering with your body’s ability to create estrogen and thereby regulate ovulation.  It can also cause your egg cells to be more prone to genetic abnormalities and is associated with an increased risk of miscarriage that has been linked to early onset of menopause.  In addition to its impact on female reproductive health and fertility, smoking has been tied to increases in the likelihood of cervical cancer and pelvic infections.

What to do about your smoking?
If you smoke, consider quitting.  The impact of smoking is greater the longer you smoke and while not all of the female reproductive health damage is reversible, stopping now can prevent future damage.  In addition to improving your female reproductive health, you can also improve other important aspects of your health, including heart and lung health.

If you don’t smoke, don’t start.

Alcohol and Drugs
Moderation is the key with consuming alcohol.  In fact, many studies have shown that there is some benefit in the consumption of small amounts of alcohol for women.  However, excessive consumption of alcohol and alcohol abuse can lead to female reproductive health problems including irregular ovulation, amenorrhea (absence of menstruation), and the abnormal development of the endometrial lining (the layer that lines your uterus on the inside).

Illegal drugs, such as marijuana, heroin and cocaine, are universally damaging to female fertility and female reproductive health.  Perhaps more difficult to manage are the risks that some legal and over-the-counter drugs may have an effect on fertility and female reproductive health.  For example, some prescription medications can interfere with ovulation cycle.

What to do about alcohol and drug use?
Don’t use illegal drugs and moderate your alcohol consumption.  Discuss any prescription drugs that you are taking with your doctor to determine if any of the medication may pose a female reproductive health problem in the future.

Toxins
Lately there is more information available on the effects of “body burden”, or the build-up of certain environmental toxins, such as pesticides, fertilizers and solvents, in our bodies, as well as its impact on female reproductive health.  While the extent to which toxin exposure contributes to infertility is still somewhat unclear, it should be considered as a preventable cause of female reproductive health problems.

Exposure to toxins has been linked to several female reproductive health problems such as, irregular menstrual cycle, hormone changes, endometriosis and higher miscarriage rates in pregnant women.

What to do about toxins?
Try to limit your exposure to toxic materials as much as possible, particularly while trying to conceive.  Take the proper precautions when using products containing or comprised of harmful toxins including the use of safety gloves, face masks and protective clothing to minimize direct exposure.

Sexual History
The best way to prevent female reproductive health problems regarding to sexual history is to practice safe sex [ see: Safety Zone > Safer Sex].  Many sexually transmitted infections (STI’s) go untreated for long periods of time because their symptoms are sometimes not visible.  This can pose a considerable threat to female reproductive health and future fertility.  STI’s, when left untreated, can lead to pelvic inflammatory disease, causing scarring or blocking of the fallopian tubes, and changes in the cervix.  In severe cases they can even affect your brain and result in death e.g. Syphilis.

What to do about your sexual history?
If you are sexually active, make use of your barrier methods [see: Safety Zone > Barrier Methods] e.g. condoms, femidom’s, silk-e’s (dental dams) and gloves, as these are the most effective way to protect yourself from STIs.  Consult with your doctor or health care practitioner on a regular basis and go for regular STI screening and HIV testing.  Remember also to live a balanced healthy lifestyle [see: Ensuring Your Sexual Health] and do self examinations e.g. breast examinations [see: Safety Zone > Routine Check-up's] and annual examinations.

Yes, lesbian individuals and couples have the right and can choose to become pregnant! Please check www.baby-ventures.za.net for more in depth information.

Maybe you’re wondering whether you can have sex or not?  Rest assured, go ahead, your baby is safe – and probably will feel the excitement too.  Or, maybe that’s not such a romantic or erotic idea – okay, focus on you and your partner.  A lot of women experience a higher sex drive during pregnancy – so make sure to make full use of this opportunity and involve your partner, this might be the best months of your sexual life, and make up for the dreaded weeks of sleep deprivation once baby is there….

Most women do feel more connected to their bodies and the bigger breasts certainly help.  But be mindful of the last trimester where exhaustion and discomfort creeps in.  Make use of the times during your pregnancy when the heat is on.  Probably the best guideline is to be mindful, be aware, don’t compare yourself – be honest and truthful and go for it!

Throughout the course of your pregnancy, you will experience a wide range of emotions and physical changes.  A variety of factors may affect your sex drive or your capability to engage in sexual activity, such as hormones, body image, relationship issues, energy levels, nervousness about becoming parents and an uncomfortable body, to name but a few.

Communication is the vital key – discuss what feels right for both of you.  What works and feels sensual and pleasurable might change from week to week.  Talk to your partner about your comfort level regarding the amount of sex you would like to have, the different positions you would like to try, and where you would like to be touched. Ask her about her preferences as well.  If you are unable to have sex due to discomfort or medical reasons, look for other ways to keep your love life alive such as giving a massage, kissing, holding hands, or bathing together.  Women are the ultimate adventurous romantics, and as long as you are experiencing a healthy or "normal" pregnancy, the lights are green!  During the latter part of your pregnancy try and avoid lying on your back, so now is the perfect time to experiment with different positions.  Take care of yourself, enjoy the intimate quantity and quality time with your partner/spouse/ wife – in future it will not only be just the two, so enjoy each other’s bodies.

Sexuality is a complex process, co-ordinated by the neurologic, vascular and endocrine systems. Individually, sexuality incorporates familial, societal, and religious beliefs, and is altered with aging, health status and personal experience. In addition, sexual activity incorporates interpersonal relationships, each partner bringing unique attitudes, needs and responses into the coupling. A breakdown in any of these areas may lead to sexual dysfunction.

Features
Inhibited Sexual Desire Disorder (ISDD) refers to persistent or recurrent low levels of sexual interest, desire or fantasies. ISDD is also referred to as sexual apathy or hypoactive sexual desire. An individual with ISDD is often considered asexual because of their apparent lack of interest. As such, there is no desire to initiate or participate in sex.

ISDD can be primary, where the person has never felt much sexual desire or interest.

• ISDD can be secondary, where the person used to feel sexual desire, but no longer does.
• ISDD can be partner related, in that the person is interested in other people, but not in their primary partner.
• ISDD can be general, in that the person isn't sexually interested in anyone. In the extreme form, the person not only lacks sexual desire, but may find sex repulsive.
• Sometimes, the sexual desire is not inhibited per se. The two partners have different sexual interest levels, even though both of their interest levels are within the normal range.
• In some cases a partner can claim that their partner has ISDD, when in fact they have overactive sexual desire and are very demanding sexually. 

Epidemiology
Approximately 30% of women report having little or no sex drives. Studies have found that complaints of low sexual desire increase with age, relationship duration, number of small children, relationship discord and symptoms of anxiety and depression. If the problem occurs after a period of normal sexual activity, the cause can be related to a partner (because of the situation or if there is something lacking in the relationship) or might be due to some trauma or to pain caused during intercourse.

Causes
Many things can cause a sexual aversion; it can be a psychological problem, or a combination of a physical and psychological problem.

Some physical reasons that may result in a loss of desire are medical or surgical interventions, hormone disorders and certain medical conditions such as diabetes, heart disease, multiple sclerosis, Parkinson’s disease and depression. Other physical factors include changes in contraceptive methods, tiredness, insomnia, chronic pain, obesity, and excessive alcohol or drug use. Certain medications can also lead to a loss of desire (such as antidepressants or antihypertensive medications).

Some psychological reasons may include poor body image, stress, anxiety, poor relationship satisfaction, and past traumatic experiences (including incest, sexual abuse or rape). It often occurs when one partner does not feel intimate or close to the other. Communication problems, lack of affection, power struggles and conflicts, and not having enough time alone together are common factors. It may also be attributed to something related to the partner (e.g., bad body odor or poor hygiene) or to the context of over-familiarization or boredom with sexual routine. A repressive family attitude concerning sex and rigid religious beliefs have also been found to play a role.

Treatment
Every woman will have a unique set of circumstances causing her loss of desire, and likewise the treatment plan should be individually tailored to meet her special needs. A detailed medical, sexual and social history should be obtained and certain blood tests carried out. This may uncover any underlying medical or psychological condition. Based on the information uncovered the treatment plan will target at the factors that may be lowering sexual interest. When an underlying medical condition is found, this will be treated first.

In the context of relationship difficulties or sexual boredom, couples may need relationship or marital therapy to enhance sexual activity. Some couples will need to be taught how to resolve conflicts and work through differences in nonsexual areas. Communication training will help couples learn how to talk to one another, show empathy, resolve differences with sensitivity and respect for each other's feelings, learn how to express anger in a positive way, reserve time for activities together, and show affection, in order to encourage sexual desire.

Many couples will also need to focus on their sexual relationship. Through education and couple's assignments, they learn to increase the time they devote to sexual activity. Some couples will also need to focus on how they can sexually approach their partner in more interesting and desirable ways, and how to more gently and tactfully decline a sexual invitation.

Features

• Sexual aversion disorder (SAD) refers to persistent or recurrent active avoidance of genital sexual contact with a sexual partner or by masturbation.
• SAD may be accompanied by interpersonal difficulty (e.g., relational dissatisfaction) and reports of disgust, fear or anxiety (including possible panic attacks: extreme anxiety, feelings of terror, faintness, nausea, palpitations, dizziness, and breathing difficulties).
• SAD can be primary, in that the person has always experienced the aversion.
• SAD can be secondary, in that the person used to have genital contact, but now avoids it.
• SAD can be focused, in that the aversion relates to a specific aspect of sexual experience (e.g., genital secretions, vaginal penetration).
• SAD may be general, in that the person experiences generalised revulsion to all sexual stimuli, including kissing and touching.
• Avoidance may include going to bed early, neglecting personal appearance, using substances, and becoming overly involved in work, social or family activities.

Epidemiology
There are relatively few statistics on the number of people with sexual aversion disorder because it is often confused with other sexual dysfunctions, or with the normal fluctuations in desire associated with life stress.

Causes
Many things can cause a sexual aversion; it can be a psychological problem, or a combination of a physical and psychological problem.

The most common causes are interpersonal problems and traumatic experiences. Interpersonal problems could include underlying tension or dissatisfaction with the relationship. Discontent with the relationship may be triggered by infidelity, major disagreements, domestic violence, or a lack of personal hygiene on the partner’s side. Sexual aversion might also be caused by strict religious or cultural teachings that associate sexual activity with excessive feelings of shame and guilt. Traumatic experiences may include incest, sexual abuse and rape. In this context, sex may be strongly associated with the painful experience or memory of the trauma.

Treatment
Every woman will have a unique set of circumstances causing her sexual aversion, and likewise the treatment plan should be individually tailored to meet her special needs. A detailed medical, sexual and social history should be obtained and certain blood tests carried out. This may uncover any underlying medical or psychological condition. Based on the information uncovered the treatment plan will target at the factors that may be lowering sexual interest. When an underlying medical condition is found, this will be treated first.

Treatment of a psychological cause usually involves a course of psychotherapy. Couples counselling may be deemed appropriate if the disorder concerns a partner. Anti-anxiety medications may be prescribed to manage associated panic attacks.

Features

• Female sexual arousal disorder (FSAD) refers to a persistent or recurrent inability to reach or maintain an adequate lubrication-swelling response of sexual excitement during sexual activity.
• The arousal response generally consists of vasocongestion in the pelvis, vaginal lubrication and expansion, and swelling of the external genitallia.
• FSAD may be associated with Sexual Desire Disorder and Female Orgasmic Disorder.
• FSAD may be accompanied by reports of little or no subjective sense of sexual arousal, interpersonal difficulty (e.g., relational dissatisfaction), and result in painful intercourse and sexual avoidance.
• FSAD can be primary, in that the person has always experienced little or no arousal.
• FSAD can be secondary, in that the person used to experience arousal, but no longer does.
• FSAD can be focused, in that a specific aspect of the sexual experience or the partner does not lead to arousal.
• FSAD may be general, in that the person does not experience any arousal no matter what the sexual stimuli.

Epidemiology
It is roughly estimated that among women experiencing a sexual dysfunction, that approximately 17-35% report a difficulty in reaching or maintaining an adequate lubrication-swelling response.

Causes
Many things can cause an arousal disorder; it can be a psychological problem, or a combination of a physical and psychological problem.

Female sexual arousal disorder has been associated with possible damage to the blood vessels of the pelvic region resulting in reduced blood flow. It may also be caused by damage to the nerves in the pelvic area resulting in diminished arousal capacity. General medical conditions, such as coronary artery disease, high blood pressure, diabetes mellitus, thyroid disorders, and adrenal gland disorders have also been seen to play a role. It may also be exacerbated by removal of the ovaries or lower levels of sex hormones due to aging. The side-effects of certain medications (such as antidepressants and antihypertensive medications) may also contribute.

The most common psychological causes include chronic mild depression, persistent emotional stress, past sexual trauma, emotional abuse, bereavement, self-image problems, and ongoing relationship problems.

Treatment
Every woman will have a unique set of circumstances causing her loss of arousal, and likewise the treatment plan should be individually tailored to meet her special needs. A detailed medical, sexual and social history should be obtained and certain blood tests carried out. This may uncover any underlying medical or psychological condition. Based on the information uncovered the treatment plan will target at the factors that may be lowering sexual interest. When an underlying medical condition is found, this will be treated first.
 

Features

• Female orgasmic disorder (FOD) refers to a persistent or recurrent delay in, or complete absence of, orgasm following a normal or adequate sexual excitement phase.
• Women generally exhibit a wide variability in the type or intensity of stimulation that triggers orgasm. A diagnosis of FOD is based on expert opinion that the woman’s orgasmic capacity is less than would be reasonable for her age, sexual experience, and the adequacy of sexual stimulation she receives.
• FOD may be accompanied by interpersonal difficulty (e.g., relational dissatisfaction) and reports of affecting body image and self-esteem.
• FOD can be primary, in that the person has never experienced an orgasm. This appears relatively more common among younger women.
• FOD can be secondary, in that the person used to experience orgasm, but this is now delayed or absent. This is usually associated with negative emotions, unresolved anger, poor communication, relationship conflict, a traumatic sexual experience, or depression.
• FOD can be focused, in that the delay or absence relates to a specific context, event or partner (e.g., relationship conflict).
• FOD may be general, in that the person experiences a delay or absence generally irrespective of all sexual stimuli.

Epidemiology
Female orgasmic disorder (FOD) is generally more prevalent among younger women. Orgasmic capacity tends to increase with age and the ability to become orgasmic once learned is rarely forgotten. Most FOD are lifelong rather than acquired.

Causes
Many things can cause an orgasmic disorder; it can be a psychological problem, or a combination of a physical and psychological problem.

Certain medical conditions that can interfere with the blood or nerve supply to the clitoris may be implicated in loss of orgasm.

Poor sexual communication, sexual ignorance and fear, inadequate or unsuitable sexual stimulation, relationship difficulties, previous traumatic sexual experiences, depression, anxiety, and a general decline in physical health can all contribute to orgasm difficulties. Lack of ability to ‘let go’ may also play a contributing role.

Treatment
Every woman will have a unique set of circumstances causing her failure to orgasm, and likewise the treatment plan should be individually tailored to meet her special needs. A detailed medical, sexual and social history should be obtained and certain blood tests carried out. This may uncover any underlying medical or psychological condition. Based on the information uncovered the treatment plan will target at the factors that may be lowering sexual interest. When an underlying medical condition is found, this will be treated first.

Features

• Dyspareunia refers to persistent or recurrent genital pain associated with sexual intercourse. At times this may occur before or after intercourse.
• The pain may be described as superficial during intromission or as deep during vaginal penetration. The intensity may range from mild discomfort to sharp pain.
• Dyspareunia is diagnosed in the absence of genital abnormalities or other physical causes.
• Dyspareunia may be accompanied by interpersonal difficulty (e.g., relational dissatisfaction) and reports of avoiding sexual activity and limiting the development of new sexual relationships.
• Dyspareunia can be primary, in which the person has always experienced pain during sexual intercourse.
• Dyspareunia can be secondary, in which the person used to be pain free, but now isn’t.
• Dyspareunia can be focused, in that the pain relates to a specific aspect of sexual experience (e.g., vaginal penetration).
• Dyspareunia may be general, in that the person experiences pain irrespective of the sexual stimuli.

Epidemiology
Based on available information, dyspareunia tends to be chronic.

Causes
Many things can cause dyspareunia; it can be a psychological problem, or a combination of a physical and psychological problem.

Treatment
Every woman will have a unique set of circumstances causing her genital pain, and likewise the treatment plan should be individually tailored to meet her special needs. A detailed medical, sexual and social history should be obtained and certain blood tests carried out. This may uncover any underlying medical or psychological condition. Based on the information uncovered the treatment plan will target at the factors that may be lowering sexual interest. When an underlying medical condition is found, this will be treated first.

Features

• Vaginismus refers to persistent or recurrent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse.
• Sexual responses (e.g., desire, pleasure, orgasmic capacity) may not be impaired unless penetration is attempted or anticipated. The physical obstruction due to the muscle contraction usually prevents penetration.
• In some cases, the intensity of the contraction may be severe or prolonged as to cause immense pain.
• Vaginismus may be accompanied by interpersonal difficulty (e.g., relational dissatisfaction) and reports of avoiding sexual activity and limiting the development of new sexual relationships.
• The diagnosis is often made during routine gynecological examinations when response to the pelvic examination results in the contraction of the vaginal outlet. Sometimes the contraction may occur during sexual activity but not during the examination.
•  Vaginismus can be primary, in which the person has always experienced the contraction during sexual activity.
• Vaginismus can be secondary, in which the person used to experience penetration, but no longer can.
• Vaginismus can be focused, in that the contraction relates to a specific partner or context.
• Vaginismus may be general, in that the person experiences contractions irrespective of the sexual stimuli.

Epidemiology
This condition is more often found in younger than in older females, in females with negative attitudes toward sex, and in females who have a history of being sexually abused or traumatized.

Causes
Many things can cause vaginismus; it can be a psychological problem, or a combination of a physical and psychological problem.

Treatment
Every woman will have a unique set of circumstances causing her involuntary spasm, and likewise the treatment plan should be individually tailored to meet her special needs. A detailed medical, sexual and social history should be obtained and certain blood tests carried out. This may uncover any underlying medical or psychological condition. Based on the information uncovered the treatment plan will target at the factors that may be lowering sexual interest. When an underlying medical condition is found, this will be treated first.

Features

• Early breast cancer has no symptoms. It is usually not painful. Most breast cancer is discovered before symptoms are present, either by finding an abnormality on mammography or feeling a lump in the breast. A lump in the armpit or above the collarbone that does not go away and may be a sign of cancer. Other possible symptoms are:
• Discharge from the nipple of only one breast that is bloody;
• New development of nipple inversion;  or
• Changes in the skin overlying the breast. Changes include redness, changes in texture and puckering. These changes are usually caused by skin diseases but occasionally can be associated with breast cancer.

Epidemiology
Worldwide, breast cancer is the second most common type of cancer after lung cancer and the fifth most common cause of cancer death. In 2004, breast cancer caused 519,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths.) According to CANSA, the latest statistics indicate that 1 in 29 women are diagnosed with breast cancer in South Africa.

General Causes
Many women who develop breast cancer have no risk factors other than age and sex. Gender is the biggest risk because breast cancer occurs mostly in women.

Age is another critical factor. Breast cancer may occur at any age, though the risk of breast cancer increases with age. The average woman at age 30 years has one chance in 280 of developing breast cancer in the next 10 years. This chance increases to one in 70 for a woman aged 40 years, and to one in 40 at age 50 years. A 60-year-old woman has a one in 30 chance of developing breast cancer in the next 10 years.

A woman with a personal history of cancer in one breast has a three- to fourfold greater risk of developing a new cancer in the other breast or in another part of the same breast. This refers to the risk for developing a new tumor and not a recurrence (return) of the first cancer.

Genetic Causes
Family history has long been known to be a risk factor for breast cancer. Both maternal and paternal relatives are important. The risk is highest if the affected relative developed breast cancer at a young age, had cancer in both breasts, or if she is a close relative. First-degree relatives, (mother, sister, daughter) are most important in estimating risk. Several second-degree relatives (grandmother, aunt) with breast cancer may also increase risk. Breast cancer in a male increases the risk for all his close female relatives. Having relatives with both breast and ovarian cancer also increases a woman's risk of developing breast cancer.

There is great interest in genes linked to breast cancer. About 5-10% of breast cancers are believed to be hereditary, as a result of mutations, or changes, in certain genes that are passed along in families. BRCA1 and BRCA2 are abnormal genes that, when inherited, markedly increase the risk of breast cancer to a lifetime risk estimated between 40 and 85%. Women with these abnormal genes also have an increased likelihood of developing ovarian cancer. Women who have the BRCA1 gene tend to develop breast cancer at an early age. Testing for these genes is expensive and may not be covered by insurance.

Hormonal Causes
Hormonal influences play a role in the development of breast cancer. Women who start their menstrual cycle at an early age (11 years or younger) or experience a late menopause (55 or older) have a slightly higher risk of developing breast cancer. On the other hand, being older at the time of the first menstrual period and early menopause tend to protect one from breast cancer.

Having a child before age 30 years may provide some protection, and having no children may increase the risk for developing breast cancer. Oral contraceptives have not been shown to definitively increase or decrease a woman's lifetime risk of breast cancer.

A large study conducted by the Women's Health Initiative showed an increased risk of breast cancer in postmenopausal women who were on a combination of estrogen and progesterone hormones for several years. Therefore, women who are considering hormone therapy for menopausal symptoms need to discuss the risk versus the benefit with their health-care providers.

Lifestyle and Dietary Causes
Breast cancer seems to occur more frequently in countries with high dietary intake of fat, and there for being overweight or obese is a known risk factor for breast cancer, particularly in postmenopausal women. However, several studies comparing groups of women with high- and low-fat diets, however, have failed to show a difference in breast cancer rates.

The use of alcohol is also an established risk factor for the development of breast cancer. The risk increases with the amount of alcohol consumed. Women who consume two to five alcoholic beverages per day have a risk about one and a half times that of nondrinkers for the development of breast cancer. Consumption of one alcoholic drink per day results in a slightly elevated risk.

Studies are also showing that regular exercise may actually reduce a woman's risk of developing breast cancer. Studies have not definitively established how much activity is needed for a significant reduction in risk. One study from the Women's Health Initiative (WHI) showed that as little as one and a quarter to two and a half hours per week of brisk walking reduced a woman's breast cancer risk by 18%.

Benign Breast Disease
Fibrocystic breast changes are very common. Fibrocystic breasts are lumpy with some thickened tissue and are frequently associated with breast discomfort, especially right before the menstrual period. This condition does not lead to breast cancer.

However, certain other types of benign breast changes, such as those diagnosed on biopsy as proliferative or hyper plastic, do predispose women to the later development of breast cancer.

Environmental Causes
Radiation treatment increases the likelihood of developing breast cancer but only after a long delay. For example, women who received radiation therapy to the upper body for treatment of Hodgkin disease before 30 years of age have a significantly higher rate of breast cancer than the general population.

Early Detection
One of the most important factors in determining the long-term outlook for the disease is detecting the disease at an early stage, before it has spread to the glands under the arm. The less advanced the disease the better the chance for long-term survival. For this reason, breast clinics have been set up specializing in the detection and treatment of breast cancer.

Features

In general early cervical cancer doesn’t show/produce any signs or symptoms. That is why it is important to go for yearly examinations (PAP SMEAR). As the cancer progresses, the following cervical cancer signs and symptoms may appear:

• Vaginal bleeding after intercourse, between periods or after menopause;
• Watery, bloody vaginal discharge that may be heavy and have an offensive odour;
• Pelvic pain or pain during intercourse.

Epidemiology
Worldwide, cervical cancer is the fifth most deadly cancer in women. It affects about 16 out of a 100 000 women per year and kills about 9 women out of a 100 000 per year. Worldwide it is estimated that there are 473 000 cases of cervical cancer, and 253 500 deaths per year. In South Africa it is the second most common cancer affecting women. According to CANSA, approximately one in every 35 women will, within their lifetime, develop this form of cancer.

Cervical cancer is one of the most common cancers that affect a woman's reproductive organs. Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cases of cervical cancer.

When exposed to HPV, a woman's immune system typically prevents the virus from doing harm. In a small group of women, however, the virus survives for years before it eventually converts some cells on the surface of the cervix into cancer cells. Half of cervical cancer cases occur in women between ages 35 and 55.

Thanks largely to Pap test screening, the death rate from cervical cancer has decreased greatly over the last 50 years. Still, an estimated 6 700 South African women develop cervical cancer every year.

Causes
Cervical cancer begins with abnormal changes in the cervical tissue. The risk of developing these abnormal changes has been associated with certain factors, including previous infection with human papillomavirus (HPV), early sexual contact, multiple sexual partners, cigarette smoking, and taking oral contraceptives (birth control pills).

Forms of HPV, a virus whose different types cause skin warts, genital warts (link to Genital Warts), and other abnormal skin and body surface disorders, have been shown to lead to many of the changes in cervical cells that may eventually lead to cancer.

Genetic material that comes from certain forms of HPV has been found in cervical tissues that show cancerous or precancerous changes.

In addition, women who have been diagnosed with HPV are more likely to develop a cervical cancer that has genetic material matching the strain of virus that caused the infection. These findings demonstrate a strong link between the virus and cervical cancer.

Because HPV can be transmitted by sexual contact, early sexual contact and having multiple sexual partners have been identified as strong risk factors for the development of cervical lesions that may progress to cancer.

Cigarette smoking is another risk factor for the development of cervical cancer. The chemicals in cigarette smoke interact with the cells of the cervix, causing precancerous changes that may over time progress to cancer.

Oral contraceptives ("the pill") may increase the risk for cervical cancer, especially in women who use oral contraceptives for longer than 5 years.

Features

Ovarian cancer is difficult to diagnose, often referred to as the “silent killer”, as there are few symptoms until the final stage of the disease. Symptoms do not occur until the tumor has grown large enough to apply pressure to other organs in the abdomen, or until the cancer has spread to remote organs. The symptoms are nonspecific, meaning they could be due to many different conditions. The only early symptom is menstrual irregularity, but again this can be nonspecific as well. The following nonspecific symptoms that may be experience on a later stage are:

Lower abdominal/pelvic pain or pressure;

• Pain during intercourse;
• Abdominal bloating and swelling;
• Frequent urination;
• Constipation;
• Loss of appetite;
• Feeling full after having little to eat;
• Increased passing of gas or diarrhea; (changing in your bowl movement)
• Irregular and abnormal menstrual cycle;
• Abnormal hair growth (tumors sometimes secretes extra hormones that may increase hair growth is specific areas).

Epidemiology
Cancer occurs when cells undergo a transformation and begin to grow and multiply without normal controls. As the cells grow and multiply, they form masses called tumors. Ovarian cancer occurs when a tumor or mass forms in one or both of a women’s ovaries. The ovaries are a pair of small organs that produce and release ova/ovum, better known as eggs sells. Another function of the ovaries is to produce the much needed hormones such as estrogen and progesterone. They are located in the lower abdomen/pelvis, on both sides of the uterus, better known as the womb. Ova released by the ovaries travel through the fallopian tubes to the uterus, where they may or may not be fertilized by the male sperm.

Cancerous tumors are malignant. This means they spread to other tissues and organs. Not all tumors are malignant. According to various studies, 95 % of ovarian cancer has no identifiable cause, but family history was definitely identified as a role player. According to CANSA, the latest statistics indicate that 1 in 297 women are diagnosed with this cancer in South Africa. If one relative, with first degree ovarian cancer – a mother, sister, or daughter – is diagnosed, the risk for other female relatives will increase to 3-5 %. The risk can further increase to 50 % if 2 first-degree relatives are diagnoses with ovarian cancer. If a woman has ovarian cancer and her daughter develops ovarian cancer, the daughter will probably develop the cancer at a relatively young age (younger than 60 years).

Ovarian cancer is more common in women who live in developed countries as well as for those women who have gone through the menopause cycle.

Ovarian cancer may be less common in women who have:

• Used the contraceptive pill;
• Had children - the more children, the lower the risk;
• Breastfed their children;
• Had a hysterectomy.

 
Causes
The causes of ovarian cancer are not clear to the medical profession, but there are a few factors that make it more likely. A known factor is that the faulty inherited genes called BRCA1 and BRCA2 increase the risk of ovarian cancer as well as in breast cancer. However, having a close relative - mother, sister or daughter - with ovarian cancer doesn't necessarily mean that there is a faulty inherited gene in your family. The cancers could have happened by chance.

Other factors that are thought to make ovarian cancer more likely include:

• Intake of hormone replacement therapy (HRT) - especially taking HRT for longer than five years;
• Being overweight or obese; (in pre-menopausal women)
• Endometriosis;
• Smoking;
• Starting your menstrual cycle at an early age (11 years of younger) and having your menopause late (55 years and above).

Fertility treatment (treatment that assists in falling pregnant) is no longer considered a risk factor after recent research ruled out the link.

Because many lesbian women have never taken a contraceptive pill, or had children, or breastfed or had a hysterectomy, they are naturally at a higher risk for ovarian cancer. The high incidence of obesity and smoking among SA lesbian women are seen as risk factors too.

CANSA offers the following tips to all women on how to detect women’s cancers early:

Cervical cancer - go for a Pap smear every two to three years if you are sexually active. Pap Smears are offered at the OUT LGBT Wellbeing’s Clinic, 1081 Pretorius Street, Hatfield, Pretoria. Contact Elmie @ (012) 430 3272

Breast cancer - do Breast Self Examination (BSE) every 7 to 10 days after your period. Repeat monthly within same time interval. Have a mammogram yearly after age 40.

Ovarian cancer - Be aware of the risk factors: hormone replacement therapy after menopause, obesity, strong family history of cancer. Have regular medical check-ups.

Lesbian women do also experience menopause like any other. Menopause occurs when your body transition from being productive, to being non-productive. This means the ovaries stop producing estrogen and progesterone. Usually, a woman will start to display pre-menopausal symptoms around three to five years before she stops menstruating, anytime between mid-40 to late 50’s. For some woman, especially smokers, it can occur much earlier in life. Some illnesses, cancer treatments, removed ovaries or a hysterectomy may affect menopause.

The decrease of estrogen and progesterone has various effects on a woman’s bodies, which includes hot flushes, depression, mood swings, increased hair growth, no periods and diminished sexual desire. Due to the reduction in vaginal lubrication and thinning of the vaginal canal, penetration could be painful. Feel free to make use of lubricants (lube), available in most pharmacies. It might also be necessary to use smaller sex toys.

For some women, the physical and emotional changes can be overwhelming. This may cause conflict, especially when there is a big age gap between partners, and the younger partner might have no idea what her partner is going through. Keep on communicating and don’t shut each other out.

Sexual health is a state of physical, emotional, and social wellbeing in relation to sexuality; it is not merely the absence of disease or dysfunction.

Sexual health is influenced by a complex web of factors ranging from sexual behavior and attitudes and societal factors, to biological risk and genetic predisposition. It encompasses the problems of HIV and STIs/RTIs, unintended pregnancy and abortion, infertility and cancer resulting from STIs, and sexual dysfunction.

[see: HIV / AIDS and STI's]

Often we focus on the physical side of sexual health and forget about the emotional side. Our attitude to our own sexuality can be positively or negatively affected by the attitudes of society in general. If you feel you have negative feeling about your sexuality you should contact a counselor or therapist who can help you address your feelings.

EXERCISE

Benefits

• Exercise improves your mood;
• Exercise improves and fights chronic illnesses;
• Exercise play an import role in weight management;
• Exercise strengthens your heart and lungs;
• Promotes sleep;
• Exercise can put a spark back into your sex life; and
• Exercise can be fun and is also a method of stress relief.

Minimum
The minimum requirement is 2-3 times per week for 30 min at a time. Exercise is a personal choice. Do something that you would enjoy and if you have difficulty being active, start small e.g. wake up 20 minutes earlier and walk around the block twice.

NUTRITION

Benefits
Your body can only be as healthy as the fuel it's fed. Rubbish in, equals rubbish out. Without adequate nutrition, the body will not be able to function optimal. This can mean poor concentration, low energy levels, and low immunity (more illnesses). Skin, hair, teeth, bones and muscles will not be as strong and healthy as they could be.

Overeating does not necessarily mean that the body is getting all the nutrients it needs. Quite often unhealthy food is substituted for necessary nutritious food, and so overweight people can suffer from poor nutrition - as well as the physical burden of excess weight.

Being overweight is a health problem as it increases the risk of heart disease, high blood pressure, diabetes and several cancers. Added to this, being overweight can limit movement and in this way it can reduce social interaction which is necessary for emotional wellbeing.

Minimum

The Food Guide Pyramid is an outline of what to eat each day based on dietary guidelines.  It's not a rigid prescription but a general guide that lets you choose a healthful diet that's right for you.

What Counts as One Serving?

• Milk, Yoghurt and Cheese group
  • 250 ml yoghurt or milk = 1 serving
  • 25 g cheese = 1 serving

• Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts
  • 55-85 g cooked lean meat, poultry, or fish = 1 serving
  • ½ cup cooked dry beans = 1 serving
  • 1 egg = 1 serving
  • Hand full of nuts = 1 serving

• Vegetables group
  • 1 cup of raw leafy vegetables = 1 serving
  • ½ cup of either carrots, beetroot, corn and pumpkin = 1 serving
• Fruit group
  • 1 medium fruit e.g. apple, banana or orange = 1 serving
  • ½ chopped, cooked or canned fruit = 1 serving
  • ¾ fruit juice = 1 serving
• Bread, Cereal, Rice, and Pasta group
  • 1 slice of bread = 1 serving
  • 50 g ready to eat cereal = 1 serving
  • ½ cup of cooked cereal, cooked rice or cooked pasta = 1 serving 

STRESS MANAGEMENT

Benefits

• Decrease stress related health problems e.g. heart attacks;
• Healthy sleep pattern, adequate sleep;
• Eating healthy;
• Regular exercise;
• Increase in productivity and concentration;
• Better sexual life; and
• Enjoying life.

Strategies and tips

You can start with these tips:

• Slow down your breathing - Breathe slowly - deep in and out. This works in two ways – it settles your energy and takes your focus away from the anxiety. This is a very effective method to start with.
•  Distance yourself - Imagine that you are watching someone else with friendly curiosity. Observe, uncritically, your emotions and sensations and reactions. This creates distance between you and your stress and helps you to take control and manage stress – instead of the other way around!
• Press your feet into the floor - By doing this you shift your focus away from your mind (and the stress) and into your body. Imagine that you are a tree and your feet are the roots. “Plant” yourself firmly and blow tension out of your roots into the ground. Breathe in calm energy from the ground back up through your roots.
• Laugh - Be humorous! Laugh at yourself and the stress! Laugh at the stress! Any way that you can!

ALCOHOL AND DRUGS

Effect of alcohol and drugs on Sexual health?

• Alcohol and drugs lowers your inhibitions and interferes with your decision making, resulting in unsafe sex.
• Increase your risk of contracting STIs and HIV due to lack off safer sex negotiation.
• Alcohol and drugs usually result in poor sexual performance but can have the opposite effect – change in sexual performance.
• Embarrassing moments – can’ remember what happened the previous night.
• Relationship problems.
• Unwanted sex.
• Financial implications.
• Unwanted injuries e.g. broken leg from falling.

Strategies and tips to reduce harm?

• Reduce frequency of drugs and alcohol use.
• Stop taking drugs and alcohol with sex.
• Avoid friends and places where you might be tempted to use excessive drugs and alcohol.
• Safer sex negotiations.
• If you are injecting, use clean water and don’t share equipment.
• Regular health check-ups and HIV Testing, at least every 6 months.
• Be faithful to one partner.
• Always carry condoms and lube with you, “play safe pack”.
• Avoid places where you might be tempted to have high risk sex e.g. dark rooms.