Shapley M, Jordan J, Croft PR. A systematic review of bleeding after intercourse and risk of cervical cancer. Br J Gen Pract. 2006 Jun; 56 (527) :45360. br AF Khattab, AA Ewies, Appleby D, Cruickshank DJ. The result of consultation with bleeding after intercourse (PCB). J. Obstet Gynecol. 2005 Apr; 25 (3) :27982. br Q: I am 64 years old and have two sexual partners. With each time you have sex, I have a bladder infection. I take Macrobid clarify this, but I hate to do this. This couple do not see very often (about four times per year), because we live in different cities, but I would avoid these infections. Why is this and what can we do to prevent it I do not experience these infections after having sex with my partner. br R: quot; mielquot moon cystitis, is a very real medical condition that affects not only women in their honeymoons. It occurs every time that vaginal intercourse leads to urinary tract infections (UTI). It usually occurs when a man's penis pushing irritates the back wall of the bladder (through the front wall of the vagina) massage bodies in the bladder which, if not pee right after sex, can multiply and cause infection. The condition is usually more common in women who have had children, representing nearly four percent of all urinary tract infections and 60 per cent of recurrences. There is also some evidence that is more common if you use condoms. But consider safer sex practices. br The ideal way to avoid sexual intercourse, urinary tract infections is to urinate before and after intercourse. However, some women find that they can not urinate immediately after sex, probably because the muscles that control release of urine not relax. So is urine in the bladder, increasing the risk of infection. Postmenopausal women in particular may have trouble urinating after sex due to changes in the vagina and urethra that occur with estrogen loss. br Start by asking your partner to be softer during sexual intercourse. You can also try changing positions, perhaps with you at the top. Also try a vaginal lubricant Replens to maintain moisture of the vagina, and make the postcoital urination a regular part of your routine. br If the problem persists, I recommend you consult your gynecologist for a thorough examination. You may have a bladder prolapse, in which the bladder has fallen into the pelvic cavity, increasing the likelihood of sexual intercourse is irritating. br You can also take some preventive measures. Numerous studies show that drinking cranberry juice every day may help prevent urinary tract infections by making your urine more acidic and therefore more lethal to pathogens. Also, make sure you're drinking enough fluids so that others go to the bathroom every few hours. You can talk to your doctor about taking an antibiotic. Can be taken prophylactically for women prone to urinary tract infections, and studies also find that taking a single antibiotic pill immediately after intercourse may help prevent sexrelated cystitis. You see your friend is rare that a single antibiotic pill after sex may be enough. br Q: I am 53 and have been married to my husband for 13 years. I have experienced sexual pleasure with him during the first nine years of our marriage, but we have not had sex for the past four years. I tried many times to start a conversation, emphasizing that really long for the intimacy we share. he feels he has quot; verdaderoquot found love and quot; peace within [myself] quot;, and no longer feels the need for sex. This has been a very important to me since I really love him. I feel abandoned, loved and insecure. he does not want to seek counseling. What can I do br A: I can feel the pain that is felt even in his brief letter. The first thing I recommend is that you get your husband to see his doctor for a complete physical examination. Many medical conditions and medications can affect sexual desire of a man and his ability to experience an erection, including depression, hypertension and diabetes. These become more common as men age. br Although her husband says quot; longer feels the need sexoquot;, reality may be that he has trouble with erections and so lives isolated from sex to avoid embarrassment. As you undoubtedly know, there are many treatments for erectile dysfunction, ranging from drugs like Viagra, Levitra and Cialis to injections, pumps, and inserts. br Nextra in the same timeind you a good sex therapist certified by the American Association of Sexuality Educators, Counselors and Therapists (www.aasect.org go and click your state). Just because your husband will not go to therapy does not mean you can not. You need to talk to someone about their feelings of abandonment and insecurity, and why have learned to equate sex with love. It is also necessary to explore other options, if there is no physical problem with her husband, but her sexual desire is still missing. Are you staying in the marriage Seeking sexual intimacy outside of marriage br That brings us to another topic. During this phase, to make every effort to ensure privacy in her life with her husband without sex. For example, the two of you could shower together, taking long walks, while the hand and give each other massages. Be sure to give her husband's long, lingering kisses several times a day, get to hug him and tell him how you feel about him. br the same time, do not ignore yourself. Take good care of yourself by eating right and exercising. And treat yourself as special long baths, imported dark chocolate, or a facial or a pedicure at a local day spa. And do not forget the emotional and physical benefits of masturbationith or without a vibrator. br The most important thing is to keep talking to your husband about your feelings. Your therapist can provide advice on how to start and maintain such talks, but at least make sure you understand how her husband loved and feels insecure. Nobody has to go years without sex intimacynd obviously means a lot to you. br Q: Recently I learned that my daughter is sexually active. She and her fiance are seniors in high school. I talked about my discovery with her, and I knew I shared with her boyfriend. My question is about how to proceed. They are going to college soon (different) and will continue to take their own decisions. This is a good relationship. Do not feel that my daughter acted impulsively or was pushed. How can we proceed without tolerating what they are doing, however, recognizing that will continue I sincerely appreciate any advice. br A: Ah, you're dealing with the dilemma of parents everywhere: how to let go completely without cutting the umbilical cord. First, let me say how good it is that you and your daughter were able to talk calmly about this. Many parents have dealt with this discovery with anger and recriminations. And may I say how healthy it is for both of you recognize that your daughter is growing. In dealing with thisnd similar situationsn the way you have, you can be sure that while growing, not growing away from you. br There is need for quot; apruebaquot, his active sex life. However, as clearly wants her daughter to develop a healthy sexual identity, do not underestimate the power of a mother's opinion. Expressing his displeasure about what you have said was a well thought out and without pressure (ie, couples), the decision may leave her daughter with guilt and quot; maloquot;. It is convenient for you to tell you how they feel about their sexual activity at this time in her life without judging. Use phrases like: quot; While I would prefer to wait until you grow up to be sexually active, I understand that this is her life, and you know I support and love that no matter what haces.quot; Then change to the mother and how to ensure that your daughter is safe. br Find out what kind of birth control you are using. Given the maturity levels of adolescents and the complexities of the university, suggests that you talk to your doctor about a longterm form of birth control that does not have to think in a day or even every month, such as Depo Provera (a shot that lasts three months), Implanon (a rod implanted in the upper arm that provides protection for up to three years) or an IUD, which can provide protection up to 10 years. br Also make sure that, whatever their choice of contraception, her daughter and her boyfriend are also using a condom to protect against any sexually transmitted infection. Suggest (very) to be vaccinated with Gardasil, a new vaccine that protects against primary forms of a sexually transmitted virus that causes cervical cancer. br And do not forget to have a conversation about the emotional consequences of sex. Ensure that you only want to make sure does not hurt and make sure you are seeing this relationship realistically. br Finally, it is well to shed some tears. Your child is growing really is a discovery upnd difficult for any mother. br Q: I am 35 years and I think may have a sex addiction. Sigo sexual behaviors (eg, having sex with strangers often), but I promised myself I will stop. How to end this compulsive behavior br A: First, it helps to understand what sexual addiction. It goes by many names, such as quot; the impulsivecompulsive sexualquot;, quot; sexualquot desire disorder hyperactive and quot; sexualquot impulsivity;. It is believed to affect between five and six percent of the populationlthough some experts think it is much more commonnd is more common in men than in women. People with the condition may be married or unmarried, heterosexual or homosexual. br People with this condition is very difficult to control their sexual behavior and thoughts despite significant adverse consequences, including the risk of sexually transmitted infections, marital conflict, financial problems and even put their own safety at risk. May occur beyond the control of sexual behavior, like having sex with strangers several times a week or more than one person at a time. Often other mental health problems, including depression, anxiety and alcohol or drug abuse or addiction. Often, people turn to sex to satisfy sexual needs are not, as the need for love, intimacy, security or simply a connection to another person. As one woman said on MSNBC's Dateline program on sexual addiction: quot; The sex part is enjoyable, and it is only a benefit for me, but that was not important. I was trying not to sexually satisfy the sexual needs and that was the only way he knew how to meet those needs. quot; br componentleasure Some kind of impulsive, excitement, or the person to seek gratificationeads sex, which then repeats compulsively. As with many behavioral conditions, it is difficult to determine exactly when a strong sexual desire becomes a sexual addiction. br The typical treatments for those struggling with sexual addiction include group therapy, couples therapy and cognitivebehavioral therapy, in which people learn to identify triggers for their behavior and develop better coping mechanisms. In addition to medication like antidepressants are sometimes used in combination with psychotherapy after a medical evaluation. Some people find relief through a 12step approach as Sexaholics Anonymous and Sex and Love Addicts Anonymous (SLAA). br The first step, however, meet with an addiction or a sex therapist to discuss their concerns and receive the diagnosis and treatment. You can find a certified sex therapist by the American Association of Sexuality Educators, Counselors and Therapists (AASECT) through its website at www.aasect.org. br Q: two to seven days after having sex (which is sometimes painful) with my male partner, begin to bleed. Could this be the result of the blood thinner I take br R: Bleeding after intercourse, also called bleeding after intercourse, should be taken very seriously. Most women notice bleeding after intercourse within one or two hours after intercourse. The greatest concern is that this could be a sign of cancer of the cervix or the endometrium. In two studies in the United States, bleeding after intercourse led to a diagnosis of cervical cancer between six and 10 percent of the time. So the first thing I urge you to do is see your health professional. Tell what is happening. Your doctor may recommend a Pap test, cervical and vaginal wet prep cultures or might want to move or the right to a colposcopy, with or without biopsy. A colposcopy is a procedure in which a doctor uses a special instrument to examine the tissue from the cervix and remove a small piece of tissue, a biopsy for further evaluation in the laboratory if warranted. br However, there are other causes of bleeding after intercourse as polyps or abnormal tissue in the lining of the uterus, vaginal dryness (bleeding and pain during sexual experience may be related to the thinning and drying of the vagina, which often occurs during menopause, after childbirth, while breastfeeding or the use of certain types of contraceptives), inflammation of the cervix (cervicitis) Sexually transmitted infections such as chlamydia, gonorrhea or trichomoniasis, pelvic inflammatory disease (an infection of the reproductive tract generally associated with a sexually transmitted infection), uterine fibroids (noncancerous tumors in the uterus), contraceptive pills low dose of control, which may leave the lining of the uterus too thin, the cause of bleeding, fungal infections and certain vulval dermatosis, which may also cause the skin of the vulva and vagina become thin and delicate at times leads to fissures (small cracks in the skin that occurs during intercourse can cause pain and bleeding). br And yes, blood thinners can also cause postcoital bleeding. What worries me most, however, is that the bleeding is not just after sex, but few days later. This type of bleeding is not usually classified as quot; coitoquot bleeding after, but as quot; irregularesquot; of vaginal bleeding. br I do not mean to scare you, but I want to see your health care professional as soon as possible. he or she may want a pelvic ultrasound to assess the lining of the uterus and pelvic organs, along with the other tests listed above. Moreover, already on blood thinners, your doctor will want to check his blood work. br Q: What is a quot; normalquot, or typical amount of sex a person has a month If a perimenopausal woman is only interested in sex once every three to four weeks, is that they are abnormal br A: What a great question. I'm sure it is you think many women, but few have the courage to actually do. This is the most important thing you need to know: There is no such thing as a quantity quot; normalquot; of sex. Sex is a very individual thing. What I would consider normal may be too often for you, and what women considered normal by the way can often not enough. In addition, quot; quererquot, sex and quot; tenerquot; sex are two different things. For example, some women may quot; tenerquot; sex more often than your body really craves, to commit to a spouse or for a greater unity. br A survey of 2,000 Americans released in 1993 found that 32 percent of women said they had sex once or twice a week, 18 percent had had sex twice a month and 11 percent once a month. Among women 40 to 49 (the most likely to be the perimenopause), 38 percent had sex once or twice a week, 18 percent twice a month and 11 percent once a month. br What does this mean for you Absolutely nothing. Her desire for sexual activity is composed of many variables that trying to determine what is quot; normalquot; or not is virtually impossible. For example, if you have children still at home, especially young children or teenagers, a stressful job, or relationship problems with his health problems, the idea that sex can be in the bottom of the list. br So how do you know if you have a quot; problemaquot; You may have a problem if the frequency (or lack thereof) of sex with their partner interferes with the quality of your life if you are worrying about him, wishing it were more (or less) often, or become a controversial issue in your relationship or in their overall ability to be intimate with your partner. That's when it's time to talk to a therapist or health professional. br Q: I have been sexually inactive for over a year, but before I had no problem achieving one or more orgasms. When I went to make my annual gynecological exam, my doctor said I had vaginal thinning and prescribed Premarin cream 0.625mg/gm PV 1GM. I have a sister who is a breast cancer survivor, so I worry about taking any type of hormone therapy. My question is: Are there other health problems associated with vaginal thinning or no worry if it does not affect my ability to have pleasurable sex br A: Like many parts of her body, her vagina is based on the estrogen to keep it healthy. You do not mention your age or menopause status, but as estrogen levels decline during perimenopause and after menopause, the walls of the vagina may become thinner, increasing the risk of wear, and often causing itching, burning and dryness. In addition, there may be less lubrication, which can make intercourse painful and contribute to the risk of vaginal tears. With less lubrication, the risk of vaginal infections also increases, because they alter the natural pH balance of the vagina, protecting it against the bad bacteria and fungi. These results vaginal changes quot; vaginal.quot atrophy; br Estrogen is also critical to the health of parts of the urinary tract including the urethra (the tube leading from the bladder to outside the body), bladder and pelvic floor muscles. As the fall in estrogen levels, can experience urinary incontinence and urinary tract and bladder infections more. br All these problems can be helped to varying degrees with estrogen, either oral or local, such as your doctor prescribed cream. However, given the history of his sister, I can understand their concerns about the use of hormone therapy. You probably know that the studies found a slightly increased risk of breast cancer in women using estrogen therapy, and that many breast cancer survivors say that not using estrogen therapy. br However, studies assessing the risks of estrogen therapy in breast cancer conducted using oral forms of hormonal therapy. These forms are metabolized by the liver and estrogen sent through your breast bodyncluding where you can act on breast tissue estrogenresponsive. Estrogen vaginal effecteaning not have a systemic, not spread throughout the body. Therefore, it is very unlikely to contribute to an increased risk of breast cancer. br However, there have been no studies evaluating this issue. Some studies found higher levels of estrogen in the blood of a woman, even with low doses of vaginally, including vaginal cream. If you want to try a vaginal form of estrogen ask your health care to begin with the lowest dose possible and start the vaginal pill (Vagifem). The studies found no increase in blood levels of estrogen pill use (which is inserted into the vagina) face cream. br If you are still concerned about the use of estrogen, however, you have other options. You might start with waterbased vaginal moisturizers such as Replens, which studies can be found more effective for vaginal atrophy symptoms including estrogen cream. Vitamin E, in oral doses of 100 to 600 IU, or administered directly to the vagina, can also improve vaginal dryness. Another option is a topical oil from botanicals, called Zestra Female Arousal Fluid, a study found that significantly improved the sexual experience of women (including orgasm) compared to placebo oil today. br Regardless of which option you choose, I recommend you find something that works for you for you to enjoy a healthy sex life and sexual and avoid the problems that may result from vaginal atrophy. br Q: My spouse and I have diabetes and high blood pressure. They often do not feel sexually aroused (and certainly can not climax), and he can not keep an erection long enough to please me. Is there any kind of sexual act or position that we explore, we like both br A: Conditions such as diabetes and hypertension are among the most common chronic health conditions that can affect their sexual functioning. Since you and your partner have both can create an even greater challenge. br A comprehensive study of men with type 2 diabetes found their risk of erectile dysfunction (or unable to get or keep an erection) was almost double that of men without diabetes. The researchers also found that half of men in the study who had diabetes and high blood pressure had erectile dysfunction (ED). Other studies conclude that between 40 and 80 per cent of people with diabetes and hypertension (men and women) have sexual problems. br There are many reasons for the effect of diabetes # 39; in erection. Over time, the disease damages nerves and blood vessels, which are needed for an erection. It may also interfere with the production of nitric oxide, which helps dilate blood vessels (including those in the penis) and is required for erection. Another effect can reduce the levels of the hormone testosterone is also required for erection. One study found that one third of men with type 2 diabetes had low testosterone levels, the researchers called quot; a new complication of diabetesquot;. br understand much less about the mechanisms behind sexual dysfunction in women with diabetes, although we know it exists. One study found that sexual dysfunction in 71 percent of married women with type 1 diabetes and 42 per cent of women with type 2 diabetes compared with 37 percent of women without diabetes. The disease may have some physical effect on women, such as decreased vaginal lubrication and a predisposition to vaginal infections, which can result in pain during or after sex, also called dyspareunia. A large study of women with type 1 diabetes found a woman's sexual dysfunction was also closely related to a variety of emotional issues and lifestyle. These include satisfaction with their marriage, the understanding of diabetes, emotional adjustment to diabetes, the effects of diabetes on daily life and satisfaction with their diabetes treatment. br As for the effects of high blood pressure on sexuality, one of the culprits may be the medication you are taking. Diuretics and beta blockers, both prescribed for high blood pressure may also cause sexual problems. We also know that the effects of hypertension on blood vessels, such as rigidity and narrowing, can interfere with the ability of the vessels in the penis to fill with blood and still full. Once again, we have less information on the effects of hypertension on sexual function of women. br The good news is that there are treatment options. The first thing that your partner may want to consider is a medication for erectile dysfunction. Studies find the three available medicationsiagra (sildenafil), Levitra (vardenafil) and Cialis (Tadalafil) safe for most men with diabetes and hypertension. An additional advantage: If the problem of her husband's ED improves, you can find their own sexual satisfaction improvement. The use of a glycerin free lubricant may alleviate some of the resulting vaginal dryness and dyspareunia. br The first step, as with most health conditions, medical evaluation is complete. Your partner probably should see a urologist, in addition to their regular health care professional may want to talk to a gynecologist or a health specialist of the pelvis in addition to their sexual and regular health care professional. br In addition to medical approaches, you may want to explore sex therapy. A trained sex therapist can work with you, both to help identify ways to improve your sexual relationship. To find a qualified therapist in your geographic area, visit the American Association of Sex Educators, Counselors and Therapists (AASECT) at www.aasect.org and click on your state. br Q: It was discovered through an ultrasound that I have a retroverted uterus. My doctor told me that can cause pain during sex. Now I'm worried. I'm 19 years old, a virgin and depression that sex is always painful for me. I've always had very painful periods. What can I do to reduce pain in sex br A: First, relax. You do not know for sure that sex will be painful, but if you get in your mind that it will, then surely you will! Such is the power of the mind. You have what is also known as a uterus retroflexion, or a tip of the uterus. Approximately one in four women have this anatomical difference. It simply means that your uterus is tilted away from your abdomen rather than in a straight up and down position or slightly tilted to the abdomen. Most women are born with a uterus retroflexion, but may occur as a result of pregnancy, aging or the scar tissue of reproductive surgeries. br There is little evidence that a tip of the uterus can cause pain during intercourse. Only one study has been conducted to address this issue, and it was a welldesigned study. However, even found that 67 percent of women with a retroverted uterus had pain during intercourse, pain level was relatively low and not interfere with daily activities of the woman or her sexual activity. br The pain is thought to be caused when the tip of the penis hitting cervix during intercourse. Another theory is that the ligaments supporting the uterus actually move in a direction different than the uterus during intercourse, causing pain. Finally, a third theory suggests that having a tipped uterus leads to another condition called pelvic congestion, or venous congestion, which often results in pelvic pain. br If you find intercourse painful once you're in a sexual relationship, something as simple as changing the positions of vaginal intercourse can reduce pain. If pain continues and is affecting your relationship and / or quality of life, you might want to talk to your health professional about surgery, but this should only be considered as a last resort. You should probably also talk to your healthcare professional or a mental health professional says the depression you feel about this. Speaking through their fears is often the best way to remove them. br Q: I'm 56 and had a total hysterectomy five years ago for uterine fibroids. He sido sexualmente inactivo durante aproximadamente un a�o ahora, pero antes de que yo no ten�a ning�n problema con la relaci�n sexual. Cuando fui a hacerme mi examen ginecol�gico anual, a mi m�dico me dijo que ten�a adelgazamiento vaginal y le recet� un producto llamado Vagifem, tabletas (uno o dos) que se insertan en la vagina a la semana. Tengo una hermana que es un sobreviviente de c�ncer de mama, por lo que me preocupa de tomar cualquier tipo de terapia hormonal. Mi pregunta es: �Existen otros problemas de salud asociados con el adelgazamiento vaginal o si no te preocupes si no afecta a mi capacidad para tener sexo placentero br R: En primer lugar, perm�tanme poner su mente en la facilidad con respecto a la terapia con el m�dico ha prescrito. Debido a que est� dise�ado espec�ficamente como la terapia con estr�genos locales, muy poco de la hormona se absorbe a nivel sist�mico, es decir, todo su cuerpo. Aunque el aumento del riesgo de c�ncer de mama con terapia hormonal sist�mica ha sido bien documentada, no hay pruebas de que locales de las cremas de estr�geno en calidad, anillos o comprimidos tienen el mismo riesgo. br La raz�n de la vagina es el adelgazamiento se debe a la falta de estr�geno en su cuerpo despu�s de la menopausia. De la vagina y otras partes de su tracto urinario y la reproducci�n son muy dependientes de los estr�genos para permanecer en el pico de condiciones de trabajo. Como la ca�da de los niveles de estr�genos, muchas mujeres comienza a experimentar problemas en este �mbito, como sequedad vaginal y el adelgazamiento vaginal con su proveedor de cuidado de la salud diagnosticados, los cuales pueden dar lugar a relaciones sexuales dolorosas. Hay otras consecuencias de esta p�rdida de estr�genos: La vagina se hace menos �cida, lo que aumenta el riesgo de infecciones del tracto urinario (ITU), comez�n y ardor. De hecho, estos s�ntomas parecen ser m�s frecuentes en mujeres que no son sexualmente activos porque las relaciones sexuales trae suministro de sangre adicional a la zona, que pueden ayudar a mantener la salud vaginal. br Puesto que el estr�geno tambi�n afecta a la vejiga y la uretra, es posible que empiece a tener algunas fugas de orina y / o sentir la necesidad de orinar con frecuencia. De hecho, alrededor del 70 por ciento de las mujeres vincular el comienzo de estos tipos de s�ntomas urinarios de la menopausia. br El uso de cualquier forma de terapia hormonal (local o sist�mica) es una decisi�n muy personal que debe ser revisado con su proveedor de atenci�n m�dica. Si decide no utilizar hormonas, existen otras opciones que puede llevar a cabo, incluyendo los humectantes contra vaginal, que, con el tiempo, han demostrado mejorar la irritaci�n vaginal, comez�n y la sequedad. br Dosis de vitamina E entre 100 y 600 UI, aplicado por v�a vaginal, tambi�n puede ayudar. Si experimenta infecciones urinarias de repetici�n, a�adiendo pastillas de ar�ndanos para su r�gimen de la vitamina puede reducir la incidencia de las infecciones urinarias. br Si desea ejercer una de estas opciones, siempre es mejor que las discuta con su proveedor de atenci�n m�dica, as� como para educar acerca de la salud vaginal. br Q: �Hace dos meses, mi vida sexual activa y muy agradable, pero emocional y f�sicamente abusivo, la relaci�n termin�. Mi pregunta tiene que ver con el llanto, durante o poco despu�s del orgasmo. �Por qu� lloro, a veces hasta el punto de llanto �Tiene que ver con alg�n tipo de liberaci�n hormonal Tengo 47 a�os de edad. br R: Lo siento mucho o�r que estaban en una relaci�n abusiva, pero muy orgulloso de ti para ponerle fin. No me digas si llorar todo el tiempo con el orgasmo, es decir, incluso cuando te masturbas, o s�lo cuando est�s con un compa�ero. Y usted no dice si se produce s�lo a partir de la relaci�n termin�. br Si su llanto comenz� una vez que termin� la relaci�n, podr�a ser un reflejo de su dolor. Dolor despu�s de terminar una relaci�n abusiva Certainly. Es probable que a�n tiene fuertes sentimientos por su ex amante, y est�n de luto por la terminaci�n de la relaci�n y la p�rdida de la relaci�n sexual fuerte que ten�a, a pesar de que esta p�rdida puede beneficiarse en el largo plazo. �Por qu� despu�s de un orgasmo Debido a la intensidad de un orgasmo puede dejar sinti�ndose emocionalmente primas. As� pues, la emoci�n m�s fuerte que est� experimentando bajo la superficie es libre de expresarse. br Si su llanto se produjo durante la relaci�n, no es de extra�ar que la mezcla de amor, el miedo y la ira que sent�an probablemente dar�a lugar a una emoci�n inmensa cuando eras m�s abierta y emocionalmente vulnerables, es decir, durante el orgasmo. Another way to look at it is that you were caught in the conundrum of a relationship with someone who could bring you such pleasure (as experienced as an intense orgasm), but at the same time cause such emotional and physical pain. The acute awareness of this at the moment of orgasm could certainly trigger sobbing. br Having said all that, it is also not out of the question for a 47yearold woman to experience some hormonal fluctuations at orgasm, with the release of the hormone oxytocin contributing to the crying jag. br I strongly recommend that you seek help from a qualified health care practitioner, as well as a qualified mental health therapist, to work through the complex issues you are most likely dealing with, as well as to evaluate your overall physical health. br Q: I am 41 and had a hysterectomy one year ago. I would like to know if that is why I can#39;t have an orgasm when I have sex with my boyfriend. Aside from the lack of orgasm, the sex is quite good. br A: First, let me congratulate you on having an otherwise satisfying sexual relationship with your boyfriend. Now let#39;s see if we can#39;t help you find a way to make it as satisfying as you would like. br There are a few things you don#39;t say here, so I#39;m going to make some assumptions. First, that your boyfriend was in your life prehysterectomy; second, that you can#39;t experience orgasm during sexual intercourse but you can experience orgasm with other forms of sensual and sexual stimulation; and third, that you had your uterus and cervix removed, but not your ovaries, since your sexual desire doesn#39;t seem to be affected. Removing the ovaries significantly decreases a woman#39;s production of testosterone, a key hormone involved in sexual desire or libido. br There is some evidence that removing the uterus and cervix, as is done during a total hysterectomy, can affect the quality and intensity of orgasm. That#39;s because the uterus as well as the vaginal muscles contracts during orgasm and because the nerve pathways that are involved in sexual response and orgasm with vaginal stimulation (pelvic, hypogastric and sensory vagus nerves) may have been cut or destroyed. br There#39;s also evidence that the cervix plays a major role in orgasm. First, it dilates to improve the likelihood of conception. Second, it is very sensitive to touch, so the pressure of the penis on the outside of the cervix can stimulate nerve endings that trigger an orgasm. In women who say this pressure is a trigger for orgasm, many find they#39;re unable to orgasm after hysterectomy. br One of the studies conducted on the issue of posthysterectomy orgasm found about one in five women reported fewer orgasms after a total hysterectomy. Additionally, other studies find significant differences in the frequency of orgasm in women who don#39;t have a uterus and/or cervix compared to women who still have those organs. br Ok, so now that you know there is likely a physical reason for your inability to experience orgasm during vaginal intercourse, what can you do about it One thing I#39;d suggest is learning to induce orgasm through the clitoris and/or quot;G spot,quot; the very sensitive area felt through the front of the vaginal wall halfway between the back of the pubic bone and the cervix. The G spot surrounds the urethra and swells when it is sexually stimulated. br For some women, the G spot plays an important role in orgasm and sexual pleasure; for others, it makes no difference. Additionally, some women find the only way they#39;re able to experience orgasm is with clitoral stimulation. You and your boyfriend might also try changing positions to stimulate your clitoris and G spot so you can have an orgasm. br You could also experiment with your hands and a vibrator to induce orgasm this way. In some women, the results of these efforts transfer to intercourse. br If you#39;re still unable to experience orgasm during intercourse, then I suggest you ask your boyfriend to stimulate you to orgasm manually before or after sexual intercourse, so you can still experience the pleasure in a way that provides you with satisfaction. br br
