A lot of us have heard stories told about the pain a woman will experience on her first night and the bleeding that might happen. As a result, fears and anxiety about not knowing what to do will cause a lot of women to experience some pain (Dyspareunia) or even inability to have a normal sexual life with their partner (Vaginismus).


Dyspareunia is defined as painful sexual intercourse can be external upon penetration or deeper in the pelvis. Each has its own approach medically.


Vaginismus is an uncontrollable spasm or involuntary contraction of the muscles around the opening of the vagina in women with no abnormalities in the genital organs. The tight muscle contraction makes sexual intercourse or any sexual activity that involves penetration painful or impossible.
Force is NOT the solution and problem won’t disappear suddenly. The couple should seek medical care.
Your gynecologist will make sure there are no anatomical abnormalities in the hymen, vulva or vagina.
If all is normal, you should know that the hymen has no nerve ending so it will not cause pain when torn. Pain comes from the muscles around it if they are tense and contracted and due to decreased lubrication.
This is why the solution is to learn how to relax and enjoy your body alone and with your partner.
If this cannot be done while comfortable then it’s essential to see a doctor for further help.
Communication between you and your partner is essential.


There is no one number, it can range from daily to once a month as long as both are satisfied and feel the same desires. Again, communication is what matters.
Sexual pleasure will come more and more with time. Some women might experience only clitoral orgasm and some might experience vaginal. This is all normal as long as both are satisfied.

How long should a couple try to get pregnant before seeking medical help?

For women younger than 35 years old with regular cycles and no history of major abdominal surgeries, a couple should give themselves a year before seeking medical help. For woman more than 35 years old after 6 months. For patients with irregular cycles, it is better to ask for your doctor’s help before trying to conceive.
It is essential not to stress, pregnancy might take some time to happen since the chance of conceiving per cycle is only 10-15%. What position used in intercourse is not important, and no, you do not have to rest on your back for 10 minutes afterward. Do not listen to stories and people around you, and talk to your doctor for any questions.

Premenopausal (More than 40 years old) and Menopausal complaints

A lot of women (50% of menopause and 15% of perimenopause) might complain of increased vaginal dryness and decrease in libido, because of a decrease in hormones, mainly estrogen and testosterone, and the fatigue and life stressors around them.
Decreased estrogen will lead to a dry vulva and vagina, decreased blood flow to the area leading to itching, pain on intercourse and decreased genital arousal and in general a very sensitive area.
Decreased testosterone will lead to fatigue, decreased sexual desire and satisfaction.
You should NOT feel shy to talk about this with your gynecologist.
Treatment that might be offered are lifestyle changes (increase flirting time, change sexual positions) lubricant use, moisturizers, localized estrogen therapy, laser treatment and in rare cases hormones replacement therapy such as estrogen/progesterone and testosterone (not FDA approved and a lot of side effects).

Other concerns:

Breastfeeding patients might also have similar complaints due to the decreased in estrogen because of the high prolactin level. Similar treatments can be offered.
Other patients who might complain of the same symptoms are breast cancer patients on hormonal treatment, or patients on antidepressants or undergoing radiation therapy.
Discuss these issues with your gynecologist, do not feel shy about them and weight the pros and cons of treatment if needed with your doctor.


It is a condition associated with a decrease in the male hormone testosterone. It is more gradual than menopause. As men age, the decrease in testosterone is responsible for male patterns causing physical and psychological symptoms.
Low sex drive, difficulties in erection, depression, lack of energy, loss of muscle mass and increased body fat.
In addition, there is an increased risk of cardiovascular diseases and osteoporosis.
If this is affecting your life talk to your doctor about it. Testosterone treatment might be offered for selected patients (not breast cancer or prostate cancer or with enlarged prostate or interested in having children or kidney or heart disease). Pros and cons need to be checked with your doctor. Please DO NOT take testosterone treatment without consulting your doctor.
Patients with high prolactin, diabetes, and hypertension may complain of similar symptoms, therefore you should always rule out medical conditions before labeling yourself with andropause.

Nutrition and your sexual health:

Good sexual health has a lot to do with good cardiovascular health. This is why the same guidelines apply to both!
Foods to include in your diet:
1- A variety of fruits and vegetables
2- Wholegrain and fibers (oat, quinoa, beans…)
3- Healthy oils (olive oil, avocado…)
4- Seafood
5- Nuts and seeds (raw almonds, cashew, walnuts, pumpkin seeds…)

Libido enhancers:

Zinc has been linked to increased libido and is found in seafood and other foods such as:
Oysters- Crab – Lobster- Pine nuts
Nutrition for proper erection:
Many nutrients contribute to a proper sexual experience, among them:
Berries- citrus fruits- red wine- red peppers- chocolate- tea
Nitric oxide:

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