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Medical Director
Women's Health & Breast Center at St. Francis
Federal Way, Washington
My wife says that we can’t have sex while she is on her period. She’s concerned about infection. I understand this may not be the best time for her, but is there any good medical reason not to have sex at that time? Are there any health risks for a woman having sex while on her period?
There are no medical reasons to avoid sexual intercourse during a woman’s period; however, many women are uncomfortable both physically (with cramping and bloating) and psychologically. In addition, there can be some challenges avoiding blood staining of sheets/clothing. For some women, orgasm during their menstrual period will actually reduce the uterine cramping and pain, while for others pain may increase with sexual activity. There is no particular infection risk associated with intercourse while a woman is bleeding other than the obvious risk for transmission of blood-borne diseases such as hepatitis C and HIV.
I have been married to my husband for 18 years and we have three children. Our sex life about a year ago was great. Now my husband says he loses feeling when we’re having intercourse. Could having our third child, who is now 4, have caused my vagina to stretch or change in any way? I am 37 and would like sex more often. I feel no different. He no longer seems interested in sex and only does it when he sees I’m getting frustrated or it’s been a long time. It used to be three to four times a week and now it’s once a week or less. I’m very frustrated. Is there anything I could get checked to see if something is wrong with me?
If your sex life a year ago was great—three years after the birth of your last child—then any changes that may have occurred with childbirth are not related to your husband’s current problem. Lack of sensation with sex may be physical lack of friction (unlikely) or it may be that he is under stress or feeling depressed, both of which can decrease pleasure in sexual activity. At times, a man will begin to have some erectile dysfunction—not enough to prevent penetration, but enough to decrease his sensation during intercourse. You can enhance your muscle tension by practicing the Kegel exercises, but I think that a frank discussion with your husband about what is really going on for him may be the best approach. He may feel financially stressed, trapped in a difficult job or have some other issues that are interfering with his enjoyment in life.
What can I do to improve my desire for sex and my ability to reach orgasm at age 60? I have a loving partner of two years. I have tried a testosterone compound through my gynecologist, and it helps a little. What other suggestions do you have that will help? Any good books on the subject?
The desire for sexual activity is directed by our thoughts and feelings and very little by our hormones. Having said that, when postmenopausal women experience pain with intercourse related to vulvar and vaginal dryness, the pain can and should reduce our desire for sexual contact. Be sure that your tissues are well-estrogenized. This can be done with topical estrogen creams or preparations that deliver very low levels of hormone—not usually enough to be risky. Topical estrogen also increases blood flow and engorgement of the tissues, which increases sensation and should improve orgasm. It’s important for you to recognize any psychological barriers you may have to a full sex life, including any past history of physical or sexual violence. Women typically feel desire for sexual activity when we want intimacy from our partner. If there have been situations in your life where intimacy resulted in violence or pain, this could quickly squelch desire. A good book to try is Making Love the Way We Used to … Or Better: Secrets to Satisfying Midlife Sexuality by Alan M. Altman, MD, and Laurie Ahsner.
If the clitoris hangs below the vaginal lips, does it mean that a woman is highly sexual? Or does it mean that there’s something wrong? Was it meant to be a penis? I’m worried that it’s maybe not as desirable to a man. Could be it be larger/longer at different times? Is this a cause of concern?
The clitoris is a small nubbin of erectile tissue that does increase in size (just like the penis) during sexual arousal. It is covered by a variable amount of skin tissue where the two inner lips join and become the “hood” of the clitoris. This covering skin tissue is quite variable in size and configuration. Indeed, the clitoris is the female equivalent of the penis. If you have questions about your anatomy, you should discuss this with your physician. There is no medical cause for concern here.
I had a total hysterectomy. When can I have sex with my husband again? Do I need to worry about infections? Also, now that my cervix isn’t there, does that affect our sexual relationship?
Total hysterectomy means removal of the uterus with the cervix. This procedure entails an incision at the top of the vagina, which needs to heal prior to resuming intercourse. However, sex with your husband without vaginal penetration is fine whenever you’re comfortable. I always tell my patients and their partners to get creative and have some fun in the six weeks or so after surgery that vaginal penetration should be avoided. After four to six weeks, your surgeon should examine you to determine how well the vagina is healed, and then he or she can tell you when intercourse is OK. The absence of the cervix has not been shown to have any effect on sexual sensation for women or their partners. There was an excellent study done in which half of the women had total hysterectomies while the other half had sub-total hysterectomies with preservation of the cervix. The women weren’t told which procedure they had. Sexual function after surgery was determined by good sexual function was before surgery and had absolutely nothing to do with the cervix removal or preservation.
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with Barbara Levy, MD
