Am I the Only One? Health Talk for Ladies

Medical Mysteries: For Girls Only

Think you’re the only one? The Doctor addresses some common questions women have about their bodies. 1. Sometimes there is pressure in my crotch and it makes it uncomfortable to sit. It usually occurs the day after I have a wet dream. Is this similar to male ejaculation but with women?

Thanks for your courage in asking up. The answer is yes. A wet dream (nocturnal emission, as discussed here regarding men) does involve ejaculation, which simply refers to the discharge of fluid, and that’s what the “wet” part is about. In guys it is semen, and in women it is other normal fluids. Not every woman has wet dreams; and for those that do, the orgasm that comes with it can be dry. The uncomfortable crotch can come from engorgement of the pelvic blood vessels as well as the after effects of the event on the tissues involved – things can get a little swollen and sore for a short time. It’s not anything to be concerned about, unless you have pain that does not go away, and then a visit to your doctor might be a good idea.

2. Does sex hurt the first time? For men, often not. For women, it usually does, for a short while. This is because a woman’s labia and vagina have some stretching to do, which has generally not occurred to that degree before having sexual intercourse. The same can be true for men and their foreskins, but usually not to the same extent, again, usually.

As husband and wife tenderly grow together in their sexual oneness, these pains often resolve quickly. However, there are also problems of a medical or psychological nature that can be present that would cause pain that is not so mild and doesn’t fade away with further intercourse. Should that occur, it’s time to see your gynecologist or family doctor.

3. Will his penis fit in me? Will I be too small? Should I do anything to stretch myself?

The vaginal opening is made from muscles that contract or relax. When a woman gets aroused, the vagina actually increases in size, both in length and in width, to be able to accept an erect penis. Remember, you are made to be able to have a baby — the baby’s head, which is bigger than a penis, comes through that opening. However, there are women who are smaller and will experience pain the first few times.

When you first have sex, it can feel tight, so use lots of lubrication. But if you can relax and enjoy your arousal, it will not feel as tight. Over time, it won’t bother you at all. There is no need to stretch yourself beforehand.

It is always a good idea to have a gynecological checkup before you get married and have sex for the first time. If you still have questions about whether you are too small, your doctor can physically examine you and set your mind at ease.

4. Is there anything a doctor can do if sex is difficult and/or painful for a couple?

Yes, there are things a doctor can do. Painful intercourse, or dyspareunia, can have many causes other than just vaginal tightness, and the physician can perform a detailed history and careful physical exam to sort things out. Her gynecologist can get her set up with a dilation program to comfortably stretch out the vagina, if that turns out to be the main issue. In the mean time, using ample water-based lubricants (e.g., K-Y Jelly), pre-dosing with anti-inflammatory drugs (e.g., Ibuprofen, naproxen, etc.), gentle but plentiful foreplay, great communication, and lots of patience will help.

If you’re constantly trying new approaches and still have pain, consult your doctor to find out if there’s something happening that you’re not aware of. If you have issues such as sexual guilt, shame or trauma, it could be helpful for you to find healing in order to solve the problem of painful intercourse.

5. What is a pap smear for? When do I need one?

The Pap smear is a screening test for cervical cancer. Cells scraped from the opening of the cervix are examined under a microscope. You can read more about Pap smears here, at the U.S. National Library of Medicine.

The Doctor shares: Cervical cancer usually does not show up as nodules or hard spots or things one can feel, thus the need for regular pap smears once a woman becomes sexually active – precisely to identify pre-cancerous or cancerous changes early on that cannot be felt.

6. My gynecologist recommended that I should get vaccination against the Human Papilloma Virus. I am not sure about the nature of HPV, only that it is mainly transmitted through sexual intercourse. Does the vaccination make sense when two virgins marry and remain faithful to each other?

Excellent question. Human papillomavirus (HPV) vaccine is for girls 11-12 years old (but effective for ages 9 through 26) to help prevent cervical cancer and genital warts. It is given to boys and men ages 9 through 26 as well. Why give this vaccine to children we raise – or adults who have committed – to abstain from intercourse until marriage? Three main reasons: (1) our children/we cannot account for the past of their/our spouses, (2) the chance of sexual violence against our children/us, and (3) despite the best upbringing, our children/we might make bad choices (though we neither predict nor wish that).

If you are already married and both you and your husband came to the bridal chamber as virgins, the only reasons for the HPV vaccine would be protection from the virus in case of sexual  violence (rape) or infidelity. Having put all the cards on the table, the final choice of whether or not to get the vaccine is your own.

Check out the Center for Disease Control and Prevention’s page on HPV.

7. I’ve heard it said that all men have a high sex drive. Is the sex drive of a woman more or less the same?

Your question is a good one, on many levels. Men do standardly have stronger sexual drives than women. Men have the higher testosterone levels propelling stronger impulses for sex and aggression, the latter of which is properly directed toward the protection of wife and family. However, the degree of sex drive varies among men – it occurs across a spectrum from stronger to weaker. It also varies with advancing age. Dudes are not equally “in the mood.”

Women, likewise, have varying strengths of sexual drives across a spectrum – some more robust and others not. Though women as a whole average lower sex drives than men as a whole, that is not the full story. A man with a relatively weak sex drive can be the spouse of a wife with a relatively strong sex drive, thus leaving the man feeling behind the power curve.

Libido is not all
about hormones, either. Something as simple as being sleep deprived or not feeling well (like the proverbial headache) can quench the flames of desire with little trouble. Medications can interfere. Past traumas, painful intercourse, and/or negative views of sex can hinder as well. The more satisfied a woman (or man, for that matter) is with her (or his) life, marriage, family, communication, and so forth, the less inhibited the desire for sex. Conversely, when relationships and financial matters are severely challenged, it is hard to feel very animated about sex.

Much goes into the makeup of a sex drive at any given time, but the short answer to your question is that not all women are alike.

8. Can you become pregnant if your hymen hasn’t broken?

Yes. Pregnancy is not really related to having an intact hymen, so a broken hymen will not hinder your ability to become pregnant.

http://www.nlm.nih.gov/medlineplus/ency/article/003157.htm

9. I have never had an orgasm during intercourse. Is this normal?

Anorgasmia (inability to achieve orgasm) can have several causes: medications (certain antidepressants, antihistamines, or blood pressure meds), medical problems, hormonal issues, emotional/relational factors, past trauma, psychological components, and more. The treatment options vary with the underlying causes, but treatments do exist. Our team would add that there is also the common problem of husbands rushing intercourse and not adequately engaging their wife in enough communication and foreplay (hugging, cuddling, talking, touching, and so forth) for a woman to be ready for sex. This alone, can make it difficult for a woman to achieve orgasm; she’s simply not primed for it. This can generally be corrected by communicating with your husband, guiding him in what you want and need in the bedroom, focusing on foreplay. You may want to consult a sex therapist for insight if the problem persists.

http://www.nlm.nih.gov/medlineplus/ency/article/001953.htm

http://www.mayoclinic.com/health/anorgasmia/DS01051

http://www.nlm.nih.gov/medlineplus/ency/article/003157.htm

http://www.mayoclinic.com/health/painful-intercourse/DS01044

10. What are your thoughts on Female Genital Cosmetic Surgery?

Labia come in various sizes and proportions that are still normal even if not just the way you want them to appear. Part of the problem is the false standards of body image promoted in the media. Even medical publications and web sites can unintentionally give girls and women a false impression, especially if what is being displayed is not quite the same as what you perceive on yourself.

Another concern is young women rushing to cosmetic surgery to “fix” what is likely just fine in the first place. Anatomy changes with the years, often for the better. The risks – what can go wrong and how it might affect sexual function – with what is formally known as Female Genital Cosmetic Surgery (FGCS) is just not that well worked out yet. [1] FGCS is rarely required and should not be approached lightly.

So if your labia minora do stand out more than most, you are still normal, there is probably nothing wrong with you, and it is not likely to cause problems. It is a natural variation. On the other hand, if your labia often hurt, are easily infected, interfere with urination or menstrual function, are too frequently injured, or pose other recurring problems for you, a visit to a gynecologist is in order.

A final encouragement for you– The man who will marry and love you will also accept you as his own standard of womanly beauty: his wife. The proportions of your labia will not likely be much of a concern to him, despite what you may fear. Likewise, your future husband is probably sweating it out about some genital imperfection of his own that you just won’t care about. Be kind to yourself.

[1] http://www.ncbi.nlm.nih.gov/pubmed/21696338