WHY DO WOMEN

Women's sexual desires naturally fluctuate over the years. Highs and lows commonly coincide with the beginning or end of a relationship or with major life changes, such as pregnancy, menopause or illness. Some medications used for mood disorders also can cause low sex drive in women.

If your lack of interest in sex continues or returns and causes personal distress, you may have a condition called sexual interest/arousal disorder.

But you don't have to meet this medical definition to seek help. If you're bothered by a low sex drive or decreased sex drive, there are lifestyle changes and sexual techniques that may put you in the mood more often. Some medications may offer promise as well.

If you want to have sex less often than your partner does, neither one of you is necessarily outside the norm for people at your stage in life — although your differences may cause distress. Similarly, even if your sex drive is weaker than it once was, your relationship may be stronger than ever. Bottom line:

There is no magic number to define low sex drive. It varies among women.

Symptoms of low sex drive in women include: ● Having no interest in any type of sexual activity, including masturbation ● Never or only seldom having sexual fantasies or thoughts ● Being concerned by your lack of sexual activity or fantasies

Desire for sex is based on a complex interaction of many things affecting intimacy, including physical and emotional well-being, experiences, beliefs, lifestyle, and your current relationship. If you're experiencing a problem in any of these areas, it can affect your desire for sex.

Physical causes: A wide range of illnesses, physical changes and medications can cause a low sex drive, including:

Sexual problems. If you have pain during sex or can't orgasm, it can reduce your desire for sex.

Medical diseases. Many nonsexual diseases can affect sex drive, including arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases.

Medications. Certain prescription drugs, especially antidepressants called selective serotonin reuptake inhibitors, are known to lower the sex drive.

Lifestyle habits. A glass of wine may put you in the mood, but too much alcohol can affect your sex drive. The same is true of street drugs. Also, smoking decreases blood flow, which may dull arousal.

Surgery. Any surgery related to your breasts or genital tract can affect your body image, sexual function and desire for sex.

Fatigue. Exhaustion from caring for young children or aging parents can contribute to low sex drive. Fatigue from illness or surgery also can play a role in a low sex drive.

Changes in your hormone levels may alter your desire for sex. This can occur during:

Menopause. Estrogen levels drop during the transition to menopause. This can make you less interested in sex and cause dry vaginal tissues, resulting in painful or uncomfortable sex. Although many women still have satisfying sex during menopause and beyond, some experience a lagging libido during this hormonal change.

Hormone changes during pregnancy, just after having a baby and during breast-feeding can put a damper on sex drive. Fatigue, changes in body image, and the pressures of pregnancy or caring for a new baby also can contribute to changes in your sexual desire.

Your state of mind can affect your sexual desire. There are many psychological causes of low sex drive, including: ● Mental health problems, such as anxiety or depression ● Stress, such as financial stress or work stress ● Poor body image ● Low self-esteem ● History of physical or sexual abuse ● Previous negative sexual experiences ● Relationship issues For many women, emotional closeness is an essential prelude to sexual intimacy. So problems in your relationship can be a major factor in low sex drive. Decreased interest in sex is often a result of

ongoing issues, such as: ● Lack of connection with your partner ● Unresolved conflicts or fights ● Poor communication of sexual needs and preferences ● Trust issues

Most women benefit from a treatment approach aimed at the many causes behind this condition. Recommendations may include sex education, counseling, and sometimes medication and hormone therapy.

Dryness or shrinking of the vagina, one of the hallmark signs of genitourinary syndrome of menopause (GSM), might make sex uncomfortable and, in turn, reduce your desire. Certain hormone medications that aim to relieve GSM symptoms could help make sex more comfortable. And being more comfortable during sex may improve your desire.

Talking with a sex therapist or counselor skilled in addressing sexual concerns can help with low sex drive. Therapy often includes education about sexual response and techniques. Your therapist or counselor likely will provide recommendations for reading materials or couples' exercises. Couples counseling that addresses relationship issues may also help increase feelings of intimacy and desire.

Your doctor will want to review the medications you're already taking, to see if any of them tend to cause sexual side effects. For example, antidepressants such as paroxetine (Paxil) and fluoxetine (Prozac, Sarafem) may lower sex drive. Switching to bupropion (Wellbutrin SR, Wellbutrin XL) — a different type of antidepressant — usually improves sex drive and is sometimes prescribed for women with sexual interest/arousal disorder.

These medications aren't FDAapproved for use in postmenopausal women.

Healthy lifestyle changes can make a big difference in your desire for sex:

Exercise. Regular aerobic exercise and strength training can increase your stamina, improve your body image, lift your mood and boost your libido.

Stress less. Finding a better way to cope with work stress, financial stress and daily hassles can enhance your sex drive.

Couples who learn to communicate in an open, honest way usually maintain a stronger emotional connection, which can lead to better sex. Communicating about sex also is important. Talking about your likes and dislikes can set the stage for greater sexual intimacy.

Scheduling sex into your calendar may seem contrived and boring. But making intimacy a priority can help put your sex drive back on track.

Try a different sexual position, a different time of day or a different location for sex. Ask your partner to spend more time on foreplay. If you and your partner are open to experimentation, sex toys and fantasy can help rekindle your sexual desire.

Ditch bad habits. Smoking, illegal drugs and excess alcohol can all dampen your sex drive. Ditching these bad habits may help give your sex drive a boost and improve your overall health.

● Low sex drive can be very difficult for you and your partner. It's natural to feel frustrated or sad if you aren't able to be as sexy and romantic as you want — or you used to be. ● At the same time, low sex drive can make your partner feel rejected, which can lead to conflicts and strife. And this type of relationship turmoil can further reduce desire for sex. ● It may help to remember that fluctuations in the sex drive are a normal part of every relationship and every stage of life. Try not to focus all of your attention on sex.

Instead, spend some time nurturing yourself and your relationship. ● Go for a long walk. Get a little extra sleep. Kiss your partner goodbye before you head out the door. Make a date night at your favorite restaurant.

Feeling good about yourself and your partner can actually be the best foreplay. We

birth. In about 1% of births, this doesn’t happen.Q& A The doctor must reach into the uterus and remove the placenta for which you may need anesthesia. All women lose some blood during childbirth. A woman is more likely to lose a lot of blood if the labour is prolonged, the size of the baby is IAMINTHENINTHMONTHOFMYFIRSTPREGNANCY. MYPROBLEMIS that both my nipples are retracted. This will cause difficulty in breast feeding my baby. Is there any way by which I can big, when instrumental (vacuum, forceps) delivery was required, after twin deliver or when the placenta doesn’t pass out on its own. In very few women (less than 1%) a blood transfusion may be required after vaginal birth if the bleeding improve the situation before delivery? was excessive.

You could begin by catching the nipple between your ● thumb and forefinger and rolling it gently forwards. Repeat CAN I HAVEAN X RAYDONEDURINGPREGNANCY? this exercise daily. Alternatively there is a small plastic cup Though X rays are best avoided during pregnancy, a lot available that has to be put between the nipple and the bra depends upon why it is needed and how much beneficial it is with the mouth of the cup on the nipple. The negative pressure to you at this point of time. The further the area to be X rayed so created helps draw the nipple out in some cases. If this too is from your baby the less likely is it to cause harm. In any case fails, a nipple shield can be used to breast feet your child. You the abdomen is protected by a lead shield to avoid exposure will be taught how to sterilise and use it after delivery. of the baby to the rays.

IAMINMYTHIRTYSIXTHWEEKOFPREGNANCYANDHAVEBEEN diagnosed to be a case of placenta previa. The doctor has said that I will need a cesarean section and blood for the same. This has scared me for I know a lot of people who have had a cesarean section but did not need blood. Kindly enlighten me.

Occasionally the placenta is attached to the lower part of the uterus and is labeled as a low lying placenta as seen on ultrasounds done in the first half of pregnancy. As pregnancy advances, the uterus usually takes the placenta up with it. Only in a small percentage of cases it remains low - before the baby’s head. This can separate during sex, internal examination or during the painless uterine contractions that occur throughout pregnancy, leading to vaginal bleeding. The severity of the bleed depends upon the degree of placenta previa and the amount of separation and can cause grave complications. Usually a cesarean section is the best option for pregnancies with placenta previa and arranging blood beforehand in patients who are expected to bleed makes sound clinical sense.

COULDYOUPLEASETELLMEWHATHAPPENSDURINGVAGINALBIRTH?

Labor contractions increase in intensity and duration over a period of hours and slowly open the cervix. When the cervix is completely open, contractions help push the baby through the birth canal (vagina). Usually, the baby’s head comes out first, then the shoulders, followed by the rest of the body. You will be shifted to the labor room when the uterus is completely open (along with your birthing partner to offer support).

Some women (about 10-15%) need help getting the baby through the birth canal. A doctor may apply a special vacuum cup or forceps to the baby’s head to help the mother push the baby out. Many women get small tears around the vaginal opening. Sometimes the doctor will cut some tissue to make the opening bigger (episiotomy) which require stitches. The stitches will dissolve during healing. The area will be sore for a few days. Normally, the uterus expels the placenta soon after

IAMINTHE 8THMONTHOFMYPREGNANCY. MYDOCTORHASASKED me to perform Kegel’s exercises. How are they done and what is the use? Kegel’s exercises make the pelvic floor more elastic and strong so that the child can pass through it comfortably. This is that part of the body that holds the pelvic organs in place and is perforated by the urinary, vaginal and anal orifices. It is made of muscle and fibrous tissue, Lie on the back with knees bent and feet flat on the floor. Squeeze the two buttock muscles together. While doing this press the thighs firmly together and pull up as though preventing the passage of stool and urine. Count slowly from one to ten. Relax to the same number of counts. Do this 10 time each 3 times a day. You can do this exercise daily, even in the standing position, while cooking, washing, standing in queues etc. ●

IAMTHREEMONTHSPREGNANTANDTHEELDERSINMYFAMILYINSIST that I eat for two. As it is, it is becoming difficult to eat for one on account of the dyspepsia and the nausea. Please tell me what should I do?

One needs only 300 calories extra per day during pregnancy (equivalent to two and half cups of toned milk) so the question of eating for two does not arise, especially if the second ‘person’ is microscopic to begin with and grows to a maximum size of 3-4 kilograms.

PLEASETELLMEWHATISAPLACENTA?

The placenta is fleshy plate like structure that is attached to the uterine wall on one side and via the umbilical cord to the baby’s navel. It carries oxygen and nutrition form the mother to the baby and takes waste products and carbon dioxide from the baby to the mother. It is usually attached to the upper part of the uterus and is called the after birth in lay terms for it is delivered soon after the baby as its utility is over.

–Dr. A.K. Bajaj