What about sexually transmitted diseases?

With the diagnosis of a sexually transmitted disease (STD) such as Chlamydia infection, trichomoniasis, gonorrhea, pubic lice, genital herpes, human immunodeficiency virus, hepatitis, and syphilis comes much fear and anxiety. If you have an STD, not only are you concerned about the immediate health impact of the disease but also its potential to affect future childbearing capabilities and future sexual function.

Some women develop a phobia of sexual function as a result of contracting a disease from a partner. Others struggle with the concept of disclosure: when should you tell a potential partner of your history of herpes infection or warts (human papillomavirus) infection, for example? Still others who are unable to cope turn to support groups and seek out partners who also have the infection. Many tell heart-wrenching stories of disclosure with subsequent rejection from a once-believed understanding partner.

There is no clear-cut answer as to when it is appropriate to disclose personal information about a past infection; on your very first date or just as clothes are being taken off before the first sexual interlude may not be the best time, however. Disclosure is a personal decision and only you know if and when it is appropriate to discuss these issues.

After experiencing a sexually transmitted disease, many women must decide whether to introduce safer sex practices into a relationship. Women will often insist on condom use, and men often cite condom phobia or other concerns such as condoms affecting potency, erectile vigor, and sensitivity/allergy concerns. This may impart additional conflict on an already-strained relationship. Effective communication is the key. Understanding key issues and the medical basis for sexual diseases is important. If sexually transmitted diseases are contributing to your sexual complaints, discuss your concerns with your healthcare provider or sexual medicine specialist.

Raye comments:

Sexually transmitted diseases are definitely on the rise. I remember just about 10 years ago when I was in high school, sexually transmitted diseases were not what we were being educated or warned about; it was pregnancy. For single women in this day and age it is so frightening. Sex is scary! Protecting yourself is not only a must, but so is monogamy[1] and having a trusting relationship with anyone you are sexually active with. What scares me the most is not even condoms are 100%—you really need intimacy and a strong emotional bond with your partner!

If sexually transmitted diseases are contributing to your sexual complaints, discuss your concerns with your healthcare provider or sexual medicine specialist.

I have had a hysterectomy! How can I get help?

A total hysterectomy, which is the surgical removal of the uterus, ovaries, and cervix, is the most common nonobstetrical surgical procedure performed in the United States. There is considerable interest concerning the sexual ramifications and implications after this very common operative procedure. Many feel that the cervix is necessary for excellent sexual satisfaction, and some researchers are now asking a hard question: Should women opt for a supracervical hysterectomy, which leaves the cervix in place to better preserve sexual function? Clearly, some women do have sensation in their cervices and feel them when they have penetrative intercourse; in such cases, a complete and frank discussion with your healthcare provider and surgeon is warranted. A few women describe orgasmic changes after removal of the cervix and uterus.

However, many well-designed medical research studies and published studies fail to provide a solid link between total hysterectomy with cervix removal and sexual complaints. Many studies do show the opposite and even demonstrate an improved sex life after the organs are removed. No study is perfect and obviously many women undergo hysterectomy for debilitating symptoms like severe pelvic pain and enlarged fibroids that are affecting bowel or bladder health. When the hysterectomy is performed and symptoms have resolved, and patients are suffering less, this may translate into better sexual activity.

If you are planning to undergo a hysterectomy, discuss your concerns regarding sexual activity with your healthcare provider before the procedure. Ask questions and have them answered. Seek out healthcare professionals who will listen to your concerns about sexuality and quality of life.

What will happen if I have my ovaries removed?

The ovaries produce hormones, and when you are cycling the ovaries produce an egg each month that can be fertilized. The ovaries are also subject to a variety of diseases such as cysts and cancer. Many women fear ovarian cancer. It is a serious, deadly disease that does not have specific early symptoms, and by the time there are obvious symptoms the disease has usually progressed to an advanced stage. Although the medical profession has made strides in treating ovarian cancer, the survival rate is not substantial with advanced disease and recurrence is very probable. Some women have taken the serious step to have their ovaries removed after childbearing, and others who have genetic predispositions to developing ovarian cancer also have opted for risk-reducing removal of the ovaries.

The ovaries are also subject to a variety of diseases such as cysts and cancer.

Even after menstrual periods have stopped, the ovaries have been known to produce testosterone. Some researchers are now investigating the postmenopausal ovary and its endocrine functions. If you are not menopausal and you suddenly remove your ovaries, you will experience sudden menopause—not only hot flashes and vaginal dryness, but emerging data also suggest cardiovascular, bone, sexuality, and even some memory issues.

Robson and associates at Memorial Sloan Kettering Cancer Center published an article in Gynecology Oncology titled "Quality of Life in Women at Risk for Ovarian Cancer Who Have Undergone Risk Reducing Oophorectomy." This is the largest study that examined quality-of-life concerns for a subset of women who underwent a risk-reducing bilateral salpingo oophorectomy (RRBSO) as part of a risk reduction strategy to decrease ovarian cancer risk. Questionnaires including a sexual function questionnaire were completed at a mean of 23.8 months after surgery. Estrogen deprivation symptoms such as vaginal dryness, painful intercourse, and dyspareunia continued to be bothersome. Patients continued to have considerable distress about sexuality and even worried about developing ovarian cancer in spite of the risk-reducing surgery. RRBSO is a beneficial intervention that reduces ovarian cancer risk; however, from this provocative study, you can see that this simple surgical intervention has serious long-lasting side effects that cause patients personal distress. It has a profound impact on quality of life concerns, especially sexual function. The surgery may not even lessen the patients' anxiety for developing ovarian cancer. This study along with others in the medical literature reiterate the long-held belief that we must strongly consider lasting ramifications from any surgical intervention. Have a frank discussion with your surgeon about side effects and possible sexual side effects from the surgery.

  • [1] Sexually exclusive couple who do not have sexual relations with other people outside their relationship.
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