Sexual Health Concerns in Nagpur

No. Discomfort the first few times, or occasionally with dryness, is common, but recurrent or persistent pain with intercourse is a medical symptom and it affects an estimated 10 to 20 per cent of women. It has a physical cause more often than not, and the cause can usually be identified on examination. Being told that it is normal, or that it will settle after childbirth or with time, is the reason many women live with it for years.

No. Dr. Kunda sees women for these problems regardless of marital status, and no explanation is required for wanting to be seen. What is examined is decided with you, and an internal examination is not always necessary.

Not without your consent, and not necessarily at all. What is examined depends on what the problem is. Where an examination will change the answer it is explained first, you are told what is being done as it is done, and you can stop at any point. Where penetration is itself the problem, nothing is forced — the assessment proceeds at your pace, over more than one visit if needed.

This is one of the commonest reasons women come to this page. A normal ultrasound does not exclude a physical cause: pain at the vaginal entrance, pelvic floor muscle pain and endometriosis are all frequently invisible on a scan and are identified by history and examination instead. Pain that has been present for a long time also changes the muscles around it, so a problem that began as an infection can continue long after the infection has gone. That is a physical process, not imagination.

Yes, and it is one of the first things to exclude, because it is treatable and because untreated infection can go on to cause other problems. Where an infection is possible, swabs are taken and treated on their own merits. Two related pages cover this in more detail: vaginal infections, for discharge and itching that keep coming back, and STD and STI testing, where a sexually transmitted infection is the concern.

It can be. Reduced desire is treated here as a symptom to be investigated rather than something to be accepted. Thyroid disease, anaemia, diabetes, depression, exhaustion, several common medicines and the hormonal changes around the menopause all reduce desire, and so does sex that has been painful — avoidance follows pain very quickly and is easily mistaken for lack of interest. The assessment looks for a treatable contributor first.

Most often because of the genitourinary syndrome of menopause. Falling oestrogen makes the tissues of the vulva and vagina thinner, less elastic and less lubricated, which causes dryness, discomfort and sometimes a sensation of narrowing, frequently with urinary symptoms as well. Unlike hot flushes it does not settle by itself with time, and it tends to progress if it is left alone. It is also very treatable.

NICE recommends offering vaginal oestrogen to women with genitourinary symptoms of the menopause, including those already on systemic hormone therapy. Serious adverse effects are very rare, and the amount absorbed into the bloodstream is minimal compared with systemic hormone therapy, so it is unlikely to have a significant effect elsewhere in the body. Symptoms usually return if it is stopped, so it is continued for as long as it is needed and reviewed regularly rather than given as a fixed course. Dr. Kunda decides whether it is appropriate for you after examination.

It should always be assessed rather than watched. Bleeding after intercourse can come from something minor such as a cervical ectropion, an infection or thin dry tissue after the menopause, but it can also come from a polyp or from a change on the cervix, and that possibility is the reason it is never ignored. Assessment includes examining the cervix and, where indicated, a Pap smear or colposcopy. Bleeding at other times — between periods, heavier periods, or any bleeding after the menopause — is assessed on the abnormal vaginal bleeding page.

Where he needs to be treated as part of your treatment — most commonly with an infection that passes between partners — that is arranged as part of the same plan. Where the difficulty is his own, it sits outside a gynaecology practice: men are seen here as partners of women under Dr. Kunda’s care rather than as patients in their own right, and he should see a physician or a urologist for assessment. It is still worth raising in the consultation, because working out which half of the problem sits where is often what gets a couple unstuck.

It depends entirely on the cause. An infection or a skin condition may resolve within a course of treatment. Dryness after the menopause usually improves over several weeks and continues to need treatment thereafter. Pain that has been present for years, with muscle guarding built on top of it, improves in stages and is reviewed rather than treated once. You will be given a realistic expectation at the first visit rather than an optimistic one.

The consultation is with you. Nothing is discussed with a family member or a partner without your permission, including with someone who has accompanied you, and clinical records are held confidentially at the clinic. If you are worried about a particular person finding out, or about a report reaching your home, say so at the beginning of the consultation so that it can be handled accordingly.