Dr. Sharmila Majumdar

Having irregular bleeding while trying to have a healthy sex life can be stressful, because you never know when you're going to have bleedingWomen with pcos shouldn't be afraid to seek help if they're having trouble with their sex lives.Most women with pcos only seek out medical or psychological help if they're trying to conceive.

Pcos is a complex female health issue. It consists of many different health concerns and risks. If permanent diet and lifestyle changes are implemented, these risks and health issues may become obsolete. There are many ways to support the proper health of a woman's body that is dealing with pcos.

Important key tips-

1. Make sure your doctor performs the correct tests and you get a proper diagnosis.
2. Follow a pcos specific diet to help decrease insulin resistance, balance weight, and improve estrogen metabolism.
3. Promote hormonal balance and support regular ovulation through supportive herbs and supplements.
4. Support a proper inflammatory response.
5. Stick to your plan, believe in yourself, only you have the ability to change your circumstances! and quite likely conceive your bundle of joy.

How to manage pcod to achieve pregnancy? 

Infertility is one of the most stressing factors in women`s life and it may influence their satisfaction and quality of life . In our study all the patients were infertile which may have impaired their sexual function that could justify the high prevalence we found. The majority of our patients had menstrual irregularities which reveals their hormonal disturbances.Pcos patients markedly suffer from sexual dysfunction as comorbidity. It seems appropriate to screen all pcos patients for sexual function.

When women with pcos are trying to have a baby, intimacy can go from" the joy of sex to the job of sex" since conceiving can often involve scheduling sex during the times they're most fertile.Women also might be taking fertility medication that can affect their libido.

Understanding and addressing female sexual dysfunctions

Whether the woman is willing to deliberately find or be receptive to sexual stimuli, depends on any factors that affect her motivation, many other factors will influence her arousability, notable the processing of sexual information in her mind. Both psychological and biological factors are involved they are inherently blended. External and internal stressors alter the immune system, neurological and hormonal physiology.If the woman becomes aroused and desires and she finds the state enjoyable, the arousal may increase in intensity and she senses a need for sexual satisfaction. If the outcome is positive both physically and emotionally, future sexual motivation is increased. This type of cycle underscores the biopsychosocial nature of sexual function of a woman and thereof dysfunction which is important for understanding the potential treatment protocols in female sexual dysfunctions.

Since it is impossible to specify with any degree of precision when a â sexual problem or complaint should be diagnosed as dysfunction, it is crucial that the clinics judgment be taken into account in addition to the womens report of distress. Contextual and interpersonal factors must be considered in order to make a complete diagnosis.

Importance of addressing sexual complaints with a physician

sexual complaints may be the result of:

• medical conditions
• medications with sexual side effects
• psychological and interpersonal issues

Intimacy based female. Sexual response cycle

So what is female sexual dysfunction?

Female sexual dysfunction involves any problem from any phase of sexual response cycle that prevents an individual or couple from experiencing satisfaction from sexual activity. It includes disorder of desire, arousal, orgasm and pain.

Categories of female sexual dysfunction

• Prevalence of female sexual dysfunction
• Fsd risk factorshypertension
• smoking & substance abuse
• hyperlipidemia
• previous pelvic surgery
• past psychological trauma

Causes of female sexual dysfunction

Medication that may adversely affect sexual function

Certain medical conditions can increase the risk

• Condition-effects on sexual function
• depression-decreased desire
• diabetes-impaired arousal and orgasm
• thyroid disease-decreased desire
• cardiovascular disease-impaired arousal
• neurologic diseases-impaired arousal and orgasmâ 
• androgen insufficiency-decreased desire 
• estrogen deficiency- impaired arousal

Comprehensive sexual assessment

• Nature of problem
• duration of problem
• primary or secondary
• situational or generalized
• relationship problems
• stressors
• sexual problems in partner
• history of physical, emotional, or sexual abuse

General treatment guidelines

• Education -anatomy, sexual function, effects of pregnancy, menopause & aging
• enhancing stimulation -erotic materials, encouraging communication during sexual activity
• distraction techniques - fantasy, kegel exercises with intercourse, background music or television
• encouraging non-coital behaviours, sensate focus exercise
• minimize pain - positional, lubricants, warm baths,biofeedback, prior to  intercourse
• treatment depends on the cause, if organic, appropriate medical/surgical interventions along with sex counselling. If psychogenic  then¨psychotherapy/sex therapy/ marital therapy or cbt can be used.
• lifestyle modification should be included in all cases.

Determinants of sexual desire in women

• reproducible measurement devices and instruments for evaluating physiological female sexual response
• clinical trials of vasoactive agents ¨and other medical treatments
• physician awareness and competency in female sexual dysfunction

Treatment option on the horizon

• androgens
• prostaglandins
• nitric oxide delivery systems
• dopamenergic agonist
• flibanserin (addyi)
• drugs useful for reducing pain in¨sexual pain disorder (gabapentin)

Holistic approach for management

Most successful treatments for fsd are psychophysiological, physiological change circularly interacts with  psychological change. The many psychological factors that motivate a woman to begin her sexual experience must always be kept in the forefront.Since a psychological treatment does impact sexual physiology,we need to continue to develop psychological approaches for intellectual interest and out of respect for the choices of patients preference.Prescription of a physiological treatment which ignores the ¨fact that human sexuality is infused with individual meaning may invite further interference with sexual functioning. 

One of the biggest impacts on people's sex drive is their diet and lifestyle.

Get your sex drive back today with these tips.

1. Get a taste for the mediterranean-Those who eat a mediterranean style diet with plenty of fresh fish, fruits and vegetables, oily fish and seafood, nuts, seeds and pulses tend to have healthier hearts.

2. Missing meals results in low blood glucose levels, which in turn leaves you feeling tired, hungry, irritable and perhaps not in the mood for some lovin'tonight.

3. Ditch the junk food-We are increasingly relying on processed convenience foods, rather than fresh, whole foods - lots of fruit and vegetables, lean meat, wholegrains, low fat dairy products, nuts and seeds - which can affect your nutrient intakes. Processed foods often contain trans fats, refined sugars and high amounts of calories, which, over time can make you overweight and affect your confidence. The better your diet, the better you'll feel about yourself.

4. Get to a healthy weight-Obesity can cause hormonal imbalances in both men and women, which can interfere with your libido. The more overweight you are, the more likely your libido is going to be affected and obesity is also a risk factor for erectile dysfunction.

5. Fill up on fruit and veg-Make sure you get your 5-a-day. Fruit and veg are packed with antioxidants, vitamins and minerals. No single fruit or vegetable contains all the nutrients you need for health and sexual health, so it's important to eat a wide variety rather than sticking to the same ones.

6. Ditch the stress-Libido is easily affected by stress and anxiety. Stress and other unhealthy lifestyle habits, like smoking and too much alcohol can deplete nutrients in our bodies – all of which can potentially have an effect on our libido. Try to have a positive mental attitude and keep calm. Stress can also cause cortisol to be pumped into the body and high levels have been shown to promote the storage of fat and weight gain over time (particularly around the midriff).

7. Watch the booze-A little tipple can help sometimes get you in the mood and make you relax, but relying on it to improve your libido is counterproductive, as it's a depressant, is highly calorific and can cause'brewer's droop' - a temporary form of impotence that occurs when the drinker consumes one too many.

Dyspareunia pain during colitis 

A lot of women experience pain during sex. A recent swedish survey suggested that it occurs in 9.3 per cent of women, with the incidence being higher among the young and inexperienced, and relatively low among the over-50s.However, quite a few over-50s suffer this sort of pain because of hormone problems, and a new drug has recently been invented to help that particular group of women.In 2015, research published in the the british journal of obstetrics & gynaecology revealed that women who have had an'operative' childbirth are much more likely to suffer subsequent pain during sex. An'operative' delivery is one in which there is some sort of surgical intervention, such as the use of forceps or of a ventouse (vacuum) extractor or else a cut to enlarge the vaginal opening (episiotomy). Rather surprisingly, painful sex is also more common in those who have had a caesarian birth.

One piece of good news which emerged from this research is that dyspareunia after childbirth tends to get much better over the next 12 months.It's not much fun having pain during intercourse, is it? after all, sex is meant to be an enjoyable and happy experience. If you get pain, it isn't.Fortunately, the trouble will often resolve if the man takes more time with love play so that the woman's vagina relaxes and her natural lubricant flows, and if the couple use one of the newer sex lubricants like eros or liquid silk.

When to seek help

You can safely disregard one isolated episode of pain during sex. After all, it's easy to feel pain when a sensitive part of you is being prodded quite hard.But if the pain keeps on happening, you shouldn't feel you have to put up with it. Get something done to improve things.

 

Spots on a men private part 

Men are often very worried when they find spots on their penises. In this article, we'll describe the different types of penile spots and their colors that you might find. Penile spots are not usually a sign of anything very serious. But nearly always, it's a good idea to show the spots to your sexologist. Please bear in mind that most penile spots that you might find there are likely to be completely harmless. But some aren't! It's understandable that men can be very concerned if they notice spots on their penis.

Men also get alarmed about the sometimes rather unpleasant physical appearance of a spotty' penis, and what their sexual partner or partners might think of it. This is quite understandable. However, very tiny and harmless bumps' and spots on the penis, alarming though they may be, they are unlikely to be noticed by a sex partner.

Where could one seek medical help?

If you're concerned about a spot (or spots) on your penis, please ask a sexual medicine specialist doctor to have a look at it.

Now let's look at some really common penile spots:

• Fordyce spots
• White or yellow spots on your penis

These are tiny white or yellowish spots, found on the head of the penis or the shaft. If your skin is brown or black, they may look more prominent. They are normal. They're minute sebaceous glands and are just part of the natural structure of many penises. Many men also have them around their lips. Fordyce spots are not sexually transmitted and they don't do any harm. There's absolutely no need for any treatment.

Hair follicles
As you know, virtually all men have quite a few hairs growing around the base of the penis. And often, the hairs extend some distance up the underside of the organ. Human hairs grow out of a tiny'pit, which is called a follicle. And very frequently, the follicles on the penis may be quite prominent. This is nothing to worry about and no treatment is needed.

Septic spots (Pimples on your penis)
Obviously, people do often get pimples, or'septic spots' on their faces and on other parts of the body. They're particularly common in young adults. Sometimes a small pimple appears on the penis. This is not a serious matter and no treatment is needed. Do not squeeze the spot, because you may spread infection. Don't have sex with anyone till it's completely gone. However, if something that you think is a pimple hasn't gone away within a week, ask a doctor to check it out.

Genital warts
Pink, brown or black spots on your penis
In contrast, genital warts do need treatment. And they are transmitted by sexual contact. They are pink, brown, ivory-coloured or black. Occasionally, they grow out of the opening at the tip of the organ. They are caused by one of the human papilloma viruses (hpv), which like living in warm, moist parts of the human body. Genital warts are easily passed on during vaginal, oral or anal sex.

It is strongly recommended that you go to a sexologist if you suspect you have genital warts, partly to make sure that your diagnosis is correct.

Treatment is either by application of special creams, or else by removing the wart altogether – for instance with an electric probe or laser. This is virtually painless.

Do not have sex until the doctor says that you are completely cured.

1. With sex, aim for quality over quantity. When spouses don't get busy regularly, they can lose physical connection.
2. Write about your fights. Researchers believe it's because the writing group was able to glean new insights about the disagreements or better understand their spouses after they'd reflected about them on their own. Next time you argue with your man, try writing down the details from a neutral standpoint. You might notice something you missed in the heat of the moment.
3. Hug for 2 minutes and kiss for 30 seconds each. Oxytocin, a chemical our bodies release when we touch one another, emotionally connects people" no need to set a timer, but do extend your hugs and kisses longer than you normally would; you'll feel a new sense of connection.
4. Take a walk together. If you're trying to decide how you two should handle your daughter's poor report card, hit the pavement. Not only will the fresh air clear your minds but also" the very act of walking in the same direction can help you two feel as though you're on the same team and want the same result. Physically heading to one place makes you more likely to be mentally in sync; it's like you're standing together instead of confronting each other.
5. Sit next to each other at restaurant tables. You may be inclined to take a seat across from your partner, but "it's a more aggressive stance" after all, it's how you and a prospective employer sit during an interview. Next time you're out, try grabbing a booth or putting separate chairs at a table side by side. Instead of playing footsie under the table, your man can slide an arm around you or touch your knee, while you can whisper in his ear" it's a friendlier and much more intimate position.
6. Jot down your guy's sweet deeds. Maybe he filled up your gas tank without you mentioning it was getting low, or brought you flowers for no good reason. Once a day for a week, secretly write down something your man did that touched you" many times, especially in long-term relationships, the little things our partners do for us get overlooked, which eventually makes the man resentful. Keeping a list helps you feel grateful for the daily blessings of marriage, and sharing that list at the end of the week with your spouse makes him feel appreciated.

The honeymoon period in most marriages has a shelf life. But does that mean you can't bring back those fluttery butterfly feelings of excitement and anticipation everyone experiences at the beginning of a relationship? Absolutely not. All marriages maneuver through rough patches. Some don't survive long enough to come out the other side unscathed. But many do. Here are 11 ways to keep your marriage fresh.

1. Remind your partner (and yourself) that you appreciate them.

After you've been married for many, many years, that passionate kiss when your partner walks in the door can easily morph into a peck on the check that can then morph into an inability even to look up from your. Studies show that nearly half of men who have cheated say it was because of emotional dissatisfaction -- and not sex. When men don't feel connected or appreciated by their wives, they are vulnerable to the advances of any attractive woman who casts a lustful glance their way. And fellows, it works the other way as well.

2. Say thank you for the little things

Playing tit for tat is childish and will do nothing but chip away at the trust and connection you've built with your spouse. If you are so inclined, keep score of all the positive things your partner does in a day -- and then thank them. Hopefully they'll get the hint and do the same for you.

3. Practice honesty, even when you're ashamed.

Although infidelity usually happens in bed, it also can happen with money. And it will be a tough road gaining back your spouse's trust if you've lied about overspending.

Along that same vein, if you feel you aren't connecting with your partner the way you used to, you need to say something -- now. If You don’t kep telling yourself that things would get better on their own, couples might not have reached what I call the danger zone.

4. Take care of your appearance.

With many years and a few kids under your belt, it's easy to let your appearance slide. Think about when you first met your partner. Would you have walked around in stained nightdress and without brushing your teeth? My guess is no. But I've seen too many couples transform from Well groomed men and women with shabby ones-- with disastrous repercussions.

Sometimes you must compliment your spouses.

5. Foster relationships outside your marriage.

"time apart."  At times It gets romantic because even the conversations on the phone get more romantic. You need some distance,” And space once in a while.

Your marriage should be your primary relationship -- but it needn't be the only one.

6. Watch your words.

There are many things you should never say to a longtime spouse, the first being: "Don't you think our new neighbor is attractive?" That's a question you just think you want to know the answer to. It's also never a good idea to start a sentence with: "You know it's always been your problem that..." Who wants to hear that from their partner? We hopefully all have a pretty good sense of ourselves at this point and having someone you love point out a failing in this way does little to engender a loving relationship.

"You always..." or "You never..." Think about it. Neither of these is true. If you start a sentence with these words your spouse is certain to shut down or start a fight. Stop for a minute and think about what you really mean to say -- and then say that instead.

7. Put away the jumper cables yourself

Most of us have problems that are more like petty and repeated annoyances, which when fed the steroids of resentment and anger, balloon up.
Most of our problems start out small enough -- he borrows the jumper cables from your car and then leaves them sitting in the driveway just waiting to get run over -- and from that sprouts a giant festering sore. It leads you to utter words like, "If you loved me you would have put the jumper cables back in my car so that when I get stuck in a bad neighborhood with a dead battery I could save myself," which, in my household, generally results in a reply like "When do you ever drive in bad neighborhoods?"

It is the small annoyances that, if left unaddressed, do us in. For a happier marriage, address them right away and keep it simple. "Honey, did you put jumper cables back in my car?"

8. Relish the silence.

Sometimes the best way to address a problem is to just walk away from it -- as in seriously let it go. Not every slight must be addressed. Know that not every insult is intended. Practice letting go as much as you can. Forgive more. Forget more. Bite your tongue until the tip bleeds. And once in a while, remind yourself of why you married this person. Focus on those reasons and let stuff pass without mention.

The trick to successful silence, however, is that you really let the problem pass. If you stay silent and still harbor bad thoughts, well, that's where ulcers come from.

9. Recognize the ebb-and-flow.

Relationships aren't flat-lined; that's death, actually. Life has ups and downs, peaks and valleys. We all go through periods where the mere thought of life without our partners can bring tears to our eyes and then a week later we can't stand the sound of their breathing next to us. We've all been there. The trick is knowing that you won't stay in either place forever. Truth is, in a marriage, you spend most of your time in an emotional middle ground. It's not songbirds chirping, nor is it considering which poison in his pasta will cause the most painful demise.

This middle ground isn't the couple who sit in the restaurant across from one another without conversing. Those people have actually flat-lined and just don't know it yet. No, the middle ground is when months meld into years and you know what the reaction will be before you say something. It's when the book you finished last night just migrates automatically to the nightstand on his side and he tells you about the recorded "Modern Family" episode you slept through. It's the every day ebb and flow without the waves.

10. Be kind.

We tend to take advantage of those we love the most -- probably because we know they love us and we can get away with it. It's the old kick-the-cat syndrome. You have a bad day at the office and come home and take it out on your mate. A much healthier pattern is to start out each day by asking yourself, "What can I do today to make my partner happy?" And mean it. Doesn't it make more sense to put your best face on for someone you love? Look for ways to say "yes." This rule applies to parenting as well, but in a happy marriage, people are busy trying to please each other. That sometimes means sitting through endlessly long ball games, putting on a tie, watching a horror movie with your eyes closed, and traveling around old Civil War battleground sites when you really wanted to be vacationing on a beach in Goa. It's doing things for your partner.

11. Maintain intimacy and passion, both inside and outside the bedroom.

Intimacy isn't just sex and passion isn't just doing it on the kitchen counter. Bedroom habits age along with the marriage. There may be no stronger aphrodisiac than a moonlight walk on the beach that ends in a kiss. There may be no greater display of passion than the zeal of a partner in a hospital room trying to get the nurse's attention for an ailing wife. Don't let others define what is a "normal" or "healthy" amount of sex for your marriage. Know that things change, but that doesn't make them less exciting or fun. And intimacy comes in many shapes, including conversation and cuddling.

Men who follow the mediterranean diet, which focuses on whole foods such as beans, fruits and vegetables, nuts, olive oil, and whole grains, are less likely to experience erectile dysfunction, according to a meta-analysis appearing in the journal of sexual medicine.

Mediterranean dietary plan contributes to the prevention of erectile dsyfunction through a variety of features, including an improvement in glucose metabolism and lipid levels, increased antioxidant potency, and higher arginine levels, which in turn could boost nitric oxide activity and thus improve erectile function.

The mediterranean diet is one of the most heart healthy diets on the planet and studies have shown that it both helps existing and prevents future erectile dysfunction. The well-known lyon diet heart study showed that after an average follow-up time of about four years, patients following the mediterranean-style diet had a 50 70 percent lower risk of recurrent heart disease. That's great news for your heart and your sex life!â this was re-verified by italian researchers who tested the erectile-improving capacities of the mediterranean diet on men with metabolic syndrome and found that it significantly improved their erectile capacity. 

The mediterranean diet also has also been shown to dramatically reduce the risk of dying from cancer and heart disease. Nuts, olive oil, legumes, cereals, fish, red wine, fruits and vegetables, unsaturated fat, low intake of dairy products, no intake of red meat is what the mediterranean diet is all about.

On top of these benefits to both your erectile and cardiac strength, a mediterranean diet has also passed the most rigorous of all tests:â mortality studies. The results of these studies have shown that the mediterranean diet improves overall mortality, which means that it is good for both your heart and multiple cancers, etc. 

Another reason that the mediterranean diet probably help with erectile dysfunction is that a recent study found to improve metabolic syndrome. Metabolic syndrome is a set of conditions (high blood pressure, insulin resistance, poor lipids, etc.) that plague india.

Mediterranean diet has also been shown to prevent alzheimer's disease and dementia. The greater the adherence to the mediterranean diet, the less the risk of alzheimer's. Those with the greatest adherence to the mediterranean diet had a 40% less risk than those with the least. So it's not just the heart and penis that desperately need you to follow the mediterranean diet:â it's the brain itself. To consult the famous sexologist you can visit doctorsharmila. In if your suffering from ed and want to reverse it.

Patient question - I used to be able to handle multiple orgasms but now after the first one, I am done. Why did I lose my touch?

Dear doctor,
I am curious about multiple orgasms. I keep reading about them. And I had them a few times when I was newly wed, (before childbirth) so I know that they exist. But my question is how to get them? did I forget how to do it because of two pregnancies and the obvious lull in that period in our sex life?

My husband is wonderful, he focuses on foreplay, knows all the right moves. He will help me go to round two but I just can't go ahead. After the first orgasm, I am done. I know that regardless of what he tries (and many times he tries too for my sake) that I won't be able to climax again for two days at least. What do I have to do to get back the ability to orgasm more than once? I am 40 years old and happily married for 17 years.

Dr sharmila majumdar says:

Multiple orgasms occur because of practiced execution, not out of dumb luck. The chances of achieving multiple orgasms are dependent on the people involved. You need to know how to elicit an orgasm and how to maintain it in order to achieve as many orgasms as possible.

*the first rule of achieving multiple orgasms is this: don't stop until you're satisfied
*the second rule is this: don't push yourself too much or you'll get hurt
*foreplay is necessary
*after the first orgasm, don't lose your momentum
*stop when you want to, or if your partner's too tired to go on any longer

A deconditioned body: achieving multiple orgasms requires you to go through an extreme amount of physical activity. Your body will be subjected to physically intense conditions like friction, pressure and nerve excitation. You need to be well-prepared for this task, and so does your partner. Work on your stamina, breathing and muscle strength, so you can achieve as many orgasms as you want.

The next time you're getting intimate with your partner, try to keep the stimulation going even post-orgasm, and see if you can successfully try for a second, a third or even a tenth orgasm!