Impaired sexual intrest & impaired sexual response are similar to erectile dyseunction in males.
The Causes :
=>Performance anxiety,fear of rejection
=>Feeling of guilt about sexual enjoyment,due to lack of Sex educution.
=>Traumatic sexual experiance in past e.g. Rape.
=>Hostility towards husband or matrial conflicts.
=>Physiological in old age due to hormonal changes.
Treatment :
=>Matrial conflict not related to sex should be solved first.Let them not be mixed with the sexual problems.
=>If the hostility towards the husband is due to smell of alcohol,tobacco,body odour, or due to some demands from the male which she does not like-proper counselling & explanation by the Family Doctor will resolve the anxiety.
=>Husbands,in our society,in our society,have negative attitude towards the wife's problems.He should be taken into confidence,motivated and explained that the response from the partner will only be increasing his pleasure !
Sexual exercises:
=>Step 1=>Non genital pleasuring .for 4 wks,the couple only limits the activity to caressing each other's bodies.Strictly,no attempt is made for intercourse.This helps to reduce the main problem of performance anxiety & fear of failure ,at the same time increases affection. If one of the two,does not accept this step,then probably there is some maritial problam and it is better to consult psychiatrist.
=Step2 =>The couple indulges in Genital pleasuring with hand or mouth,but without orgasm,and Strictly no attempt at intercourse.The couple is encouraged to talk & express their pleasure to each other.If there is erection,allow their pleasure to each other.If there is erection,allow it to subside,then stimulate againto remove the fear of losing erection.Continued for at least 4 wks
=>Step 3=>The couple is encouraged ,to attain extrvaginal orgasm.Gradually,penetration is permitted,but withdrawn to have ejaculation outside vagina.The husband is encouraged to practice perineal exercises mentioned below.
=>Step 4=>Finally,after several weeks,when the couple has gained confidence in itself,intravaginal ejaculation is allowed.
=>Petroleum jelly locally for Copious lubrication to compensate for lack of vaginal secrations.
=>Adequate foreplay and if necessary,subsequent manual stimulation of clitoris to help the wife to reach orgasm.
Note=>The entire therapy is long drawn and demands tremendous co-operation from the partener(wife).The wife must be motivated and explained her role independentaly,particularly stressing that if at point,she shows negative response such as anger or frustration,the treatment will fail and problam will become even more difficult.
If no response ,consult u r doctor.

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