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"August 15, 2008 Q: I&amp;#x27;ve been feeling pelvic pain when I have sexual intercourse. I got tested for chlamydia, gonorrhea and syphilis. The results were all negative; I&amp;#x27;m worried that it might be pelvic inflammatory disease. Can you help me? A:Pelvic inflammatory disease (PID) is generally a serious infection, and although it is possible to have it without any other signs, most of the time the pain is more constant than you describe (not just during intercourse). Other symptoms may include fevers, vaginal discharge and a general tenderness in that area. However, you do need to schedule an appointment with your gynecologist for a sonogram to rule out endometriosis, an ovarian cyst, fibroids or other pathology. The truth is, the amount of time that patients have with their doctors today is so brief that it&amp;#x27;s important for you to initiate a conversation about anything abnormal you might be feeling. If a woman came into my office complaining about pelvic pain during intercourse, I&amp;#x27;d ask a lot of questions. Is the pain inside of your vagina? Does it occur on penetration or only with deep penetration? Do certain positions make it worse? Is the pain always present or just during certain times of the month? If your doctor doesn&amp;#x27;t ask these questions to explore the problem from all angles--not just ruling out STDs--you might want to consider finding someone who will. Sex should never be painful, and if it is, you deserve to work with a doctor who will find out what&amp;#x27;s really going on. August 14, 2008 Q: I was having sex with my boyfriend and when we switched positions, I got really dry. He tried entering me again but couldn&amp;#x27;t get in. After a while it started to hurt, so we stopped. It&amp;#x27;s been two days and I&amp;#x27;m still in pain! Should I be concerned? A:When you have severe vaginal dryness, it is possible that you&amp;#x27;re actually rubbing off a layer of skin inside the vagina during intercourse. It can take several days for this friction &amp;quot;burn&amp;quot; to heal completely, so I don&amp;#x27;t think you should be concerned if you&amp;#x27;re still experiencing discomfort after a couple of days. At this point, you just need to give your body time; the vagina will heal itself naturally. (You definitely don&amp;#x27;t want to use an ointment or cream, which could lead to an infection.) In the future, apply a water-based lubricant before or during sex--I&amp;#x27;d recommend Astroglide, which you can buy over the counter. August 13, 2008 Q: I&amp;#x27;m on the birth control pill Yasminelle and wondered if I should explore other contraception options after having a blood clot. A:If you&amp;#x27;ve had a blood clot, you should never, ever use the Pill, because you significantly increase your chance of getting another one and you could die. I&amp;#x27;d recommend that you stop taking the Pill immediately and call your doctor to find another method of birth control. There are other factors, too, that increase your risk of having a blood clot when you&amp;#x27;re on the Pill, such as smoking, obesity or having a very sedentary lifestyle. However, those are things that would increase the risk of blood clots in anyone. Still, if my patients fall into any of those categories, I do recommend that they use another form of birth control, like a barrier method or an IUD--a small device placed by a doctor in your uterus to prevent fertilization. You should see your gynecologist to discuss the best alternative for you. August 12, 2008 Q: I heard there is a correlation between physical fitness and sex. Is this true? I recently started kickboxing and feel great--and more horny. A:Good for you! Yes, exercise has been shown to increase testosterone levels, and of course it increases endorphins, the feel-good hormones that generally increase desire for sex. What you&amp;#x27;re feeling is absolutely, fabulously normal. Exercise also increases stamina, endurance and flexibility, which help to make sex better--and better sex makes you want it more. Plus, getting into shape means you&amp;#x27;re probably feeling better about yourself with your clothes off. Keep doing what you&amp;#x27;re doing for your health--and your sex drive! August 11, 2008 Q: I worry that I&amp;#x27;ve lost my sex drive. I&amp;#x27;ve always had a healthy sexual appetite, but after my tubal ligation in 2006, I noticed a decrease in desire; I&amp;#x27;m just not in the mood as often. Is that the culprit or could it be something else? A:The physical act of tying your tubes should not have an effect on your sexual appetite. In fact, for many women, desire increases after the surgery because they no longer worry about getting pregnant. So it&amp;#x27;s important to think about what your feelings about sex are now--and what they were before the procedure. How did you feel about your decision to undergo permanent sterilization? Was it your choice? Sometimes women feel pressured to do it by their spouses, and they&amp;#x27;re not 100 percent comfortable with it. What value did you give to sex before the procedure; were you taught during childhood that the main purpose of sex is procreation--not pleasure? Could it be that you feel like you&amp;#x27;re not as much of a woman now that you can no longer procreate? It&amp;#x27;s important to examine all of these feelings, because it seems to me that this is an emotional issue and not a physical response. My advice would be talk to a sex therapist if it&amp;#x27;s causing you distress-and bring it up with your gynecologist. There may be other medical problems, like thyroid disease, that might be affecting your libido. This column is for informational purposes only and does not constitute specific medical advice. It is not, and is not intended to be, a substitute for professional diagnosis or treatment from your doctor."^^<http://www.w3.org/2001/XMLSchema#string>
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