Love and Sex Prescription

By Dipika Dandade

QUESTION

My little sister of 19 is sexually active. We do not really talk about sex openly in our family, but I need a way to make her understand that she needs to use some sort of birth control. I know that she and her boyfriend are not using condoms, and that she is not on the pill. How do I approach my baby sister about being sexually responsible, without her thinking that I am sexually active myself?

ANSWER

Your fear of letting your sister know that you may be sexually active shouldn’t stop you from talking to her about safe sex. She is obviously going to have sex no matter what your views are. So, you need to intervene and make sure she is having safe sex. Abstinence (which not only means no intercourse

but also no genital contact, period) is the only way to be completely safe. When that is not an option, condoms are the next best bet to help decrease the rate of transmission of sexually transmitted diseases and help prevent pregnancy. To prevent conception, other options include the birth control pill, the patch (Ortho Evra), the vaginal ring (NuvaRing) and the shot (Depo-Provera). For those women who can’t be bothered to take a pill every day, these latter three options are great alternatives. The patch needs to be replaced weekly, the ring monthly, and the shot is given every three months. Impress on your sister that if she wants to continue living a carefree life, she has to be smart about it. It’s not so easy to be young, unwed, and pregnant. Nor is it a picnic to be young and HIV positive.

Both of you are adults, so try to approach the topic of sex in a mature, thoughtful manner. Don’t put your sister down for being sexually active. She is old enough to choose her own course in life. But that doesn’t mean that she couldn’t use a little guidance. And, what if you did let her in on your secret? Admit to her that you are sexually active. This may make your sister more comfortable and get her to open up more than she would have otherwise. You may find that she has a number of questions or, perhaps, even believes some mistruths about sex. You may be able to clarify these for your sister. On the flip side, you may learn a thing or two from her.

Since sex has been a taboo topic in your family, it's understandable if you find it difficult to bring it up with your sister. You might want to be in an environment where you both are comfortable. That may mean going out for a one-on-one dinner or going out with a group of girlfriends for a night on the town. If you still find it difficult to have an in- depth discussion, suggest that she follow up with a gynecologist to get more information on preventing sexually transmitted diseases and obtaining birth control. Or, there may be a girlfriend of hers that you can ask to broach the subject. Heck, if you need to, leave a copy of this article around to give her that gentle nudge to start practicing safe sex. In the end, your sister can't fault you for caring so much about her!

QUESTION

I am in my early twenties and was diagnosed with Multiple Sclerosis a couple of years ago. I have found that this disease is not well known in the Desi community. It's very difficult for me to function sometimes—especially sexually. I was in a relationship in which we had sex frequently (at least 4-5 times a week) and there were times when I was too tired to perform. We had our falling outs over this, and ended the relationship. I am too scared to begin a new one because of my illness, but it is going to be with me my entire life. What should I do?

ANSWER

Multiple sclerosis (MS) is an autoimmune disorder that affects the central nervous system. Nerves are covered by a fatty layer called myelin. MS leads to the destruction of this myelin—leading to problems conducting electrical impulses through the body and resulting in symptoms that differ from person to person in degrees of severity. The course of the disease varies as well. Symptoms can include (but are not limited to) vision problems, dizziness, problems with walking, bladder or bowel dysfunction, pain, fatigue, and sexual dysfunction. Men and women with MS can experience erectile dysfunction, difficulty with orgasm, retrograde ejaculation (men), and the inability to become sexually aroused.

Up to 90% of men and women with MS have symptoms that affect their sexuality. When it comes to sexual dysfunction and MS, there are not many medical options for treatment. You might even find that some of the medications prescribed to treat the symptoms of MS, such as those used to help depression, can lead to sexual problems. Viagra is available to men to help with erectile dysfunction. It is also available for women’s sexual problems, but only off-label because the Food and Drug Administration (FDA) has not approved its use for women.

As you mentioned, MS is going to be with you your entire life. The only predictable thing about MS is that it is unpredictable. It’s tough to say if and how your symptoms may progress. If fatigue is an issue, try to have sex when you have the most energy. Those with chronic pain should seek different positions that put them most at ease. Vaginal lubrication can be affected by MS and can be improved by using over-the-counter lubricants such as KY Jelly. Do not forget foreplay— you may even need more time to get aroused, both mentally and physically.

Sometimes you, yourself, can be your worst enemy. Feelings of anxiety, fear, or inadequacy may affect your desire and arousal. Sometimes intimacy comes not from actual intercourse but from touching, saying nice things to each other, talking dirty, or even a romantic dinner. Leave any previous expectations behind. Do the best that you can do in your present health. No matter what, be open with your partner from the beginning and discuss what does or does not work for you.

Dipika Dandade, 31, is an obstetrician/gynecologist practicing in the Los Angeles area.
Manjit Risam, M.D. is a board-certified Obstetrician and Gynecologist practicing in the Washington, D.C. area.

ABCDlady does not provide medical advice, diagnosis or treatment. See additional information.

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