“It’s not fair that women don’t get to orgasm.”
—Betty Dodson, sex innovator and activist
So, for all of us who’ve ever faked an orgasm. For all of us who came late to the dependable power of the clitoris. For all of us still trying to maintain capacity, potency, and sexual vitality.
For all of us, there is Betty Dodson.
She was ribald and norm-busting. She was an art student who was raised on a farm in Kansas with three brothers. She was one of a vanguard of feminist women (read about the others in our series here and here) who found their stride and their calling in the sexual revolution in the 1970s. She celebrated sex of all kinds, but focused on the special role of the clitoris in female orgasm. She died this year at 91 on Halloween morning, just as outspoken and bawdy as she had lived. “We need to embrace death like it’s our final orgasm,” she said in 2014.
Of course Betty migrated to New York City from the farm to work as an artist. Kansas could not contain a personality the size of Betty. After participating in several sexual swap meets, she noticed that even the most uninhibited, free-loving women struggled to orgasm. Thus began Betty’s focus on the clitoris and its ability to allow women to dependably orgasm and to release them from dependence on men for sex. She developed a workshop to teach women about their own body parts as well as how to masturbate effectively—the Bodysex workshops. And thus began her life’s “work” of modeling unapologetic, unbounded sexuality.
The workshops were a place for women to overcome embarrassment and body-shame and to experiment with pleasuring themselves. Clinical studies suggest that they continue to have a 93 percent success rate in helping anorgasmic women achieve orgasm, not just by experimenting with clitoral stimulation but by confronting “repressed shame, guilt, and other negative feelings associated with body, genitals, and sexuality, and the repressed sexual pleasure and desire,” according to an article in Jezebel.
She also gave sex a wide-open, shame-free space to roam. She described herself as a “heterosexual, bisexual lesbian.” She enjoyed a 10-year affair with a man 50 years younger (which she broke off because she didn’t want to be another Hugh Hefner) and ended her life with Carlin Ross, 47, her business partner with whom she demonstrated the Bodysex masturbation method live on camera while filming series 3 of Gwyneth Paltrow’s Goop Lab Netflix series.
During the segment, she corrected Paltrow’s emphasis on the vagina as the source of sexual pleasure for women. When Paltrow enthuses that the vagina is her favorite subject (her company sells a candle that is supposed to smell like her vagina), Dodson interrupts: “The vagina’s the birth canal only. You wanna talk about the vulva, which is the clitoris and the inner lips and all that good s*** around it.”
While most of us, who still live on a metaphoric farm somewhere, can’t quite follow Dodson in her naked masturbation workshops and few-holds-barred sexual experimentation, we can all be grateful for her promotion of the clitoris to celebrity status.
As you may have noticed, this is the approach we espouse at MiddlesexMD as well. Whether you use it for self-pleasure or to enhance variety during couple sex, it helps keep all your sexual organs responsive, hydrated, and healthy, and it puts women on an equal footing in the sexual sphere—we can take care of ourselves just like a man.
There is also something to be said for a healthy, shame-free enjoyment of sex and our own bodies. For an example, look no further than Betty.
When it comes to your clitoris, you have a lot more material to work with than you might think. In addition to the familiar tiny button (the glans), the clitoris is made up of a body, bulbs, and crura (or legs). Some people say it looks like an inverted tulip emoji; others like a high-tech boomerang or a wishbone.
With its thousands of nerve endings, the glans is the star of the show. But the rest of the clitoris has pleasure potential, as well. Menopause might be the perfect time to explore that potential. Estrogen production falls off during menopause, causing a woman to lose up to 80 percent of her genital volume. Less circulation means less sensation. Tapping all pleasure possibilities is a smart move.
Vibrators can help, but not all vibrators are designed for the full clitoris. The Sona Cruise is. It uses sonic waves and pulses to stimulate the entire clitoris, delivering consistent intensity in use for deep-tissue massage, which can produce a prolonged climax. It’s small and quiet, so it’s discreet. With its eight patterns and varying intensities, you can find the sensation you like. Easy-to-use controls let you adjust along the way.
Explore and enjoy! When we consider that the full clitoris wasn’t mapped until 1998, we wonder what discoveries may await!
Note: The fabulous, anatomically correct pewter pendant was pointed out to me by a friend. It's made by Lennart and Josefine, of Sweden, and offered through their Etsy shop Farjil; their image used with permission. To see their full collection of nature- and anatomy-inspired jewelry, visit their online shop through this link: etsy.com/shop/Farjil
I have a friend who recently decided to stop dying her hair. “I’m tired of trying to ‘do young.’ I just want to ‘do me.’” When it comes to the way we look, it seems like there’s a fine line between being your best self and just being yourself.
To dye or not to dye used to be the only decision midlife women had to make, but now, if you have the interest, time, and money, you can lift and reshape any part of your body, from your derriere to your ears. That includes your lady parts.
In labiaplasty, the surgeon trims the inner lips surrounding the vagina (the labia minora) to make the entire area look smooth or removes the lips entirely (by the way, this will happen naturally with menopause, during which the labia tend to ‘melt away’). The surgeon can also tighten the vaginal opening, tweak the outer labia, reduce or remove the clitoral hood.
Since there’s no proof that these procedures enhance sensation, I assume that women do it because they think that area doesn’t look the way it should. Perhaps at some point they got the message that the way they are built is somehow inferior or not normal. As a practitioner, I have seen many, many women’s private parts and I can tell you that normal encompasses a very wide range. Furthermore, in surgery there’s always a risk of infection or nerve damage, which could reduce sensitivity.
You’re the only person who can decide what’s right for you, but I do hope you weigh the risk of actually having less sensation during sexual activity with the “benefit” of a cosmetic change. Don’t be swayed by anyone’s ideas of what’s normal or perfect when it comes to genitalia.
If you have real concerns about how your vagina or clitoris are functioning (or not), rather than the way they look, talk to your medical professional. They can identify the problem and offer solutions.
I always enjoy hearing from visitors to our blog, and recently one sent me a poem she’d written, which I’m sharing (with her permission).
What else do you lose,
After I said
The clitorati shrinks.
Hair. It thins
Or makes a career move
To your upper lip.
The plump walls of your vajayjay
—oh, and everything else down there—
Contract and dry up.
By, like, eighty percent.
What you lose in volume,
You gain in bladder infections.
So, you know.
Desire takes a swan dive
Off the cliff
While you’re not even looking.
Your waistline vanishes.
(Although my sister says
It might be hiding under your breasts,
Which have retired and moved south.)
Forget about creaming your jeans.
Remember those days?
Memory goes, too.
You suddenly become invisible.
Unless, according to research,
you’re an orca.
Which, you know,
All those years
Of little deaths
Knocking you off your feet,
Washing over you,
Pulling you under,
Tossing you back
Onto the sparkling sand
Is there anything it doesn’t take?
(Not that I’m bitter.)
The poem is both funny and true (even the part about 80 percent). During menopause, there are a lot of things we lose. But that doesn’t mean we have to just give up. My whole reason for starting MiddlesexMD was to provide information and offer products that help women enjoy sex after menopause.
Your hair may thin, but the cause isn’t always menopause. Talk to your doctor. There may be something you can do about it.
You can improve the suppleness of all your urogenital tissues with things like localized estrogen cream (talk to your doctor), vaginal moisturizers, and lubricants. Do your kegels!
What about desire? It depends—but there’s a lot you can try, including testosterone therapy, increasing intimacy in your relationship (which is different from but related to having intercourse), and increasing the mindshare that you devote to sex.
Maybe orgasms aren’t effortless any more, but they can still be very good. Try these tips.
With a little work, you can still have an amazing sex life!
(Oh, and if you wonder what orcas are doing in the poem, read this.)
I’m happy to have friends and colleagues who keep up on the news on my behalf. I can’t count the number of them who texted or emailed me a link to the story that unfolded at the Consumer Electronics Show (CES), which is truly not something I normally pay attention to.
If you missed the story, I’ll try for a short objective summary: A tech company was notified they’d won an innovation award, and then, before the show opened, the company was informed that the award was being rescinded and they were blocked from exhibiting at the show. Crazy, huh? It’s one kind of crazy all by itself; it’s another kind of crazy when you consider that the product was, essentially, a vibrator with some cool new technology. (Here’s the open letter the company’s CEO published after the award was rescinded; here’s a different kind of explanation from Wired magazine.)
I wish I could ignore this controversy. But the reality is that I run into cultural barriers nearly every day in my practice, preconceived notions and prejudices that make women reluctant or entirely resistant to taking simple steps that could improve their sexual health. My correspondence with women across the country through this website tells me that cultural barriers get in the way of frank discussions between patients and their doctors about sexual health and sexual satisfaction.
I watch “Grace & Frankie” and I imagine that we’re turning a corner in willingness to talk about women over 50 as full humans. Then I read about the CES controversy, and I feel a need to restate the obvious, from my medical perspective:
I’d really prefer to be practicing medicine, rather than musing about cultural dynamics. But I can’t help but think that for most Viagra users, the drug is really about pleasure, not about procreation—and yet there has seemed to be ready adoption of the concept. We don’t call Viagra a “recreational drug,” and many insurance companies don’t balk at covering the cost.
Women can be helped by a simple device, one not requiring a prescription and with no adverse side effects. Approaching and beyond menopause, we lose some sensation, which can make an orgasm more elusive. All it takes is some additional stimulation—which a vibrator provides without taxing our (or our partners’) dexterity or endurance. For us, a vibrator isn’t a “sex toy,” however playful we might be with it. It’s like a hearing aid (“audio toy”), a cane (“mobility toy”), or reading glasses (“vision toy”)—devices that help us mitigate the effects of growing older.
We’re not where we need to be. And we won’t make progress—in making options available to women and assuring they’re comfortable pursuing them—if we don’t acknowledge that’s true. Did you read the Wired article? I was struck by the reminder that the full shape of the clitoris wasn’t mapped until 1998. We can’t take for granted that women matter, that women’s sexual health matters, and that women’s pleasure matters, too.
Join me. Speak up. We can make this part of life different for ourselves, our sisters, and especially our daughters.
You say MiddlesexMD has been a valuable resource to you, and you’ve begun to use dilators and lubricants. I’m thankful to hear MiddlesexMD has been helpful to you, and happy to coach you through this next step! We’ve talked about vibrators quite a lot; you can be assured you’re not the only person considering that option! Here are some quick references:
Don’t be intimidated! Read all that’s helpful, stop when you want to, and know that your own experimentation is most important. I recommend you select a vibrator that can be inserted into your vagina. That will provide some of the important benefits to maintaining vaginal health, stimulating circulation, which is good for healthy tissue. You can also use that style externally, directly on the clitoris, as well; that’s where most women need the stimulation to achieve orgasm (and, as you mention, orgasm helps with pelvic floor muscle tone). These are the vibrators we call “mid-size” on our website. I don’t think you’ll have issues with insertion of any of those if you’ve been able to use dilators as you’ve described.
Enjoy! And I’m so glad you’re taking charge of your sexual health--finding your own resources for learning about your body and acting on what you learn.
You say that the changes to your clitoris have affected your sex life and made you feel embarrassed. Let me assure you that this is not your fault. It’s a natural part of aging.
Here’s how it happens: Perimenopause and menopause cause a decrease in estrogen. The decrease in estrogen causes a decrease in the blood supply to the genitals, and this leads to a decrease in size of and loss of sensation to the clitoris and the genitals, in general.
If the cause is related to a loss of estrogen, restoring estrogen to the genitals (localized therapy) may be just the ticket!
Another factor could be the amount of intimacy you’re having. I always say “use it or lose it”—and that definitely goes for the vagina and surrounding tissues. The less you use them, the more likely it is they’ll get smaller and less sensitive.
For those women who are not in a relationship, this is a great reason to use a vibrator. It keeps all those tissues healthier. Remember that this is a totally normal part of aging (but there are things you can do to make it better)!
You say that penetration is becoming increasingly difficult, although you’re using lubricants. This is normal progression: In the absence of estrogen due to menopause, our genitals atrophy. The vulva and vagina get smaller, the vagina narrows, there’s a significant loss of volume of the genital tissues, including the clitoris. There are fewer folds in the vagina (I’ve talked about a transition from a pleated skirt to a pencil skirt to give an idea of the change in elasticity). The tissues become thin, pale, dry, and fragile, and the pH level changes.
These changes are what we in medicine consider to be “chronic and progressive,” so without treatment, there’s no question that the changes will continue. The most basic “treatment” is regular sex or external and internal use of a vibrator (if you don’t have an available and willing partner), which improves blood supply to the area and restores some comfort and tissue health. Using a vaginal moisturizer daily or at least twice a week can also help somewhat to keep tissues healthy.
There are also prescription therapies that are designed to really reverse the atrophy. They are all very effective. They include localized estrogens, the oral non-estrogen Osphena, and now, the newest, the non-estrogen daily vaginal insert Intrarosa. A discussion with your health care provider would be very helpful to determine next steps.
Sometimes the use of dilators can be helpful to stretch the vaginal tissues to maintain capacity. But without prescription treatments like those listed above or, possibly, systemic hormone therapy, the tissues are not very elastic, which limits the degree of stretch you can obtain.
With some investigation and follow-through, you can “keep the shop open”!
You say you’re using estrogen therapy, have sufficient lubrication, but are experiencing pelvic muscle spasms that cause you some discomfort during sex. You’re wondering whether being sedentary contributes to the problem, and whether a vibrator, which your doctor recommended, may help.
It’s unlikely that sitting too much would contribute to the muscle spasms (although as a doc, I need to recommend more physical activity). Unfortunately, most of the time we don’t have a good explanation as to the cause of muscle spasms. A vibrator works by increasing (through stimulation) blood supply to surrounding tissues, which, in turn, promotes vaginal health. If you choose a vibrator, make sure it’s one you can use internally, not just externally on the clitoris.
The other tool that’s often helpful with muscle spasms is a set of vaginal dilators. These are designed to provide a gentle stretch to pelvic floor muscles to reduce spasm.
I hope this is helpful! Part of the solution is to be confident you can address the issue.
The loss of hormones (estrogen and testosterone) with a hysterectomy and bilateral salpigoophorectomy (removal of ovaries) is definitely a “hit” to sexual function for women (I assume based on your message that your ovaries were removed). The genitals are, as we say in medicine, abundant with hormone receptors. In other words, hormones play a big role in the health and function—both urinary and sexual—of the genitals. So now, moving on without those hormones, what to do?
For most women, it’s direct stimulation of the clitoris that leads to experiencing orgasm. In the absence of estrogen, there is less blood supply, and, in turn, loss of sensation and ability to arouse or orgasm.
This can also be a time to consider treating the genitals with prescription treatments such as localized estrogen or the non-estrogen options, Osphena or Intrarosa. Using testosterone off-label can help women with arousal and orgasm as well.
I’d encourage a conversation with your healthcare provider to see if there are options that may be helpful for you.
Good luck! I’m glad to hear that your husband is supportive in addressing this frustration for both of you!