Dr. Krychman’s “Meet Your Vibrator”

In the course of our conversation about vibrators, I asked MiddlesexMD medical advisor Dr. Michael Krychman how he recommends that his patients begin to use a vibrator. Here’s what he says:

“Get to know your vibrator. Take it out of the package and learn how it works, how to charge it or what kind of batteries it takes. When it’s charged, play with the buttons, turn it on and off. How many speeds and settings does it have? Wash your vibrator well before using it; use warm water with a mild soap and rinse it well so that no residual soap remains. If it isn’t waterproof, be careful not to get any water near the battery case. Check for sharp edges or seams.

“Start on your own. Even if you’re planning to use your vibrator with a partner, it’s a good idea to check it out by yourself first. You’ll feel less self-conscious and you can really concentrate on how it feels. Make sure you have enough time and privacy. If you have roommates, children, thin walls, or nosy neighbors, turn on some music, shut the blinds, and use blankets and comforters to mute the sound.

“Play with the lights turned on. Not everyone is comfortable with this suggestion, but I think playing with a vibrator with the lights on can be very educational and useful. You can discover specific places on your body that are rich with nerve endings and ready for enjoyment and stimulation. You can use this information yourself and share with a lover when you’re ready.

“Turn the vibrator off before you turn it on. Get comfortable with the feel of the vibrator on your body. Run it along your body without even turning it on. Notice how it feels. Press it firmly against your skin; press it onto you body and massage your muscles. If the vibrator is made of a hard material this will probably feel nice. If the vibrator is a soft rubber and doesn’t feel smooth against your skin, try it on top of your clothing. This isn’t meant to give you an orgasm, but it’s a gentle and non-threatening way to introduce your body to the vibrator.

“Move your vibrator from the outside in. Once you turn it on, start by touching the vibrator to your body; this will help you understand the vibration sensation. Even though vibrators are used mostly around the vulva and clitoris, get a feel for the vibration all over your body, including touching the breasts and other areas that feel good. Slowly move to the more sensitive parts of your body.

“Don’t be in a rush: Explore every part of your body. Vibrators never get tired, and they let you explore every inch of your body for sexual pleasure. Many women find that one side or one part of their clitoris responds to vibration more than another. Don’t rush: Leaving a vibrator in place can allow it to establish sensation connections that previously weren’t there. Adjust the speed, pressure, and angle of the vibrator. Most vibrators have multiple speed settings; always start on low and work your way up. Experiment with applying different pressure. You may enjoy a lot of deep pressure with clitoral stimulation.

“Most women use vibrators for external stimulation, but as long as your vibrator is safe for it, there’s no reason not to try penetration. While far more nerve endings are outside the vagina than inside, lots of women enjoy penetration with a vibrator. A vibrator that is safe for penetration will be smooth, have no rough edges, and won’t absorb bodily fluids. Again, start slow and get yourself aroused by using the vibrator externally first.

“There are just two things I caution women about: First, make sure you’re using the right lubricant with a vibrator. Silicone-based lubricants will degrade silicone vibrators. And if you’re sharing your vibrator outside of a monogamous relationship, put a condom on it.”

Sounds like good advice! And getting acquainted with a vibrator yourself will help you introduce it to your partner, too--which I'll focus on in our next post.

Q: How can I increase sensation and more readily orgasm?

There is no doubt that the ability to achieve an orgasm becomes more difficult as we age, and the orgasm itself is often briefer and less intense. As we age, we need more time for every step of the process, starting with foreplay. Sometimes our partners need to hear a clear message about what's changing for us! We hope our website can make it easier to have those discussions with a partner.

Using a warming lube, like Oceanus G Stimulating or Sliquid Organics Stimulating O Gel, can improve sensation for some women. Warming lubes include a minty or peppery ingredient, which increases circulation and sensation in genital tissues.

You mention occasional orgasm success with a vibrator. Not all vibrators are alike: Some don't provide the intensity of vibration that our tissues need in midlife. We offer vibrators by Emotional Bliss that are more powerful than average, designed for those who specifically need more stimulation, more intensity. I’ve seen some amazing results with these in women who previously were unable to have an orgasm because of neurologic diseases or medications that are known to interfere with orgasm.

You might also talk to your health care provider to see whether vaginal (or localized) estrogen is a good option for you. Lack of estrogen to vaginal tissues results in a decrease in circulation, which leads to less sensation, which is why you may not sense penetration as you did before.

Do talk to your partner and explore your options. Sexual satisfaction comes in many forms, but if you're missing orgasms, there's no reason to leave them behind.

Q: Incontinence with stimulation? What’s up with that?

Urinary incontinence for women is usually classified as "stress incontinence" or "urge incontinence." Losing bladder control during sexual stimulation is most likely urge incontinence: The stimulation of the area nerves causes the urge to urinate and then contraction of bladder muscles (for some women it's just a strong urge, for others it's actual leaking).

While it poses no risk to you or your partner, it is definitely undesirable! Make sure to empty your bladder just before sexual activity. See your doctor to rule out a bladder infection. Performing regular Kegel exercises may be of benefit. The type, duration, and location of stimulation may influence the urge; more practice may help you better understand cause and effect. Certain positions may decrease leakage (for example, woman on top or side-lying position).

There are medications for urge incontinence that could be trialed just before having sex. Taken 10-60 minutes before sex play, the medication can decrease the urgency sensation and actual loss of urine.

This issue can really interfere with sexual expression, so addressing it sooner than later is important. See your gynecologist or urologist to further discuss which of these options are best suited to you based on your medical history.

Our Secret Recipe for Sex after Menopause

The post title is just tongue-in-cheek, folks. A little health writing humor, poking a stick at the whole idea of health “secrets.”

We don’t believe in keeping information about attaining good health secret.

So here, today, long before going live with our website, we are happy to divulge our recipe for sex after menopause. The ingredients are:

Tada!  Whooot!!! We have balloons falling and confetti rising over here at MsMD headquarters!! How about you?! No?

Wait, No?

Maybe you don’t realize how hard it is to distill good-sex-after-menopause down to an easy-to-remember system? So let me explain: Months ago, we began our work with a hard look at the American Psychiatric Association's DSM-IV description of disorders contributing to Women’s Sexual Dysfunction (There’s a phrase we won’t use a lot around here, because it worries us. If we don’t yet understand Women’s Sexual Function, how can we comfortably describe its dysfunction?).

We embraced (and strive to remain mindful of) the point of view of women’s sexual problems developed by the New View Campaign, and their concerns about the medicalization of human sexuality. We reduced by our focus on peri-menopausal and menopausal women. Filtered all of these concerns through recent research and publications by members of the North American Menopause Society (NAMS) and the International Society for the Study of Women’s Sexual Health (ISSWSH).

We surveyed current literature on female sexuality. We added recent work by sex researchers and therapists and coaches, relationship coaches and mindfulness gurus.

That was the first step.

The next step was sorting all of the helpful advice, tips, skills, and learning into clear descriptions of conditions and pragmatic actions so that women in menopause can understand exactly what is going on with their bodies and what they can do about it if they want things to be different.

We didn’t go looking for the recipe. It surfaced from the work, organically. We began to see how all of the latest and best advice of medical, psychiatric, and sex researchers and coaches, seeking to help older women enjoy their sexuality, clustered into just a few central goals. What does a woman need to do to enjoy sex after menopause? (Assuming, of course, that she wants to enjoy sex after menopause at all. Because that is still her choice.)

1. Knowledge

She needs to know the physiology of menopause, so she understands what is happening when it happens, and especially that though her experiences are unique to her, she's not alone. And she needs to know some new sexual techniques that will keep sex enjoyable as she ages.

2. Vaginal Comfort

She needs to learn how to take care of her vulvo-vaginal tissues so that sex remains comfortable.

3. Pelvic Tone

She needs to learn how and why to strengthen and maintain her pelvic girdle to encourage circulation and maintain or strengthen her orgasms.

4. Genital Sensation

She needs to compensate for less blood flow and less sensitivity in her genital tissues by providing herself with more stimulation, more sexual sensation.

5. Emotional Intimacy

She needs what every woman needs at every age for sex to be good. Sex needs to be intimate. It needs to mindfully create and reinforce a real connection. There it is. No secrets. When we take our site live in April, you’ll get all the rest, descriptions of conditions that get in the way of achieving these five goals, actions you can discuss with your doctor or take on your own to enjoy sexuality for life, and products we have selected to help you on your way.