Q: Does the Intensity’s vibration help to strengthen the pelvic floor?

The Intensity Pelvic Tone Vibrator works in two ways: It has electrodes that stimulate the muscles of the pelvic floor, causing them to contract and therefore strengthen. The vibration feature of the Intensity, which you can control separately, improves pelvic floor muscle tone the same way any vibrator does: They all help the user to experience orgasm, which is intense contractions of the pelvic floor. Those contractions, whether from the electric pulses or orgasm, improve muscle tone, just like flexing your bicep does. The contractions also increase blood supply to the pelvis, which improves function and sensation, too.

Yes, orgasm is good for muscle tone! And improved muscle tone can strengthen future orgasms, as well as holding organs in place and preventing or minimizing incontinence. I guess I’d call that a virtuous cycle.

Q: Can I experience vaginal orgasm?

I’ve got good news and bad news for you. The good news is that you’re just like 75 to 80 percent of women! The majority of women are not able to experience orgasm only with vaginal penetration or stimulation. Most of us need direct clitoral stimulation to orgasm, whether that stimulation is oral, digital, or with a vibrator.

You asked. Dr. Barb answered.A recent journal article on this topic described one factor of influence was the distance between the clitoris and the vaginal opening (read more in this blog post). A few millimeters can make a difference to how orgasm is experienced--and that’s an unmodifiable factor! Since each of us is individually made, the bad news is that if you haven’t experienced vaginal orgasm by now, you’re likely not going to.

There’s one option for you to try: Some vibrators, like the Gigi2 and the Celesse, are shaped specifically to put pressure on the “G spot.” If you’re one of the people for whom orgasm can happen through G-spot stimulation, one of those vibrators can help!

June 22, 2017


communication ›   intimacy ›   orgasm ›  

More Orgasm Evidence (in Case We Needed It)

Lots of attention has focused on the finicky female orgasm in recent years, from Dr. Rosemary Basson’s model of the female sexual response cycle to the helpful finding of just how female anatomy influences the probability of vaginal orgasm.

A new study from Chapman University, Indiana University, and the Kinsey Institute colored in some details of female sexual response, in part by rounding up a wide net of participants. Over 52,000 men and women between the ages of 18 and 65 responded to an online survey, including a more robust sample of those who identify as gay, lesbian, and bisexual.

There's significant misunderstanding between Venus and Mars.The take-away from all this analysis was the jaw-dropping finding (tongue in cheek) that men (95 percent) orgasm dependably, while women, not so much (65 percent). About 44 percent of women said they rarely or never reach orgasm with vaginal intercourse alone, a number that is quite low compared to other studies suggesting that fully 70 percent of women don’t orgasm with vaginal penetration. These numbers point (again) to some very significant differences in sexual response, which in turn, lead to significant misunderstanding between Venus and Mars.

“About 30 percent of men actually think that intercourse is the best way for women to have orgasm, and that is sort of a tragic figure because it couldn’t be more incorrect,” said Dr. Elisabeth Lloyd, a professor of biology at Indiana University and author of The Case of the Female Orgasm in this article.

Additionally, while 41 percent of men think their partner orgasms frequently, far fewer women (33 percent) say they actually do orgasm. The researchers note that this difference could be due to women faking orgasm for several reasons: “to protect their partner’s self-esteem, intoxication, or to bring the sexual encounter to an end.”

The researchers were particularly interested in the disparity between how dependably lesbian women orgasm (89 percent) versus heterosexual women (that 65 percent figure). They theorize that this is due, in part, to women having a better anatomical understanding of each other’s needs.

The headliner result of all those survey is a “Golden Trio” of sexual moves that the researchers say are almost guaranteed to induce the Meg Ryan-style “Yes! Yes! Yes!” in women: clitoral stimulation, deep kissing, and oral sex. Even without vaginal penetration, 80 percent of heterosexual woman and 91 percent of lesbian women were able to orgasm dependably with this magic trio. (Although deep kissing and oral sex seem either mutually exclusive or tremendously acrobatic.)

The research noted that women who orgasm more frequently also have sex more frequently and are more likely to be satisfied with their relationships. Whether satisfying sex is the chicken or the egg—a contributor to a satisfying relationship or an effect of a good relationship, it’s safe to say that the two go hand-in-hand. Good sex and good relationships are both enhanced when partners communicate about what works and include a healthy dollop of fun and flirtation.

“I would like [women] to take that home and think about it, and to think about it with their partners and talk about it with their partners,” said Lloyd. “If they are not fully experiencing their fullest sexual expression to the maximum of their ability, then I think our paper has something to contribute to their wellbeing.”

March 16, 2017


couples ›   intimacy ›   orgasm ›   sexual health ›  

Q: What can help my male partner orgasm?

You say that you and your partner use manual and oral stimulation, since you’re no longer able to have intercourse. Your partner requires extended stimulation, and you’re wondering what might help.

Stronvivo is a nutritional supplement developed for men’s cardiovascular health; it’s been found to significantly improve sexual health--because circulation is integral to arousal and orgasm. It is used for both male and female sexual health, improving both desire and function (ability to arouse and orgasm). I’ve had many women report improved ability to orgasm, and the clinical trials report the same for men.

The other factor to consider is medications that may be interfering with orgasm, or hormonal factors, like low testosterone. I’d strongly recommend a conversation with his physician, if he hasn’t already had one, to see whether there are health factors to consider.

Good luck!



January 30, 2017


menopause ›   orgasm ›   sexual health ›  

Q: Is my clitoris working right?

You say orgasms are new to you (congratulations!), and, having had the experience, you’re looking to  explore it further. You’re not sure your clitoris matches what you’ve read in books.

You asked. Dr. Barb answered.The external part of the clitoris is the head or glans; the shaft is deep to that. When you touch the clitoris, you’re touching the clitoral head. With arousal, there is usually minimal “engorgement” noted for women. By comparison, think of the penis, whose head doesn’t enlarge all that much when aroused. It’s the penis shaft that enlarges, and for women, the comparable clitoral shaft is internal (here’s a blog post with an illustration, which could be helpful).

A person’s size, weight, and number of pregnancies or childbirths don’t usually alter this part of our anatomy. As we age and hormone levels decrease, the clitoris does diminish in size and there can be skin conditions of the vulva that make the clitoris more “hooded.”

The most consistent, reliable way for most women to experience orgasm is direct clitoral stimulation (for others it’s vaginal at the “G spot”), and a vibrator tends to provide that for most women. But “most women” isn’t “every woman,” so you might try warming products, which can be helpful by providing stimulation to bring more blood supply to the area.

I wish there were a single route to experiencing orgasm--or maybe I don’t. There’s something nice about it being individual and unpredictable. Continuing the pursuit is fulfilling and, I hope, ultimately satisfying, too!



That Vibrator: Honey, Meet the Vibrator

In the last post, I made the case (persuasively, I hope) for why you might want to introduce your partner to sex with a vibrator. Now, let’s look at some non-threatening, sensitive ways to do that.

First, let me remind you that he might not be as threatened as you fear. Vibrators are everywhere—he’s probably seen them in the drugstore, on TV, or on social media. Maybe he’s curious, too. He may also be aware that your libido and sexual responses have been changing. You need more stimulation, more time, and maybe a change of pace to keep the flame alive. Maybe he needs something different as well.  

Create a sense of mutual exploration and play.A good beginning is with a conversation. Something like, Hey, I’ve been thinking…or, I read an article on… What do you think about…? Or, Maybe you’ve noticed I’m not as responsive as I used to be… Sex and relationship educator Kate McCombs suggests that “people really underestimate the sexy power of talking about what you’re going to do to each other later. For example: ‘…Should we try it? Hey. Why don’t we check it out online? Ooh. Let’s do it, and let’s get the expedited shipping.’ Then, by the time it arrives, you’ve basically been engaged in this four-day foreplay. I think that can be powerful for people.”

Shopping for your vibe together not only builds anticipation, but it feels like you’re sharing this new adventure—you’re on the same team, rather than either one of you being in charge or leading the charge.

You may need to reassure him early on that a vibrator never replaces sex with the living, breathing person you love. It’s a tool and a toy; it adds a new dimension; it can feel good; and you can learn a lot about what you both like. But it isn’t a replacement; you won’t become dependent on the vibrator; you won’t prefer it to him. In fact, studies show that women (and men) who use vibrators usually perform better and feel more positively about sex with their partners.

(There’s a physiological reason for this. Orgasm begets orgasm, because the muscle contractions, genital stimulation, and increased circulation makes it easier to orgasm next time. That’s why you never need to worry about the myth that a vibrator will make climaxing with your partner impossible; in fact, it’s just the opposite.)

A more oblique approach might be to introduce something new but less threatening, like massage or shower sex to your routine. Buy a new lube or massage oil. Expand your repertoire of sexy smells and touch. If you’re getting green lights, maybe you can, in time, gift him a “Happy Wednesday” vibrator.

Create a sense of mutual exploration and play while being sensitive to your partner’s comfort level as you go along. If he’s reticent, slow down and explore why. Fear is usually the underlying cause of anxiety or resistance. Bottom line: It’s worth trying something new, but if you both can’t play, it won’t be fun.  

Bottom line #2: If you get a complete shutdown with no wiggle room? Completely fine. You don’t need toys for a loving sex life. Maybe you can shelve the conversation for another time. I believe, however, that you are free to use a vibrator by yourself. Using a personal vibrator will keep your tissues healthy and your interest in sex alive. That’s a good thing for you and your partner.

If you’re still with me, in the next post we’ll dig into vibes for beginners (and beyond) and how to use them with your partner.



Can’t Orgasm Vaginally? It’s in Your Anatomy, My Dear

A study just came out in the journal Clinical Anatomy. The study reviewed the scientific literature regarding male and female anatomy with regard to sexual performance. While no new stones were unturned, the study has perhaps confirmed a few things we already suspected.

Most of us (gasp!) don’t orgasm with vaginal penetration alone, even though we may have tried mightily, maybe wondered what was wrong with us, and maybe pulled off a few (or more than a few) fakes. Something like 70 percent of us rarely orgasm with penetration alone and 10 percent of us don’t orgasm at all. Most of us need a little additional help in the form of clitoral stimulation.

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However, this new study does add some anatomical clarity to what we’ve suspected all along. Turns out, the distance between our urinary opening and the clitoris is the critical anatomical feature determining whether we orgasm easily—or at all. And that feature, like our eye or hair color, was determined in utero, before we were born.

The critical number for orgasm with penetration is 2.5 centimeters—that distance still allows the clitoris to be stimulated by vaginal penetration. If the clitoris is farther from the urethra than that, orgasm without additional stimulation is difficult or impossible.

“It's so strong a correlation that if you give us a woman who has a distance of 3 centimeters, we can very reliably predict she won't have orgasm with intercourse,” said Elisabeth Lloyd, an affiliated faculty scholar with the Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University-Bloomington in this article.

(You and your partner can do the measurement yourselves to figure out how to finesse your style.)

So all that performance anxiety—and maybe those faked orgasms—had nothing to do with your sexual skill or appetite and everything to do with your anatomy.  Which is something you can’t change, but you can work with.

Bottom line for women—for all women the clitoris is the critical organ when it comes to orgasm. The closer it is anatomically to the vaginal action, the more likely you’ll orgasm. If it’s farther away, you may want to switch up your moves.

You can't change your anatomy, but you can work with it.The best sexual positions to stimulate that little hot button are the good old missionary and the “cowgirl” with you on top. Maybe you’ve already discovered that some positions, notable the “doggy” style (rear entry) doesn’t work so well because it tends to stimulate the rear wall of the vagina and leaves the action far from the clitoris. If you can grind a little on his bones, you’re nicely positioned for direct stimulation. Either you or your partner can also include a little extra hand, mouth, or sex toy action if necessary—or nice.

So—get nicely lubed; don’t neglect the languorous foreplay; and practice positions that strategically stimulate the clitoris. And drop the worry about that elusive vaginal orgasm-with-penetration. There might not be such a thing. “To put this banner of healthiness [about] having orgasm with intercourse kind of stacks the deck against these women who, because of their anatomy, cannot have orgasm with intercourse,” Lloyd said.



Testosterone Therapy: A Voice from the Trenches

Ever have a medical professional say to you, “This procedure is a piece of cake. You’ll be back on your feet in a couple days,” only to be popping Tylenol and cursing the day you were born fully a week later?

Ever step off the plane into a throng of strangers and realize you really should have researched this off-the-beaten-track destination a whole lot more before you booked the flight?

I don’t know about you, but before I venture into uncharted territory, whether It’s a medical procedure or a new travel destination, I like to talk to someone who’s “been there,” who knows what she’s talking about and is willing to tell it straight. The voice of experience is always reassuring.

So for Part 2 of our discussion on testosterone therapy, we bring you the voice of one of my patients who is on testosterone therapy and who was kind enough to share her experience with us.

Each woman's menopause story is unique.As I mentioned in Part 1, in my clinical experience about 40 percent of women aren’t helped by testosterone therapy at all. A few others experience unpleasant side effects, and others still, like this patient, experience additional positive effects. While each woman’s experience is unique, many really do benefit from small dosages of the hormone.

Here’s a Q&A from one who did. Let’s call her Elaine.

MiddlesexMD: What were your expectations of menopause? Did you have a general idea of what to expect?

Elaine: The only idea I had of menopause was what is popularized by general media: hot flashes, temperamental moodiness, weight gain, fatigue, dry vagina, low sex drive. I didn’t want that to be my experience, and I decided I would do all I could not to have that be my story, but I really didn’t know what that would mean. Lucky for me, I have a smart, proactive health care provider that has always felt like she was on my team with my health story.

MiddlesexMD: What was your experience of menopause?

Elaine: My complaints were: intermittent feelings of anxiety, which I had never experienced before. Also I experienced somewhat diminished sex drive, but worse than that, when my hubby and I did have sex, it was SO MUCH WORK to achieve orgasm for me. Exhausting. I am so glad I am a runner and in good shape, because there is no way an out-of-shape me could even hope to work that hard without having a heart attack!

Then finally the orgasm was very flat and not very satisfying. Also I experienced some mild general fatigue; almost daily I would require a 10-minute nap, which never bothered me, but was relatively new to me.

MiddlesexMD: What was the problem--or set of problems--that you wanted to solve by seeking medical help?

Elaine: I described the symptoms listed above (anxiety, diminished sex drive, flat orgasm, some fatigue), without really expecting a solution. I expected Dr. Barb to say, “Yep, that’s menopause! Most women experience those things.” I thought she might recommend some herbal remedies, at most. I was obviously delighted with the solution she prescribed!

MiddlesexMD: What was the impact on your relationship of the symptoms that you had?

Elaine: My sex drive is improved, and the quality of orgasm is VERY much improved. Also, it doesn’t take forever for me to achieve orgasm. I almost never require a nap anymore, can’t think of the last time I took one, actually.

MiddlesexMD: Any other effects of testosterone therapy for you?

Elaine: The following are the unexpected effects: My anxiety symptoms, which were mild, are gone. I have noticed that mentally I feel more assured; I am able to more clearly see the forest for the trees; I am able to make confident decisions more quickly. I also have noticed that I am less likely to worry about whether people agree with me, or if they like what I have to say. I feel I can make intelligent decisions without being bogged down by wondering how my responses are received and if people agree or like me more or less for what I say.

I feel I am more able to present my true, authentic self/opinions. I am able to make decisions more quickly and with more confidence. I notice I don’t tolerate as much B.S. as I used to. (I am not rude, but I don’t go down that road with people anymore?) I feel somehow more clear and comfortable in my skin. I never expected this, but I love it.

I also have noticed that my muscle tone is improved, nothing freakish or dramatic, but I do notice it. I am running a tad bit faster, and I have more energy after a long run. I am no longer whipped for the day following a long run. I have noticed I have more overall energy, actually. I still sleep well at night, always did. I have experienced no other side-effects, such as extra hair growth or acne. I have noticed no negative side effects, actually.

MiddlesexMD: Does this experience suggest anything that you wish other women knew or were told?

Elaine: It sure makes me happy that I have such a great health care provider who is on the cutting edge with drug therapies, knew about this option, and took the time to explain it to me. I have mentioned it to several friends, and they have never had such a discussion with their health care providers. I wish women knew that all the stories about menopause (icky side effects, moodiness, weight gain, etc.) are not necessarily the experience of every female.

January 15, 2016


intimacy ›   orgasm ›   relationships ›   vibrators ›  

Q: How can I introduce sex aids to my partner?

First let me say that what you describe doesn't make you at all unusual. You say that you require a feeling of fullness and some G-spot stimulation to experience orgasm. Your partner's health issues make erections "fleeting," and yet you both enjoy intimacy; you'd like to explore adding a dildo or other device to increase your enjoyment.

Most couples find mutual satisfaction an invaluable component of intimacy; a partner's arousal and satisfaction enhances pleasure for most of us! Your partner's situation has changed, and if you're like most women, orgasm may have become less reliable over time, too. Now is the time to have a conversation with your partner—just to acknowledge the changes and that you'd like to try something new. (I wouldn't recommend that you produce a surprise vibrator or dildo during a intimate interlude! At that moment it could be taken as a judgment rather than an enhancement.)

The analogy we often use at MiddlesexMD is to vision. When it becomes more difficult to read the fine print, we get "cheaters" or reading glasses! We don't shelve our books. Why shouldn't we take the same attitude toward sex?

You may find that your partner is relieved to have you start the discussion. You might even look at options together and make the selection as part of extended foreplay.

Have confidence! It sounds like you and your partner have conquered more daunting obstacles together. I'm certain you can navigate this one.

July 13, 2015


body image ›   desire ›   orgasm ›  

The Hidden Benefit of "Exercise"

In an ideal world, we’d all love our bodies exactly as they are. We’d love our little muffin tops for the reminder of all the ice cream sundaes we’ve shared with a best friend, our marshmallow tummies for the children we carried, and our pancake boobs for making bras (practically) pointless.

But we don’t live in an ideal world, and the way we perceive our bodies affects how we feel about having sex. We probably all have personal experience with this, and research backs it up.

Fortunately, there’s a way around poor body image and it’s called exercise. Before you groan and stop reading, just let me say that this post is about more than exercise’s effect on that muffin top. It’s about exercise’s effect on a whole lot of things.

Research shows that exercise improves body image, desire, and (our male readers will be happy to know) erectile functioning. It also leads to an increase in overall sexual satisfaction, according to research, the findings of which were published in the Electronic Journal of Human Sexuality.

And here’s the best part of that research: the exercise doesn’t even have to be strenuous. “Overall sexual satisfaction was significantly associated with all modes of exercise/physical activity (i.e., sport, aerobics, recreation, and strength training).”

Improving your satisfaction with your sex life might be as simple as taking a walk or a leisurely bike ride or going canoeing—the more frequently, the better. So the benefit of exercising isn’t just that it tones our bodies. It’s that we feel better about ourselves and our sex lives, maybe long before the effect shows up on our middle-aged middles.

Perhaps you already do those walks or bike rides. If so, good for you! Want better orgasms? Consider adding weights or aerobic exercise to your routine; the research also showed that strength training had “the strongest relationship to overall satisfaction with quality of orgasm.” And many studies show a correlation between aerobic exercise and quality of orgasm.

See? No need to be deterred by the word “exercise.” Just think of it as adding a little more activity that will lead to getting a little more action.

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