Recently, I joined with two colleagues to produce a “continuing medical education” unit for the American College of Obstetricians and Gynecologists (ACOG). Our topic was “Vibrators and Other Devices in Gynecologic Practices” (if you’re a health care practitioner, you can investigate the CME offer here).
I was joined by Mary Jo Rapini, a sex psychotherapist and long-time friend of MiddlesexMD, and Debra Wickman, a gynecologist who teaches at the Banner Good Samaritan Medical Center in Phoenix. We talked about a 2009 study in the Journal of Sexual Medicine that says that 52.5 percent of women have used a vibrator; that led us to talk about the roughly half who have not.
A number of myths might get in their way, and we hope we made some progress in busting them.
Myth #1: Vibrators are for people whose relationships are in trouble. Based on what the three of us have seen, the opposite is true. As Mary Jo explains, “Vibrators are for couples who want to explore, who want to try new things, who want to play and have fun in their sex life.” Couples who share that desire are typically interested, trusting, and care about each other.
Myth #2: Vibrators make it hard to have an orgasm any other way. I’m happy to debunk this one with a medical reality: As the muscles involved in orgasm grow stronger, orgasm becomes easier and more intense. Vibrators are good at stimulating—and they don’t get tired or fumble, as we sometimes do as we lose a little strength and dexterity. Staying sexually active with a vibrator will increase your responsiveness to manual stimulation—that’s just the way we work.
Myth #3: There’s something sinful about a vibrator. Again, it’s Mary Jo who addresses this most directly. She’s had a number of conversations with faith leaders on her patients’ behalf, when religious concerns weighed on their minds. The ministers she’s talked to are invariably in favor of keeping marriages strong, and maintaining physical intimacy is a natural part of those relationships.
Myth #4: Vibrators are only for self-stimulation. Vibrators are good for self-stimulation, and that’s a good option for women who want to maintain their sexual health when they’re without a partner. But they’re also part of intimacy for couples. They’re especially good for couples who see a need to slow down and spend more time in foreplay. Which, now that I think about it, could be any of us who’ve achieved midlife!
If you’re among those who haven’t tried a vibrator, I support your right to decide for yourself. Here’s hoping, though, that none of these myths is what’s standing in your way.
What you describe is going from arousal to "resolution," without experiencing what you used to as orgasm in between.
The first thing I'd check if you came to my office is whether you're on any medications that could interfere with orgasm. The biggest class of medications in this category are the SSRIs—antidepressants like Prozac and Zoloft. If you are, you can talk to your health care provider about alternatives that would have the effects you need without the same side effects.
Difficulty with arousal and orgasm are more common as our hormones change through menopause. The loss of estrogen diminishes blood supply to the genitals, which affects sexual response. There are a few ways to counter that loss:
One more thing to consider: Women have at 50 about half the testosterone she had at 25, and testosterone plays a critical role in libido and ability to orgasm. There's no FDA-approved product for women, unfortunately, but I prescribe testosterone off-label for patients with good results. Off-label use of Viagra or Cialis is also helpful to a few women. All of these off-label prescriptions require a conversation with your health care provider—and consideration of your overall health.
There's every reason to be optimistic about regaining satisfying orgasm!
I have a lot of conversations with women about sex, given my line of work. And, because of that little pink “Ask Dr. Barb” button on our website, I get some cryptic emails, too. Sometimes I have to read between the lines, both in person and online, to understand what the situation—and therefore the question—might be.
One recent email referred to male partners who were not especially “gifted.” As I think about it, I suspect that my correspondent was wondering about her own orgasm—or her failure to experience it. That’s not the topic we corresponded about, since she went on to ask a different question, but because I’m sure that woman is not alone, let me lay it out here.
In spite of the passionate scenes we see in movies, most of us—70 percent—don’t experience orgasm during intercourse without additional stimulation. For most of us, it’s the clitoris that’s the key to orgasm, and most positions for intercourse just don’t provide enough stimulation. There are other sources of stimulation that can lead to orgasm—some of us have very sensitive nipples, for example, and some of us have found success with the G-spot.
It’s rare for a partner, whether “gifted” or not, to be psychic; and most women I know would prefer that their partner not be too widely experienced in the varieties of women’s responses. And that’s why I encourage women to know their own bodies, exploring either on their own or in the presence of their partners (many of whom find the experience quite erotic, by the way). Vibrators have proven to be very effective in clitoral stimulation; adding internal stimulation is helpful for about a third of us.
When you find what works for you, you can give your partner some suggestions, which will be much appreciated. (If, by the way, you’re wondering whether you’ve experienced an orgasm, keep exploring. You’ll know when you have.)
Ninety-six percent of us can experience orgasm. Be assured of that and relax. Being focused on that goal can inhibit your ability to achieve it. And let’s affirm one more time that sex can be pleasurable without orgasm, too, for the intimacy you share with your partner, for the feeling of wholeness and power it gives you.
Another email exchange—with a woman who experienced her first orgasm at 70—confirms that it’s never too late.
Perhaps you’ve seen reviews of a new book, called Sex After…: Women Share How Intimacy Changes as Life Changes. It’s definitely in my reading pile. The author, Iris Krasnow, interviewed 150 women from 20 to 90 about their sex lives.
The surprise—to Iris and some reviewers—was that the women in the later chapters were claiming some of the best sex of their lives. Among the comments:
We are so comfortable with each other that we will try anything to keep things hot.
When you’re younger, it’s all about the orgasm, then it’s over. I love this suspended feeling, the absolute intimacy we have been able to achieve.
Given my conversations with patients in my practice, I’m not surprised. There’s a whole lot of life after 50, and a whole lot of pleasure.
Two things typically get in our way: First, just as our kids never wanted to know we had sex (mine are adults and still don’t want to know!), we’re culturally just a little uneasy with grandparents having sex. Silly, but there it is.
And second, we could do a better job of sharing information about how to keep sex comfortable for just as long as we want it—and expanding our thinking about what “sex” means as intimacy beyond vaginal intercourse.
Most of the women I see are interested in being sexually active—I am, after all, a gynecologist. Every now and then, though, a woman will tell me, “We’re done with all that. And it’s okay.”
I think it’s awfully hard to tease out how we really feel about that “okay”: If it’s not cultural messages that we’re too old for sex, it's a cultural message that we need to keep at it to stay young. For many of us, the discomfort we may now experience with sex is enough to sway us toward that “too old” message.
But beyond the effect on relationships I’ve talked about before, what I hear from the women in this book echoes my own experience: Sex is part of feeling alive, powerful, energized, secure, blissed, refreshed. I’ll decide for myself when I’m ready to give that up.
And you can, too.
You may be among the 4 percent who won't experience orgasm--who, for some reason, simply can't, under any circumstances. It's more likely that you're among the 96 percent who can. When a woman tells me she's not sure if she's experienced orgasm, I say she probably hasn't; it's fairly obvious when it happens.
Most women need direct clitoral stimulation to reach orgasm; what we see so often in movies, of partners climaxing together through intercourse alone, is rare in real life. Beyond that, there's plenty of variation: Some women may need an hour of clitoral stimulation; others may experience orgasm through brief nipple stimulation.
I recommend that each woman know her own clitoris, because degrees and types of pleasurable stimulation vary among us. Vibrators are very effective in stimulating the clitoris, and spending time yourself, exploring in a relaxed environment, will help you advise your partner on what feels good. Soothing or arousing music or a sexy scene from a movie can help, too.
When you're ready to go further, you can try internal stimulation, which leads to orgasm for about 30 percent of us. A vibrator like the Gigi2 can be used both externally and internally, so you can place it in the vagina (use a lubricant to be sure you're comfortable) and see what happens.
While chances are good (about 96 percent good!), there's no guarantee of orgasm. And because being focused only on orgasm can actually inhibit your ability to experience it, I hope you'll enjoy the intimacy and other sensations along the way!
You mention a variety of things that play a role, all coinciding with the change in hormone levels that comes with menopause, which you'll reach in a few more months (the milestone is one year without menstruation).
The Vagifem that's been prescribed for you should be having some positive effect with vaginal dryness; it should not interfere with orgasm. Vagifem is a very, very low dose of estrogen, delivered directly to the vagina and surrounding tissues. This is partial compensation for the estrogen delivered through the whole body when ovaries are intact and functioning.
SSRIs (selective serotonin reuptake inhibitors, a type of antidepressant), which you mention taking, can be a barrier to orgasm. If you've taken them for a while and only recently have had issues, it could be that the combination of the SSRIs and the lower hormone levels of menopause is now problematic. There is limited evidence that Viagra can help women on SSRIs experience orgasm. It's not just estrogen that declines with menopause: Testosterone also declines. You might talk to your health care provider about testosterone therapy; among my patients, many who trial testosterone note sexual benefits, usually describing more sexual thoughts, more receptivity (a patient recently told me she's "more easily coerced"!), and more accessible orgasms.
You also said that vibrator use has become ineffective for orgasm. Among midlife women, I find that the specific vibrator really counts. There is a definite range of vibration intensity, and as our bodies change, that can make all the difference. Lelo has just doubled the "motor strength" of two of their already powerful (and MiddlesexMD favorites) vibrators for the Gigi2 and Liv2.
Best of luck! My work with women every day says it's worth exploring your options. (And, to take the pressure off, remember that intimacy without orgasm is still intimacy!)
To ask your own question, use the pink “Ask Dr. Barb” button top and center on our website. You’ll receive a confidential reply via email, and your question may be used as the basis for a Q&A post here on our blog.
Sex is all about the senses. That’s why “sex” is the fraternal twin of “sensual,” which broadly refers to “voluptuous gratification of the senses.”
Now, I ask you, what is more voluptuously gratifying to the senses than sex?
Trouble is, sometimes our senses get a little dull. They need a tune-up. They need variety and stimulation. They need us to pay attention.
We can pay attention to our senses, for example, by noticing the glint of sun on water, the smell of coffee in the morning, a warm breeze on the skin, a meadowlark singing on the fencepost.
But sex is where the senses can have a field day. We tend to rely on touch when we make love—and that’s a lovely place to start. As we mentioned before, the skin is our largest sex organ, so it makes sense to cultivate that sensory garden.
We do, however, have four other delicious sensory organs to awaken. And since our menopausal bodies need more stimulation and a longer runway these days, sexually speaking, why not incorporate other types of sensory delights into our lovemaking? This can serve several purposes—becoming more attuned to the senses we don’t rely on as much; introducing playfulness and novelty into our lovemaking; and creating the more erotic and stimulating environment that helps get us airborn, so to speak.
Here are a few suggestions for cultivating the garden of your senses during sex. If you come up with other suggestions, please share!
Smell. Most of us rarely think about engaging the sense of smell when we make love. Sure, it’s nice to have, but doesn’t seem critical to performance in the bedroom.
Smell may be subtle indeed, but that doesn’t mean it’s not powerful. For one thing, it’s closely linked to memory. The part of the brain that registers scents nestles right next to the limbic system that controls emotion and memory. That’s why a certain smell is often linked to an experience or a person. And that’s the basis of aromatherapy—using certain scents to trigger certain emotion.
We can use this to our advantage in our love life. Is there a scent that you associate with particularly happy or romantic times? I love the smell of jasmine because it reminds me of a wonderful visit to the city of Oaxaca in Mexico. A whiff of jasmine, and I’m transported right back to the Zócalo in the middle of town.
Here are a couple ways to incorporate smell into your love life:
Taste. This is probably another sense that we don’t incorporate well into sex. One way to develop our taste for sex might be to try some foods that are considered aphrodisiacs.
Some foods simply look suggestive, like fresh figs or asparagus, while other foods actually increase blood flow to the genitals. Some, like avocado and asparagus, do both.
The idea isn’t to eat until you’re stuffed. (Romantic candle-light dinners are bad for that.) The idea is to use the sight and taste of food to stimulate your senses and your passions. So maybe create a lush tray of aphrodisiacs to sample in bed. Or to feed each other. Or to slowly undress while you sample and feed each others.
Here are the top aphrodisiacs:
As we saw in the last post, vibrators were developed by doctors in the late 1800s to replace the “pelvic finger massage” they routinely administered to female patients. The massage was intended to relieve symptoms of “hysteria” or “neurasthenia,” such as anxiety, sleeplessness, and general malaise. Done successfully, it induced a “hysterical paroxysm,” which offered temporary relief to patients. By some estimates, over 75 percent of women suffered from these symptoms.
By the early 1900s, small electric vibrators had a comfy niche in middle-class homes right on the shelf between the toaster and the electric iron. At the time, they were perceived as medical devices that had nothing to do with sex.
The porn industry, however, was not so easily deluded. In the late 1920s, early porn films embraced the gadget for its own version of “doctor.” In this context, the “hysterical paroxysm” looked unmistakably like (gasp!) an orgasm. Once that connection was made, the veneer of the vibrator as a nonsexual treatment for a medical condition became uncomfortably hard to sustain, and the vibrator quietly disappeared from respectable society and doctors’ offices.
It became so utterly invisible, in fact, that in the 1970s only 1 percent of women had ever used one, according to the Hite Report, a famous study of female sexuality. “This was perhaps unsurprising, given that most vibrators by then were modeled on a very male notion of what a woman would want–a supersized phallus–replicating, in other words, the very anatomy whose shortcomings had precipitated the invention in the first place,” writes Decca Aitkenhead, in the Guardian.
At the heart of the matter was that:
Rachel Maines, author of The Technology of the Orgasm, the seminal work tracing the history of the vibrator, commented in an article in the Daily Beast, “In effect, doctors inherited the job of producing orgasm in women because it was a job nobody else wanted. The vibrator inherited the job when they got tired of it, too.”
That many women were not completely (or at all) satisfied by ordinary coitus was a source of confusion, frustration, and threat to some men. According to the Hite Report, most women can reach clitoral orgasm through masturbation. But the idea of women masturbating was also extremely threatening.
“I have read debates between doctors over whether women should be allowed to ride bicycles or whether the pleasure they might induce from the seat made it an unacceptable moral hazard,” writes Erik Loomis in “The Strange, Fascinating History of the Vibrator.”
Lest you think that we’ve evolved beyond these repressive and delusional ideas and that female sexuality is more acceptable today, think of the recent diatribe against a college student who spoke in favor of requiring health insurers to provide contraception. Or the statements alluding to “legitimate rape,” or the suggestion that a woman can’t get pregnant because her body “will shut the whole thing down.”
Have we really come all that far, Baby?
In any case, the discredited vibrator slunk back into view in the 1960s, first as a kinky sex toy and then as a symbol of women’s sexual liberation by feminists.
In a major national study of sexual behavior conducted in 2009, of over 2,000 women surveyed, 52.5 said they had used a vibrator.
If nothing else, the peculiar story of the vibrator should help us recognize how strongly we are influenced by cultural messages. A vibrator is not a medical device nor is it some unsavory symbol of sexual deficiency. For those of us who need extra stimulation to keep our sexual parts lubricated and functional, it’s just one important tool.
Just released on September 21, Hysteria is a light comedy about a dark and silly time. So touchy is its topic, in fact, that it took the producer, who is a woman, about ten years to find a studio willing to back the project. So unnerving is the topic that the author of the book on which the movie is based, who is also a woman, lost her job as an assistant professor when it was published.
Hysteria, the movie, and the book, titled The Technology of Orgasm by Rachel Maines, explore the modern history of the vibrator. And a surprising story it is. The movie, which stars Maggie Gyllenhaal and Hugh Dancy, approaches the topic with a comedic touch. It is described by Movieline.com as “spirited, a jaunty trifle that’s low on eroticism but high on cartoony coquettishness.”
But beneath the silliness—because, really, how else can this be portrayed?—lies the basically true story of the invention of the vibrator. The unnerving truth may be that the paternalistic and harebrained notions that led to the invention of the vibrator continue to entangle themselves in our “modern” cultural psyche. The movie, but more insistently the book, raises some instructive and faintly unsavory questions about embedded cultural expectations regarding women and sex.
First, we’ll look at the vibrator story, and then, in a future post, we’ll explore the cultural attitudes lurking beneath.
If you’ve ever read novels from the late 1800s—the Victorian period in England—such as those by Jane Austen or the Brontë sisters or Edith Wharton in New York, you may have noticed a certain… reticence… a naiveté, an innocence about sexual matters. “Making love” in these novels refers to the most innocuous verbal expressions of admiration. Respectable women were corseted, cosseted, and shielded from turbulence of any sort. The preoccupation of a young woman was to attract a suitable match, and having done so, she was to run an efficient household and be an asset to her husband. Little was heard of her henceforth.
Having read many of these novels, I’ve often wondered how children were ever conceived.
So I was amazed to discover that these same respectable Victorian women were prescribed a very unusual medical procedure by their doctors to alleviate emotional afflictions, which were diagnosed generally as “hysteria” or “neurasthenia.” Symptoms ranged from anxiety and nervousness to headache and sleeping difficulty to abdominal “heaviness.”
A procedure that seemed to temporarily relieve these symptoms was known as a “pelvic finger massage,” typically administered by those very proper doctors. The goal of this treatment was to induce a “hysterical paroxysm.”
So—to put it in contemporary terms—doctors were masturbating their female patients to orgasm in order to relieve the sexual (and other) frustrations that women in this era commonly experienced. And this in a culture that viewed a glimpse of ankle as risqué.
“It's very difficult to imagine that 100 years ago women didn't have the vote, yet they were going to a doctor's office to get masturbated,” said Gyllenhaal in an interview with the UK’s Guardian.
At the time, however, the procedure wasn’t thought to be sexual. In fact, doctors considered it routine, tedious, and boring.
“Annoyed doctors complained that it took women forever to achieve this relief,” writes Eric Loomis in “The Strange, Fascinating History of the Vibrator.” Yet, since repeat business was virtually assured, doctors weren’t complaining about the steady income.
So, they invented a machine to do it for them. Thus the vibrator was born.
Early models ranged from comic to frightening. A steam-powered vibrator called the Manipulator, invented by an American doctor in 1869, required the patient to lie on a table with a cutout at the business end. A moving rod was powered by the steam engine in another room.
Lack of mobility was a problem with this contraption—a doctor was committed to a large, stationary object that consumed two rooms. And if the engine was coal-powered, who did the shoveling?
The next model was electric, and the battery only weighed 40 pounds. This was developed by Dr. J. Mortimer Granville, our erstwhile hero in the movie Hysteria. So it was that the vibrator predated the invention of the vacuum cleaner or the electric iron by over a decade. I ask you, where are our priorities, ladies?
Despite their size and lack of attention to attractive design, the things worked. From over an hour of manual manipulation, a woman could now reach “paroxysm” in five minutes.
But progress marches on, and by the turn of the last century, more domestic households had electricity, and vibrators had become small, portable, and widely available. Reputable magazines and catalogs sold them alongside the toaster and the eggbeater. A woman could buy a “massager” for what a few visits to the doctor cost, and thus the medical profession lost its cash cow.
Advertisements in magazines like Women’s Home Companion, Sears & Roebuck, and Good Housekeeping promised that “all the pleasures of youth… will throb within you” and “it can be applied more rapidly, uniformly and deeply than by hand and for as long a period as may be desired.”
It beggars the imagination to believe that no one through all these decades considered that massaging a woman’s genitals had anything to do with sex. And in fact, the Guardian article states, “Despite the lack of evidence to suggest otherwise, it seems unlikely [that women really did not know what they were buying]–and the manufacturers surely knew what they were selling.”
This level of schizophrenia is the vexing conundrum at the heart of the vibrator phenomenon.
In a future post, we’ll explore the more recent history of the vibrator and the questions suggested by this massive blind spot.
The American Association of Retired Persons (AARP), the venerable group that’s always looking out for our best interests, has completed three major surveys of the sexual behavior of midlife (and older) adults.
This third such survey was released in 2009 (following earlier surveys in 1999 and 2004), and while nothing was truly shocking, some information was interesting, and some might be helpful. And, with three such studies conducted over a period of years, the organization is able to identify some trends and changes.
The 2009 study surveyed 1670 adults (the “panel”) over the age of 45. According to the firm commissioned to conduct the study, it’s “the first online research panel that is representative of the entire U.S. population.”
So, what’s happening behind our bedroom doors?
It’s no news flash that men and women are different in the way they view sex. For one thing, Mars thinks about sex more than Venus. (Men are five times more likely than women to think about sex once a day). They masturbate more (34 percent to 12 percent) and admit to having oral sex more. (Presumably with women? So… are the women just too timid to admit it?) They are also twice as likely to have sex outside their long-term relationship (21 percent of men admit to infidelity as opposed to 11 percent of women).
Bottom line: “Sex is far more important to the overall quality of life of men than women and also more critical to a good relationship.”
This doesn’t mean women don’t like sex—or think about it, or fantasize, or masturbate. It just means sex is front and center in the male brain, while it nestles cozily into a less prominent lobe in women.
Married vs. dating
While simply having a partner increases the odds of sexual satisfaction (now there’s a news flash), being married doesn’t—necessarily. Respondents who were “partnered but unmarried”—single and dating or engaged—have sex more often and like it more than their married counterparts.
Gives those of us who are married something to work on, hey?
But having a partner, whether married or not, also seems to make a difference in the broader scheme of things. Partnered respondents reported significantly higher overall quality of life and greater sexual satisfaction than those without a partner. And, obviously, they have sex more often, too.
So here’s the news flash. According to the study, “the number one factor predicting satisfaction with one’s sex life is the frequency of sexual intercourse.” See? Use it or lose it. The more you have it, the more you like it.
You heard it here first. What are you waiting for?
Among those who have sex once a week, 84 percent are satisfied with their sex life, compared to 59 percent of those who have sex once a month and 16 percent of those who haven’t had sex in the past six months.
And how often are those Eveready bunnies doing it? Of those who have partners, 41 percent are doing the once-a-week thing and 60 percent have sex at least once a month. Partnered folks are pretty touchy-feely, too: 78 percent hug and kiss at least once a week and 64 percent caress or otherwise give a little booty squeeze (sexual touching).
For women, that whole partner business is a bit of a conundrum. As we know, demographics is not on our side, since we live about five years longer on average than men, plus men tend to partner with younger women. As we age, we are more likely to be unpartnered, with the predictable impact on our sex life.
In addition to being affected when we're partnerless, sex is, of course, exquisitely sensitive to other events in our lives. The major life events that impact sexual frequency and satisfaction are health, stress, and financial worries (a different kind of stress, no?).
Good health is a top predictor of sexual frequency and satisfaction in many surveys. In this one, of those who rated themselves in “excellent” health, 42 percent have sex at least once a week and 54 percent are satisfied. Of those in fair health, 19 percent have sex once a week, and 23 percent are satisfied.
And while good health is partly the result of good genes and good luck, it’s also strongly related to good habits. The most active respondents—those who report exercising at least 3 to 5 times weekly—also rate themselves in excellent to good health.
Stress “is a major factor in sexual satisfaction,” especially among the youngest respondents. After age 60, respondents tend to experience lower stress levels. So, while younger people tend to be more sexually active, the study’s authors hypothesize that they might be even more so if they were less stressed.
The economic crisis and its attendant financial uncertainties may account for lower levels of sexual frequency and satisfaction, which were a full ten points lower than the 2004 survey.
From the mass of data they collected, the study’s authors compiled a short list of qualities that are good predictors of a happy sex life. They are:
Whether you’re a tortoise or a hare on the sex scale, remember that studies like these are only for information; they aren’t meant to pigeonhole or categorize. Your sex life and habits are unique to you and your partner. If sex is pleasurable and satisfying for both of you, who cares how often you “do it”? And if you find yourself dissatisfied and frustrated, well, this is one area in which improvement is always possible.
If you want to read the full report, you can find it here.