August 02, 2012

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arousal ›   comfort ›   intimacy ›   sensation ›  


Q: Do other women orgasm more easily than I do?

From what you describe, you sound like a typical patient of mine! About 4 percent of women never can have an orgasm. "Orgasmic dysfunction," or difficulty with orgasm, is reported in 9 to 27 percent of women. Sixty to 80 percent of us cannot have an orgasm with intercourse only; we need more direct stimulation, whether manual or "battery powered."

There are lots of reasons for "dysfunction," including neurological disorders, post-surgical complications, endocrine or medical disorders, side effects of medications or drugs; most often the reason is sociologic or psychologic, which includes everything from unsuitable stimulation, poor relationships or communication, history of sexual trauma, and more.

And as we grow older, vascular and hormonal changes don't make orgasm any easier.

If the vibrator you're using isn't quite doing the job, you might trade up to a more powerful model. We've chosen the vibrators we offer at MiddlesexMD (most rechargeable instead of battery-powered) in part because they have stronger motors, which equals stronger vibrations and more sensation. Take your time and focus on arousal as well as the "end game." Even if you're not experiencing dryness, a lubricant can encourage more touch and playfulness. Warming lubricants or oils can also increase sensation.

Perhaps the most difficult advice to follow: While orgasm is quite lovely (and good for our health!), making it a required outcome of intimacy can make it more difficult to achieve. The more you can focus in the moment, on each sensation and touch, the lower the obstacles!

Q: What might help me orgasm?

First of all, know you're not alone. By some estimates, as many as one in ten of us has never experienced orgasm, and among those of us who have, it happens in only about half of our sexual encounters. I'm not suggesting that makes it okay that you're struggling; knowing the facts, though, can lessen your stress about what's happening—or not happening.

In spite of what you see in the movies, most women—up to 80 percent—cannot have an orgasm with intercourse alone. Most women need direct stimulation of the clitoris, and the mechanics of intercourse just don't provide that. Oral or manual stimulation of the clitoris tends to lead to orgasm, and vibrators give the kind of stimulation needed—as variety or because it's easier. Especially as we grow older, many women need the extra stimulation a vibrator provides.

Vibrators can be for external or internal use. External vibrators (Fin, and Kiri) work extremely well for women who respond to direct clitoral stimulation. Other women like the internal stimulation of the vagina and G spot, too, for which some vibrators (Gigi, Raya, Celesse) are designed for insertion. Those vibrators can also be used externally on the clitoris. If you want the extra stimulation during intercourse, the external type will work best.

There are additional features you might think about, too; I've written whole blog posts on the topic. Whatever you might choose, I often recommend to women that they try self-stimulation to see what kind of touch where feels best. That, too, lessens the pressure when you're with your partner.

Enjoy the exploration! It's never too late to learn even more about your body.

May 17, 2012

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Q: Can I use my electric toothbrush erotically?

I get occasional questions about erotic use of various household objects. I am, after all, long trained as a physician, so safety and hygiene are among my first concerns. And, since starting MiddlesexMD, I've seen some very well designed vibrators, dilators, and dildos that I know are safe, easy to clean, and designed specifically for older women's pleasure.

That said, I encourage women and their partners to be playful. These are the things I would look for to be safe: Are there sharp edges, seams that might pinch, protrusions that might surprise you? Can you clean the material thoroughly—before and after use? Is it compatible with any lubricants you might use? And, less clinical but just as important, will it make you feel like a valuable, sexually alive person?

With those cautions, have fun exploring.

New Study: Docs Don’t Talk about Sex

When was the last time your doctor asked you how your sex life was going?

I thought so.

In a new study, a team from the University of Chicago surveyed over a thousand OB/GYNs about whether they talk with their patients about sex. The results may not surprise you, but they won’t reassure you, either.

  • 63 percent routinely ask whether their patient is sexually active. (Good, but fairly superficial.)
  • 40 percent routinely ask if the patient is having any problems regarding sex. (Which means that 60 percent don’t ask about sexual problems.)
  • 28.5 percent ask about sexual satisfaction. (Which means that two out of three doctors don’t ask.)
  • 28 percent ask about sexual orientation or identity. (Yikes! Two out of three don’t even know if their patient is gay or bisexual.)
  • 13.8 percent ask about sexual pleasure. (Which means that 86 percent don’t ask whether the patient enjoys having sex.)

Even more distressing was that 25 percent of OB/GYNs reported expressing disapproval of a patient’s sexual practices. Foreign doctors, older doctors, and very religious doctors were more likely either not to address the issue of sex or to express disapproval. Female doctors and those whose practice focuses on gynecology rather than on delivering babies were more likely to do some sexual assessment, although it was often insufficient.

Dr. Stacy Tessler Lindau, a practicing OB/GYN and lead researcher in the study, points out that OB/GYNs are the most appropriate health care provider to be asking these questions, and if they aren’t, it’s unlikely that anyone else is. Which means, as we have found repeatedly, that women tend not to mention sexual problems, to assume that a doctor can’t help anyway, and to suffer with or adapt to sexual problems on their own.

Doctors should be talking about sex with their patients because

  • Sex is an intimately linked to overall quality of life and the quality of one’s relationship.
  • One-third of younger women and one-half of older women report having some sexual issues, from lack of desire to painful intercourse
  • A change in sexual patterns can indicate an underlying health problem, such as depression or thyroid problems.
  • Women with ongoing sexual issues are more likely to feel self-conscious, isolated, embarrassed, ashamed, or guilty.
  • Assuming that a patient has a heterosexual orientation is alienating to patients who are lesbian or bisexual and can result in miscommunication and misdiagnosis.
  • Common medications, such as those for depression and breast cancer, for example, can cause sexual problems, such as low libido. Women are often not told about sexual side effects of medications and are therefore unprepared to cope with them.

The researchers hypothesize that doctors don’t talk about sex because, like everyone else, they’re embarrassed or they may worry about embarrassing their patients. Talking about sex isn’t part of their medical training, and although they may treat a woman’s sexual organs, they aren’t equipped to assess and treat her sexual problems. So what’s a frustrated patient to do?

Take the initiative, counsels Dr. Lindau. If you trust your doctor, but he or she hasn’t asked about your sex life, you can, and should, begin the conversation.

  • Formulate your questions ahead of time. What, exactly, do you want to ask your doctor about sex? Do you have specific issues, such as painful intercourse or low libido? Are you anxious about entering menopause and need information about what to expect? Write down your questions and be as specific as possible.
  • Acknowledge your discomfort, advises Dr. Michelle Curtis. It clears the air. “I know this is a little embarrassing, but I have some questions about sex I’d like to discuss.” Don’t worry about embarrassing the doctor, says Dr. Curtis. It’s his or her job to answer your questions.
  • Empower yourself. The medical profession will change as women take responsibility for their own sexual health and begin asking questions and expecting thoughtful answers. You can ground yourself in basic information with websites like this one or others backed by solid medical organizations, such as the Cleveland Clinic or Mayo Clinic. Then you can approach your doctor with good, informed questions.
And if your doctor doesn’t respond in kind, avoids your questions, or seems uninformed, you can consider finding another doctor. We’ll discuss that process in a future post.
April 09, 2012

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comfort ›   sensation ›  


Q: Would a vibrator be less irritating than manual stimulation?

If you're experiencing some irritation with clitoral stimulation, you might start with a hybrid (Sliquid Organics) or a silicone lubricant (Pink or Pjur). They provide more slipperiness for longer than their water-based counterparts.

And I would recommend that you try a vibrator. You can vary the intensity of the vibration, the pattern of vibration (continuous or pulsed, for example), and the pressure you (or your partner) apply--all helpful to finding what you need *now* for arousal. I'd recommend the Fin as an external options that is versatile, have nice soft surfaces, and can be recharged. The Kiri is a battery-operated, waterproof option with similar features.

Finally, if you're using a localized hormone like Premarin internally, with an applicator, there may be no added benefit from using a vaginal moisturizer. There's no harm in trying it, though, and I encourage moisturizer use among women who are not using localized hormones. If you choose to, Yes is the preferred product for many women who come to MiddlesexMD.

April 05, 2012

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arousal ›   conditions ›   sensation ›  


Sexual Desire. Still Trying to Figure Us Out.

If one-third of women don’t fantasize and rarely feel sexual desire, does that mean they’re all sexually dysfunctional? (Actually, the term is “hypoactive sexual desire disorder.”)

Or does it mean that the medical community needs a better understanding of how women get turned on, why we want to have sex, and why we might not want to have sex?

The research is clear and consistent: A lot of us simply don’t feel much sexual desire. We don’t think about sex much “in between,” and we aren’t particularly motivated to initiate sex. We do, however, enjoy it once the ball gets rolling, and we feel pretty good about our sex lives overall. “Research confirms that women report sexually satisfying lives despite rarely or never sensing desire,” writes Dr. Rosemary Basson in an editorial in Menopause: the Journal of the North American Menopause Society.

Basson is a champion for less labeling and a more open-minded understanding of female sexual arousal and response. (That’s why we love Rosemary!) She and others hypothesize that women have a different arousal mechanism than men, less straightforward and linear, more subtle and complex. Maybe desire and arousal overlap and reinforce each other in women. Maybe we need to light the kindling—a little nibble on the earlobe, a little stroke along the thigh—before desire and arousal begin to smolder. And sometimes life experiences affect our sexual appetite and responses. Longstanding personal issues, like childhood abuse or problems with our partner, for example, or recent developments, such as illness or depression.

Basson advocates careful consideration of all the variables when it comes to labeling one-third of women as sexually dysfunctional because sexual desire in women is subtle and many-faceted. Is a physical illness the impediment, or is it the financial worry that accompanies the illness? Or is it depression brought on by the medication for the illness?

Basson encourages a more “detailed, careful interview” to establish causation. And she is hesitant about blaming hormonal or neurochemical imbalances, which she says there is lack of evidence for.

When women are carefully examined, she feels that only a “theoretical sub-fraction… would merit a diagnosis of intrinsic sexual disorder.”

The bottom line, ladies? Lots of us don’t think about sex much in the course of daily life, but light the match, and we warm up nicely. For most of us, this isn’t a problem. So why consider it a sexual disorder?

And if it is a problem in our relationship, try to find a medical professional who’s willing to perform  the kind of “detailed, careful” examination that Basson recommends.

Between Flannel Pajamas and Birdhouses

When “intimate massagers” are placed between the flannel pajamas and the birdhouses in the Vermont Country Store catalog you know that vibrators have gone mainstream! The ad rightly points out that sometimes, as we age, we need a little more help getting where we used to go effortlessly.

As I've said before, regular stimulation helps keeps our sexual organs responsive and functional, and the stimulation might have to be stronger and longer. That’s where a vibrator comes in handy. The steady stimulation it provides tones the muscles and reinforces the nerve and vascular pathways to your genitals. But using a vibrator can also help you learn where you’re sensitive and how you respond to different stimuli (which will improve your lovemaking). It can get you aroused during foreplay, and it can be a gentle way to “cool down” afterward.

A vibrator is an equal-opportunity toy, and it can be a useful aid for couples as well. In this post, we’ll discuss some features to consider before buying a vibrator, and we’ll offer some suggestions for your first session or two.

Generally you want your first vibrator to be a versatile, multi-function machine until you know more specifically what you like. Perhaps choose a wand-style vibrator that can stimulate you internally and externally. (Some do both at the same time.) Typically, models with a  good rechargeable battery last longer and deliver stronger vibrations than those with disposable batteries—but there are some nice exceptions; check for motor strength. Opt for a vibrator with variable speeds so you can change the level of stimulation.

Some women use a vibrator in the bathtub, so you might consider a waterproof model. If noise is an issue, that might factor into your decision. You also have a choice of materials, from stainless steel and hard plastic to soft, fleshlike silicone. Some users recommend starting with a hard plastic model that doesn’t mute the vibrations and is easy to clean. If you want a less direct sensation, you can cover it with a towel or hand cloth.

Don’t spend a lot on your first vibrator until you know what you like. Better to be out $40 than to spring for $80 and find out you don’t like vibration at all. (Some women don’t.) After a few practice sessions, you might end up ordering several vibrators for different uses—small, discreet numbers for travel, say, or multipurpose gadgets for vaginal and clitoral stimulation.

Once you’ve received your first vibrator, however, take some time to get acquainted. Remember that part of the object is to learn about your own body—what stimulates you, where the sweet spots are, how you like to be touched.

Set aside a few hours of undisturbed time when you can relax. You might want to start in the tub. You can set the mood with music, a glass of wine, dim light, scent, even candles. You could read a sexy story or watch a movie that turns you on. Begin exploring your erogenous areas gently with your hand—labia, clitoris, nipples, vagina, thighs, belly, noticing the various sensations and what spots are more sensitive.

Lubricate your hands, genital areas, and the vibrator. (Don’t use silicone lubricant on a silicone vibrator, however). Turn it on and feel the sensation with your hand. If you have variable speeds, start with the lowest one. Place the vibrator on your thighs. Try your nipples if you like stimulation there. Place it on your perineum (the space between your vagina and anal opening). Move on to your labia; place it on your clitoris.

Try various speeds. Let youself become aroused, then back off. Your orgasm will be more powerful if you let the arousal build. Can you orgasm clitorally? Can you orgasm more than once? Do you need more stimulation or a higher speed?

Maybe that’s enough for one session. Or maybe you want to move on to the vagina. Insert the vibrator (assuming you have a wand-style model) and move it around. Try different speeds. Can you find your G-spot? Try clitoral and vaginal stimulation simultaneously. (Use your hand and the vibrator.)

For many women, the clitoris, labia, and first few inches of the vaginal opening (the vestibulum) are the most sensitive.

Use your vibrator to stay “in shape” between lovemaking sessions or to “warm up” beforehand. But let’s not neglect the new possibilities a vibrator brings to couples’ sex as well.

The G-spot: Defined but Not Demystified

Remember the G-spot brouhaha?

Yes, there is one. No, there isn’t. Is. Isn’t.

If you were aware of that controversy you might wonder whatever happened to it. Was anything about the mysterious G-spot ever resolved?

For all intents and purposes, after a flurry of attention in the 1980s, the G-spot seemed to go underground for a decade or two, but lately, with the advent of newfangled imaging devices, the search for the G-spot has resurrected once again. So, in case you’ve been wondering, let us bring you up to date on this mysterious region.

The G-spot is defined (and yes, there is a definition) as an erogenous area about the size of a nickel located 2 to 3 inches inside the front wall of a woman’s vagina.

The name comes from the German gynecologist Ernst Gräfenberg, who first wrote about its existence in 1950. But a mysterious pleasure center in roughly the same place had also been mentioned in ancient Indian texts and by Regnier de Graaf, a Dutch physician, in 1672, who wrote that secretions from this area “lubricate their sexual parts in agreeable fashion during coitus.”

But it was the publication of The G-Spot and Other Discoveries about Human Sexuality in the 1980s that ignited a frenzy. Couples contorted themselves into pretzels seeking the elusive mind-blowing orgasms that accompanied just the right stimulation. (Leaving many women feeling inadequate and their partners frustrated, I’m sure.) Researchers, too, overheated their Bunsen burners trying to find the darned thing.

Then, without further fuel to fan the fire, the short attention span of popular culture wandered, and interest in the G-spot waned.

In 2008, however, Italian researchers using new ultrasound technology discovered a thickened area on the front vaginal wall of about half of 20 women. Women with this thickened tissue were more likely to experience vaginal orgasms. In 2010, a group of British researchers asked 90 pairs of twins if they had a “so called G-spot, a small area the size of a 20p coin on the front wall of your vagina that is sensitive to deep pressure?”

Unsurprisingly, given the subjective nature of that question, the results from the British study were ambiguous and were challenged by other scientists. The following month French researchers, askance at the sloppy work from the boys across the channel, declared that 56 percent of women did indeed have “un point G.”

Physiologically, a G-spot has not been definitively identified by gynecologists, nor in dissections nor consistently in ultrasounds. So the mystery remains, according to urologist Dr. Amichai Kilchevsky, who led an extensive review of all research on the issue. “Without a doubt, a discreet anatomic entity call the G-spot does not exist,” says Dr. Kilchevsky.

Yet, women consistently report that stimulating the front of the vaginal wall produces a deep, pleasurable orgasm. “…it has been pretty widely accepted that many women find it pleasurable, if not orgasmic, to be stimulated on the front wall of the vagina," said Debby Herbenick, researcher at Indiana University and author of Because It Feels Good.

According to Australian researcher Dr. Helen O’Connell, the clitoris, urethra, and vagina all work together during sexual stimulation, creating a “clitoral complex.” Since the urethra lies along the outside of the vagina and the clitoris has deep “roots” within the vaginal walls it’s no stretch to imagine that all the parts work together during sex.

Some doctors compare the G-spot controversy to obsession over penis size—much ado about nothing. Lots of women don’t orgasm with vaginal penetration alone; indeed, most of us need both vaginal and clitoral stimulation to orgasm. So, if “we don't even have orgasm all figured out yet, I don't know why we would expect to have the G-spot figured out,” Herbenick said in an article on Netdoctor.

Because of its approximate location, the G-spot is devilishly hard to reach, especially in the standard missionary position. However, if you’d like to spice up your bedtime routine with a little research of your own, try sitting astride your partner, on a sturdy chair or firm surface. Lean backward so the penis has a better chance of connecting with the front of the vagina.

If this sounds too acrobatic for a fun Friday night, you can always fall back on the trusty index finger. Lie on your back while your partner inserts his finger, using a “come hither” motion to stimulate front of the vagina. Or try a toy. Special G-spot vibrators are available that are longer with a kink at the end. Results are still mixed, so focus on the exploration, not a specific result.

And remember to be well-lubricated and relaxed. Light a few candles and some incense. Research has never been so fun.

January 23, 2012

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Turn-on? Or Creep-out?

A male reader wrote to me recently. He’s “turned on” at the thought of his wife using a vibrator and wants to incorporate it into their sex life. The problem is that his wife is “creeped out” at the thought and won’t consider it.

This dilemma presents several issues that I think can be instructive to explore.

The first issue has to do with respect. We’re all at different points with regard to what turns us on and our openness to new approaches. Trying something new takes a willingness to explore and be vulnerable—and that can’t be forced, especially in intimate relationships. Otherwise, rather than feeling close and connected, your lovemaking will feel tense and coerced. Respecting boundaries is fundamental to a loving relationship.

That said, it’s also important to keep an open mind about what pleases your partner. Grownups do all kinds of things in bed, and as long as it’s safe, consensual, and pleasurable for both partners, there’s no right or wrong. The willingness to try something new, especially if it’s a “turn on” to your partner, is a loving act. And, who knows, you might like it, too.

When you encounter resistance from your partner to an idea or suggestion, you need to take a step back. Maybe discuss exactly what turns her off about, say, using a vibrator. Maybe she’d be more receptive to something smaller and less intrusive. Maybe she needs to try it alone first.

On the other hand, you could also talk about what your partner finds arousing. What has she always wanted to try? What are her fantasies? Try a trade-off. You do something for your partner, then switch roles.

There are some very good reasons to use a vibrator. They help us maintain vaginal health and boost blood circulation. They give us the strong, consistent stimulation we may need to reach orgasm. Using a vibrator, either alone or as a couple, isn’t “creepy” by most standards, and it isn’t particularly unusual. In fact, studies consistently show that introducing new things to your sexual routine in the form of toys, sex aids, or places and positions is helpful in maintaining a healthy sexual relationship.

If you’re at an impasse, you might consider continuing the discussion with a sex therapist, who can provide perspective and suggestions for moving forward in a loving way. But the bottom line is that you need to respect your partner’s boundaries, communicate about your desires and fantasy as well as your fears, keep an open mind, and be willing to incorporate new things into your sex regimen.

January 19, 2012

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Study Confirms Older Women Like Sex

Hm. We could have told you that.

Recently, we reported on the results of an international survey that explored how satisfied older couples are with their relationships and sex lives. Turns out that sex continues to be important to older women, and it’s an important element in overall satisfaction with their relationships—and sometimes it’s even more important to the women than to the men.

Now, another survey adds a little more texture and depth to that glimpse behind the bedroom curtain. Gals, we’re sexier than we thought.

Since 1972, researchers from the University of California San Diego School of Medicine have regularly surveyed a group of residents of a southern California community to track various characteristics of health and aging.

Recently, the results of a new survey of this group were published in the January 2012 issue of the American Journal of Medicine. Several hundred older women in the community were questioned about their sexual activity. In a mail-in survey, they were asked about how often they’d had sex in the past four weeks, about hormone use, lubrication, orgasm, and level of satisfaction.

“Sex” was broadly defined as “caressing, foreplay, masturbation, and intercourse” (of the penis-in-vagina variety). The women didn’t need to be partnered, and they didn’t need to be sexually active. Slightly over 800 women responded, ranging in age from 40 to 99 with a median age of 67. Most (90 percent) were in good to excellent health. Almost two-thirds were postmenopausal and 30 percent were on estrogen therapy.

What the researchers found, somewhat to their surprise, was that half the women reported being sexually active in the previous four weeks. Unsurprisingly, sexual activity declined with age (83 percent of younger women were sexually active versus 13 percent of the oldest women). Yet, one in five of the sexually active women over 80 reported arousal, lubrication, and orgasm “almost always” or “always.” They were also as satisfied with their orgasms as the youngest women in the study. (You go, girls!)

Sexual desire (libido)—or lack of it—was another surprise. One would think that desire might precede the act itself, but not so. What the researchers found in this study was that one-third of sexually active women had little or no sexual desire. Yet, most of them (61 percent) were satisfied with their sex lives. This suggested to the researchers that “women engage in sexual activity for multiple reasons, which may include nurture, affirmation, or sustenance of a relationship.”

The interesting thing about desire was that, although the younger women had the highest levels of desire, they were less satisfied with sex. They were also more likely to be distressed about their relative lack of desire (low libido). The oldest women, on the other hand, were more likely to be content with their sex lives and less bothered by lack of desire. But that doesn’t mean they weren’t getting any. The oldest women in the study who were sexually active experienced orgasm with the same frequency as the youngest women.

Hormone use was linked to higher libido and to greater sexual activity, but that doesn’t translate to greater emotional closeness with a partner. Emotional closeness wasn’t linked to age or use of hormones, but it was linked to more frequent sex. And most of the sexually active women in the survey were emotionally close to their partner. The researchers didn’t address the question of whether emotional closeness leads to better sex or whether good sex creates emotional intimacy. Cause or effect? Chicken or egg? I’m not sure anyone cares.

The final nugget unveiled by the study was that almost half of the women who aren’t sexually active are satisfied with their (non)-sexual lives, too. The researchers guess that they “may have achieved sexual satisfaction through touching, caressing, or other intimacies that have developed over the course of a long relationship.”

Overall, the survey seems to suggest that, given good health and a capable partner, older women are sexually active and quite content with that activity, and that, despite lack of desire, they enjoy sex just as much as younger women.

“A more positive approach to female sexual health focusing on sexual satisfaction may be more beneficial to women than a focus limited to sexual activity or dysfunction,” writes Susan Trompeter, MD, and one of the study’s authors.

Amen to that.