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Archive for February, 2011

This is the second part of our interview with sex therapist Sarah Young, who works with individuals and couples to help them rediscover–or perhaps discover for the first time–the joys of sex.

Q: At what point does the woman’s partner usually get involved?

A: Usually, I work with a woman for about a month before bringing in her partner. At that point, I try to get a feel for where he’s coming from, whether he wants to meet individually. If he does, we might move ahead where every other session is with the couple–so it’s couple, individual, couple, individual, through the duration of the therapy.

Q: What are some of the therapy techniques you use with couples?

A: We have many techniques, but if we need to talk about the basics, such as specific sexual positions and so on, I have these two little pipe cleaner people. The little blue person with the erection represents the man, and the pink one, with little boobs, is the woman. It’s delightful because some people have a problem even looking at pictures, so it’s a very neutral way to teach people positions.

I’ll also suggest readings, and we use a lot of sensate focus, too, which is kind of the default “go-to” for sex therapy in terms of reintroducing touch to couples. They rediscover the joy of just looking at each other, or sitting together, or holding each other. That also gives the therapist some control to say, okay, I’m going to take over your sex lives for awhile. You don’t have to worry about whether you should be doing this or doing that. You just have to do this one exercise, and it’s not even going to involve your genitals.

Because sex is not just about orgasms; it’s not just about his erect penis and your lubricated vagina. If that’s how it’s framed for couples, they’re doomed for failure. But if they can broaden their definition of the sexual experience, it’s huge for them in terms of being allies in the bedroom, on the same team, saying, this stage of life can be fabulous, how can we really embrace it?

Q: Can you give an example of a successful case involving a husband and wife?

A: There was a woman who came to see me because she wasn’t enjoying sex; for her entire married life it had been, “Okay, let’s just get this over with…” Come to find out, when she was a little girl, she was experimenting with masturbation, as kids often do. Her mother, who was very uptight about sex, discovered her and flipped out, making her filled with shame and guilt over it.

First we had to deal with her wounds, dissolving some of the lies she believed and getting her to see her sexuality from an adult perspective, rather than through the eyes of a seven-year-old.  We talked about how a person’s sexuality is not just limited to the bedroom; it’s part of who you are every day. I gave her some exercises to increase her confidence. For instance, a lot of women will look in the mirror and just see sagging boobs and cellulite. But I had her stand in front of the mirror and take joy in her hands, the hands that had held her children and made food for her family. And instead of keeping her sex drive on a low boil, I told her to go get some red underwear to remind herself that she’s a beautiful, sexual woman who has a right to enjoy and to be enjoyed by her husband. So it was getting her to see things in a new way, as an adult.

Over a period of time, she began to gain confidence, becoming more mentally present with him in the bedroom. And it just kind of took off from there. She’s still working on not feeling uptight, but she’s doing really great.

Q: Your work must be very satisfying. Do you enjoy it?

A: I absolutely love it; to see the hope in a woman’s eyes when she finds out she’s not crazy or abnormal or to see a husband who feels like he’s got his wife back, it’s just the best thing.

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A few months ago we talked about couples therapy, which caused some discussion about a closely related field: sex therapy. The idea of going to a sex therapist may be so scary that you wouldn’t even consider it! You’re probably not alone. That’s why we decided to talk with Sarah Young, MA, who is a sexual therapy specialist whose practice is Christian-based.

Sarah was educated at the Institute for Sexual Wholeness in Atlanta; her philosophy is that sex is not just sacred, it’s meant to be enjoyed. “It’s still such a taboo issue,” she says. Her goal is to help people find a “voice” for their sex lives, to talk about it and explore it freely without shame or guilt.

She had so many interesting things to say, we’ve divided the information up into two parts; here, she talks about getting started:

Q: What’s the biggest “fear factor” or misconception women have about sex therapy?

A: Sex is such a personal, intimate thing. They’re afraid they’re going to have to get naked and perform: Oh, my gosh, am I going to have to take my clothes off and show her what we do? That’s not how it works at all.

Q: Let’s talk about how it does work: How do you get started?

A: A lot of my referrals come from doctors working with women, so I’ll usually start with the woman. We’ll just have a conversation at first. Patients often ask how I got into sex therapy, and that gives me the opportunity to establish my professionalism, my ethics, and how I feel about the sacredness of sex, which always makes them feel more comfortable.

Then we’ll begin by talking about the bigger picture, her world as a whole: What are her other life stressors? I need to get an idea of everything that’s going on in her life, the larger dynamic, because it’s all entwined in the bigger circle. It’s not, Okay, give me all the details and let’s go.

Facing failure goes against what Hollywood says your sex life should be; it’s very threatening for people. So I try to validate her in that first session ­— here’s where you are and this is fine — and to offer her hope.

Then in the second session, I’ll usually engage in a pretty in-depth sexual history just to find out where she’s coming from. What are her automatic thoughts, how has her body image been formed, and what other experiences are in her reality? Some of the questions are very difficult for people, like whether she is masturbating, and if so, how often.

Once we uncover all the issues, we’ll talk about a game plan. At that point, I usually give it three weeks to a month between sessions, so they can just go through a cycle of life. Because you need to give this time; one week you might have a hormone issue, the next week, everything is okay. You need that whole cycle to give it a framework.

Q: What kinds of issues do you typically deal with in older women?

A: One big thing, of course, is menopause and all the changes that come with it. Women sometimes feel defective when they’re going through it, which is understandable. Often it’s a matter of shifting their perspective to just normalizing it; it is what it is, you need to take it one chunk at a time.

Other issues might be aging in general, or a partner’s infidelity, or the reality of cancer and mastectomies: How am I still supposed to feel sexy when my breasts are gone? And the empty nesters: The kids have gone off and mom and dad haven’t paid attention to each other for years. Now all of a sudden, she’s thinking, I don’t even know how to be his friend, let alone his lover. So a lot of it is empowering people to reignite the passion and the friendship they once had; they’re in a place when they can engage in a more mature perspective.

Q: Once a person starts therapy, how long might it last?

A: It really depends… I have couples I’ll see every few weeks for three months and they’ll check in after that every few months to update, or if they’ve hit a glitch or want to talk through it. Every case is different, really.

Watch for part two of Sarah’s interview, in which we discuss partners’ roles and therapy techniques used; you can see it next week!

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Dilators don’t treat vaginal atrophy, but they do help counter a consequence of vaginal atrophy: narrowing or shortening of the vaginal. Used over time in graduated sizes, dilators help to restore vaginal length and width, which we also call vaginal capacity.

The loss of estrogen leads to vaginal atrophy. Using vaginal moisturizers and/or vaginal estrogen helps to restore tissue health. In turn, healthy tissue responds well to the use of vaginal dilators for comfortable intercourse!

It helps to understand the varied effects of a reduction in hormones. You can read the whole story on our website in what we call “the recipe” for continued sexual health!

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Who has time for sex any more? That’s a question I hear from women whose plates are full with working, caring for parents, caring for kids, even caring for grandchildren. With all of the demands on our time and energy, why not just let sex fade into the background? Beyond the intimacy sex brings to our relationships, research continues to document how and why regular sex improves both our mental and physical health. These effects are significant enough to feel as good about an active sex life as about taking our daily vitamins.

Consider, for example, that sex is

  • a beauty treatment. Intercourse releases estrogen, which helps keep skin firm and hair shiny.
  • a good aerobic workout. A moderately strenuous 30-minute frolic burns about 85 calories. (A vigorous, one-hour session can burn up to 200 calories!) Not only that, it gets your heart pumping. Pulse rates rise from about 70 beats per minute to an athletic 150. Finally, intercouse tones the butt, belly, and those all-important pelvic-floor muscles that are so critical to bladder control.
  • a natural chill pill. Sex lowers blood pressure and relieves stress. One study revealed that simply being hugged by their partners lowered women’s blood pressure and raised their oxytocin levels.
  • an antibiotic. Regular sex is linked to higher levels of the infection-fighting antibody immunoglobulin A (IgA).
  • a love potion. Sex pumps up to five times the normal levels of oxytocin into our systems just before orgasm. This chemical has been called the “love drug.” It makes people feel trusting, bonded, intimate, and generous—all good things for a relationship.
  • a pain killer. Those high levels of oxytocin release endorphins into the bloodstream, which can lower pain thresholds by half. Intercourse has been known to relieve aches and pains, such as arthritis and headache.
  • an antidepressant. Again, the chemical and hormonal stew that sex unleashes, including oxytocin, endorphins, and serotonin, make us feel good in body and mind. The release of serotonin can stabilize anxiety and improve mood. It enhances our overall sense of well-being.
  • a cardiac protective factor. Regular sex (up to three times per week) could lower the risk of heart attack by half, according to a study at Queen’s University in Belfast.

With all these positive outcomes, sex is certainly “good for what ails you”–and can prevent ailments as well!

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This topic comes up more often with girlfriends than with patients. But it comes up often enough with girlfriends that I know it’s on my patients’ minds, too! The question is whether it’s sometimes okay to fake an orgasm.

I think it depends on how you define “sometimes” — and what your reasons are for faking. Let’s start by acknowledging that, by some estimates, as many as one in ten of us has never achieved an orgasm. Among those of us who orgasm, we might do so in only about half of our sexual encounters. And, just to dispel one widespread myth, only about a third of us achieve orgasms with heterosexual intercourse alone.

All that said, I think you get to decide when you signal your partner that you’ve achieved orgasm when you haven’t. Maybe you’re getting tired but you don’t want to break the intimate mood. Maybe you want to satisfy or boost your partner’s confidence. Studies show that nearly 80 percent of women will fake orgasm at some point.

But making a habit of it isn’t fair to you or to your partner, even though, with our busy, fast-paced lives, it can be an easy pattern to fall into. It’s worth it to spend some time—alone and with your partner—learning more about your body and its paths to orgasm. Even if you’ve had a lot of experience, changes in hormone levels, circulation, and tissue health can mean your needs have changed.

If you’re faking more than once in a great while, there may be something else going on that needs attention. Do you feel like it takes too long to reach orgasm? Does your partner know exactly what to do to help you achieve an orgasm? Is there something on your mind that’s making it hard to relax when you’re having sex? There are lots of ways to increase your mindfulness, sensation, and response.

We like sex for lots of reasons, and orgasm doesn’t have to be one of them. If you’ve never learned to have an orgasm, or if you don’t have them regularly, don’t consider yourself a sexual failure! But if you’re finding yourself pretending more than you used to, it’s never too late to learn or relearn our bodies.

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This is a great question. Overall wellness is vital to sexual health; a woman who enjoys good health will usually have more sexual satisfaction, as well. There’s a clear tie, for example, between regular exercise and reported sexual satisfaction. Chronic conditions like hypertension, diabetes, and cardiovascular disease can adversely affect sexual health.

Over the years, patients have tried numerous alternatives to enhance sexual function, including chocolate, ginseng, oysters, and black cohosh. There is a product called Vigorelle that includes herbs and botanicals; it is reported to be the ‘Viagra for women.’ However, there are still no randomized, controlled clinical studies to ensure efficacy or safety for this supplement or any others for this indication. Unfortunately, these products are often expensive, and my experience is they are not significantly effective.

So the answer to your question is that there doesn’t seem to be an herb, vitamin, or supplement that is proven to improve sexual satisfaction… yet. We keep an eye on the research and promise we’ll let you know!

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If you read this blog regularly, you know that I usually summarize questions I receive from visitors to the website when I think the answers will be helpful to more people.

An e-mail I received today, though, makes me want to say more. The message was from a 63-year-old widower who says, I “have met the second love of my life, something I thought would never ever happen again.” He goes on to explain that he’s doing research because he and his new love have enjoyed intimacy, arousal, and orgasm, but have been unable to have intercourse.

Unfortunately, time and aging are not friends of the vagina. Without ongoing maintenance—meaning regular use and moisturizers—it is typical that a woman will lose function over time. The vagina narrows and shortens and the tissues become more fragile, as this couple have experienced.

Vaginal dilators are part of the solution for many women who’ve reached this point; most women can regain vaginal function in a matter of weeks. Using a moisturizer or vaginal estrogen at the same time helps to improve tissue health and elasticity.

What I found really encouraging about this e-mail was that it came from a man, a man who took the initiative to get information to equip himself and his partner to address these issues together. “I don’t want to hurt her,” he said; “I want to make love to her.”

Making love. It’s a reminder that our physical intimacy is something we create together with a partner, and that a partner has an interest in—and can help us—to overcome or work around physical changes that get in our way. As women, we don’t have to keep secrets or try to compensate for problems on our own.

And if we find ourselves without partners? Loving ourselves is part of remaining open—figuratively and literally—to those relationships that still surprise and delight us. It’s easier to maintain vaginal health and functionality than it is to regain it, and you’ll bypass the physical and emotional pain that this e-mailer described. Even if you think you’re done with relationships and sexual intimacy… well, the patients I see in my practice and the e-mails I receive at MiddlesexMD.com tell me to never say never—even when you’re sure it will “never ever happen again.”

I see it happen all the time. Has it happened to you?

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There are two principle non-surgical options for birth control: hormonal and barrier methods. Sounds like you’ve already decided to steer clear of hormones, at least for a time.

The most common barrier options include condoms (male or female) or diaphragms, in combination with a vaginal spermicide. (Vaginal spermicides, available as film, foam, and suppositories, have a slightly higher failure rate than other methods when used alone.) We haven’t yet found a female condom that is easy to use and reliable–let us know if you have a recommendation! Don’t count on condoms that have been rattling around in a drawer while you’ve been on the pill: Freshness does count so the condoms aren’t brittle.

You’ll need to talk to your health care provider about a diaphragm, since it needs to fit you well.

And, of course, there are surgical options for your partner (vasectomy) or for you (tubal interruption). Again, a discussion with your health care provider will help you weigh those options.

You’re smart to be thinking ahead about this!

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