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Archive for April, 2015

We saw the obituary for Dell Williams while we were gearing up for our MiddlesexMD anniversary. Realizing how many women have come before us, paving the way for straightforward conversations about women’s sexuality, we decided to start our sixth year with a series on those women pioneers. This is the first in that series.

The courageous pioneer Dell Williams died in March at the age of 92. She spent the second half of her life on a crusade to help women “define, explore, and celebrate” their sexuality. Back in 1974, she founded Eve’s Garden, the first store in America where women could buy vibrators and other sexual aids in a safe, private environment. All these years later, it’s still going strong.

Dell Williams grew up in the Bronx. After thriving as a WAC, in show business, and as a New York advertising executive, she made an unexpected career move, precipitated by a march. As she put it, “I stepped into the Women’s March for Equality in 1970 like a lamb and I walked out like a lion.” She joined the New York chapter of NOW, and “another chapter in [her] life began.” It was an intoxicating time, when women were giving each other the strength to redefine what their lives could be.

In 1972 she helped to organize the Women’s Sexuality Congress, which set her on the path of her life’s work. More than a thousand women gathered at a New York high school to talk about sex in a brand-new way. About the sex educator Betty Dodson, Williams said, “Her forthright talk transformed women from body-shy to body-proud.” Dodson recommended the Hitachi Magic Wand, which was supposedly for muscle massage but was highly functional as a vibrator. Inspired, Dell Williams went to Macy’s to buy one. The male sales clerk asked what she was going to use it for. The embarrassing encounter led her to think, “Somebody really ought to open up a store where a woman can buy one of these things without some kid asking her what she’s going to do with it.”

So she founded Eve’s Garden, first as a mail-order business in her kitchen, then as a store nearby on West 57th Street, discreetly upstairs. She wanted it to be a place where women could “celebrate the joy of their own sexuality” in comfort, at first with no men allowed. The mission was “to encourage women to take responsibility for their own sexuality, honor the sacredness of sex, and clearly understand that bodily pleasure and spiritual joy are one, and an inalienable right.” Kim Ibricevic, the current manager of Eve’s Garden, said that Williams “wanted to focus on the spiritual side of sex and felt that if every woman had an orgasm, there would be peace in this world.”

In a video made when she was well into her 80s, she is as warm and enthusiastic as ever. Flanked by two doctors, women whom she was introducing as sex counselors, she exclaims that “Eve’s Garden is just a garden of delights.” She describes how empowering it was for her to learn that she could take responsibility for her own pleasure, and how she had spent decades fighting for “women’s awareness that they had a right to enjoy themselves.”

As she put it, after so many years of studying the subject, “Sexuality is the biggest mystery of them all.”

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Birthdays are a useful thing—although it’s increasingly easier to celebrate them for our children (or grandchildren) than for ourselves. Here at MiddlesexMD, we’re celebrating a milestone: It was five years ago this month that we launched our website. While I’ve been practicing medicine for much longer (did I say it’s not easy to celebrate every milestone?), this marks five years of encouraging women to learn about and take charge of their sexual health throughout their lives.

Celebrating Five YearsThere are a number of ways to measure how far we’ve come, like marking our children’s height on a chart. The first that comes to mind is the number of women who’ve been in touch. We’ve been in contact with hundreds of thousands of women (and men who love them) from 209 countries. Many have thanked us for solving a specific problem, or for simply providing some hope and a path to follow. We’ve talked to hundreds of women in person, too, at medical conferences. Nurse practitioners and other health care providers have said how grateful they are to have a resource for patients and, because many of them are women, have shared personal stories, too. As a physician, I have more options available to me than I did five years ago. Osphena comes to mind as a treatment for vaginal and vulvar pain. And while localized estrogen products have been on the market for a while, I’ve noticed more advertisements for them. While too much advertising—especially of pharmaceuticals—can sometimes just be noise, I see the ads as an increase in conversation about women’s sexual health. And that’s a good thing. I’m hopeful about increased conversation at the FDA, too. Last fall I attended meetings to discuss how the agency reviewed and set priorities for drugs to treat women’s sexual health challenges. It’s been rewarding to join with colleagues in Even the Score, a campaign for women’s sexual health equity. In March, eleven members of Congress signed a letter to the commissioner of the FDA, expressing the firm belief that “equitable access to health care should be a fundamental right” and noting the disparity between the number of FDA-approved drugs for male sexual dysfunction (26) and female sexual dysfunction (0). It will take some time for new treatments to make their way through development, testing, and FDA approval. In the meantime, I’m also happy to note more books (including my own) and websites offering information, encouragement, and community to women as they navigate midlife and beyond. I hope you’re talking, too—to your partner, your friends, your sisters, and your health care provider. When we share our experiences, we feel less alone. And we can also learn from each other about what’s happening and what works to keep us vital and engaged. Because we know that even at—especially at—midlife and beyond, we’ve still got it! (Through the end of April, celebrate with us by using the code PARTYFIVE to take 20 percent off your purchase from our website.)

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You say you’re taking daily doses of Wellbutrin and Effexor. Effexor is the likely culprit, since Wellbutrin is actually “pro-sexual.”  Wellbutrin increases dopamine, a neurotransmitter beneficial for sex; Effexor increases serotonin, a neurotransmitter that is negative for sex—in that it can decrease libido or ability to experience orgasm.

If you can decrease the dose of Effexor without an increase in other symptoms, that may help. Decreasing the dosage may mean other symptoms comes back, or that orgasm is still out of reach or diminished. In those cases, I offer Viagra, used off-label for women. A number of clinical trials have shown Viagra to be helpful when SSRIs (selective serotonin reuptake inhibitors, a class of treatments for depression and other disorders) lead to an inability to experience orgasm.

A newer SSRI, Pristiq, is reported to have fewer negative sexual side effects. I’ve seen that to be true, but also have worked with patients who found that health insurance was not supportive, since newer drugs are often more expensive. It may be worth exploring!

Another alternative that works for some women is to take a ‘drug holiday’: skip the daily dosage of the SSRI on a weekend day when they are more likely to be sexual. This doesn’t work for everyone. Some people have withdrawal symptoms or other unintended side effects with the ‘holiday approach.’

I encourage women in my practice to consider using a vibrator, which can increase sensation and sometimes lead to orgasm. At midlife, it’s important to stay sexually active (that ‘use it or lose it’ thing), so it’s worth the effort to experiment.

I see how frustrating this dilemma is for women to manage through! I wish you patience and perseverance to find the right balance of overall health and intimacy for you.

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You say you’ve had itchiness and dryness and get bladder infections fairly regularly. Those symptoms are completely consistent with the absence of circulating estrogen to the genitals. Until recently, this condition would have been called vulvovaginal atrophy; its current name, genitourinary symptom of menopause, does a better job of describing that it affects both the urinary system and the genitals.

Women have estrogen receptors throughout their bodies, but they’re most concentrated in the vagina, vulva, and lower urinary tract. In the absence of estrogen, symptoms in that area are more notable. That’s the bad news.

The good news is that there are steps we can take to keep our tissues healthy and vital. See our website’s suggestions for vaginal comfort, and I encourage women to consider, with their menopause care providers, the use of localized hormones.

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Just a Perfect Day

If you could plan out a perfect day, what would it look like?

Two researchers explored that question in a study, “Developing a Happiness-Optimized Day Schedule,” published in the Journal of Economic Psychology. The researchers, Christian Kroll and Sebastian Pokutta, took data on how a large number of women spent a typical day and how much they enjoyed each activity. Then they had some fun with the numbers.

Subtracting 8 hours for sleep, they were left with 16 hours to divide up, minute by minute, into a day that would offer the most pleasure and satisfaction. Here is what they came up with:

106 minutes “intimate relations”
82 minutes socializing
78 minutes relaxing
75 minutes eating
73 minutes praying or meditating
68 minutes exercising
57 minutes talking on the phone
56 minutes shopping
55 minutes watching TV
50 minutes cooking
48 minutes using a computer
47 minutes doing housework
46 minutes taking a nap
46 minutes childcare
36 minutes working
33 minutes commuting

Some journalists joked about these oddly precise numbers. Simon Kelner asks whether a perfect day is different for men (likely answer: yes) and recalls Lou Reed drinking sangria in the park in his classic song.

But the researchers’ method actually makes sense. They write, “Our research asks what a perfect day would look like if we take into account the crucial fact that even the most pleasurable activities are usually less enjoyable the longer they last and the more often we do them.”

Imagine doing a jigsaw puzzle for twelve hours straight. If you like jigsaw puzzles, you would enjoy the first hour or two, especially if you don’t do jigsaws every day. But over time it would get way less fun.

Using that idea, the researchers took 16 common activities and allotted a number of minutes to each one, so that the last minute of each offered an equal amount of happiness. The more pleasurable the activity, the longer it took for the pleasure to diminish enough to match the others.

True, anyone who tried to follow the suggested schedule would go berserk. That wasn’t the authors’ intention! It’s a thought experiment: a way to think about what’s most important for an individual or a society. As the researchers point out, their computation “differs considerably from how people usually spend their time.”

If I use myself as a test case, I ask: Only 36 minutes of working? Fortunately, I love my work. I hope my perception of pleasure throughout a whole day of seeing patients is not an illusion. And 56 minutes of shopping? That’s not at all attractive to me as a daily activity.

But the study encourages us to be intentional with what we do with our precious time. The six activities at the top of the list, which the women enjoyed the most—intimacy, socializing, relaxing, eating (eating well, we hope), praying or meditating, exercising—are all vital to health in body or mind. We can think of each one as a different color thread, and make sure to weave them all through our days—with intentional planning of time for our relationships, for example.

We will be happier, and so will the people we love.

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