Archive for June, 2015

A recent report in The Journal of Sexual Medicine caught my eye. “Vibrators and Other Sex Toys Are Commonly Recommended to Patients, but Does Size Matter? Dimensions of Commonly Sold Products” is the title. First, I was happy to see that the authors are furthering the discussion about health care providers telling patients about “vibrators and other sex toys” (and, full disclosure, my article in OBG Management is footnoted as among the voices encouraging physicians to consider what they offer women through their practices).

Beyond that encouragement, the researchers compiled dimensions of vibrators and dildos, noting that not every source provides accurate or complete information. The conclusions they reached were that while the size of products varied, the dimensions, overall, “approximated mean penile dimensions.” They further suggested that further familiarity with the product category among clinicians, which is never a bad idea.

Since I’ve been recommending vibrators to women (and men) for some time, I’ve got some practical observations to share, for both patients and clinicians.

First, don’t do anything that hurts. Really.

The corollary to that is that you get to decide what hurts and what feels good. There are no “shoulds.” That’s true even if someone has a chart of dimensions and predictions.

I find that women like vibrators that can be inserted into the vagina for three reasons:

  • They like the feeling of fullness (and for them a dildo is also effective)
  • They like direct stimulation of the G-spot (which, as we’ve said before, has a mystique all its own)
  • While they don’t specifically think of the G-spot, they like the internal stimulation

Their favorite toys are as varied as the women themselves, and dimensions are only one part of that equation. Materials, pulse patterns, and vibration strength also count. Sexual partners and history can have an influence, as can progression of menopause, which can mean narrowing and shortening of the vagina. Over time, women may want a shorter, narrower vibrator, quite possibly with a stronger motor for more intense sensations.

But, again: Using a vibrator should feel good. If a vibrator is too large to comfortably insert, don’t insert it—or wait until you’re more fully aroused before you try again. And regardless of “insertable length,” don’t feel like there’s anyone but you who decides how deep to go.

And if insertion doesn’t sound good or feel good, remember there are a number of vibrators designed to stimulate the clitoris, which is where the nerve endings are concentrated that 70 percent of us need for orgasm.

So if your health care provider is still studying up, don’t be discouraged. Women have more than 100 years of experience using their own judgment with vibrators and pleasure, and you can do the same.

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Last week, an advisory committee to the Food and Drug Administration made history. Or, as the Even The Score folks have been hashtagging, Herstory.

They recommended that the FDA approve flibanserin, which is a pharmaceutical product intended to address hypoactive sexual desire disorder (HSDD). There were a number of concerns voiced, and some cautions will likely be recommended, including caution with interactions with alcohol and while driving.

Sally Greenberg, National Consumers League executive director, was quoted in The Washington Post as saying, “I think this is a huge moment for women’s sexual health, in the way that the pill was for women’s sexual health and ability to control their own destiny.” The Wall Street Journal article on the FDA panel said “… the panel’s vote marks a turning point in women’s health.”

I’m celebrating. This particular drug will not be the silver bullet for all women with HSDD, but I’m hopeful that we have turned the corner that the Wall Street Journal reporter envisioned. HSDD has been recognized as a legitimate health problem, and this panel of the FDA has accepted evidence that brain chemistry is a factor (as it is with depression and other mood disorders).

As a medical practitioner, I know that every woman is different, and no treatment will be perfect for everyone. Each woman has her own medical history, her own values, her own desires, her own trade-offs, her own attitudes toward medical treatments—and, for that matter, toward sex. Having options to choose among helps each woman to navigate challenges as she prefers.

The FDA is expected to take action on flibanserin in August. I’m hopeful that after that, I’ll have an option to offer women who have lost desire. And I’m hopeful that having seen this hurdle overcome, other researchers will add to our armorarium so we have even more choices to offer.

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This week Thursday, there’s a dry-sounding meeting that is a big event on an issue of enormous interest to a relatively small number of us. I’m talking about the joint meeting of the Bone, Reproductive and Urologic Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee of the FDA. Snoozing yet?

This meeting will hear presentations about Flibanserin, a drug developed to address loss of sexual desire, which is a real issue for some women. I’ve been following the prospects for Flibanserin (and other pharmaceuticals) for some time, as you may know if you’ve followed this blog. There’s been controversy—in medical, regulatory, and sociological circles. Some said the original studies were inconclusive. Some said the side effects were too significant. Others said that loss of desire isn’t an issue at all—that, variously, couples therapy, a romantic dinner, or more chocolate was the answer.

As a physician, I have conversations with women about their sex lives every day. Some women are clear about relationships that are no longer satisfying. Some have emotional issues—some from past sexual trauma, others from life’s over-abundance of stress—that affect their attitudes toward intimacy. Some have physical symptoms of discomfort or pain or loss of sensation that we can address.

But there are some who have simply lost desire. They love their partners, they have no physical symptoms or obstacles to overcome, they have no complications in their lives that would explain away the change. The overwhelming emotion they share with me is sadness. They are experiencing a loss. And my overwhelming response is frustration. Because as many options—over the counter and by prescription—as I have for vaginal dryness and pain and loss of sensation and even depression, I have no options for treating loss of desire.

Here are the things I hope the members of the advisory committees are keeping in mind when they hear the presentations this Thursday:

  • Loss of desire—for insurance code purposes, Hypoactive Sexual Desire Disorder (HSDD)—is real. Women and their doctors are smart enough to figure out when there’s another issue of physical or emotional health. And one in 10 women has HSDD.
  • Women are as deserving as men of treatment for conditions that affect their quality of life. There are 26 drugs for male sexual dysfunctions; surely a healthy and satisfying sex life can be as important to women as to men.
  • Women and their doctors are capable of deciding for themselves what trade-offs they’d like to make with their health. We’re already doing it with hormone therapy; for some of us, the benefits to our overall health and quality of life outweigh potential risks or side effects.
  • No blanket rules are required. Whatever treatments are available will be choices, subject to the insight of health care providers and individual patients’ health histories, values, and priorities. We’re hungry for options.

And I recognize that this week’s meeting is only one step down what has already been a long road. The advisory committees will make recommendations, but they won’t make a decision. That’s the work of another day. The pharmaceutical industry has to retain interest and commitment actually to bring drugs to market. Health care providers need to educate themselves and their patients about the options and the trade-offs.

So it’s a long road, still. Please, let’s just take one step. With open minds and fingers crossed.

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