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Posts Tagged ‘orgasm’

I’ve got much to catch up on, study up on, and share with you from my trip to the North American Menopause Society (NAMS) annual meeting a couple of weeks ago. It was a whirlwind of great talks, and such a marvelous time to catch up with colleagues who are doing wonderful work.

One of my all-time favorite people, Dr. Susan Kellogg-Spadt, who’s been a medical advisor here at MiddlesexMD, spoke at the conference! She was fantastic, of course.

She’s a nationally recognized expert in pelvic and vulvar pain and the Director of Female Medicine at the Bryn Mawr office of Academic Urology at the Center for Pelvic Medicine, in Rosemont, Pennsylvania. She treats patients throughout the United States as a vulvar specialist, sexual dysfunction clinician and therapist.

At her NAMS talk, Susan talked specifically about the sexual needs of menopausal women, and in some detail. We gain so much from having her in our field! But without further, um… gushing? Here are Susan’s top clinical pearls for our sexual health and happiness:

Add moisture daily. If we use a water-based, bio-adhesive lubricant several times a week, regardless of sexual frequency, we can get a lot more comfort and satisfaction with sex and just make it easier to have an orgasm whenever we want to.

Nourish yourself. A Mediterranean diet has been shown to promote sexual function, (and, we just learned, perhaps lower breast cancer risk). And regular exercise improves mood and overall health, both of which contribute to better sex.

Talk it out. When we use “I” language to talk with our partners about sex honestly and in a non-accusatory way, we increase the chances of sexual success. Your NAMS doctor or therapist can help provide the vocabulary and communication tips.

Prioritize pleasure. Don’t wait for intimate time to just happen. Even a 20-minute block of time, scheduled weekly, for touching and intimate conversation can clear the way to better sex. Putting it on your checklist may seem like a cold thing to do, but trust us, it gets hotter with practice.

Mindfulness matters. Reading or watching even the softest erotica, being mindful of erotic thoughts as they occur, and focusing on sensation rather than distractions during arousal are all important. All mindfulness training can contribute to your ability to stay in the moment during your most intimate moments.

Intensity, baby. After menopause, many women need more intense stimulation to reach orgasm. Consider introducing vibrators into sex play. The term, “Doctor’s orders!” can be very useful here. You have our permission to use it.

Do try. Just opening up and talking about sex problems, and finding what can still be sexual successes, shows that a woman is committed to her partner, and taking action shows her level of care and concern for the relationship. Mutual affection, honest attempts at exploring what is possible, comfortable, what still feels good, does amazing things for a relationship.

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In an ideal world, we’d all love our bodies exactly as they are. We’d love our little muffin tops for the reminder of all the ice cream sundaes we’ve shared with a best friend, our marshmallow tummies for the children we carried, and our pancake boobs for making bras (practically) pointless.

But we don’t live in an ideal world, and the way we perceive our bodies affects how we feel about having sex. We probably all have personal experience with this, and research backs it up.

Fortunately, there’s a way around poor body image and it’s called exercise. Before you groan and stop reading, just let me say that this post is about more than exercise’s effect on that muffin top. It’s about exercise’s effect on a whole lot of things.

Research shows that exercise improves body image, desire, and (our male readers will be happy to know) erectile functioning. It also leads to an increase in overall sexual satisfaction, according to research, the findings of which were published in the Electronic Journal of Human Sexuality.

And here’s the best part of that research: the exercise doesn’t even have to be strenuous. “Overall sexual satisfaction was significantly associated with all modes of exercise/physical activity (i.e., sport, aerobics, recreation, and strength training).”

Improving your satisfaction with your sex life might be as simple as taking a walk or a leisurely bike ride or going canoeing—the more frequently, the better. So the benefit of exercising isn’t just that it tones our bodies. It’s that we feel better about ourselves and our sex lives, maybe long before the effect shows up on our middle-aged middles.

Perhaps you already do those walks or bike rides. If so, good for you! Want better orgasms? Consider adding weights or aerobic exercise to your routine; the research also showed that strength training had “the strongest relationship to overall satisfaction with quality of orgasm.” And many studies show a correlation between aerobic exercise and quality of orgasm.

See? No need to be deterred by the word “exercise.” Just think of it as adding a little more activity that will lead to getting a little more action.

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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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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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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.

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I may be going out on a limb here, but I’d like to make a case for oral sex. It gives us another avenue to intimacy and pleasure, and as such, is an important component of a lusty love life. It’s a skill that couples should try to develop. Or at least keep an open mind toward.

Here’s why.

First, most women (70 percent. Did you get that number?) don’t climax with vaginal penetration alone. In my practice, postmenopausal women commonly tell me that the only way they can orgasm is through clitoral stimulation or oral sex.

For all women, no matter the age, the most dependable orgasm is clitoral—which, as we’ve said before, is a powerful organ with twice as many nerve endings as the penis.

Sure, the clitoris (and the penis) can be stimulated in many creative ways, but the mouth and tongue are darned effective.

Second, I know I sound like a broken record, but we lose sensitivity and the ability to lubricate vaginally as we age. And our partner’s ability to maintain an erection will eventually wane as well, despite the little blue pill. As the old penis-in-vagina sex becomes less dependable, it’s helpful to have other tricks up our sleeve.

Oral sex is one way to keep sexual pleasure alive as a couple. No less venerable an institution than the AARP says so in this article. It makes sense to give ourselves alternatives and room for compensation, so that when one capability diminishes, another can fill in the gap.

Now, I’m not for a minute suggesting that you haven’t tried oral sex. Sex coach Kathleen Baldwin, says that “It’s somewhat rare in my experience to find a woman over 40 who doesn’t enjoy oral sex.” She thinks that mature women are less influenced by cultural norms and are more familiar with how their bodies function, including their lady parts.

For many women, however, the “yuck” factor presents an impediment. Some women consider their genitalia “gross.” They worry about cleanliness or odor. They worry that it will take them too long to climax.

Funny thing is, most men really like oral sex—both giving and receiving it. I ran across an article by a man on the topic, who writes:

It’s an amazing feeling to satisfy a woman, and cunnilingus is the most foolproof way to do it.

It also minimizes our own performance phobia. Women can’t see what we’re doing, our tongues will never need Viagra and we’ve all got a similarly sized piece of equipment. But most of all, [cunnilingus] is a five-sense experience that places us up close and personal in a way that no other act can. …most vaginas smell and taste pleasantly mild…

The pleasure you can give your partner (and ultimately yourself) may be worth getting over any squeamishness. And you can always address the cleanliness issue by showering (or a bath!) before sex.

Oral sex, whether cunnilingus (oral sex to a woman’s genitalia) or fellatio (oral sex to a man’s genitalia) works best with some technique, and like any other skill, practice makes perfect. The most direct path to improvement is communication. You have to let your partner know what feels good. (More on technique in the next post.)

One final consideration: if you aren’t sure about your partner’s status with regard to sexually transmitted disease (STDs): you can still transmit them with oral sex. Chances of infection are lower, but Chlamydia, gonorrhea, herpes, human papyllomavirus (HPV), even HIV can still be “caught” through oral sex. For example, one woman I know caught genital herpes from a cold sore on her husband’s mouth!

So, if you’re with a new partner and you aren’t completely knowledgeable about his or her sexual history, you need to use protection—a dental dam (piece of latex placed over the vulva) condom, or femidom (female condom).

Kind of takes away the sexy, but it sure beats the alternative.

Oral sex is just another way of expressing intimacy and sharing pleasure. And it’s a particularly nice option if more traditional forms of lovemaking become problematic. Well, heck. It’s a nice option any time.

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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:

  • More direct clitoral (external) stimulation can help—and not all of us are accustomed to needing that. A good vibrator is effective; we encourage women to consider vibrators with stronger-than-average vibration strength, and choose the products we offer at MiddlesexMD with that in mind.
  • Localized vaginal estrogen can also be helpful; you’ll need to talk to your health care provider to see whether a prescription is appropriate for you.
  • Keeping the pelvic floor muscles in shape is a critical piece of enjoyable sex, too. Strong muscles are part of strong orgasms–as well as preventing incontinence. We offer a new product, the Intensity pelvic tone vibrator, that uses electrical stimulation to contract the pelvic floor muscles in addition to its vibration patterns.

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!

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