Feeds:
Posts
Comments

Posts Tagged ‘sexual intimacy’

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.

Read Full Post »

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.)

Read Full Post »

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.

Read Full Post »

A recent Wall Street Journal headline read, “Sex in Old Age May Lead to a Sharper Mind.” The article describes a study in which Dutch researchers looked into the way cognitive function and attitudes toward sexuality might be related among older people. Nearly 2,000 adults, with an average age of 71, were given a variety of cognitive tests. They were also asked a series of questions about sex—whether it was important for older people generally or themselves personally, whether they found it pleasant or unpleasant. They were asked whether they still benefited from intimacy and touching.

Quite a few—41 percent—said that their current sexuality wasn’t important, but 42 percent said it was important for older people in general. A quarter considered sex important or very important. Only 6 percent found sexual activity unpleasant. More than two-thirds believed that intimacy and touching were still vital.

The results of these questions and the cognitive tests were correlated. Both men and women who thought sex was important and were satisfied with their current sex lives tended to do better on the cognitive tests.

The Wall Street Journal article points out that the study made no claim that sex improves brain function, or vice versa: only that the two are associated. It can be difficult to disentangle cause and effect.

Another study looked at how cognitive function affects sexual behavior interest and sexual behavior among the elderly. The 352 Italians studied were between 65 and 105 years old. They were asked, “Are you interested in sex?” and “Do you have sexual relations?” They were also given two tests of cognitive functioning. One third were still having sex and 40 percent were still interested. This study suggested that a sharper mind might help keep a sex life going.

It could be that older people who are healthy enough to have sex are also healthy enough to do well on cognitive tests. Generally, whatever is good for the brain is also good for sex. That’s a good reason to keep on exercising, or to start.

Read Full Post »

A heart attack, whether it’s your partner’s or your own, is a devastating challenge for any couple. Recovery may be slow. Anxiety and fear are inescapable. Depression is common. The partner who is suddenly thrust into the role of caregiver may, at times, feel overwhelmed. Amid so many physical and emotional challenges, sex may feel like a low priority.

But it shouldn’t. What both of you need most of all is comforting, and nothing comforts like the touch of the one you love.

Both partners may be afraid of risking a recurrence. Not knowing what to do, they wait. Sadly, most are not getting appropriate advice from their doctors. In a recent study of patients aged 55 or younger, only 12 percent of the women and 19 percent of the men talked to their doctors about sex, and patients were more likely than doctors to bring it up (and I’d wager the numbers grow smaller with older patients). As one man said, “The subject was never mentioned in ten weeks of after-care sessions for life style and food advice and recuperative gym exercises.”

When sex did get talked about, two-thirds of the doctors gave advice that was more restrictive than the American Heart Association guidelines. Jalees Rehman writes, “The kind of restrictions recommended by doctors in the study—and presumably by medical practitioners who weren’t polled—are not backed up by science and place an unnecessary burden on a patient’s personal life.”

Blanket restrictions are unreasonable because every patient and every heart attack is different. It’s vital to discuss with your doctor your case in particular. After an uncomplicated heart attack, one week may be long enough to wait. Or you may need longer. The important thing is to be guided by where you are in your recovery.

Having sex is like doing mild to moderate exercise. If your doctor gives you the okay—and ask if he or she doesn’t give you the answers you need!—and if you can handle such activities as climbing stairs and carrying groceries without chest pain or feeling out of breath, sex should be fine as well.

You will be adjusting to new medications. Antidepressants may lower libido, and beta-blockers may interfere with erections. If you’re in open communication with your doctor about sexual issues, dosages may be adjusted or medications switched.

Various stressors are unavoidable, but sex can relieve stress and soothe both patients and their partners. The years of cultivating awareness of your own and your partner’s body will pay off. Care in tending to your relationship in the years before a crisis is like money in the bank. You never know when you might need it.

Sex is exercise, and exercise strengthens heart muscle. Sex also strengthens relationships. It’s a medicine no couple should be without for long.

Read Full Post »

You ask whether there’s a downside to using saliva as a lubricant. What makes it good for digestion makes it not so good as a lubricant: The enzymes that help break down food can be irritating to the delicate vulvar skin. As we lose estrogen, the vulvar tissue gets more fragile and delicate; what once was fine may become uncomfortable.

I also hear from many women that water-based lubricants don’t last as long as they’d like them to; they prefer a silicone or water/silicone hybrid lubricant for staying power through more foreplay.

That said, if it works for you and your partner, you can keep using saliva for some or all lubrication. Just be aware of the potential for irritation, and wash with a warm cloth after sex to minimize exposure.

Read Full Post »

In the last post, I ran up the flag for oral sex—mostly as a way of keeping our repertoire broad and deep as we and our partners face age-related issues with sexual sensitivity and/or function. After all, there are many ways to skin this particular cat.

But, as with any kind of sex, a little technique and creativity can put some spice into what too often devolves into a boring routine. All the tricks in the world, however, can’t take the place of communication and some interest and even excitement about the task at, um, hand.

Some level of communication is fundamental to sexual play and exploration. You can encourage: “I love it when you do that.” You can ask: “Does this feel good?” “What would you like better?” And you can pay attention to non-verbal cues: breathing, muscle tension, sounds, movement.

I’d also like to emphasize that, while it’s good to push your boundaries, if any part of sexual exploration feels really uncomfortable or off-putting, you don’t have to go there. We all have lines, and it’s important for both partners both to draw them and to respect them. But don’t just draw lines, continue to look for ways to keep the intimacy alive.

I’ve had women tell me that fellatio (oral sex on men) gave them a sense of empowerment, because they were controlling the action. By the same token, it gives the guy a break—he’s not in charge, plus he still has a good view of the action, which can be its own kind of turn-on.

With loving attention and communication on the front burner, here are some ways to change up your oral sex technique.

  • Take it slow. Don’t go for broke right away—let momentum build. Start with sensitive areas at the periphery—belly, inner thighs, buttocks. Use light touch, blow, kiss, lick. Take your time.
  • Move in. When you get to the genitals, keep the action soft and slow at first. Cup his testicles in your hand or mouth. Slide your tongue up the shaft of his penis. The frenulum is a particularly sensitive spot on the underside of the penis where the shaft meets the head. Tease a little before you commit.
  • Take a break. If your jaw gets tired, use your hands or your tongue to keep the action going.
  • Cool off. For a surprising change of pace, take a drink of ice water. The change of temperature is startling.
  • Heat and spice. Don’t keep doing the same old thing while you’re in warm-up mode. Use different sensations, change the speed and the rhythm. Build up to a firm, steady rhythm. Even if he isn’t totally erect, he can still orgasm and ejaculate.
  • Avoid the gag. You don’t have to deep-throat. Use your hand on his shaft and only take the head of his penis in your mouth. Then, you can suck or use your tongue creatively while stroking the rest with your hand.
  • Swallow—or not. You’ve probably already settled this, but if you don’t want to swallow his ejaculate, you can tell him to warn you just before he comes.
  • Hold him gently afterward.

Of course, the need for skill and technique apply equally to cunnilingus (oral sex on female genitalia). If your partner could use some coaching, slip him the highly rated “essential guidebook to oral sex,” She Comes First: The Thinking Man’s Guide to Pleasuring a Woman by Ian Kerner.

Women whose men have taken it to heart (and to bed) give it rave reviews.

Kerner also has a female guide to men’s sexuality, which includes pointers on oral sex: Passionista: The Empowered Woman’s Guide to Pleasuring a Man.

Now that you have your required bedtime reading, maybe you want to give each other an occasional pop quiz.

Read Full Post »

Older Posts »

%d bloggers like this: