Do your Kegels!

August 25th, 2010 by Bat Sheva Marcus LMSW MPH PhD

I’m sure I’m not the first one to tell you this, but kegel exercises are really important. As you age, the muscles around your vagina and urethra weaken. This can lead to all kinds of problems which, trust me, you don’t want.

Most often women experience leaking urine when they cough, laugh or sneeze. It happens to some women when they have an orgasm. While this is not the worst thing in the world (Panti-liners and towels on the bed during sex help handle the “symptoms”) it is a part of our physical health and well-being.  And because there is a simple way to work on this, there’s really no excuse for slogging through a soggy situation.

The Medical Center For Female Sexuality is putting out a Kegel CD to help you exercise your kegels every day. Stay tuned. We promise we’ll let you know as soon as we have it for you! In the meantime, check our website for instructions on how to do kegel exercises.

The Cookie Sutra

August 23rd, 2010 by Bat Sheva Marcus LMSW MPH PhD

Every once in a while a book comes out that makes us smile. The Cookie Sutra is one of them.

Written with a witty tongue-in-cheek style with adorable pictures of gingerbread men and women in a variety of compromising positions, this book would make a really fun gift. As the cover states, this is the book  “Where imaginations are fertile, love will never grow stale, nor crumble.” The book’s dedication is (presumably) to the author’s  partner: “For Lisa, for showing me where we keep the baking stuff and not asking why.” And it even has a recipe for gingerbread cookies at the end. Haven’t tried it yet… but believe you me, I will!

Book Review: Will “Sex at Dawn” influence sex therapy?

August 18th, 2010 by Stephen Snyder, MD

Recently, Sexuality Resource reviewed Christopher Ryan and Cacilda Jetha’s Sex at Dawn a new book drawing on a vast amount of cultural and physical anthropological scholarship to argue that for our hunter-gatherer ancestors, sexual promiscuity may have been an established way of life.  And that the development 10,000 years ago of agriculture, an ownership society, and sexual monogamy brought an end to this golden age of sexuality.

As a sex therapist in New York City (where the kind of ownership society begun 10,000 years ago has perhaps reached a pinnacle of development), I wonder about whether the ideas discussed in this book will influence my field much.

So far, it doesn’t look promising.  The dominant public reaction to the book in its first month has been that it “shows that humans are meant to be sexually promiscuous.”   This is a subtle and understandable misreading of Sex at Dawn, but a misreading nonetheless.

Let me explain why it’s a misreading — using an excerpt from Sex at Dawn that you may worry is a digression.  But trust me, it’s relevant.

Human nature?  It’s the bananas, stupid.

During Jane Goodall’s first four years studying chimpanzees in Tanzania, according to Sex at Dawn, she observed them to be remarkably peaceful creatures.  But they were difficult to observe, since they tended not to hang around her camp much.   So she tried to attract them nearer by regularly feeding them bananas.   The effect, evidently, was to make the chimpanzees more aggressive.  Fighting between them increased dramatically.

Now, which represented the chimpanzee’s true nature?   The gentle chimpanzees happily feeding far apart in the forest, not bothering each other?   Or the hoodlum chimpanzees shoving each other out of the way at the daily banana trough?

The answer, as Ryan and Jetha eloquently express, is neither.   It’s like asking whether water’s true nature is ice or liquid. It all depends on the conditions. Change the conditions, and you change which of many potential natures will be manifest.

Goodall’s observations also show the relative delicateness and vulnerability of an established primate social order.  For the chimpanzees, a peaceful society depended on abundant food supply that was dispersed, with lots of feeding spots for everyone. Stick a big box of bananas in the middle of the forest, and the whole neighborhood goes to hell.

The kind of early human social structure that encouraged sexual promiscuity was a delicate thing.  It required a small tightly-knit group of less than 150 individuals, an abundant natural food supply, and an inability to hoard resources.   As I look out my front door in New York City, I don’t detect much potential for the establishment of that kind of social order.   It’s strictly big boxes of bananas, all the way up Columbus Avenue.

Yet the popular buzz in the book’s first month seems to miss all of this.   “We’re really meant to be promiscuous,” yell the headlines.

No.  The reality is more sobering.  The material conditions that would permit a stable culture of sexual promiscuity are long since gone.

The sober reality is that, as the poet Wordsworth wrote 200 years ago, talking about something completely different but really not so different — “nothing can bring back the hour / Of splendour in the grass, of glory in the flower.”

Will Sex at Dawn influence sex therapy?  In my own practice it already has.  But in a different way than you might think.

The Wordsworth poem about “splendor in the grass” begins with the poet’s awareness that as an adult he no longer is capable of the extremes of ecstatic pleasure that he recalls from childhood.

Since reading Sex at Dawn, I’m even more conscious in my work with individuals and couples that even our best sexual experiences are probably only a dim echo of a once-ecstatic form of sexual being.  One that can no longer be adequately described in words or images, because the psychological and cultural conditions necessary for it have vanished.

This once-ecstatic form of sexual being was probably often communal, and involved an absence of shame and a deep sense of communal connection that I cannot imagine.

There is currently some talk in the sex therapy field about whether we can “change the conversation” about monogamy vs infidelity that currently dominates the American media – perhaps change it to a more European-style model, which takes sexual infidelity less seriously.

Maybe.   But I think we’d just be tinkering around the edges.

To me the message of Sex at Dawn for sex therapists is this:  Be sensitive to the fact that we’re all sexual exiles.   Be tolerant of the sexual struggles of your fellow moderns.  They’re doing the best they can under quite compromised circumstances.  Or, to quote the Wordsworth poem again,

We will grieve not, rather find
Strength in what remains behind;
In the primal sympathy
Which having been must ever be;
In the soothing thoughts that spring
Out of human suffering.

Our sexual exile will not end anytime soon. In the meantime, we’ll do the best we can — to treat our sexual selves with kindness and understanding.

© Stephen Snyder, MD 2010    

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Tips for Selecting a Sex Therapist

August 9th, 2010 by Bat Sheva Marcus LMSW MPH PhD

At the Center we treat women who suffer from various conditions that prevent them from having satisfying sex lives.  Our goal is to uncover the physical causes of these conditions and treat them medically.

On staff at the Center are human sexuality counselors who conduct a psycho-sexual intake before a patient’s physical exam.  Through this intake, and by getting to know our patients as we treat them, we gain a better understanding of the psychological backdrop to a patient’s sexual issues.  And sometimes what we learn leads us to recommend that a patient or couple seek counseling with a sex therapist.

We, of course, have some local favorites, but often women write to us for recommendations beyond our geography and we don’t have a comprehensive list; or we just don’t have professional experience with them so we hesitate to recommend.

But we do have a strong perspective on what to look for in a sex therapist. Click here for some solid tips on choosing a sex therapist.

Should dinner always come first?

August 4th, 2010 by Bat Sheva Marcus LMSW MPH PhD

I’ve been thinking of the very romantic notions we have regarding dinner dates.

The typical order of events is: large, beautiful, (usually quite saucy) romantic meals and then great sex. In a way that makes sense because dinner is seen as the wooing and romancing which is then followed by sex. The problem with this picture is that so many people I know say they have better sex BEFORE they eat. Big dinners make them sluggish and tired, not exactly the two adjectives you’d want to use before the word “sex.”

Some people even go so far as to say that sex is better when they are a little bit hungry. Their senses are attuned and heightened. Now, I’m not suggesting that you starve yourself into great sex… I’m just suggesting that maybe flipping around the order a bit would make sex better.

So, next time you have a hot dinner date, maybe ravage your date BEFORE DINNER, doze for a few minutes and then go indulge your (now much bigger) appetite. Or, to help this fit into our real lives, when your partner gets home from work,  suggest a before-dinner tryst and see what happens!

Response from a patient on the “medicalization” of female sexuality debate

July 27th, 2010 by Ilene Rosenthal, Marketing

We received an unsolicited response to Dr. Marcus’ position piece on the “medicalization” of female sexuality from a patient.  Her words speak for themselves.

“The last time I was in the office I told Dr.Marcus that she will be remembered for her contribution to Female Sexuality the way that Margaret Sanger was with birth control.

I read the article (in the latest e-newsletter from the Medical Center for Female Sexuality) and I could not agree more. It took a great deal of courage for me to pick up the phone and make that first appointment. I had spoken with a psychotherapist at length about the problem itching. discomfort and pain in my vagina; loss of desire that had nothing to do with my attraction to and love for my partner and finally my inability to achieve orgasms after being someone who previously had no sexual problems and certainly no problems achieving an orgasm. As I was in a new relationship my therapist said it was just a matter of getting comfortable with a new person. I know my body and I knew she was wrong. I tried the ‘herbal cures”, specifically Thandia from Native Remedies. Three months and I felt no difference.

I have been on Dr. Marcus’ s treatment regime for less than a month. The vaginal dryness and discomfort ended the first week. My level of sexual desire has returned almost to the level it was before I noticed a change and this weekend I had an orgasm that was as good as some of the ones I had at 30. So, I am a firm believer that there is no “magic pill” but a complex mixture of supports that Dr. Marcus has developed for each patient. You saved my sexuality and thus my relationship which is a huge part of my ongoing happiness.”

“M”, July 2010

Debate: the “Medicalization” of Female Sexuality

July 23rd, 2010 by Bat Sheva Marcus LMSW MPH PhD
I hope you’ll forgive the lengthy perspective below, but this is an issue I am extremely passionate about. 
 
If I hear one more time that women’s sexual dysfunction is a myth created by the media, and that the search for medical solutions is merely a thinly veiled way for the pharmaceutical companies to fleece innocent and gullible women, I may shoot someone. 

The Numbers

Ask around:  women have long been complaining to each other and their physicians about various sexual problems that present issues in their relationships and with their own quality of life:   ”I have pain.”  “I don’t get turned on.” “I can’t have an orgasm.” Even if you do believe that the pharmaceutical companies are looking for ways to keep their shareholders happy, it is difficult to find fault given these statistics.

Current studies indicate that 43% of women express dissatisfaction with their sex lives at some point in time. Hmmmm. Let’s say the “real” number is being inflated by 100% — that would still leave us with one quarter of all women suffering from these conditions and their unhappy consequences.

How real is this?  For the skeptics,  let’s say that number is still inflated and the real, discounted number is only 10% of all women who are experiencing female sexual dysfunction.  Even that would 30 million women in US alone!  Do the math:  21% would be 60 million women.  And 43% would be 120 million. 

Are we painting a clear picture here?   Whether it’s 30, 60 or 120 million women suffering from female sexual dysfunction, it’s only reasonable to accept that it’s a problem worth addressing.

Big Bad Pharma

Now let’s talk about the big bad pharmaceutical companies accountable to their shareholders. Profit and share-price are the motives for making a product which works and will sell to a large patient population driven. No question.

When they look at the statistics they must be salivating!  What a huge group of prospective users!  An effective drug that solves low desire, for example, would be a boon!

So what’s wrong with that? 

What if the motivation for studying a solution for millions of women is profit?  Personally, I don’t really care what their motives are as long as they are working on the problem. If Big Pharma is trying to produce a drug that may help low desire or arousal, good for them!  This may also be good for some my patients, which is the point, isn’t it?

Medical treatment and psychotherapy

Strikingly, you most often hear complaints about the “medicalization” of female sexual dysfunction from psychotherapists.  Many seem horrified at the possibility that physiology may be at the root of female sexual dysfunction, and claim that practitioners will push suffering women into spending their hard earned dollars on questionable medical treatment. 

In our practice, we have the opportunity each week to refer some of our patients – including some who have found medical treatment for their fsd – to local psychotherapists for longer term counseling connected with their experiences with sexual dysfunction. We recognize that the priority is getting patients the help they need in whatever way best suits their temperament, medical condition and wallet.  Even though we believe that our approach of integrating the psycho-sexual with the physiological is powerful, we accept that some women will decide on traditional talk therapy to address their needs. Just because there may be a physiological reason for a particular sexual condition, does not mean that there cannot be related psychological – or even psychiatric – dysfunction that needs to be addressed by a specialist.  But let’s be fair – the reverse is also true.

And finally, as part of the health care debate it’s hard to disagree with effective medical treatment that carries an annual cost of less than $2000,  particularly when compared to upwards of $7000 per year for psychological counseling alone.  So, factoring in the cost of different treatment options must be part of the equation for every patient.

“Quick Fix” vs. the “Long Haul”

To women who experience ongoing sexual difficulties, the choice between a quick fix and an interminable journey is unhelpful.  Calling medical treatment for female sexual dysfunction a “quick fix” undermines the hard work patients do to face their condition head on.  Patients will often overcome great embarrassment and insecurity to seek treatment.  They may try unfamiliar or even uncomfortable procedures to address their problems.  They may need to involve a disappointed or resistant partner in order to make progress.  None of this describes a “quick fix” and the psychotherapeutic community’s knee-jerk assignment of that term demonstrates disrespect for women who are sincerely struggling with an untenable situation.

Two key questions remain at the fore when a patient considers treatment options:  will it work and is it safe?  After that, the next question is often: how long will it take (the adult version of, “Are we there yet?”)?  Of course, the fact that medical treatment of FSD often resolves problems within a few months may alienate therapists who believe in a longer-term process.  That, we believe, needs to be left up to the patient.

At the root of this argument is another assumption:  that intimacy and sex are the same. The sooner we recognize that this is not true in every case, the more open the psychotherapy community will be to considering other channels to help patients find complementary paths to solving the distress of FSD.

A “quick fix” for the media

As we watch the media respond to the news regarding Flibanserin,  Boehringer Ingelheim’s drug to improve sexual desire in women currently in clinical trials,  we see how desperate they are to find a  pithy, newsworthy way to present an issue.  That’s where “Flibanserin, Viagra for women” comes from.

Such a synopsis ignores the different way the medications work (vascular for Viagra, hormonal/neurotransmission for Flibanserin) and disregards the complexity of sexual dysfunction for women.  The lack of depth in describing the problem and its possible resolution is astounding and only reflects poorly on responsible media coverage.

“The consumer is not an idiot. She is your wife”

This quote is only one of many tenets of advertising and marketing proffered by David Ogilvy, considered the father of modern advertising.

To suggest that women will be sheep and buy whatever cream or pill is recommended, and keep using it even if it’s not working, is ludicrous and infantilizing. Women are smart consumers. When they have a problem they try a solution and they stop if it doesn’t work. I can list a slew of herbal “remedies”  that have been on the market for sexual dysfunction. Some had significant marketing and PR dollars behind them, and nearly all of them are no longer being sold.

I have the utmost confidence in women who are seeking solutions to obstacles that stand in the way of their goals.

An intelligent, responsible person will evaluate treatment options with her own needs at the fore, and with an eye towards efficacy and safety and effort.  She will not be convinced by phony claims, snake oil or an unsatisfying experience.

So, as you can see, this is not snake oil or fantasy, but a set of sound alternatives based on medical practice and fact.  Virtually all conditions can be addressed in far less than one year with follow up assessment as needed.    If you’ve ever met a young married woman who has been unable to consummate her marriage, a vibrant mom of teenagers who simply cannot find her libido, a post menopausal 55 year old who can no longer achieve orgasm, a young single woman who wrestles with her relationship because she cannot feel aroused, then you know how important it is to be prepared with all possible solutions.  It is our job the help her have the sexual life she wants, regardless of what the critics say.

Kids at Camp = more time for sex!

July 21st, 2010 by Bat Sheva Marcus LMSW MPH PhD

We had to repost this advice since, well, it’s summer!!

Okay so your kids are at camp, you’re alone in the house — have sex! The summer might be an unusually great time for you to reconnect with your partner. Even if you’re not lucky enough to have the house to yourself, for many people the summer is a slower time — and may be a great time to work on the relationship.

One of the things I hear over and over again from couples is how universally the intimacy in the marriage affects the whole relationship. As one patient told me yesterday, “You know, now that we’re having sex, and I’m ‘into it,’ we just seem to be having so much more fun together. He’s happier, I’m happier, he’s being more helpful. Our life is just so much better.”

So this week, maybe instead of reorganizing your closet, and plowing your way through your “to do” list, you’ll think about climbing back under the covers (or back into the shower, or onto the living room sofa) and put some sizzle back into your marriage.

Size….again

July 15th, 2010 by Bat Sheva Marcus LMSW MPH PhD

 Am I starting to sound like a broken record? Again and again, we get women saying “I wish my partner was a little smaller. I guess I’m an anomaly, but I just don’t like having intercourse with a large penis. It hurts.” You’re not an anomaly. It is so rare that anyone complains of a penis being too small, but larger penises can present their own challenges and not every women’s vaginal canals can handle the larger penis. So guys… one more time – (should we say it in unison?) BIGGER IS NOT NECESSARILY BETTER!

Goin’ Down

July 12th, 2010 by Shannon Bertha, ACS, DHS

At times we may feel that our partners are not adequately stimulating us during sex.  This can be true for men and women.  It isn’t that our partners are bad lovers or do not know how to perform, but rather that they may not know what really turns us on.  There can be many ways to guess what turns on your partner, for example, how they move during sexual activity or what sounds they make;  but the clearest, most direct is verbal communication. 

This subject comes up a lot when women talk to us about oral sex.  Let’s face it: oral sex for women is complex and asks couples to face many aspects of lovemaking that are sometimes difficult to address:  physiology, physics, the senses (sight, smell, taste), patience, power within a relationship, and more.

Here’s a scenario we hear a lot:  A woman really enjoys oral sex but doesn’t want to ask for it too much because she believes her partner doesn’t like to do it.  So she goes though a number of sexual encounters with intercourse,   enjoys it, but does not climax during any of these events.  Finally, she decides she is going to take matters into her own hands and tells her husband, before intercourse, that she wants an orgasm and would like him to perform oral sex on her.  To both of their surprises, he smiles , gets very excited and takes action.  As it turns out, he really enjoys giving oral sex to his wife, and he’s pretty good at it!  But she hesitated to express interest in it because of her own assumptions about her husband.  This little event sparked many more conversations about what they can do for (and to) each other to make each sexual experience fulfilling. 

If you find your partner needs some help in this area, or would like different technique suggestions, there are a number of books that are available for performing oral sex on women, such as: 

She Comes First: The Thinking Man’s Guide to Pleasuring a Woman by Ian Kerner

Guide to Eating Out – The Lick-by-Lick Guide to Mouthwatering and Orgasmic Oral Sex by Palmer Strong

And books that discuss both:

The Going Down Guide: Tongue Tips and Oral Sex Techniques for Men and Women by Emily Dubberley and Al Needham