Archive for June, 2010

Dining and Differentiation

Monday, June 28th, 2010 by Stephen Snyder, MD

What’s the secret to making your love a lasting one?    What’s the secret to keeping sexual passion alive?    There’s no one best answer, and every couple is different.   But many sex therapists, myself included, talk about something called “differentiation” as a key factor.   Differentation means being able to take care of yourself, as a separate person, while you’re in intimate dialog with your mate.

A popular book on the subject of differentiation is David Schnarch’s Passionate Marriage. Schnarch has probably done more than any modern sex therapist to promote the idea of differentiation as a core value in a romantic partnership.

Differentiation is hard. Especially if one hasn’t seen it demonstrated in one’s family of origin.   One of the benefits of a good enough marriage or any other deep partnership is that it provides a holding place in which differentiation can occur.   In which each partner can “become more truly oneself.”

Differentiation is not easy to describe, as an idea and as a feeling.    Many couples tell me,   “It sounds nice, but I don’t get what it’s supposed to feel like”

In such situations, I offer an analogy:

Let’s say you really want to go out for sushi, and your husband really wants pizza.   You could (1) go along with his wish.   (2) insist he go along with yours     (3) decide to go to separate restaurants.    All pretty conventional approaches.

None of them, though, are going to help you feel what it’s like to be more differentiated.

But let’s say that instead you decide to (4) stand on the street bickering about it, getting more and more hungry and upset, and wondering if this relationship is really going to work.

Now that’s a good start!   You’re suffering together.    You’re both being real clear about what you want, and advocating for your own needs.

Now let’s say you’re so exhausted that you say to each other, “let’s see if we can find a place that would work for us both.”   You walk down the street looking at restaurants.  You find an Indian place that looks promising, but you discover that one or both of you don’t really like Indian food.

The next night you go out again, thinking, “there’s got to be SOMETHING that we both like – and damn-it, we’re going to find it together!”

Now you’re really on your way!    And when at long last, after many weeks of searching, you find a kind of food you both like, and a restaurant that serves it, you are so happy and feel so accomplished, that it becomes “your restaurant.”  You find recipes for all their dishes and start learning to make them at home.

Those recipes are YOURS as a couple.   You worked hard for them.    They belong to no one but the two of you.    They are your story – of keeping faith with yourself, and with each other.

If you’d never met each other, you’d never have found them.   The relationship (this is important) took you someplace that neither of you ever intended to go.    The relationship expanded you, and changed you.   But it only did so BECAUSE you and your mate both insisted on what you really wanted. The answer wasn’t clear at first – but you found it.

You’ve differentiated from your respective families as well.   No one in either of your families ever knew anything about that kind of cuisine.     Your families think your new dining habits are a little strange.    But they don’t understand about this particular journey you’ve been on together.

Only the two of you understand.  You’ve become a more differentiated couple.    Now you’re more confident that you can each take care of your own wants and needs in the relationship, and make it work.

And you know that the next time you stand together on the street bickering about whatever the next thing is . . .

You’ll figure it out.

© Stephen Snyder, MD 2010    

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Green sex toys? Well, eco-friendly anyway.

Thursday, June 24th, 2010 by Ilene Rosenthal, Marketing

Does anyone else have a hard time reading all the magazines that get delivered each week or month?  It’s crushing, sometimes.  But before I throw it all away I try to peruse headlines just so I’m not left speechless at an upcoming cocktail party.

Here’s where that pays off:

In Time Out New York, a weekly event magazine, there is a column called Sex & Dating. In the April 28th edition (sorry for the delay) there is a report on eco-friendly sex toys, including something called a “Tidy Cloth” that resembles grandma’s hankie but is used for other purposes, a wooden dildo varnished to a glimmer, sea oils and a few ideas having to do with rope (hemp, the kind that softens with use…)

Take a look.  It’s summertime! Time Out New York Sex & Dating

Avoid male infertility tomorrow – even if you’re not ready to be a dad today!

Wednesday, June 23rd, 2010 by Michael A. Werner MD

Did you know that nearly seven percent of 12th grade boys use or have used sterioids to build muscle mass and improve athletic performance?  And that these synthetic male hormones can surpress the testes ability to make sperm?  And how about recreational drugs?  Or frequent bike riding or racing on particularly thin bike seats? Or even cigarettes and cologne?

It is admittedly difficult to anticipate male factor infertility challenges when making a family is not the first thing on your mind.  But if you think Father’s Day is in your future, read up on how what you do today can impact how easy it is to become a dad in the future.

The Estrogen Conversation

Monday, June 21st, 2010 by Ilene Rosenthal, Marketing

OK, gal pals.

You know,  I’m not a doctor.  So this is not a recommendation.  But I am in a tizzy over the recent article from the NY Times Magazine on April 18, 2010  on estrogen replacement in perimenopausal or early menopausal women. The article is called The Estrogen Dilemma, written by Cynthia Gorley.  

 The article is balanced and intelligent.  It details the research errors in the W.H.I study of the early 90′s that damned hormone replacement therapy [the misinformation surrounds the age of the women in the study (10+ years beyond menopause), the kind of therapy (the pregnant horse urine-derived hormone), and how conclusions about stroke and cardiac problems were surmised].

I don’t know about you, but I’m wrestling with this strange phase and wondering about how to manage it.  And there I was, in the voices of the scientists and the reporter in this article.  It is balanced, yes, and delineates all the uncertainties in any hormonal regimen.  But make no mistake:  when the author talks about Alzheimers, my phone is dialing my gynecologist asap.

Here’s a blip from the article.  The author is referring to her conversation with a woman, a scientist studying the brain at USC:

 ”We were sitting in a campus garage in her Prius one day, and I asked her what made her so sure her own midlife difficulties — she had the hot flashes, which were obvious, but also the sleep disruption and the infuriating distractibility — were the product of hormonal events, not some womanly existential crisis. We get a lot of that, societally. It’s meant to be empathetic. Your role in life is changing, Mrs. Brain Seized by Aliens! Your children are growing up, you’re buying expensive wrinkle cream, ice cream makes you gain weight now, of course you’re distraught! “Because with estrogen — ” Brinton looked at me sharply, and then smiled — “I don’t have attention-deficit disorder.”  ”

Read on, girlfriends.  Let me know your thoughts.

 http://www.nytimes.com/2010/04/18/magazine/18estrogen-t.html

How long is too long: the average time for intercourse

Thursday, June 17th, 2010 by Bat Sheva Marcus LMSW MPH PhD

Okay ladies (and the men who may be looking over their shoulder.) The average time for intercourse is 3-5 minutes. So if your partner is thrusting inside of you for 25 minutes and your vagina hurts or gets sore, there is nothing wrong with your vagina. There is something wrong with your timing! Now… lets respond to all the possible women’s reactions:

 “But I LIKE intercourse for 30 minutes” Great!! You’re just not average. If you and your partner enjoy prolonged intercourse and you’re not having pain afterwards – go for it! Have fun.

 “But he needs 25-30 minutes to ejaculate” – Try exploring other stimulations for 15-20 minutes. Rubbing against your body, using your hands, using your mouth, him using his hands are all good possibilities. Then when he comes inside of you he may only need 5 minutes or so.

 “He really needs 40 minutes inside of me to ejaculate.” This is where I think you need to bring in a male sexual dysfunction specialist to have him evaluated.

 Bottom line. Don’t always blame your vagina!!

A primer on sexual arousal

Monday, June 14th, 2010 by Stephen Snyder, MD

Arousal (a-ROUS- al): The normal change from a non-sexual to a sexual state of body and mind.

The secrets of good sexual arousal are hidden in plain sight.    They’re obvious, once you know what you’re looking for.   But so many couples end up losing their bearings in this area, that a good general introduction to the subject seems overdue.

Physical sexual arousal — the sexually aroused body — has been endlessly studied, most famously by Masters and Johnson in the 1960’s.   And less rigorously but no less intensely by every sexual couple since the dawn of human self-awareness.    Most heterosexual couples study the male partner’s erections and the female partner’s state of lubrication carefully for reassurance about their respective states of sexual arousal.   Urban legends rise and fall over the decades concerning other putative guides to one’s partner’s level of sexual arousal (see “nipple erection,” “pupil dilation”).   But through all of this, we’re in the realm of the sexually aroused body.

The sexually aroused mind has proved harder to study.    Research on mental sexual arousal continues to await its Masters and Johnson; no one has yet shown up for the job.   A particularly thorny problem with the study of mental sexual arousal is the overwhelming diversity in people’s experience of arousal.    But I’m going to be brave here and offer some practical generalizations.  Here is what I tell my patients to look for, as the hallmarks of mental sexual arousal:

Attention to sex (to the exclusion of practically everything else).    When we’re aroused, sex grabs our attention.   We think about sex, and we stop thinking about bills, problems, responsibilities, image, reputation . . .  our entire portfolio of ordinary concerns.   Sexual arousal focuses us.  It focuses us on sex.    Our time sense typically becomes impaired.   (Sexually aroused people tend to arrive late to meetings).   If someone gave us an IQ test during peak sexual arousal, we wouldn’t do very well on it.  The tester might have a difficult time getting us to pay attention to the questions.   Good sex makes us definitely dumber.   And great sex can make us downright stupid.

Regression to infantile thinking and behavior.   There is an essential selfishness about sexual arousal.  When we’re aroused, we don’t tolerate frustration very well.   We’re likely to get upset when the phone rings.   We don’t care who’s calling, or what they want.    When we’re aroused, we don’t want to be bothered by anything except our sexual needs.   We may be deeply absorbed in passionate feelings towards our sexual partner, but we might at that moment not want to hear all about their day.   We just want to be treated very nicely, and told we’re wonderful and that everything is fine.

A sense of specialness.    This is the hardest part to put into words — but it’s readily obvious to anyone who’s ever had good sex:   Sex feels special.  When most of us recall the greatest sex we ever had, what we remember is an experience of sustained, intense, and therefore intensely meaningful sexual arousal.   Deep, sustained sexual arousal stirs something ancient in us, and is intensely validating.  It feels special, and makes us feel special.   When I ask couples about their recent sexual experiences, I often ask, “Did it take you someplace special?”

It should be clear from the above description that we’re talking about a kind of mental state that is complex, contradictory, and volatile.  And that has the capacity for great good as well as great harm and grief.     But wouldn’t that just about fit our ordinary experience of what sex is like?    Perhaps it’s not so surprising that so many long-term couples largely avoid the heights of sexual arousal.

Many times people come to see me complaining of a sexual symptom, such as lack of sexual desire, or sexual boredom, or some other dysfunction.   And within the first several minutes, it’s clear that the person or couple has been attempting to have sex despite neither of them being mentally sexually aroused.

Sometimes a couple simply never knew to pay attention to the mental aspects of sexual arousal.   But more often, at some point early in their sexual relationship, with all the vulnerable feelings that can get stirred up during sexual arousal, something just didn’t feel right.    And no amount of talking or fighting or lovemaking seems to be able to make it feel right.

Sometimes in therapy a couple can find a way to finally express in words what it is that hasn’t felt right in bed.   Often the lack of good sexual arousal will turn out to have been a sign that something needed attention.  And sometimes, with a bit of luck and enough careful attention, a couple that lost their way can find it again.

© Stephen Snyder, MD 2010    

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Sex and the City sparks interesting commentary – if nothing else – among reviewers

Thursday, June 10th, 2010 by Ilene Rosenthal, Marketing

OK, so by now you’ve all read the reviews of SATC2 and, sadly, it has become the punching bag of movie critics around the world.

But this piece from www.womenandhollywood.com is facinating in its review of, well, the reviewers.  Melissa Silverstein writes that the movie’s shortcomings have served as a conduit  for a “pent up torrent of misogyny against women” and has provided avenues for excessive ‘meanness’ that is, frankly, undeserved, regardless of  how bad the movie may be.

Silverstein makes her point, of course, by comparing the SATC2 commentary to Polanski’s escapades and the postively regarded movie, The Hangover.

It’s hard to ignore the claim in this article that the opportunity to unleash a venomous attack on aging women was too tempting to ignore.  Rather than read more bad reviews, take a minute to consider this perspective on women, the movies and critics of both.

Sexual gridlock

Monday, June 7th, 2010 by Shannon Bertha, ACS, PhD

Sexual dysfunction is a complicated problem and often it isn’t one thing – or one person’s issue –  that is causing it.  If the problem goes on long enough, often it begins to affect other issues in  the relationship.  I notice that women often take on this problem as their own, “It’s my fault” or “It is my problem” or “My husband is fine, it is ME!”  At times, partners may be contributing to the problem or experiencing sexual dysfunction themselves.  At the Center, we work with our female patients to achieve optimal sexual functioning, but at times, we can only take the patient so far and may need her husband or partner to seek treatment as well.  He may be suffering from sexual dysfunctions such as difficulty achieving or maintaining his erection, low desire or ejaculation problems.  At times, men are embarrassed about getting help and therefore stop initiating lovemaking.  If  this disrupts the natural patterns in a relationship,  sexual activity may decrease in frequency and women are then left wondering what happened.   The lack of desire may become magnified, no one feels comfortable initiating sex and we have  sexual gridlock!  No on’e s moving. No one’s initiating. No one’s talking about it.  And…no one’s having sex!

Keep in mind that sexual issues are a multidimensional and it is important to investigate this from many angles. If you begin to sense gridlock in your sex life, stop the cycle, be gentle with your partner, and try to understand what’s happening between you.  If it appears to be a physical issue, there are practitioners who can help men and those who specialize in women’s sexuality.  If it doesn’t seem to be sourced in a physical problem, often some short term couples therapy can help you talk through immediate issues and get back to business!

In other sexological news…Don’t Ask, Don’t Tell is repealed

Wednesday, June 2nd, 2010 by Shannon Bertha, ACS, PhD

Today the House of Representatives repealed the United States military policy, “Don’t ask, Don’t tell” which states the U.S. cannot ask the sexual orientation of its military personnel, and they in turn are not required to disclose this.   Repealing this policy is not a revolutionary idea.  In fact, of the 26 military forces that make up NATO, 22 of them allow gays to serve openly.  Repealing this in the House is only one step in making a monumental change in equal rights under the Obama Administration. 

http://www.huffingtonpost.com/2010/05/28/dont-ask-dont-tell-repeal_n_593695.html

On Trusting Yourself.

Tuesday, June 1st, 2010 by Bat Sheva Marcus LMSW MPH PhD

We saw two patients in two weeks who had severe vaginal pain. In both cases the pain started 3- 6 months after starting a new form of birth control pill. In both cases the patient felt that it was related to the birth control pill and asked their prescribing physician about it. In both cases they were assured that it had nothing to do with the new birth control and they recommended that the patients stay on.

The sad part is that in both cases the patients were absolutely correct and could have saved themselves a great deal of pain and sadness. Each patient steadily got worse for 2-3 years and underwent treatment after treatment until each found her way to our center. They both needed to get off the offending drugs and then do some rehab. But, they are both doing well now.

So my message is important. Trust yourself. If something feels wrong – test it out. Doctors are not infallible. We all make mistakes. More importantly, even if something is not reported in medical literature, you are unique and you know your body best. So listen to your body, trust your instincts and heal thyself.