The New York Times

So if I were a guy, my immediate natural reaction would no doubt be  “argghhh. No way am I spending more time with my kids. I need my testosterone.”  And I’m assuming that was other people’s reaction because, under the header of “me thinks the lady doth protest too much,” the Times argued mightily — but frankly illogically —that the conclusion should be different. “The real take-home message,” said Peter Ellison, a professor of human evolutionary biology at Harvard who was not involved in the study, is that “male parental care is important. It’s important enough that it’s actually shaped the physiology of men.”

Huh?

That strikes me as a rather illogical conclusion. If men’s bodies changed before they had kids and that made them want to stay home with the kids, one could make that argument, but this sounds more like biology follows the decision. Once a man has decided to become a father, his body shifts to support his decision. But that’s  a lovely thought on its own so I suppose I shouldn’t split hairs. I love the idea that biology will help support your decisions, like a woman who decides to become a mother and becomes pregnant, her  body shifts and changes to make that possible. These changes in men are obviously more subtle, but seem similar. Especially since the males with higher testosterone were most likely to find a  mate and get married. “Scientists say this suggests a biological trade-off, with high testosterone helping secure a mate, but reduced testosterone better for sustaining family life.”

Much more interesting to me is the fact  that the study “suggests that men’s behavior can affect hormonal signals their bodies send, not just that hormones influence behavior.” Hell yes!! Once more we are seeing the fine line between what we think of as “in your head” and “in your body.” So hormones work both ways and testosterone is affected by our behavior. How great for us to see in studies what seems clear to so many of us in this field. When you’re having more sex, you want more sex. When you meet someone new, something hormonal shifts and your gears are up and running.

As we understand more and more about hormones, how our behavior affects the hormones and how the hormones affect our behavior, maybe some of the mysteries of the world (why, for example, my husband can’t multitask) will be answered once and for all.

Millions of couples have met, married and stayed married from online introductions. As a therapist who works in the field of relationships and sexuality, I think anyone can meet and marry. The complicated part is to stay married if that is what you want. I look forward to longitudinal studies done on couples who met online versus those who met other ways and how they all fare over time. I think the way a couple meets is probably not predictive in one way or another of how successful they will be, but it would certainly be interesting to see if it is.

Online dating is the most popular way for couples to meet today. Young people will never know the stigma once attached to online dating, and in my opinion that is a great thing.   Many people, young and old, have had bad online experiences, but I would say the exact same statistics hold for meeting someone through a friend, family or at a bar. Relationships are complicated because people are complicated, and in general I feel that most people reveal only what they are comfortable revealing. So the process of discovering or uncovering another person and assessing if they are a good match for you remains one of life’s great mysteries. Online dating  just makes the whole process a little more accessible.

At the Medical Center for Female Sexuality, I treat a lot of women who come from religious backgrounds.  I see people from all kinds of religions and all different levels of religiosity. The thing that strikes me is that many of our world’s religions do not support sex before marriage. Many people have been told their whole lives not to have any kind of sexual thought or activities up until the moment  of marriage and then suddenly one day all that is supposed to change. I have seen that with so much pressure on the moments just after marriage and the belief that only after that ceremony should one be sexual, I see that sex can become fraught with a lot of anxiety and ambivalence. In that period, just after marriage, all those cognitive pathways are supposed to be  reversed, which I think is incredibly difficult to do.

Human beings are generally creatures of habit. It is through repetition that we arrive at mastery. And one of the ways to change your behavior is to explore your thoughts or ideas about that behavior. Of course you can just start trying a new behavior as well. At the Center we try to do both. The moment  at which I come in to the picture is when an individual or couple is struggling to break in to a new pattern or behavior.  Though many women with sexual dysfunction are told it is all in their heads.  I have found this is rarely the case.  Sexual dysfunctions are generally a combination of multiple factors-physical, psychological, physical and possibly hormonal. And we do a thorough assessment to determine what is causing the problem and exactly how to go about treating it. My point is that women need to be gentle with them selves when they are in the process of changing their behaviors. And if you have never had sex and then all of a sudden you have it, it can be scary. It is often a process to learn to enjoy, so be patient. It will happen!

 
One of our recent botox patients just had intercourse with her husband after 9 years of marriage. Pretty cool, no?
 
She had been trying to have intercourse for years with no success.   She tried traditional dilator therapy and though she could insert the smallest sizes, she felt pain when she got to the medium one. It was just too severe, and the years went by…
 
Then she tried traditional talk therapy. She spent two years “doing really great work” with a sex therapist.  I question the nature of that work, since the problem was pretty clearly in her vagina and not her head. A therapist who keeps a patient in therapy for two years talking about why they can’t have intercourse instead of getting them to find more appropriate help is nearly irresponsible. But the patient found it helpful… and maybe, ultimately, the work she did in therapy gave her the courage to call us.
 
About a month ago, she found our website and, despite having to fly in from Denver for the treatment, she made the decision to do so. She called and had a phone consultation, and decided that she had spent enough time trying “everything,” and that she wanted to arrange for a Botox procedure to help her overcome her severe vaginismus.
 
She received her pre-op review from her primary care physician in Denver, and then flew in to see us about two weeks ago. She came in the day before the procedure so that we could meet her and give her a last minute consult on her feelings about the procedure, and her physical preparedness to proceed.  The next day she had the procedure.
 
This patient could not believe that by the evening she was inserting and removing a large dilator with no pain.
 
She stayed in town to see us four days later and flew back to Denver and to her husband.  A week after the procedure, they got clearance to have intercourse. It took a few tries, a little bit of coaching from our staff and a sense of humor; but by this past weekend – within two weeks of the procedure – they were really and truly having pain free intercourse.
 
Now that’s what I call a week well spent!!

Wow. This certainly leads to many interesting questions and to be fair I’m just starting to think about this and analyze it so here are my initial questions:

1.       Where is the line between education and voyeurism?  I don’t think this is a new question but it is one that has all of us struggling. When is it okay to “show” something and is there a difference between showing things on film on in “real time.” Somehow, we FEEL that there’s a difference but it’s hard to express why.

When Kinsey started his surveys, wide spread polls and, let’s face it, human experimentation, there was a huge outcry. But the information he provided for the world has been invaluable and people’s sex lives have never been the same.

I think part of what makes us so queasy when it comes to sex is that watching sex elicits a physical and emotional response.  (hence it feels like voyeurism) But so does watching violence. And yet, as a society, we seem so much more comfortable showing horrible, disturbing violence and the nausea and headaches that result don’t seem to disturb us quite as much as the arousal that might come from watching a couple having sex.

2.       Is “normative” sex any different than “kinky” sex when it comes to “show and tell.” That is, would we have had as strong a reaction if he had a couple demonstrate normal, missionary position intercourse? My guess is probably yes, but SHOULD our reactions be the same? As someone who sees people regularly who struggle with intercourse, I wonder if it wouldn’t be helpful to have some live demonstrations some time. Maybe because, again, when you move into kink it feels more like voyeurism. (See questions 1).

3.       But the question I’m asking which no one else seems concerned with is this: female ejaculation during orgasm is a real but infrequent occurrence. Why set up students yet again to a standard that is unrealistic for most woman and now becomes a norm? If a professor is going to go out on a limb to show students something so provocative, couldn’t he show something more useful? Okay… I realize I’m a geek. I’m probably the only one so focused on details, but really…

My goal is to teach women to turn down the volume on their own judgments. If these negative, critical voices can be tuned out and the focus can be on pleasure, a great sexual experience is always possible. Often our partners are not judgmental. Most men care far less about how their partner looks and much more about creating an intimate connection.

It may not be easy to overcome strong societal forces telling women to look and act a certain way. However, with focus and determination to be your best self and to create the most satisfying, fulfilling sexual experiences, you can take small steps towards self acceptance and slowly begin to see yourself in a more positive light.

1.       You need to be tested by someone who knows what they are doing. Many times women say to us that they were tested by their primary care providers who told them that their hormonal levels were perfectly normal. “Normal,” unfortunately,  is still a relative thing in this field and you need to be tested by someone who can read the results with a skeptical eye.

2.       You need to use the right product. Compounded products can be extremely tricky, and may not work as well. Biodentical products are probably the way to go but need to be adjusted accordingly. Work with someone who has significant experience with using specific products.

3.       Too weak a dosage or too short a time of usage are unlikely to yield any reasonable results or any results at all. This may be more frustrating than doing nothing, so be ask the right questions and be compliant when you are prescribed.

4.       Be conservative. Make sure all the relevant blood levels are monitored regularly and that you are being followed by a professional in a way that feels thorough and responsible.

Having warned you about the issues – it’s definitely worth a try!

Dr. Stephen Snyder writes again on sexual arousal and the role of “simmering” in getting us there!

Simmering: A two minute technique for nourishing the erotic bond between partners. Useful for modern couples for whom the idea of leisure time is a quaint memory, but who’d like to stay in touch.

A modern dilemma

Recently I had lunch with my colleague Eric Amaranth, and the conversation turned to the subject of polyamory — the practice of having more than one ongoing sexual relationship at a time. As you may know, there’s been an uptick of attention in the media about polyamory and other alternatives to conventional monogamy. Eric knows the polyamory community well, and I don’t — so I was curious to hear his thinking on the subject.

“The main problem with polyamory,” he said, “is time. Not many people have the time to devote to multiple committed relationships.”

Walking back to my office, I thought – “That’s the trouble with monogamy, too. How many people these days have time for even ONE committed relationship?”

Putting arousal on the schedule

Traditionally, we sex therapists have preached that it’s necessary to reserve enough time for lovemaking. Masters and Johnson advocated taking long turns giving and receiving sensual pleasure. They called it “sensate focus.” In the 1960’s, couples would travel to St Louis for a week with Masters and Johnson. They’d meet with a sex therapist each morning, then spend each afternoon in their hotel room doing sensate focus.

Many modern practitioners recommend a kind of meditative togetherness based on Indian Tantra, an ancient body of techniques for prolonging and deepening sex. And countless self-help books have been written on the subject, each containing page after page of tasty recipes for wonderful lovemaking.

The problem with such recipes — is that no one cooks anymore.

For many of the Manhattan couples I see, especially those raising children, the idea of leisure time is a quaint memory.  As one patient of mine, a married attorney with three kids, puts it – “My weekday consists of thirteen hours of work, seven hours of sleep, and four hours left over for everything else – bathing, eating, transportation, and administration. There’s not much time for conversation, much less sex.”

Many thoughtful ideas have been proposed for how to create time for good lovemaking.  But overall I’m not impressed with the results. Don’t get me wrong.  I think date nights are fine. But too many modern couples just pass out exhausted after an evening out. I favor a somewhat different approach.

Saute and simmer

Most couples’ erotic foundations are not sustained by just sex. Rather, they’re sustained by what in the sex therapy business we call “simmering.” In a previous blog article, I drew on an earlier discussion of sexual arousal to suggest a theory of simmering.

Simmering means taking a quick moment to feel aroused with one’s partner, even under conditions where sex is not going to be practical. That generally means no orgasms, no intense rhythmic genital rubbing or stroking, no heavy breathing. Nothing that’s going to leave you too frustrated after you have to stop. Simmering is just a moment of light arousal, simply for its own sake.

An example: A young man and woman are high school sweethearts. During a five minute break between classes, they meet at the woman’s locker. They smile, kiss, stroke each other’s hair, and enjoy each other’s scent. They embrace, and their bodies mold together. Then the bell rings. They hold each other’s gaze for a long moment, steal one more kiss, then run off in different directions.

You remember the feeling, right? You get to your next class feeling mildly intoxicated. The intoxication, of course, is sexual arousal in action, making you a littler goofier than usual.

There’s no reason that older couples can’t get just as goofy, in the privacy of their own kitchens, before they have to go off to work. All that’s necessary is to recognize that there’s more to sexual arousal than just sex.

Two minutes to simmer, on the way out the door in the morning. A pretty good recipe for keeping an erotic connection, for even the most harried modern couple. The payoff in good lovemaking later can be dramatic.

Just heat and serve.

Copyright © Stephen Snyder, MD 2010
www.sexualityresource.com New York City

Follow Dr Snyder on twitter:  www.twitter.com/SexualityToday

Okay, so to be fair this is not directly related to sex but a patient brought it to my attention and I thought it was so great, I thought I’d share it on our blog.

There seems to be a new “condition” out there: cyberchondriact.  We see A LOT of that in our practice.

A cyberchondriac is someone who has a symptom, runs to the computer and decides that they are suffering from at least five major conditions.

A cyberchondriac is someone who goes onto the internet to look up the medications before they start taking them and are convinced that they will have every possible side effect.

A cyberchondriac is someone who looks up every possible treatment for every possible condition and wants to review every one of them with their physician.

I have a confession. I am somewhat of a cyberchondriac. So I can sympathize with my patients who are too…But you know what?? It’s driving me crazy!

Let’s all take a deep breath and remember what the critics of the web are saying: ” information is different than knowledge,” “too much information is a dangerous thing,” “sometimes a pickle is just a pickle.”

Get good information, process it slowly and turn it into knowledge using all the right tools.  It’s better for your health!

A train in motion

On the B train, one hot summer Sunday afternoon. I’m bringing my children and a few of their friends back to Manhattan, after a long day at the beach in Brooklyn.

There’s a young couple standing near the exit door, sharing an ipod headset. Each with an earpiece in one ear — the two of them tethered together by the cords of the headset.

She’s leaning against the wall, sweat-soaked in a T-shirt and shorts. He’s a few inches shorter, wearing sandals, beach clothes, and long hair. His hands are resting lightly on her hips. Her arms are draped over his shoulders.

They seem entirely absorbed in the music, the motion of the subway car, and each other. Their eyes, half-shut, are out-of-focus, dreamy. They’re both wearing goofy, crooked smiles – as if sharing some silly secret. They look as if they might easily miss their stop.

Amidst the noise of the children, and the rocking and bouncing of the subway car, it would be easy for this couple to pass unnoticed. But there is something about them that holds my attention. A certain aura.

It’s sex, of course. Their goofy smiles, their dreamy manner. Definitely sex. They’re fully clothed, standing up and doing nothing obviously improper, but definitely enjoying a long moment of sexual arousal on the trip home from the beach.

Turning away self-consciously, I realize I’m not the only one watching this couple. The young children are oblivious, of course. But all the adults in the car are clearly aware of what’s going on. Everyone is stealing glances at them, transfixed by the same sexual vibration. Their sexual aura is now general throughout the subway car. I fear we will all miss our stops.

Sexual arousal is more than just sex

As I wrote in an earlier article, the secrets of sexual arousal are hidden in plain sight – and completely obvious once we know to look for them. Sexual arousal, if all goes according to nature’s plan, makes us dumb and happy, absorbed and distracted. We miss our subway stops, and arrive somewhere far uptown wondering what happened to us.

Most of us learn that to succeed in a fast-paced world we need to make all our subway stops. We learn that we don’t really have time for arousal. Many modern couples hurry through sex, without letting themselves get very aroused — then wonder where their sexual magic has gone.

In my sex therapy practice, I teach couples a technique for cultivating arousal even when they don’t have the time or energy for sex. The technique, which in sex therapy circles is called “simmering,” is a foundation technique for preserving a couple’s sexual bond. Good simmering can be nearly as important in this regard as good lovemaking.

What the couple I’ve described on the subway was doing — enjoying arousal for its own sake — is something every couple can do in the morning together, getting ready to leave for work; or while clearing the dishes after dinner.  All that’s necessary is to recognize that there’s more to sexual arousal than just sex.

For 21st Century couples in the age of the Blackberry, it’s likely to be the simmering that holds us together. In the next blog article, we’ll discuss simmering in more detail.

Stay tuned.

Copyright © Stephen Snyder, MD 2010, New York City
www.sexualityresource.com

Follow Dr Snyder on twitter:  www.twitter.com/SexualityToday

www.centerforfemalesexuality.com