Archive for the ‘Uncategorized’ Category

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, M.D. 2010.  All rights reserved.                                                     www.sexualityresource.com

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, DHS

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, DHS

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.

Dr. Bat Sheva Marcus interviewed by CBS News on female sexual desire

Wednesday, May 26th, 2010 by Ilene Rosenthal, Marketing

Last week, Dr. Bat Sheva Marcus, who has been the clinical director of the Medical Center for Female Sexuality for 10 years, was interviewed by CBS Channel 2 News in New York regarding the expected upcoming approval of a treatment for low sexual desire in women.  Flibanserin, manufactured by the pharmaceutical company Boehringer Ingelheim, is expected to gain FDA approval in the coming weeks for the treatment of hyposexual sexual desire disorder, or HSDD.

The treatment works by increasing the production of dopamine, a chemical in the brain that contributes to sexual desire.

Experts acknowledge that female sexual desire stems from a combination of hormone levels, chemicals in the brain, blood flow and, of course, the quality of the intimate relationship between two people.

Dr. Marcus applauded the addition of Flibanserin in her “toolbox” of possible treatments for her patients, but cautioned that female sexuality is complex and no one treatment is a panacea for all women with low desire.

MCFS patient Gail Marien was also interviewed on CBS and spoke honestly about her journey from the virtual desmise of her libido following a hysterectomy to her satisfying sex life with her husband today.

View the video here

Defining “bioidentical”

Tuesday, May 25th, 2010 by Bat Sheva Marcus LMSW MPH PhD

There is so much confusion and misinformation when it comes to “bioidentical hormones.” Let me see if I can clarify a little: 

  • “Bioidentical hormones” does not mean that the hormones are “organic.”
  • “Bioidentical hormones” does not mean that the hormones are “natural.”
  • “Bioidentical hormones” does not mean that the hormones are “not really hormones.”

 “Bioidentical hormones” means that the chemical makeup of the hormones exactly matches the chemical makeup in the same hormones in your body. It can be man-made but the molecular components are exactly the same as that same hormone in your body. For example, if you look at bioidentical estrogen under a microscope it would look exactly the same as the estrogen your body makes. It could have been created all chemically, in a laboratory, but the components of the compound match your body.

 “Hmmmm…” you ask, why would anyone make non-bioidentical hormones to replace those in your body. Well, for one thing bioidentical hormones can’t be patented. The same way you can’t patent water, unless you add some flavorings to it, you can’t patent estrogen unless there is something different about your estrogen. So drug companies are incented to change the chemical compound. Sometimes makers of specific hormones suggest that the difference they have made is a “good” difference and thus justify the changes. We haven’t found that to be the case. In general we find that women seem to respond better to bioidentical hormones.

 But don’t worry about the drug companies. Now that many realize that women prefer the bioidentical compounds they have found ways to patent their product by developing better or unique delivery systems: a specific cream to hold the compound, a patch, a pellet.

 So, if a practitioner wants to prescribe a hormone, you can discuss the options intelligently. For more information you can read these two articles, the first is authored by the Mayo Clinic and is a negatively predisposed to bioidentical hormones; the next comes out of Harvard Medical School and is more balanced. Let us know your thoughts!

G-Shot Parties: A Shot at Better Sex?

Monday, May 24th, 2010 by Bat Sheva Marcus LMSW MPH PhD

It feels as though the “bad idea bears” are rearing their heads yet again. If you don’t get the reference, you can check back on a post from April 2008  in which I talk about the bad idea bears” from Avenue Q and the idea of reconstructive vaginal surgery. 

The Bad-Idea-Bears are cute, cuddly and charming and pop up whenever a character in the play has an idea that they know in their heart of heart is NOT a good idea.

So, why do I think G spot shots are a bad idea? Let me first say that I don’t think they are nearly as bad an idea as reconstructive vaginal surgery. We’ve seen many cases of surgery gone wrong and weird looking reconstructed vaginas. The possible side effects (or disasters) from collagen injections into the vagina is much more minimal. But they are a possibility. Whenever you do something invasive, there is a risk of some sort and the procedure is fairly unknown. Personally, I wouldn’t want to play the odds with my vagina for no specific reason. Do you really want to do it?

 However, if I thought there was a really good reason to do it, I’d be the first to say “let’s trial it,” to patients. But so far, all we have heard are vague comments that don’t seem to be very helpful. “It makes it feel better.” Better than what? And was the “not feeling good” a problem? If women (or physicians conducting the procedure) claimed it was restoring orgasm, or making anorgasmic women orgasmic, or increasing lubrication or arousal , then it might make sense. As it is, however, this feels like it is just exchanging a sex toy – a completely safe way to make sex more fun,  for something so much more invasive with much less evidence that it works. 

There’s nothinkg wrong with trying new things; we are all for that!  But I would suggest thinking twice (or three or four times) before injecting your vagina experimentally, “just for fun.”