Here at Planned Parenthood of Delaware we always support comprehensive
age-appropriate sex-positive evidence-based approaches.  In fact, the
evidence based curriculum Making Proud Choices! is what we use most often
with our teenage youth.  The authors of that curriculum are:  Loretta Sweet
Jemmott, John Jemmott, and Konnie McCaffree (President-Elect of SSSS).
http://www.selectmedia.org/customer-service/evidence-based-curricula/making-
proud-choices/    I saw Loretta Sweet Jemmot speak at a Delaware conference
last year and again, I can assure you she is an advocate of comprehensive
sex ed and science-based approaches. We even offer training to teachers and
youth-service providers on this curriculum:
http://www.plannedparenthood.org/delaware/ed-workshops-29159.htm When I saw
the ab-only study results I was surprised but then comforted that the author
of the study / main researcher was Dr. John Jemmot.  He is a known credible
researcher and comprehensive sex ed curricula autho and a supporter of
science-based approaches. 

So you may want to check out more!
http://nsrc.sfsu.edu/article/abstinence_only

What you loved when you were 18 might be totally different than what gets you going at 30 and may be completely different than what turns you on at 45.  Different life experience make us appreciate new things, new images may become imbedded in our brains, we may become more experimental or more conservative.  That’s life.

But what we don’t always take into account is how the physical changes in our body may also change as we age. I just saw one of our long-time patients here yesterday. She’s a wonderful woman who came to us about 4 years ago, distraught. She was depressed, her relationship was on the rocks and her sex life non-existent. Over the course of six-to-eight months, we worked with her, carefully addressed the obstacles in her sex life,  and her life gradually turned around. No longer depressed, with a renewed satisfying sex life, her relationship was back on track and she was one happy woman.  She stayed on the same regimen for about 4 years and things were fine.

Yesterday she came for one of her twice-a-year follow up visits. Things weren’t so great. She is going through menopause and it’s hitting her pretty hard. She’s having a harder time reaching orgasm. Her desire seems to be sliding a bit. I was so happy she was here; before things got really bad we could intervene. Together we worked out a new plan and over the course of the next few months we’ll keep working with her until things feel right again.

The take home message is this:  in order for us to address our needs as we change, first, we need to acknowledge and accept that we change. Our bodies, our minds, our relationships: nothing is static. In fact, change is what keeps things spiced up, interesting, moving forward.  We wouldn’t really want them to remain static, would we?

But sometimes we have a hard time internalizing the fact that what works for us right now won’t work for us forever. And it’s hard for us to identify the times we need to take stock and re-assess what we’re doing and what might work better. The important message is this:  Keep an eye on your needs. If they’re not being met, perhaps there are changes in your mind or body or lifestyle that have also altered what makes you happy, sexy, satisfied.  The more we accept this our dynamic lives, the faster we can find healthy, productive solutions to the challenges we face.

Embrace change. It may even be fun.

I am so sorry.  I placed you in a drawer months ago and have not sought you out since.  Please understand, though I enjoyed you, I got nervous that this may be the only way I can orgasm.  My orgasms with you were intense and powerful and would occur like clock-work 10 minutes into vibrations.  I enjoyed them so much.  I guess I started to feel bad that I was enjoying my orgasms this much with something so artificial.  I became embarrassed.  I wouldn’t even tell my husband that I was using it; I didn’t want him knowing I was using a sex toy.  It was a shame too,  because there were so many ways I could have used you to help me orgasm during sex with him!  Again, I was embarrassed.  So now it is six months later.  It takes me much longer to orgasm using my hand and because of that I’ve kind of lost interest!  Did I really forgo all of that pleasure because of embarrassment?  Is not having orgasms a better alternative than having one with you? 

Recently, I went to the medical center for female sexuality about this orgasm issue.  The women there were very open, positive and non-judgmental.  They were very encouraging about using vibrators, especially during intercourse.  They helped me to realize this can be part of a healthy sex life and that my partner might actually like it too!  They had lots of vibrators to show me so I could touch them and see how they worked.  I couldn’t believe the variety.  So I bought one and decided to try again!

So vibrator, I am writing this to let you know I am sorry for treating you the way I did, and I promise to take you out from time to time and have you play with my husband and I.  Also, to let you know, now you have some competition!

Thank you for the good times and the times that are ahead of us.

Yours truly,

A satisfied customer.

The Western world is dominated by preconceived notions about what is normal sexuality.  Often in the west, we tend to focus just on orgasm and the organs that may bring about orgasm (i.e. the penis, the clitoris).  However, there are many different parts of the genitals that enjoy sensation and touch and often they get forgotten about.  Eastern practices of sexuality, like Tantra are a bit different.  Although the practices of Tantra may be difficult for some, I think everyone can take something from this practice and make it applicable for their lives.  Eastern practices focus more on sensuality, having to do with the five senses.  The focus is on the intimacy, sensations and connection of the couple.  The focus is not on the orgasm, so there is no race to finish.  Try this in your own sex life.  Try to make the focus about the touch and sensations and not so much on penetration and orgasms.  Go into your own body and evaluate how this makes you feel.  Although I think having a light on during sex can be fun so you can see what is exactly happening, if the light is off, you have fewer distractions.  Partners can go into their own body and really experience the encounter.

 So in the field of sex it is a common game we play to see what things the APA has labeled as a disorder today…. Liking sex too much? Having it too often? Getting turned on by high heels? The new DSM (the 5^th) is slated to come out with its changes in the next few months. Here’s a great article on the general concerns regarding what is included and what’s not:

http://www.advocate.com/Society/Commentary/Sex_Disorders_According_to_the_APA/

Feel free to put your two cents in!

So the writer and her husband saw noted psychologist and sex therapist David Schnarch for a three hour session.  Presto! Whammo! In one afternoon  their primary issues were identified and addressed and she was back in the game.

Okay, so I’m oversimplifying things. But the author did comment on the fact that once her husband was able to be “real” with her and get “angry” and not always be “so nice,” she experienced real desire for him for the first time in a long while.

That is great.

I mean it.

I’m skeptical it will last, though. Really intense emotions and sudden epiphanies and moment of deep connection are important and no doubt do wonders for the short term sex drive. They really help. And some times, honestly, kick-starting the sexual relationship with a short term energy blast can make all the difference and turn things around again.

But I think that often, when the ongoing, slow simmer of a regular sex drive is gone, it’s important to get the whole picture, that is the physical stuff as well as the psychological stuff.

So if you’re one of those people who’ve been able to  create moments of deep passion through sex therapy, but have wondered why these moments don’t seem to sustain themselves, don’t give up. Get the whole picture.

If you catch your child stimulating him or herself, don’t overreact!  Masturbation will not cause psychological harm to your child; however, your reaction might.  So take a deep breath, and address it when they are not masturbating.  Explain that this is okay for them to do, but in the privacy of their bedroom or home. 

No one wants their kid masturbating in the cereal aisle in the grocery store.  Talk about privacy and you may be able to equate it to going to the bathroom, which kids are able to understand.  Explain that just like we go to the bathroom in private and take a shower/bath in private, this (masturbation) should also be done in private.  Although discussing sexuality with your kids can be uncomfortable, it is essential for their development.  At the medical center, though we only treat female sexual dysfunction, we have a number of resources for kids and parents on how to open up this conversation.  Some book recommendations: It’s So Amazing and Our Bodies, Ourselves.

Women who come to the Center generally have their own primary gynecologist for routine cervical screening.  That said, when we treat women with vaginal pain, painful intercourse or  vaginismus (a condition that results in extraordinary pain when anything is inserted  into the vagina) one of the first things that crosses our mind is, “how long ago did she have a Pap smear?”.  Women with vaginal pain or vaginismus often avoid pelvic exams and Pap screening because they fear the pain it may cause. 

If you or someone you know is avoiding a Pap because it’s impossible to imagine a speculum entering the vagina without intolerable pain, there is help.  There are different kinds of treatments – from creams to dilators to Botox injections under general anesthesia – that can help a woman take care of her health in every possible way.

http://www.annarbor.com/health/understanding-the-guidelines-for-maintaining-your-cervical-health/

When I am lecturing and trying to explain vaginismus , the analogy I use to describe how a patient feels is to compare it to what your reaction might be if I told you I was going to put a pen into your eye. 

If I said to you,”Listen, I am going to put this pen in your eye. Not to worry, it won’t hurt a bit and actually it will feel good,” you would look at me as though I had three heads and run for your life.

Patients with severe vaginismus feel that way. Often with anti anxiety medications, behavior medication, relaxation exercises we can work with a woman to help her get those first dilators in. Sometimes it just doesn’t work and it’s just too hard.

 This new procedure has the women under general anesthesia while a physician injects Botox (stops the muscles from going into spasm) local anesthesia(so that there is absolutely no initial pain) and put in a large dilator. The patient wakes up having the dilator in and that really is jumping the first few hurdles. There is still significant work for the patient. She has to work with dilators, get comfortable with the idea of inserting something into her vagina, internalize the idea that there is really no pain and then make the  transfer to intercourse.

It doesn’t solve the whole problem, but it can be a big help and relief for the right patient and we are so glad that we will be able to offer  it in our office as well.