Posts Tagged ‘female sexual dysfunction’

PGAD (Persistent Genital Arousal Disorder)

Tuesday, September 13th, 2011 by Bat Sheva Marcus LMSW MPH PhD

We recently had a PGAD patient in her 80’s. The PGAD (or PGAS) started a few months ago after a head trauma and a broken hip. Her symptoms were classic: constant genital engorgement (she described it as heat and a feeling of fullness) and a burning feeling that was always present and was driving her crazy. Like many PGAD patients she would need to get up and walk around to alleviate the miserable feeling which seemed to get worse when she sat too long.

Here’s the really scary piece – she had tried to commit suicide a few weeks before she came to see us.

That’s how miserable her symptoms were. One of the most heartbreaking elements of this condition is that it is so misunderstood. Most physicians haven’t heard of it, let alone seen a patient with the condition. So in good, classic medical style they tell patients “it’s in your head” (it isn’t by the way—we don’t really get it but we think it’s probably connected to pudendal nerve issues). Or, even worse, they think the patient is crazy or “hypersexualized”.  You have no idea how awful it is for a woman who is experiencing constant and severe unpleasant symptoms to be told she’s turned on. She’s not!

We don’t know an awful lot about PGAD, but we do know it’s a real and concerning medical condition that can drive perfectly normal women to the brink. We’ve had a young woman who had to drop out of school, a woman who stopped working, and now this 80 year-old who tried to commit suicide. As we learn more about the condition we will hopefully develop more effective ways to treat it. In the meantime we work with patients, trying to alleviate their symptoms and assuring them….that they are not crazy, and it is most definitely not in their heads.

Seeing Vaginismus Everywhere

Monday, August 29th, 2011 by Bat Sheva Marcus LMSW MPH PhD

My husband claims I see vaginismus everywhere. Okay. Maybe he’s right. Maybe I do….it kills me. When I see a woman who is totally avoidant of relationships I suspect she is fearful of penetration. When I see a young girl fearful of tampons, I suspect she is panicked at the idea of putting something inside.  What kills me is that I know how unbelievably treatable the condition is!! And it kills me that anyone is letting it ruin their relationships or their life.

Anyhow, last weekend I was reading a book by AS Byatt, Possession. It’s a beautiful book about two modern English researchers who are studying 2 Victorian poets who they discover had a clandestine love affair. (By the way, writing this book was no easy feat since the author had to write poems that were supposedly written by 2 separate Victorian poets in addition to writing the book around their work!) Anyhow, back to my point that my husband suspects I see vaginismus everywhere. “Hey,” I gasp, “one of the characters has vaginismus.” He smiles knowingly… “No really.” I  say. “Here. You read it!’

 

A few flames made their sinuous way upwards. She remembered her honeymoon, as she did, from time to time, and deliberately.

She did not remember it in words. There were no words attached to it, that was part of the horror. She had never spoken of it to anyone, not even to Randolph, precisely not to Randolph.

She remembered it in images. A window, in the south, all hung about with vines and creepers, with the hot summer sun fading.

The nightdress embroidered for these nights, white cambric, all spattered with lovers’ knots and forget-me-nots and roses, white on white.

A thin white animal, herself, trembling.

A complex thing, the naked male, curly hairs and shining wet, at once bovine and dolphin-like, its scent feral and overwhelming.

A large hand, held out in kindness, not once, but many times, slapped away, pushed away, slapped away.

A running creature, crouching and cowering in the corner of the room, its teeth chattering, its veins clamped in spasms, its breath shallow and fluttering. Herself.

A respite, generously agreed, glasses of golden wine, a few days of Edenic picnics, a laughing woman perched on a rock in pale blue poplin shirts, a handsome man in his whiskers, lifting her, quoting Petrarch.

An attempt. A hand not pushed away. Tendons like steel, teeth in pain, clenched, clenched.

The approach, the locked gateway, the panic, the whimpering flight.

Not once, but over and over and over.

When did he begin to know that however gentle he was, how-ever patient, it was no good, it would never be any good?

She did not like to remember his face in those days, but did, for truthfulness, the puzzled brow, the questioning tender look, the largeness of it, convicted of its brutality, rejected in its closeness.

The eagerness, the terrible love, with which she had made it up to him, his abstinence, making him a thousand small comforts, cakes and tidbits. She became his slave. Quivering at every word. He had accepted her love.

She had loved him for it.

He had loved her.


So, he did read it – and agreed I was right and it wasn’t my imagination.

I was moved because Byatt describes so dramatically and poignantly the pain and psychological damage associated with Vaginismus.

But all I could keep thinking that night and the next day was: We could have helped her! We really, really could have.

Alas and alack, there is little to no market for “fixing” fictional characters. And then poor AS Byatt would have had to rewrite the entire book.

 

Weighing in on the film Orgasm Inc.

Thursday, February 24th, 2011 by Bat Sheva Marcus LMSW MPH PhD

Once upon a time people couldn’t see. They bumped into walls, they had trouble reading, they saw double, they had horrible pain in their eyes and in the worst cases they went blind. This was a big problem and since this was a hundred years ago no one really had good language to use to describe different problems.

They didn’t realize that there were some people who could see close-up but not far off; or those who could see in the distance but could not read clearly within an arms’ distance.  They certainly didn’t realize that you could scratch your cornea and have pain, develop a film over your eyes as you aged or go blind from certain diseases and too much eye pressure. All they knew was that people had “sight problems.”

Luckily, over generations, our understanding of the eye has increased dramatically. We understand that the eye has lenses that can get scratched or bent.  We understand that diseases can create deterioration and change and we have given these conditions descriptive names often with medical emphasis. People are now near-sighted and far-sighted, have strabismus, macular degeneration, glaucoma and corneal disease. As more and more numbers in our population present with these conditions, we have begun to better understand the fundamental differences between them and because we understand them better we have been able to treat them appropriately. Treatment devices include glasses, ocular exercises and surgery.

So what does all this have to do with FSD – Female Sexual Dysfunction?

The term FSD was coined about ten years ago as a broad catch-all phrase to include women’s low sexual desire, problems with arousal, trouble achieving orgasm and painful sex. These over-arching diagnoses were too general to be helpful at times, but they represented a first step in acknowledging the very real concerns that many women have with their sexual function.   By using the term FSD to characterize these conditions, the medical and psychological community loaned legitimacy to problems encountered by a large swath of the population, problems that interrupted the natural progression of relationships, marriages and productive self-esteem.

Liz Canner in her new film Orgasm Inc., makes a legitimate case that FSD, as a diagnosis, has been created by the companies that hope to make money off their treatments. The film links FSD as a diagnosis to the launch of Viagra.  Viagra allowed society to begin discussing sexual health in a more open manner around men and their sexual function.  The film suggests that pharmaceutical companies saw a cash cow nestled in the common complaints from women about sexual satisfaction. If it worked for men’s erections, might it work for women’s sexual desire?  The film’s analysis of FSD stops years ago when the practice of treating women for sexual issues was young, and the press was hot to trot out event after event about sexual health.

But if we examine the topic and the real progress made over the past ten years, Ms. Canner’s argument looks more and more like a straw man.

The field is no longer simplistically defined as “female sexual dysfunction.” A decade or more of experience working with women has helped us understand the difference between arousal and desire problems, between pain sourced in muscular contractions in the introitus or pain due to skin irritations, between physical conditions and issues that lie mainly in a personal history or relationship. These layers of understanding help professionals in the field tailor treatment protocols so they can have the best outcome.

It is true that the bucket of FSD diagnoses has exploded in the last 10 years.  Today, we have a much more sophisticated understanding of the myriad issues that a woman might be facing and the solutions that might help her.  From my seat across the table from these women every day, that’s a good thing.

The point is, this is a new field. And as in all new fields the initial challenges of identifying, classifying and understanding the variations is a tricky practice,  especially when trying to do it in a respectful, thoughtful manner. And those urologists, gynecologists, vulvar physical therapists, psychiatrists and psychologists and sexologists in the field, all dedicated to women who come for help, need to be considered as the professionals they are, not lumped in with spokepeople for pharmaceutical companies or snake oil salesmen.

There’s no way we’re going to get it perfectly right the first time around. And things that seem obvious to us today, may seem erroneous tomorrow. But we are trying. The fact that abuses may occur on the way does not mean the entire initiative should be delegitimized and discarded. If that were the case, the thousand women we see every year would have nowhere to turn for help.

Allowing women the freedom to express their concerns about their sexuality and giving them broad approaches to solutions is, in my mind, the only reasonable way to effect change. We will never find one solution and there is no one drug or one behavioral therapy that will help all women. The more tools we have in our arsenal, the more pieces of the puzzle we understand the better we will be at helping women find solutions that work.

One thing I know for sure. We don’t tell people who are having trouble seeing that watching a sunset, looking at a painting or admiring a flower should be something in their past, that they should be willing to live out their lives without that pleasure. We also don’t tell them that they should spend a year in therapy mourning the loss of the pleasure of vision. What we do is address the problem and help them see again, as well as possible. Don’t women deserve the same with their sex lives?

My First Time – Medical Center for Female Sexuality Welcomes Tara Ford!

Friday, December 3rd, 2010 by Tara Ford, R.P.A.

Hello Everyone!  My name is Tara Ford. I’m a Physician Assistant and the latest practitioner to join MCFS.  As this is my first time blogging here, I’d like to give you a little insight on what I’ve discovered.  Like you, I wasn’t sure of what to expect. Once I heard about this center, I did what most of you have done…I searched the internet and scoured this webpage!

Although I have experience working in women’s health, I had never stepped foot into a medical center that focused solely on female sexual health.  As I’m sure you’ve realized, there aren’t many centers like this that exist in the world!  As I read the patient’s testimonials on the website touting success I couldn’t help but wonder, “Are these testimonials about actual, real life patients here?”

When I first arrived at the center, I was impressed by the professionalism of the staff.  Everyone I encountered, from the receptionists to the medical staff were friendly and kind. I approached the situation with the mindset of a patient.  “Would I feel welcomed by the receptionist when I came for my first visit?” “Would I feel comfortable talking about my sexual health with the medical professionals?” “Are these people actually going to care about what I’m going through?”

The answer to “our” questions is a resounding “YES!”

At this center, you will find a warm, supportive, knowledgeable staff eager to help you; a staff that acknowledges the courage it takes to seek help for a sexually related problem. You have already taken the first step by visiting this website. Don’t wait another day or let another year go by.

And by the way, I asked about the testimonials.  Yes, they are based on real life patients treated here! More importantly, there is a space on this website waiting for your success story!

And I look forward to helping you achieve that success!

Once again, the media needs headlines about sex

Tuesday, October 5th, 2010 by Ilene Rosenthal, Marketing

You’ve already heard us opine about claims that practitioners who treat female sexual dysfunction medically with tremendous success.  Here, ABC News again fusses over the fact that big pharmaceutical companies are creating products to address the condition of low desire.

Of particular interest are the comments below the story.  Proof from real people, right there.

Tips for Selecting a Sex Therapist

Monday, 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.

Debate: the “Medicalization” of Female Sexuality

Friday, 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.

Goin’ Down

Monday, July 12th, 2010 by Shannon Bertha, ACS, PhD

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

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!!

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!