In my opinion, faking an orgasm is not the right choice. Although you may retain your mate in the short term, you could very well jeopardize the health of your relationship for any long term possibilities. Most people don’t like to be lied to, and in simple terms, faking it is to lie. It creates a breach in honesty, which can hinder intimacy and be hard to repair. A couple’s sexual health and compatibility always contains an element of communication, and  if your partner has no information about what you like, it can be exceptionally hard to make you feel good or have an orgasm.

I often see women who have been lying to their partners for years leading to two problems in their relationships as opposed to one; first we have to deal with the betrayal and only then can we face the orgasm issue. Why not just tell the truth from the beginning? In this case the truth can set you free.  If you are honest with your partner, you will be freed up to have authentic satisfying orgasms. Doesn’t that sound better than practicing “mate retention manipulation”?

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.

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.

One day a week or two ago they were on the phone and he said, “You know, I never asked you this, but do you like the way I kiss?” She stopped for a moment and then decided to do something really radical.

She decided to tell the truth.

“No. Not really honey.” There was a moment of dead silence on the other end of the phone. Then, “Okay. Why?” “Well, you keep your mouth too closed, kind of scrunched up….” He started to laugh. “I’m so glad you’re telling me. “ He said. “I’ve been so nervous. My ex-wife used to think my mouth was too open all the time, so I’ve been trying really hard not to open it!”  The two of them laughed  and the next time they were together… well you can guess the rest of this story.

So what’s my point? That things really can’t get better unless you decide to ‘fess up and tell the truth when there’s a problem. Try telling the full unadulterated truth next time, and let me know what happens.

Someone once asked me what makes a good day at our center.

Today is one of those days.

• Today I got an e mail with a copy of a baby picture from a patient who struggled for 2 years with vaginismus. She is fine, having great sex and has a beautiful little baby girl to prove it.
• Today we got an email from a patient with chronic pain from a severe and significant accident. Six months ago she believed she could never be approached by her husband again and that she’d never had an orgasm again. She and her husband were so sad that this part of their life was over. They just emailed from vacation. They are having sex (albeit with some modifications) and she is having orgasms again. They feel like they have been given an incredible gift.
• Today I received an email from a young woman who sat in our office 4 years ago sobbing. Her marriage was ending because of her inability to have intercourse and her low desire. She felt hopeless, beyond help and so very alone. She emailed to tell me that those problems are far behind her. She is in a new, wonderful, supportive relationship. No pain. No problems with desire. She is starting a new chapter in her life.

So on those frustrating days when I am sitting across from someone who is struggling and whom we are struggling with to help find the right solution, I just have to remember these days. Because when you help someone restore their sex life you have given them a powerful reminder of just how great life can be!

“I want you.” Three simple words, but somehow they seem nearly impossible to define. Desire can be very complex and often seems mysterious to us. It appears as a magical equation of attraction mixed with physical attributes, eroticism, passion, simple physical need, or love.

And when desire is not there, in its place there is often a sense of emptiness, of an open yawning space, a chasm that can’t be breached and sometimes even a feeling of loss.

When a woman’s desire is low it makes it hard for her to connect with her partner in a physical way, and that can cause many effects that ripple throughout the relationship. It can have significant ramifications on her partner’s feeling about her, about himself, and about his own desirability. It can greatly affect her feelings about her role in the relationship, as well as the overall tone of the relationship itself.

We live in a busy world and many of us lead complicated lives. That means most of us will have stress and anxiety, less-than-perfect relationships, and almost never enough time to relax and regroup. This alone can wreak havoc on a woman’s libido. Some of the craziness of life can be controlled, but not all. A healthy libido can usually weather the normal ups and downs of a crazy life and bounce back after a relatively short “shut-down.”

But there are more complex reasons a woman suffers from a low libido. It can be influenced by physiological conditions in our bodies: hormone levels, vitamin deficiencies and neurotransmitter health. It can be a symptom of depression. It can hint at thyroid problems or anemia. It can be caused by problems in the relationship: lack of intimacy, lack of trust, lack of time. It can be caused by personal struggles of our own: a dislike of our bodies, a general unhappiness with our lives, a lack of time or energy.

The bottom line is, for so many reasons, a low libido should be taken seriously and examined appropriately. You don’t have to live with low sexual desire if you don’t want to—and don’t let anyone else tell you otherwise!

Here is the most important thing to remember: NO ONE NEEDS TO LIVE WITH AN UNCONSUMMATED RELATIONSHIP. EVERYONE CAN BE HELPED!

Really and truly. I promise you.

So if you are sitting there thinking “I am the worst case ever. I can’t possibly do this, ” I’m here to let you know that it just isn’t so. And now you are probably shaking your head saying “But you haven’t met ME and you can’t imagine how bad my case it.”  Oh yes I can. “No, really,” you’re saying. “My gynecologist made it clear to me (by their looks and impatience?) that I am like the most hopeless case ever” or  you’re saying “ You don’t know ME. I am really nuts. I can’t let anyone touch my thighs without hyperventilating or shaking.” Yes… I do know you. We see someone like you every single day here at the Center.

We won’t scream at you. We won’t make you feel guilty. We won’t shame you. And we never, ever make you feel like a freak. Because you’re not. Because every day there are hundreds and thousands of women walking around with the same issue. Just no one talks about it. So when you come in to see us for the first appointment, all we will ever think, is that we know how incredibly scary this is for you… and you? You are incredibly brave!

How is one’s sexual identity formed? Is it formed from our parents? Our biology and hormonal makeup?  Our friends, or the media, or how we look? How much do our early sexual experiences with a partner, or partners  form us?

One’s sexual identity is a complex and dynamic entity.  Some of us grow up feeling proud and self confident.  Others feel shame and self loathing. Most of us feel a combination of all these emotions. In my job as a sexuality counselor at the Medical Center for Female Sexuality, we consider all these aspects of a person. We also take a sexual history, I have been particularly interested in exploring the impact of our earliest experiences with a partner on our sexual identity today. Were we in love? Did we feel safe? Did we feel scared or ashamed?

In a conversation with a colleague recently, she felt that if she had had a different first experience, her whole sexual history would have been different. She expressed that that first experience was not particularly safe or good. She mused that had it been a better experience, she might have felt more confident and she may have chosen more partners and different kinds of partners. She felt that this early experience made her more timid and had ultimately limited her sexually. Do you think that one’s first sexual experience sets each person off on a certain trajectory? I would like to hear what you think. How did your first sexual experience or experiences inform you as a sexual person?

The great news is that there are opportunities to build on that first experience.  Some people have very traumatic early experiences of themselves and their sexuality. Yet, from that early trauma they still heal and grow and change. The beauty is in the power to embrace where you began and then build on it or even transform it. There will always be tools that enable us to  move towards more acceptance and a fuller sense of your sexual self. This is an aspect of my job I love the most. We are in the business of more… more pleasure, more connection, more varied experiences, more joy and hopefully more self acceptance. It is a fantastic thing to have concrete tools to allow and nurture more of all that is good about inhabiting a body and exploring a more fulfilled sexual self.

http://www.nytimes.com/2011/04/21/fashion/21VIBRATORS.html?_r=1&scp=1&sq=vibrators&st=cse

The article ends by saying that all women need, is a little more freedom. The implication is that with added freedom, they could use vibrators, and their sexual problems might be solved. Though freedom is wonderful and can certainly be a necessary component to making a woman feel more comfortable.  Sometimes when a woman suffers from female sexual dysfunction, she may need a therapist and/or a doctor too. At the Center we see the benefits that therapy and medications have in the treatment of low desire, as well as issues with arousal and orgasm.  We definitely advocate the use of vibrators as well! Let’s give women all the help we can offer and not stigmatize any of it.

One researcher hypothesizes that the female orgasm helps maintains vaginal functionality. I would argue with that slightly because you can maintain vaginal health with use which does not culminate in orgasm. However orgasms will potentially make that process more enjoyable.

Another researcher named Baker states, “that the female orgasm has evolved to selectively retain sperm and manipulate competition between sperm from insemination by different men. He argues, “that it could be advantageous for women to be different from each other in their sexual responsiveness, (e.g. to ensure insemination by a highly skilled partner, to avoid pair bonding to a male who is unlikely to invest in offspring.” These are not particularly conclusive studies but the question of why some women do and some women don’t is pretty interesting.

The great news is that with vibrators many women who previously couldn’t, now can.