Posts Tagged ‘sexuality’

We Would Love to Hear from You!

Tuesday, January 31st, 2012 by Bat Sheva Marcus LMSW MPH PhD

There is nothing I love more than feeling like I’ve helped a woman that came in to see me at the Center.  The struggles of sexual problems, whether it be painful intercourse, lack of desire, difficulty becoming aroused  or so many of the other issues that arise, affect so many areas of a woman’s life. Getting a woman to a place where she can be happy and excited again is such a rewarding feeling!

Sadly, I also know that for every patient that comes in here to find a solution for their problems, there are hundreds if not thousands of women that can’t get here. And I know that there are so many women who have concerns and questions about what is going on with their own sexuality, and would like to hear a better answer than “it’s all in your head”.

We, at The Medical Center for Female Sexuality, would like to invite you to take the time to ask us your questions and our staff will do our best to come up with a helpful answer.  We will take a question a week from those that are emailed to us at info@centerforfemalesexuality.com, and answer it for you right here, on the Center’s blog. We will be sure to keep you anonymous, so you never need to worry about having your personal issues exposed unwillingly.  So please, send us your questions, and we will do our best to answer as many as we can.

So start sending in those questions!

The year in clinical sexuality, 2011

Thursday, December 29th, 2011 by Stephen Snyder, MD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

As we get ready to leave 2011 behind, I would like as always to express my gratitude to family, friends and colleagues for your support and encouragement over the past year; and to my patients for your trust and confidence.   May we all merit much happiness in 2012.

Here’s my list of 2011′s most interesting happenings in clinical sexuality and related disciplines.


Vampire love

This year, in Twilight:  Breaking Dawn Part 1, Bella finally consummated her relationship with Edward, after three years of cinematic foreplay — and immediately ended up pregnant.  By the end of the movie, she’d become both a mom and a vampire.    Shows what can happen.

In SexualityToday at the Movies:  Breaking Dawn, we continued the discussion of the “integrative” aspect of ordinary female desire that we began in Twilight and the Art of Foreplay and in The Nine Rooms of Happiness:  What Does a Woman Want?

Elsewhere on the paranormal sexuality front, The NY Times Magazine featured a cover story on the new MTV series Teen Wolf —  “We Are All Teenage Werewolves.”  In Wolf Love in the New York Times, I discussed how the human-to-werewolf transformation works as a metaphor for sexual arousal — especially its primal, selfish aspect.

Australian writer Katherine Feeney picked up on the idea in Unleashing the Animal Within.  And Cosmo ended up interviewing me for an article in the December issue entitled “The Fierce Sex Every Couple Should Try.”    Shows what can happen.

 

What can we learn from Google about sexual motivation?

This year saw the publication of A Billion Wicked Thoughts, an interesting report on what must be the world’s largest sex experiment — an analysis of 55 million sex-related Google searches.   The book has a new and rather interesting theory of human sexual motivation, but the theory gets lost in its popular book format.

As I wrote in The Simple, the Complex, and the Still-ForbiddenA Billion Wicked Thoughts hasn’t had an easy time in print so far.  The New York Times Book Review assigned the book not to a sex researcher but to a cultural critic, Wesley Yang, who called it a “farrago.”   And most sex therapists I’ve spoken to so far have been unwilling to read it.

I’ve argued that  it would be foolish to ignore the book’s’ ambitious theory of sexual motivation, or the huge and unique set of data that supports it.    I’ve attempted, in a series of articles loosely based on A Billion Wicked Thoughts, to place the work in cultural and scientific context and to show its applicability to the practice of sex therapy.

It’s turned out to be a larger project than anticipated, and one I still haven’t completed.   But for anyone with the time and interest, Lessons from the World’s Largest Sex Experiment contains the links to the series of eleven articles I’ve written so far on the subject.

It’s still politically tricky to discuss the ordinary differences in sexual psychology between men and women.   Yes, I know, there’s lots of intra-gender diversity as well.   But that doesn’t make the inter-gender differences less important.

So I was pleased recently to find that Dr Meredith Chivers’  Sexuality and Gender Laboratory (Sagelab) at Queens University in Kingston, Ontario, a leading center for research into gender differences, has also taken up the challenge of communicating the results of this new research to the public – both on the web and on twitter.    That’s good company, and good news for the rest of us working in this politically slippery area.

 

The male of the species

Even now, 13+ years since Viagra was introduced, few people understand the physical/psychological complexities of male sexual arousal.   In Diary of a Manhattan Sex Therapist:  The Other Side of Saturday Night we discussed some of the psychological issues in younger men with erectile dysfunction (ED.)

The past year saw publication of two important professional articles highlighting the risk of sexual side effects from the chemical finasteride, used in the hair-loss medication Propecia and the prostatism medication Proscar.   In Diary of a Manhattan Sex Therapist:  Propecia, and Another Look at Sex and Propecia we discussed the common and often devastating side effects that can occur in men who take finasteride.

Premature Ejaculation (PE),  the most common sexual problem in young men, still gets surprisingly little publicity despite the significant impact it has on men and their partners.   Johnson&Johnson’s PE drug Priligy (dapoxetine) was rejected by the FDA in 2006, but has been approved in many other countries now worldwide.

Will the FDA be considering Priligy again?    It doesn’t seem imminent.    In the meantime, men seeking medication  for PE can be treated off-label with any of the Prozac family of so-called SSRI’s (Priligy is just a short-acting SSRI).   But until a medication is specifically approved for PE here, few MD’s in the US will be motivated to become skilled in doing this kind of treatment.

Take a look at 2010′s  The Latest News About Premature Ejaculation.   Not much has changed since then.

 

More on monogamy and near-monogamy

Problems with monogamy continue to fascinate modern readers.  In the wake of the Anthony Weiner episode, The Search for Sexual Sanity Continues  discussed the controversy over how to evaluate and treat what one might call ”Impulsive/Compulsive Courtship Behavior.”

Is strict monogamy often not worth the emotional cost?  That’s the opinion of Dan Savage, quoted in Mark Oppenheimer’s Married, with Infidelities in The New York Times.  In What’s So New About the New Non-monogamy? and Still Further Along the Road Less Traveled, we responded to the Oppenheimer piece, as did Ross DouthatRabbi Shmuley Boteach, and many others.  

Sex at Dawn, whose lead author Christopher Ryan has claimed that monogamy for humans is about as natural as a Big Mac and fries (and about as healthy), continues to be the decade’s most interesting and talked-about sex book, and clinched the Society for Sex Therapy and Research‘s Consumer Book Award for 2011.

Will Sex at Dawn influence sex therapy? Well, at least it might increase our empathy for people who find monogamy particularly difficult.

We reviewed the related book Bonobo Handshake by Vanessa Woods in Sex in the Wild, discussed some of its implications for our era in Empathy’s Magic, and ventured a bit into the evolutionary psychology debates with Eros, Thanatos, and Sunday Afternoon.

 

On loving your Blackberry

The most interesting sex article of the year, in my opinion, was Jonathan Franzen’s New York Times article about the sensual charms of his new Blackberry device.

As Franzen notes, electronic machines can now supply some of the self-affirmation that humans have traditionally only been able to obtain though intimate relationships.   He writes, “our technology has become extremely adept at creating products that correspond to our fantasy ideal of an erotic relationship, in which the beloved object asks for nothing and gives everything, instantly, and makes us feel all powerful . . . a world so responsive to our wishes as to be, effectively, a mere extension of the self.”

In the past, one of the few ways an adult could experience this kind of automatic, effortless self-affirmation was through the magic of really good sex.   But that’s no longer entirely the case.  As I discussed in Eros and Technology, Franzen’s essay alerts us to the still-difficult “problems of actual love” – including the challenge of relating long-term to someone who, unlike a piece of electronic equipment, was not designed specifically to meet our needs.

 

What’s ahead in 2012?

Well, obviously, I don’t know.   I’m hoping to finish the long series of articles loosely based on A Billion Wicked Thoughts that I began this year in Lessons from the World’s Largest Sex Experiment.

For the sake of my many patients with adult ADHD who keep asking me for reading materials (OK, it’s usually their spouses who ask for the reading materials), I’d like to continue the series on adult ADHD that began with ADHD, Marriage, and the New York Times, Alvin?  Alvin?  Alviiin!!!!,  and  Dr Laura Muggli on ADHD in Women — plus deliver my long-promised reviews of The ADHD Effect on Marriage,  and Is It You, Me, or Adult ADHD?

Plus we’ll continue the series on sex therapy fundamentals that began with Some Open Secrets About Sexual Arousal,  Sexuality, Simmering, and the B Train Back From the Beach, and Sexual Arousal for its Own Sake.

That’s assuming nothing else comes along in 2012 to distract us.   A dubious assumption, I know.

 

Fantasies

Thursday, September 22nd, 2011 by Barbara Gross, LMSW

Most women don’t feel comfortable  sharing their sexual fantasies. In fact, many say they don’t even have them. There is some notion that one should fantasize about their boyfriend or husband only, and that fantasies should be fairly tame and not involve anything out of the ordinary.  In fact, the beauty of a fantasy is that 1. no one ever has to know about it,  including your partner and 2. it is just a fantasy and therefore can include anything you want; same sex, many individuals…really anything you dream up is valid. A fantasy is not about what you would actually like to have or do, it is about finding the most pleasure sexually.

Many women get stuck when trying to fantasize because they feel self-conscious. They may ask themselves:

Am I normal?

Where do my sexual fantasies come from?

What do my sexual fantasies mean?

If they are upsetting what can I do about them?

Can fantasies enhance or improve my sex life?

These questions are from the book, “Private Thoughts”, by Wendy Maltz and Suzie Boss. They are great questions and I think many women have grappled with them at some point. In my practice at the Center I repeatedly see what a big impact fantasies (or the lack of fantasies) can have on a woman’s sexuality. Arousal can start in several places, for some it starts in the mind and for others it starts in the body. Typically, if a woman is having difficulty with desire, arousal and/or orgasm I suggest that she work on her fantasy life. There are many ways to go about that but ultimately the best thing to do is simply pay attention to what turns you on and don’t edit it and don’t judge it…just enjoy it.  And if you are having concerns about your fantasies, find a good therapist to speak to about them.  If you are having difficulty getting interested in sex, begin to pay attention to what you like because that is the first step towards implementing it in some way that might make your sex life better.

Asexuality

Friday, August 12th, 2011 by Barbara Gross, LMSW

The concept of asexuality first came to my attention a few months ago when I began to see a young woman who was struggling with the fact that she felt no desire to be sexual.  As a teenager she felt ostracized from having no interest in sex of any kind.  Her girlfriends were all talking about hook-ups and sex while she had very little interest in boys.  Even when she had experiences with them, she felt it was boring.  As we began to work together it became clear that she had spent a great deal of time both worrying about her lack of desire and researching it.

She spoke at length about a web site called AVEN.  AVEN defines itself as, “the Asexual Visibility and Education Network. AVEN strives to create open, honest discussion about asexuality among sexual and asexual people alike.” AVEN is a great resource for individuals struggling with asexuality.

An asexual, as defined by AVEN is, “someone who does not experience sexual attraction. Unlike celibacy, which people choose, asexuality is an intrinsic part of who we are. Asexuality does not make our lives any worse or any better, we just face a different set of challenges than most sexual people. There is considerable diversity among the asexual community; each asexual person experiences things like relationships, attraction, and arousal somewhat differently. Asexuality is just beginning to be the subject of scientific research.”

AVEN seems to have been a starting point for several women I treat,  yet it leaves many questions unanswered. It is limited in getting to the deeper issues around desire. In my practice at the Center we view desire as a multi-faceted condition; we do a thorough evaluation to uncover what might be causing a lack of desire.  It is obviously different in each person.  We do start from the assumption that most individuals want to have desire and that we can work through a process to help them discover or reclaim it, but if one feels that they have no desire and would rather embrace it, that is a fine choice too.

As a sexuality counselor, this idea of asexuality poses a unique set of questions. I see women all the time who have low libido or non-existent libido.  What makes one person asexual and another person an individual struggling with a lack of desire?  Ultimately it is personal decision and I hope that each person finds what they are seeking.  If you have no interest in sex or sexuality or in having a sexual relationship, perhaps the term asexual is a good one.  If you are someone who is struggling with a lack of desire and you would like to feel differently than you do, I would probably not use the term asexual.  Either way, you can always reach out for help to gain tools and support for what you are struggling with.  Struggling alone is what concerns me the most; with help you can come to a place of greater comfort with yourself and whatever choices you decide to make.

Adversity and Desire

Monday, August 8th, 2011 by Bat Sheva Marcus LMSW MPH PhD

It happens all the time. A tearful, distraught woman sits down and informs us that:

Her husband is leaving her/has left her.

Her husband is having/was having an affair.

She believes this is due to the fact that they haven’t had sex in (you fill in the blank: 6 months, 1 year, 2 years, 5 years, 11 years.)

The funny thing, she’ll say, is that her sex drive (the lack of which caused all the problems) has miraculously re-emerged. Now, on top of every other painful emotion she is experiencing (abandonment, anger, betrayal, sadness, fury) she feels crazy and distorted.

Now my sex drive is working????? Am I crazy?

No. You’re not crazy. Not only are you not crazy, but nearly every other woman we’ve seen in the same situation feels similarly. (A variation of the theme is that after their first appointment with us, their sex drive comes back and they think we are genius miracle workers.)

Okay. So now you (the reader) are probably saying something like: “Yea. We all want what we can’t have.” Or “it’s the competition thing going.” Well, that’s probably right, but it doesn’t actually explain anything nor does it account for such a sudden and extreme shift in what these women feel as a physical reality. Some of them are getting wet for the first time in years and having orgasms easily when they couldn’t before.

Helen Fisher  (noted sociologist) wrote in “Why we Love”, “As adversity [in relationships] intensifies, so does romantic passion. This phenomenon is so common in literature and in life that I coined a term for it: ‘frustration attraction.’” She then goes on to explain how when we suffer a disappointment or a delay in reward, the dopamine procuring neurons in our brains prolong their  activities- increasing brain levels of the natural stimulant “ And very high levels of  dopamine are associated with intense motivation and goal directed behavior”  — and I will add here, arousal and orgasm.

So here we have it yet again. Is it something physical or psychological? I don’t really know the answer. I only know that the two are becoming more and more intrinsically linked in the way we practice here at the Center and I only wish we knew more.

When it comes to sex, lying is not a good idea!

Thursday, March 17th, 2011 by Bat Sheva Marcus LMSW MPH PhD

Yesterday we saw a wonderful patient of ours. She originally came in because she felt like “there was something wrong with her.” She was having a difficult time having orgasms and, more often than not, she could not have them with a partner.

We’ve worked with her for a while to help her understand that most women don’t have an orgasm from intercourse; and that if having an orgasm with a vibrator was the best way for her do so, she shouldn’t feel badly about feeling good! We’ve also tried to help her have orgasms more easily since it really did seem like there were physiological reasons that she might be having a difficult time.

Two days ago she was in our office and told us she was dating  a new man who was interested in having sex with her. She was turned on and excited about the idea of having sex with him but nervous that she’d have problems with orgasm with him. She needed advice… and her therapist told her a)not to come clean with him about her orgasm concerns and b) “maybe you can just fake it in the beginning so that you don’t have an issue!!!!”

I almost fell off my chair.

She loves her therapist and I’m sure her therapist is good for her in some ways. (Okay, maybe not… who know?) But I do know that this could not have been a worse suggestion. Lying in this way just creates so many problems in the long run and in no way sets the stage for a normal, healthy sexual interaction.

Here’s the RIGHT answer:

Before you get involved in sex with him, talk to him. Tell him:

  • you feel anxious because sometimes you have a problem with orgasm in a relationship.
  • The easiest way for you to have an orgasm is with a vibrator, and at some point you may want to bring that into the relationship.
  • In the meantime, you hope he can understand that you really want to have sex with him and he turns you on but it would really help if he didn’t focus on orgasm so strongly. You will have fun anyway.

Our hope is that, ultimately, they’ll have great sex, she can bring her vibrator in to the room and have great orgasms and all will be right with the world.  We believe this can happen.  If, that is,  you start out being honest and open from that very first intimate encounter.

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

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

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!

Erotica for the blind

Monday, May 3rd, 2010 by Bat Sheva Marcus LMSW MPH PhD

Here’s an interesting article about a new sexy book with a twist. It’s been written and produced for the blind.

‘Tactical Mind’ is billing itself as the first erotic book for blind people and it incorporates raised sexually explicit images as well as erotic descriptions in Braille. The book has received a great deal of attention recently by mainstream newspapers here and abroad. “Porn you can touch,” was how it was described by the  New York Daily News.
  
The author, Lisa Murphy, is a photographer who observed, as many of us do, the sexualization of , well, everything and she decided to create a new venue for pornography – tactile erotica.  She wasn’t sure it would appeal to a large crowd, more, that she worked hard on the idea and was commited to it.  “I’d been dragging it around to erotic fairs for the last two years,” Murphy commented. “It was a labor of love and I never expected to make any money from it.”

It certainly seems like it involved a great deal of labor as the author used friends to pose for pictures and then created sculptures for each one. It took her hundreds of hours.

 What I find particularly fascinating about this project is that too often the physically challenged get left behind in an erotic world. We somehow think they “don’t really count.” Or aren’t sexual beings. It’s always important to recognize that all of us, yes all of us, deserve healthy ways to attend to our sex lives.  

 If you want to read more about the project click here: http://www.france24.com/en/20100417-tactical-mind-first-erotic-book-blind-lisa-murphy-canada

sting article about a new sexy book with a twist. It’s been written and produced for the blind! ‘Tactical Mind’ is billing itself as the first erotic book for blind people and it incorporates raised sexually explicit images as well as erotic descriptions in Braille. The magazine has received a great deal of attention recently by mainstream newspapers here and abroad. “Porn you can touch,” was how it was described by the New York Daily News. “I’d been dragging it around to erotic fairs for the last two years,” Murphy commented. “It was a labor of love and I never expected to make any money from it.” It certainly seems like it involved a great deal of labor as the author used friends to pose for pictures and then created sculptures for each one. It took her hundreds of hours. What I find particularly fascinating about this project is that too often the physically handicapped get left behind in an erotic world. We somehow think they “don’t really count.” Or aren’t sexual beings. It’s always nice to see someone or something pay positive attention to the sex lives of the handicapped. If you want to read more about the project click here: http://www.france24.com/en/20100417-tactical-mind-first-erotic-book-blind-lisa-murphy-canada