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Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly “Medical Monday” column for Women’s Voices for Change. (Search our archives for her posts, calling on the expertise of medical specialists, on topics from angiography to vulvar melanoma.)
In response to a woman whose husband wants her to began taking the new female “Viagra” pill, Addyi, Dr. Pat turns for expertise to Dr. Hilda Hutcherson, professor of obstetrics and gynecology at Columbia University College of Physicians and Surgeons. (Dr. Hutcherson and Dr. Pat have both written many articles for us as the “Sex Talk Team.”) Dr. Pat also turns to Dr. Cecilia Ford, clinical psychologist with a practice steeped in marriage and family counseling, and sex therapy.
Dear Dr. Pat
I am a 46 year-old woman who has been married for 20 years to a really great guy. I remember liking sex well enough in college with my second boyfriend then I met my husband, my third sexual partner and we were married when I was 26. I never masturbated. I was finally able to be orgasmic when my husband bought me a vibrator but I only used it when we had sex together. He really liked sex and was thoughtful but truthfully I never found it to be such a big deal. However, I had sex twice a week most of our married life. We still have sex once or twice a week. I never initiate. I never did. Then the news about the woman’s “pink viagra” came out and my husband is all over me to call a specialist and get this prescription. I don’t really want to take a pill every day and I am concerned about the possible side effects. And I like having a glass of wine every night with dinner. I don’t want to stop my wine and take a risk just to make my husband feel like I have made every effort to be waiting in lingerie when he comes in the door at the end of the day. Is there something really wrong with me? The only thing wrong with our marriage is his insistence that I see “someone.” Shouldn’t pleasant intercourse and sometimes a few surprises in the bedroom be enough?
Sad in Seattle
Dr. Hilda Hutcherson Responds:
Perhaps you’ve heard stories about how the “little blue pill” turned men into sex machines. Or you’ve watched your husband go from an anxious man who avoided sex for fear of failure to a highly sex-confident lover after ingesting Viagra. If so, the announcement of the “pink Viagra” might lead you to rush out to the nearest pharmacy and demand a year’s supply. But before you do, let’s talk a little about female sexual desire.
Female sexual desire is complicated, and full of ebbs and flows. Desire changes throughout the monthly cycle, and dramatically during major life stages. Desire may tank during pregnancy, the first year after giving birth, while breastfeeding, and during menopause. Desire can also take a dive when you are fatigued, stressed, coping with medical problems, taking some medications, or when your relationship with your spouse is suffering.
Unlike the typical male, most women do not think about sex or have sexual fantasies several times a day. In fact, many women never have spontaneous sexual thoughts and fantasies. And that’s normal. But when approached in the right way by the right partner, she may become interested in sex. Some sex experts have determined that it is more common for women to experience arousal first in response to sexual stimulation, and the arousal then leads to sexual desire. Therefore, it may be normal for women not to have spontaneous sexual thoughts and fantasies. And the pressure for women to have a sexual response cycle that is similar to the male response, places great pressure on women and makes them feel inadequate and abnormal.
So since female sexual desire is complicated, normally ebbs and flows, and may not be spontaneous in most normal women, should women rush out to buy the new “pink Viagra,” Addyi, for “low libido?”
What Addyi Won’t Do:
It won’t compensate for a marriage to someone who is ungrateful and takes you for granted (or a bad marriage), a certain desire-killer. It won’t compensate for a man who can’t find your clitoris if it sat on the end of his nose and who doesn’t know his way around your body after 20 years of marriage. Nor will it compensate for lack of self-knowledge about how your body works and what brings you sexual pleasure. And it won’t compensate for guilt and shame stemming from negative sexual messages that you might have received during childhood that continue to make it difficult for you to relax and embrace pleasure.
What Addyi May Do:
It may lead to a modest increase in your desire. Some, but not all, women who took the drug every day had a slight increase in satisfying sexual events each month over that of women taking placebo. It will drain your wallet, as the drug will not be cheap. You will have to give up all alcohol. And it will place you at risk for side effects that may include decrease in blood pressure, dizziness and fainting.
Women who suffer from a complete loss of sexual desire and responsiveness deserve our concern and attempts to find appropriate treatment. The most significant effect of the FDA approval of Addyi for female sexual desire may be increasing sex education and opening an honest discussion about female sexual needs, desires and experiences, including what’s “normal” and how to make sex better. It may also peak the interest of other companies to investigate other ways to improve women’s sex lives.
Next Page: Dr. Cecilia Ford Responds
As summer’s end approaches, bloggers worried about the lack of women in Washington budget talks, but blogland stayed mostly steamy, with Jane Fonda’s sex guide and thought-provoking memories of the film Dirty Dancing.
- “Here’s the math: Women are 50.7 percent of our population, only 17 percent of Congress, and an appallingly low 8 percent of the Super Committee,” writes Kristin Rowe-Finklebeiner at Moms Rising, referring to the legislative action team appointed after the recent debt-ceiling crisis in Washington. That is true, she adds, even though women will be disproportionately affected by proposed budget cuts. Rowe points out that inclusion of women is demonstrably essential to a good outcome, citing “A 19-year Pepperdine University survey of Fortune 500 companies [that] showed that those with the best record of promoting women outperformed the competition by anywhere from 41 to 116 percent. Our economy needs every bit of entrepreneurship possible, and disproportionately leaving out women hampers our nation’s success.” Godspeed to that one woman, Sen. Patty Murray of Washington: we have your back, and hope you have ours.
- We mentioned Jane Fonda’s new book Prime Time a few weeks ago, but Ceri Roberts at AOL Lifestyle points out something that should delight WVFCers: frank sex talk from the former Barbarella. “I have never found a book that talks about everything from the psyche and sprit and wisdom to penile implants,” Fonda told Time magazine recently. “So I decided that I’d write about as much of the research as I possibly could — everything I wanted to know as a woman who is 73 years old and still sexually active.” We’d love to have Fonda in our next Sex Talk series, and see if our sex expert Dr. Hilda Hutcherson and our racy publisher could shock her.
- Speaking of that publisher, Dr. Allen makes a stylish appearance in this week’s Quintessence, the blog of WVFC style maven Stacey Bewkes. Among the beautifully-photographed china and cutting-edge fabrics Bewkes found on her New England journey, click over and check out Dr. Allen in a hat oddly similar to the one featured in her recent report from the Highland Games, though in less Scottish garb.
- What would you do if you suddenly found yourself unemployed? At Successful Blog guest writer Molly, a co-founder of Women Who Drive Foundation, experienced that exactly a year ago, and describes what the year has been like — a year that included getting her foundation started. “I believe wholeheartedly that we are never presented with anything too big for us to handle,” she writes. “If we have the ability to recognize the challenge, then we have the capacity to overcome it. Our responsibility lies with identifying the skill required within ourselves that we have allowed to remain dormant or underdeveloped necessary to overcome the challenge at hand.” Now that’s the kind of reinvention we love.
- Quickly: what do you remember about the 1987 film Dirty Dancing — the dancing, the sex or the politics? Even a politics junkie like your editor has to confess mostly remembering the bodies, whether writhing clothed on the dance floor or the half-clothed young Jennifer Grey and Patrick Swayze. But as Sarah at Feministe points out, recent talk of a remake has prompted a wave of feminist effort to reclaim the film from the ugly-duckling storyline used in its marketing — including this from Atlantic writer Alyssa Rosenberg and a Jezebel.com-sponsored benefit including screenwriter/co-producer Eleanor Bergstein, whose memories prompted the film. Irin Carmon at Jezebel even declares it “The Greatest Movie of All Time.” We wouldn’t go quite that far, but streaming the film via Netflix after reading it all, we saw anew the protagonist Bergstein created: “Told her whole life that she could do anything and change the world, she’s faced with the hypocrisy of a long-shunned minority enacting its own unexamined exclusion, this time on class grounds. The guests at [the resort hotel] look comfortable, but they were raised in the Depression and traumatized by World War II. She can contrast the welcome her family received at the resort with the chilly, dismissive one Johnny and his working class dance crew gets. She can dance with the owner’s son and thaw a little when she learns he’s going freedom riding with the bus boys…” If you’re still not sold, then read the links. But first, here’s the reason most people remember the film:
A WVFC reader recently wrote to us:
My wife had a total hysterectomy about 3 years ago, and since her surgery she has not been able to achieve orgasm. She still has vaginal sensation but no clitoral sensation at all. This has been devastating to my ego and has caused my own erectile dysfunction problems. My wife is 55 years old and I am 59. We married 18 years ago and had a wonderful and fulfilling sex life. We would like to continue having sex, but my entire reason for having sex with my wife was to make her orgasm—it’s the one thing I did for her that made me feel good about myself, and my wife was the beneficiary of my ability to make her feel really loved. Don’t get me wrong, I still love my wife very much and always will, but the spark and excitement is gone. We now just exist as old married people who sit around and watch TV, go to sleep, and get up and go to work.
My wife has been an RN for over 30 years, and for the last 13 years she has been an educator who teaches medical students about ostomy and wound therapy. She is a caring person, but like me, she feels we’re missing a major part of our life.
Is there anything that can be done to help my wife regain sensation in her clitoris? She still gets very wet and her nipples respond to touch, but that’s all. Please help us if you can.
We asked gynecologist Hilda Hutcherson, M.D., a member of WVFC’s Medical Advisory Board—and one-half of WVFC’s “Sex Talk” team—to respond. (Ed.)
Hysterectomy is the most common pelvic surgical procedure. Most women who receive a hysterectomy will continue to have an active satisfying sex life after surgery. For some women, sex is even better. However, the procedure can sometimes injure nerves that are necessary for sexual response and pleasure. The vagina and/or clitoris may become less sensitive. Orgasms may become less frequent, milder or may not occur at all. Orgasms may be particularly elusive if a woman received pleasure from stimulation of her cervix, which has now been removed, during deep penetration. In addition, if the ovaries are also removed, loss of estrogen and testosterone hormones can cause painful sex, vaginal dryness and decreased arousal.
Sex may change after hysterectomy, but that does not mean that it can’t be intensely satisfying. You can help put that spark back into sex by discovering new, exciting ways to experience pleasure. For instance, the female body is full of erogenous zones, those sensitive areas that can provide pleasure when stimulated. Massage her entire body and look for those undiscovered areas that make her moan when touched, stroked or massaged. Her nipples respond to touch, so give them particular attention.
You say that your wife’s vagina remains sensitive, and that is good. I suggest that the two of you focus on learning how to find pleasure in her G-spot. Some women find that when this very sensitive area is massaged and stroked, it may lead to an orgasm. You can locate the G-spot by placing your fingers along the front wall of her vagina, midway between the top of her vagina and the opening. Massage this area while curling your fingers in a “come hither” fashion. Initially, it may not be pleasurable. In fact, she may only feel the urge to urinate. With practice and patience, she may begin to feel great pleasure, and even orgasm.
Vaginal dryness can be a problem after the ovaries are removed due to the loss of estrogen. Using a good lubricant can make sex more comfortable and pleasurable. Likewise, her clitoris may be more insensitive because of loss of estrogen and testosterone hormones. In my practice, I prescribe estrogen suppositories or rings that are placed in the vagina, and a small amount of testosterone cream that is massaged on the clitoris. The combination of estrogen and testosterone may lead to an increase in the sensitivity of the clitoris that makes it easier to experience orgasm. (Note: Testosterone is not approved for use in women and is used off-label in select patients.) Toys may also add a new dimension to your sex life. The intense stimulation provided by a vibrator may be all she needs to reach the height of pleasure.
I applaud your desire to make sure that your wife is satisfied. I am concerned, however, that your self-esteem appears to be tied to the sexual response of your wife. Every person is responsible for his or her own sexual experience. You can’t wrap an orgasm up in a little blue box and hand it to her. You may use techniques that assist her along the way, but you can’t control it or will it to happen. And if she feels pressured to perform sexually, it will become even harder for her to experience pleasure or orgasm again.
Remember, sex is so much more than orgasm. Intimacy alone is very important in a marriage. You might find that helping around the house, massaging her feet at the end of a long day, and spooning against her body as she sleeps gives her as much, if not more, pleasure than an orgasm. Let her know that you are there to help her have the best sexual experience that she is capable of, without pressuring he to respond in any particular way. Chances are, with relaxation, patience, experimentation, and exploration, her ability to achieve orgasm will return.
March 19, 2011 by Patricia Yarberry Allen, M.D. and Hilda Hutcherson, M.D.
Filed under Sex & Sexuality
In this installment of the ongoing conversation, Dr. Pat and Dr. Hilda talk about what it takes to keep older vaginas healthy and ready for action.
Dr. Pat: Hilda, do you have many patients who complain that, you know—
Dr. Hilda: They look terrible?
Dr. Pat: —that their labia have become elongated and droopy.
Dr. Hilda: All the time.
Dr. Pat: I find it to be so odd. I mean, I have had in my entire practice perhaps three patients who truly have had discomfort with intercourse because the labia were unusually long, and would get caught when the penis was entering in the vagina, and make it difficult for them to be orgasmic. But I think the risk of having labioplasty—
Dr. Hilda: It’s also called vaginal rejuvenation.
Dr. Pat: Right, or labioplasty—meaning that they’re going to use laser, generally, to refine the shape of the labia, make them more pre-pubescent looking.
Dr. Hilda: They look like babies.
Dr. Pat: They look like little girls’ labia. And then, if they’ve had children, and don’t have other symptoms of a dropped bladder or symptomatic vagina opening issues—if they don’t have those symptoms, but don’t like the fact that their vaginal opening is not small, they think they should have that fixed as well. And Hilda, you and I both know that there’s nothing more unpleasant for a postmenopausal woman than to have a stenotic vaginal opening—you know, so tight that it causes painful intercourse.
Gynecologists often see women who’ve never had a vaginal birth who have gone through menopause and may no longer be having intercourse on a frequent basis, because they have not been in a consistent sexual relationship. These women often have not have been using any kind of genital estrogen. Then they meet someone and are having a nice relationship and decide to take it to the next level without checking with their gynecologist. Often they’re horrified because it’s so painful they frequently can’t have intercourse. It’s very distressing.
It’s very important that a woman who fits this profile understand that before she begins a sexual relationship, if she has been celibate for some period of time and is menopausal, and especially if she has never had children—or never had a vaginal birth—that she check with her gynecologist before she plans to begin a sexual relationship. It can take about six weeks to get the tissue thickened and elastic again.
We usually use an Estradiol cream on the outside, and a Vagifem pill that goes into the vagina, though not on the same day. Every other day for a couple of weeks, and then decrease it to two or three times a week. I suggest that women whose blood levels of calcium are normal also take high doses of vitamin D short-term—one month or so—which improves the thickness of the layers of the vaginal tissue. The major reason that women develop painful intercourse at this time of life is not only that the vaginal opening is small and tight and inelastic, it’s also that the genital tissue is so very thin. So it gets easily abraded or worn off with friction, even with lubrication.
I have a number of patients who have called me, despondent. “There’s something really wrong with me. I tried to have sex and it was so painful I had to stop, and I was so embarrassed. What am I going to do? I have to see you right away.” However, I try to bring the subject up as a part of the annual visit. I always offer the patient a chance to discuss sex. I say things like “Are you seeing anyone?” And I often hear, “No, there is not one, not one dull man left in New York City who isn’t gay.” [Laughter]
Dr. Hilda: And patients may need dilators. We have medical dilators, and I often start with those when there is a stenotic, inelastic vaginal opening. If a patient comes in and you notice that her vagina is stenotic, or small and tight, not only do you give the estrogen, but after they’ve been estrogenized you prescribe the dilators. I usually just have them go on to a website. There are several websites where you can buy vaginal dilators. My favorite is vaginismus.com, but it is important to speak with your gyno for recommendations and instructions.
[Dr. Pat leaves momentarily and returns with a plastic bag of different-sized dilators.]
Dr. Hilda: They’re over-the-counter, not prescription. [Inspects the bag Dr. Pat has brought in.] These are from a surgical supply store and do require a doctor’s prescription. The over-the-counter ones work as well for most patients, but some insurance companies cover only the ones from a surgical supply store.
Dr. Pat: [Takes bag and holds it up, gesturing to the largest dilator] This is known as the Big Boy, by the way. [Laughter] I have never seen a penis that large.
Often, I have the most amusing conversations with patients when they return for evaluation after using the dilators. Most of them have husbands who want it known that they are a Number 4! They say, “Make sure you tell Dr. Allen that I’m the Big Boy.” [Laughter] They all want me to know that. In my gynecologic practice, I apparently have the most extensive collection of ‘Big Boy’ husbands in America!
The funniest thing about the dilators is that when I send these home, I tell patients that for the postmenopausal woman, the small penis is fine. Many post-menopausal women who have experienced painful intercourse are much more interested in men with smaller penises. At last, the small guy is king!
[Crosstalk and laughter]
No, no, no, no, no, no, no. This is very important. [Picks up the bag and points again to the largest.] This is the Number 4 dilator out of a series of four. The woman will work with Number One, and then she’ll work with Number Two, and then generally come back for me to help her insert Number Three. She inserts them while lying down in bed.
And you know, I have to remind her, because some women may not know that the vaginal canal is in a posterior position—directed toward the rectum when a woman is lying down. If a woman is having pain with intercourse, another thing she has to learn is make sure that the rectum is empty. Because a constipated rectum full of stool will push the vagina anteriorly and cause bladder infections and pain. Who would know?
If a patient has had comfortable intercourse in the past and has restored the health of her genital tissue, but she continues to have pain when the penis enters the vagina, I often recommend an evaluation by a pelvic floor physical therapist. I work with two physical therapy groups here in New York City. It’s generally three sessions a week for 12 weeks. They’re educational. The female therapists get right in there with gloved fingers, teaching patients about breathing exercises, relaxing, biofeedback, the anatomy, the physiology, how to change position. And there are exercises that patients are given to do at home.
In the next Sex Talk, more about pelvic floor physical therapy, and how much, when, and where to apply genital estrogen.
March 5, 2011 by Patricia Yarberry Allen, M.D. and Hilda Hutcherson, M.D.
Filed under Health
In this installment of the ongoing conversation, Dr. Pat and Dr. Hilda talk about feeling sexy, attitudes that can get in the way, and how to get past them.
Dr. Pat: Hilda, you asked some interesting questions about women who don’t like their bodies or body parts as they age. And one of them is about a woman who has large breasts. Those breasts are perhaps no longer as perky as they once were, and she feels uncomfortable because she has large, pendulous, sagging breasts. And a question is, how can a woman feel better about herself so that she will feel sexier? Because when we’re constantly judging how we look in the act of lovemaking, it certainly will impede the capacity to have an orgasm, and it certainly would have a big impact on libido.
I think the answer to that is that, we live in a time when there is absolutely fabulous lingerie that’s fun for any woman to wear, fun for her to have on in bed. And they make wonderful lingerie for the full-busted woman. I think that’s a great way of turning what she is feeling ashamed of into an asset.
Dr. Hilda: Certainly, bras now not only lift, but separate [laughter] pendulous breasts, and they’re beautiful. So you can find bras for a full-breasted woman that are absolutely gorgeous, and that she can feel confident and comfortable in when she goes to bed with her partner. And I often tell my patients to put on sexy negligees with the bras built in them—
Dr. Pat: Yes, they’re wonderful.
Dr. Hilda: —and wear that to bed. If that makes her feel sexy, then that’s something she should do. The other thing I tell them is that when a man gets to that point where he has you in bed, he’s not worried about your sagging breasts, your midriff bulge, or the dimples in your thighs. Men have a way of focusing on—
Dr. Pat: What’s to come.
Dr. Hilda: [laughter] —what’s to come.
Dr. Pat: And when I’ve talked to men about this issue, they say that they don’t really focus on parts. They focus on the totality of the experience. They’re interested in a woman sexually not just for how she looks by any means, but, you know, is she a lot of fun? Does she have a great personality?
Dr. Hilda: And does she like sex. [laughter]
Dr. Pat: Does she like sex!
Dr. Hilda: Exactly. Enjoying sex is the most important thing.
Dr. Pat: Many women focus on the change in their skin, the muscle loss, the less taut abdomen and begin to resist going to bed naked, resist making love with the lights on, and worry that they will not be seen by their partners as sexually desirable. The partner, one assumes, is in the same age range and is very likely to have a paunch, less hair on the head, and visual changes to his genital tissue as well. Men get droopy down there as they age too, you know.
I suggest that women be realistic about some bodily change and create an action plan for changing what can be changed. Start an exercise program if you are not in one. Focus on toning and developing aerobic endurance exercise, as long as there are no contraindications to a more vigorous exercise program. Start slow and build on this. It is well known that exercise improves the blood flow to the brain, the skin, and all those other parts. Feeling in charge of one’s own body is itself invigorating. And always remember that sexy lingerie makes most women feel good, and most men are delighted that their partner made the effort to “dress for the occasion.”
Dr. Hilda: I think one of the things that things that makes women feel uncomfortable with their bodies is their worries or concerns about how other people view them—how men view them, how their partners view them. And that’s why I spend time trying to convince them that he’s not so worried about your breasts, so you can just push that out of your mind. If that affects how you see yourself, then let’s try to deal with that issue. And then you also need to work on how you view yourself and why you see yourself in a negative way.
Dr. Pat: But you know, there’s a limit. As gynecologists who are interested in sex therapy, there’s a limit to what we can do or should do. I’m not a relationship expert. I’m not a psychologist. So I do discuss the basics. I try to provide information and cheerleading. But if the issue is unresolved unhappiness about body change as a woman is growing older—
Dr. Hilda: You certainly can give tips, right?
Dr. Pat: Oh, many tips.
Dr. Hilda: One is lingerie . . .
Dr. Pat: Right.
Dr. Hilda: Another is choosing positions. If your breasts are your biggest concern, and you’re worried about how your breasts look, then you might not do the woman-on-top position because that gives a fuller view of your breasts. Or if you are going to do woman-on-top, you’re going to keep your little nightie—a little see-through teddy with a formed bra inside—on when you’re on top, if that position makes you uncomfortable and you can’t get that out of your head.
Dr. Pat: And also there’s the side entry, where the man and woman, usually from the rear—
Dr. Hilda: Yes, from the rear. Rear-entry positions might make you feel a little bit more comfortable.
Dr. Pat: And men like that because they get to hold and caress the breasts.
Dr. Hilda: Exactly. So you might choose positions in which you feel that you’re not being exposed as much. It’s little tricks that people can do to make themselves . . .
Dr. Pat: Information from older friends who have remained sexual is so empowering. Patients who are still very sexual in their 60s, 70s and 80s have made it a priority. They also learned to get past the change in their bodies. But the truth is many of these women do work hard at looking sexy, acting sexy, and staying sexy. Ignorance about how you might feel about body change is a bad choice. Ignorance about how the body changes in each life stage is avoidable. You know, it’s like when I found out about having my first period. Believe me, it was a shock because nobody told me what to expect. I was absolutely appalled. There is nothing about menopause that appalled me nearly as much [laughter] as growing up in the South and having—
Dr. Hilda: [laughing, nodding] —in the South and having nobody tell you …
Dr. Pat: —nobody tell you anything about what’s to come. So at some point, you just have to make peace with it, and have some common sense. I mean, when so many people we know lose their breasts completely because of breast cancer or disease, the fact that somebody has healthy breasts is already a plus. You know, looking at the positive, if you have generally good health and you have someone with whom you might share your sexual self, these are already fabulous gifts.
Dr. Hilda: But I think it goes beyond breasts for most women. Breasts are one part. But I see women who worry that their belly’s not as flat as it used to be. They’ve got stretch marks because they’ve had kids. Or now they’ve got fat on their hips that they didn’t have when they were 18. Or they’re 20 pounds heavier than they would like to be. They don’t look like the models in the catalogues. They’re overweight.
Dr. Pat: But may we point out that their husbands don’t, either.
Dr. Hilda: Well, most of them—
Dr. Pat: You know, men age as well.
Dr. Hilda: Most women just don’t think about that, though. [Laughs] They really don’t. They don’t think about the fact that he doesn’t look the way he looked 20 years ago, either. And he’s not usually focusing on his quote-unquote “imperfections” in the same way that we do. We’re a lot more critical of our bodies and how we look and less accepting of aging. Men don’t spend a billion dollars on Botox and fillers in the same way that—
Dr. Pat: Some do. [Laughs]
Dr. Hilda: Well, a few. But most of them don’t do that, or hair pieces, or any of the things that we do. But most of my patients don’t think about that part of the equation.
Dr. Pat: But I do bring that up. I say, “Excuse me. Does he look just the way he did?”
Dr. Hilda: Well, certainly we do that. We bring that up when we’re talking to our patients. But they don’t usually think about it. And there are so many issues. We’re very, very hard on ourselves. The whole issue of weight. Now, I’m a woman who’s overweight but I don’t feel that I’m not sexy. I feel very sexy. Yes, I’d like to be 20 pounds lighter than I am right now. But I feel that I’m sexy, and I don’t hide in the bedroom.
Dr. Pat: And you don’t hide in clothes.
Dr. Hilda: No. And I talk to my patients about that. Just because you don’t fit that stereotypical mold that we have in this country about what is beautiful, it doesn’t mean that you’re not sexy. And that has to do with how you feel inside. And so you have to change those messages that you’ve received from whatever—the media, or wherever you’ve received them. You have to change them into positive ones and find the things that make you feel good about yourself.
In the next Sex Talk: Stretching and fitness for the post-menopausal vagina.
February 26, 2011 by Patricia Yarberry Allen, M.D. and Hilda Hutcherson, M.D.
Filed under Health, Sex & Sexuality
In the previous installment of Sex Talk, Dr. Pat and Dr. Hilda kicked off a conversation about vaginal lubrication, sexual satisfaction, and oral sex. Here, they get down to business, talking about their favorite lubricants and vaginal moisturizers, how to save those expensive bed linens, and why they know that men enjoy performing oral sex on women.
Dr. Hilda: There are so many lubricants on the market now, it’s just amazing. I love going to the adult stores in New York City because there are so many really good ones.
Dr. Pat: Ovules that go into the vagina —
Dr. Hilda: They have ovules that keep you moisturized —
Dr. Pat: Right. You put one in two times a week.
Dr. Hilda – every day. That’s a moisturizer. That’s the difference between a moisturizer and a lubricant. The lubricants you use right before sex or during sex. For older women, I love lubricants with silicone. They ruin your sheets, though. If you’ve got nice, expensive, cotton sheets, they stain.
Dr. Pat: Put a towel on top of the sheets!
Dr. Hilda: Yes! That’s what I do—put a towel on it, because they ruin your sheets.
Dr. Pat: And a water-based lubricant is especially important when we talk about condom use.
Dr. Hilda: Exactly.
Dr. Pat: Oil-based lubricants can interfere with the effectiveness of a condom, both in terms of preventing sexually transmitted diseases and allowing the emergence of those crafty spermatozoa.
Dr. Hilda: Absolutely. And the silicone-based ones, which are also water-based, have an oily texture, but you can use them with a condom. And the reason I like to use them in menopausal women is because they last a long time. THEY really lubricate the vaginal wall very, very well, protect it from abrasions, and last a long time, so you don’t have to add any additional lubricant during sex. But silicon lubes are difficult to remove, and will stain your sheets, so you do need to put a towel down. [Laughs]
And then there are a lot of other ones. Astroglide is not silicone-based, but is water-based. It has glycerin in it. Some women who have diabetes may find that they get more yeast infections when they’re using lubricants with glycerin in them, but it’s a great over-the-counter water-based lubricant that I particularly like.
Dr. Pat: And for patients who are allergic to just everything, who are in a monogamous relationship and do not need to consider condoms, mineral oil is a very good lubricant. Not a moisturizer, but a lubricant. You know, it comes in that quart jar, it costs $10 for a quart. And I always say to my patients, “Honey, be sure to decant that into something pretty and pink, because no erection is going to withstand the sight of a quart of oil being pulled out.”[Laughter]
But I also suggest to patients that they try a little of a new lubricant, that they try it just on the inside of their upper thigh a couple of days before they decide to really put a lot of it on there. Because I’ve seen some really unpleasant reactions. We just don’t know how each woman will react to every product.
Dr. Hilda: Yeah.
Dr. Pat —No woman wants to use the wrong potion.
Dr. Hilda: I think that’s especially true if you’re going to use one of the warming lubricants. You know, now they have these lubricants that warm, that tingle, that do everything except –
Dr. Pat: And how do they do that?
Dr. Hilda: They have menthol.
Dr. Pat: Ah!
Dr. Hilda: A lot of them have something like menthol in them, so when you put it on a moist surface, body part—
Dr. Pat: Yes.
Dr. Hilda: — it warms.
Dr. Pat: Like camphor rubs. Vicks.
Dr. Hilda: It warms up. And for some women that’s very arousing. When you put it around the clitoral area and it heats up, they become very aroused.
Dr. Pat: And also there’s always the placebo effect.
Dr. Hilda: Of course.
Dr. Pat: You know? Yes, they say “This works on television,” so …
Dr. Hilda: Do they say “This works on television?” I haven’t been watching the right channels! [Laughs]
Dr. Pat: Certainly there are commercials.
They also have these wonderful flavored lubes. Yours & Mine, Kissable Sensations.
Dr. Pat: Ah!
Dr. Hilda: Amazing! Chocolate and strawberry. And they actually taste good.
Dr. Pat: Well, this is a way to enjoy counting calories.
Dr. Hilda: They say, “Don’t use it inside your vagina.” But why would you need to put it inside your vagina? You put it on your vulva.
Dr. Pat: Right.
Dr. Hilda: And you rub it on the penis, and it just makes the whole oral experience so much better. And I find that women are very uncomfortable with oral sex because they worry about how they smell and how they taste. Now, I always say that men love —
Dr. Pat: Yes!
Dr. Hilda: … men love nothing —
Dr. Pat: Men love it!
Dr. Hilda: — more than giving oral sex. What I say to my patients is, “If a man didn’t find it pleasurable, do you think he would stay down there for more than ten seconds?” I mean, really now. What man would stay in that position —
Dr. Pat: Right.
Dr. Hilda: — for more than ten seconds if it wasn’t pleasurable?
Dr. Pat: Right.
Dr. Hilda: I mean, we might be martyrs . . .
Dr. Pat: [Laughs] Right.
Dr. Hilda: . . . but very few men are going to be martyrs like that.
Dr. Pat: That’s true.
Dr. Hilda: And so I try to get women to be more accepting of their bodies by giving them that little scenario. But this lube, it’s a combination called His and Hers. It doesn’t matter whether he uses the chocolate or you do, or he uses strawberry or you do, whatever. You can even make a nice little mixture of chocolate and strawberry on your vulva. And it makes women feel better because it also smells good. So if they can smear some of this on the vulva, it makes them feel more comfortable, because “Now I don’t have to worry about how I smell or how I taste because it smells good, and it tastes good because of this lube.” And so I’ve found that many women enjoy oral sex more by using this little addition of the flavored lubes. And they really do taste good.
Dr. Pat: Of course, so many women are only orgasmic with oral sex, which is why —
Dr. Hilda: Absolutely.
Dr. Pat: — which is why it’s such a shame that they feel bad about it.
Dr. Hilda: Absolutely. And I tell them, the easiest way for most women to experience orgasm is to get it out of their heads that they’re distasteful down there, that it smells bad, it looks bad, it tastes bad.
Dr. Pat: Oh, let’s get to the looking bad part.
Dr. Hilda: But once they get past that, they can just like present themselves, like dessert on a plate — [Laughter]
Dr. Pat: Yes.
Dr. Hilda: —and they’re able to enjoy it. [Laughs]
In the next Sex Talk, Dr. Pat and Dr. Hilda on “the looking bad part:” women, body image, and the bedroom.
February 19, 2011 by Patricia Yarberry Allen, M.D. and Hilda Hutcherson, M.D.
Filed under Emotional Wellbeing, Sex & Sexuality
WVFC recently invited Dr. Patricia Yarberry Allen—our own Dr. Pat—and WVFC Medical Advisory Board member Dr. Hilda Hutcherson, both practicing gynecologists, for a wide-ranging, freewheeling conversation about women, sex, and sensuality over 40. Here’s the first installment of that conversation, covering everything from vaginal lubrication to erectile issues, with a few cupcakes on the side.
Dr. Pat: Some patients who are in the menopausal transition and beyond will tell me that they have genital awareness during or after intercourse—maybe it burns when they urinate after they’ve had sex. Or they’ll say that there’s a little stretching feeling when the penis enters the vagina, and they don’t feel as lubricated, even though they feel turned on.
And many of my patients are ashamed about this. They don’t want their partner to know that they’re not lubricated. So I get lots of questions about “What can I put in there before I have intercourse so he won’t know that I’m not lubricated?”
By the way, I find this a great opportunity to say to patients, “Honey, he is going to have some erectile function issues. You can just count on it. And this is the time to begin the conversation [with your partner] about it. “Now that we are entering a different phase of our lives and want to have frequent, comfortable intercourse, there are things that you need to know about me. And there are things that you are going to want me to know about you—that I already know about, because I’ve done my homework.”
There are lots of drugs that have an impact on vaginal health: drugs for breast cancer prevention or breast cancer recurrence, like tamoxifen, the aromatase inhibitors, proton pump inhibitors like Aciphex, Nexium, Prevacid. Those drugs inhibit the absorption of calcium and vitamin D, and are often toxic to the vaginal mucosa. Even SSRIs—antidepressants—have an impact on vaginal dryness. There are many drugs that may have an impact on genital health, and that’s an important thing to know.
Dr. Hilda: Even birth control pills.
Dr. Pat: Low-dose birth control pills often cause vaginal dryness, because they have levels of estrogen that are much lower than a woman might have in her late menopause—when she’s having a lot of estrogen, anyway. So if a woman is on the birth control pill and she’s in her 40s, one of the things we can do is get her off the pill and find another form of contraception. If she’s on the low-dose birth control and wants to continue with it, I sometimes suggest vaginal estrogen, like Vagifem, that acts to increase estrogen impact on the vaginal mucosa.
Dr. Hilda: I wanted to add [something] to when we talked about medications and things that can cause vaginal dryness. Besides the loss of estrogen, obviously, when you’re becoming peri-menopausal, I’ve found a lot of women in their 30s who are saying, “You know, it’s just not getting there. It’s not getting moist the way it used to. What’s going on?” And sometimes I attribute that to just the beginning of peri-menopausal period when estrogen is starting to go down.
One of the other things that I find fascinating is that we often will immediately say it’s hormones, or it’s medications, or it’s one of those physical causes. I find that a lot of women, as they get older—in their 40s, for instance—will start to have problems with their relationships. There’s something about being a woman in your 40s, when you finally realize that you’re very deserving of some things.
Dr. Pat: Yes! [Laughs]
Dr. Hilda: You’re deserving of respect, and you’re deserving of love, and you’re deserving of good treatment.
Dr. Pat: And sexual attention in bed. With somebody who knows what he’s doing.
Dr. Hilda: Exactly! So it’s often only when you get in your 40s that you start to wake up and say, “Hm! Something’s missing here.”
Dr. Pat: I mean, some lucky girls get it earlier, but —
Dr. Hilda: Well, yeah.
Dr. Pat: But a lot of us don’t.
Dr. Hilda: But a lot of us don’t. And I find that in the 40s, many, many women start waking up, and they start to realize that “This isn’t as good as I would like for it to be. You know? And I need more out of this relationship sexually and otherwise than I’m getting right now.” And so there’s this tension that develops in the relationship. And of course, relationship issues will cause you to lubricate less. You have problems lubricating, problems becoming aroused because there’s some anger and resentment that’s coming forth in the relationship. So another reason why someone will be dry and not lubricating may be because the relationship isn’t what they might want it to be.
Dr. Pat: What do you prescribe? Do you prescribe a vaginal moisturizer when a woman is not ready for estrogen, because she’s still having periods and just complains of—less lubrication?
Dr. Hilda: For women who don’t have this relationship issue—which of course, you need a marital therapist for, because you need some help to get that relationship resolved and you need communication skills to communicate with your partner—but for women who have physical reasons for dryness, if we’re not going to go the estrogen replacement route because it’s not time yet, because they’re producing estrogen or they just don’t want to use estrogen creams, there are suppositories or rings.
There are so many great lubricants. Years ago, when I first started my practice, how many years ago was that? A lot. [Laughs] Like 25 years ago. When I started my practice there was KY. KY jelly.
Dr. Pat: That was it.
Dr. Hilda: That was it!
Dr. Pat: The same thing we use to examine patients.
Dr. Hilda: Exactly!
Dr. Pat: Dries quickly.
Dr. Hilda — which dries out and gets sticky, and it’s just not very pleasant. Or some people try the Vaseline, which isn’t good for our vaginas, and some tried various oils, cooking oils —
Dr. Pat: Ew!
Dr. Hilda: — which hang around for a little bit.
Dr. Pat: I once had a patient who was unmarried and had an unexpected one-night stand and chose to use a flavored olive oil that had pepper in it. That didn’t turn out well for either one. [Laughter]
Dr. Hilda: For either one!
Dr. Pat: It was a hot time in the old town that night!
In the next Sex Talk–Getting down to business. Dr. Pat and Dr. Hilda on their favorite lubricants and vaginal moisturizers, how to save those expensive bed linens, and why they know that men enjoy performing oral sex on women.
What’s the new “girl’s best friend?” The Rabbit. I don’t mean the soft fluffy critter that one associates with colorfully decorated eggs and chocolates in the spring, but the one at the right: a powerful vibrating, rotating instrument of pleasure.
Personally, I think that every woman should own at least one sex toy, especially if she is over 40.
Sexual frequency and satisfaction can decrease as we age, often due to the lack of a suitable partner or, if we have a male partner, his sexual dysfunctions. That’s where a treasure trove of sex toys can change your life, whether you choose to use them for your own private pleasuring or to enhance sex play with your partner. Sex toys can help you take charge of your sex life as only a woman over 40 can. Toys can help keep the your vagina healthy and moist during those dry spells when you don’t have a sex partner. In fact, I recommend that all of my patients of a certain age who are not having sex regularly use a dildo or Rabbit vibrator to keep the blood flowing and to avoid thinning and atrophy of the vagina. Think of it as insurance against sexual pain in the future when, hopefully, you do have a partner.
Adding toys to sex play with your partner can add spice and increase pleasure for both of you. I think of a sex toy as a beautiful accessory. Imagine a gorgeous diamond brooch, perhaps, that you add to your favorite outfit. The outfit looks good on its own, but the brooch really makes it pop!
Starting your toy collection can be as simple as taking a cyber-field trip to a female-centered adult toy site, such as Babeland or Eve’s Garden. Start with something small and gentle, like the finger vibe (left) or the bullet (right). Slowly work your way up to more adventurous gadgets, and always use lots of lube. And while you’re there, do browse the toys for boys. They make great stocking stuffers!