Sex Talk: Lubrication, Satisfaction, and Oral Sex, Part 2

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.

Dr. Hilda: I don’t watch enough television, I think. PBS doesn’t have much of that.

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.

Sex Talk: Dr. Pat and Dr. Hilda on Lubrication, Satisfaction, and Oral Sex—for You

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.