In the last Sex Talk, Dr. Hilda and Dr. Pat discussed the pleasures—and risks—of non-monogamous sex for older women. Here, the conversation continues and moves on to condoms and the power of female sexuality.

Dr. Hilda: As I was saying, there’s a risk in everything you do. And you measure the risk versus the benefits. There’s a small risk in engaging in oral sex these days. I tell women to be careful—

Dr. Pat: But what does that mean?

Dr. Hilda: I tell them to carry their condoms. That’s important. At this point I think the risk of throat cancer is small, but be smart. You go to your dentist. You ask them to look under your tongue and the back of your throat, which are the most common areas, and then their palate, to do—

Dr. Pat: The sides of the tongue. The back of the tongue and the sides of the tongue are the most likely places that the head and neck cancers start.

Dr. Hilda: Underneath the tongue and in the back of your throat as well. And even on your palate. Have your dentist look completely in your mouth. Because often they don’t. They’re focusing on the teeth and the gums, and they’re not looking at the other areas.

Dr. Pat: The issue of HPV of the mouth has become such a pressing concern that all modern dentists not only talk to patients about it. They do a careful exam, they document it, and they tell the patient that they’re doing it. I’m hearing this all the time from patients. We want to make sure that dentists across the nation understand, and women understand, that as a part of their evaluation by the hygienist, followed by the evaluation by the dentist twice a year, they should have a thorough check for oral cancer.

I have a patient now who has multiple areas of squamous cancer in situ, which means that it’s not broken through the cell layers. She is having constant surveillance at our big cancer hospital here in New York, and she’s having excisions of these lesions. In another day and age, she would be dead. A solution is used in the mouth that is very similar to that which is used in the vagina or the cervix. It causes the affected areas to turn white, and then those areas are biopsied. This patient has diffuse areas of squamous cellular change in situ. Associated with HPV, I might add.

Dr. Hilda: So that’s oral sex and how to handle the risks involved. But we need to talk about intercourse, too. Because one of the other things that women tell me is that if you’re in your 50s and you’re single for the first time, you are most likely going to be having sex with a man who’s in his 50s or 60s or older, and that many of these men are not accustomed to using condoms, either. And they will automatically say, “I can’t maintain my erection with a condom.” So women come to me and say, “Well, what do I do if he says that?”  What I say to women is that there are so many condoms on the market now, it’s amazing. You know, back in the day, we used to call them rubbers for a reason, because they were thick, like tires. [Laughter]

Dr. Pat: Lamb skin.

Dr. Hilda: Yes!

Dr. Pat: Some men are allergic to latex, and so are some women.

Dr. Hilda: But there are so many new condoms now, and new condom manufacturers.  My favorites are condoms from Japan. I love Japanese condoms because they tend to be very thin, so you still get the warmth from his body, and they’re strong at the same time. So those are my favorite type of condoms. And what I usually say to women is to have a little grab-bag of different kinds of condoms and make it a game, and to explain to him that these new ultra-thin condoms allow transmission of warmth and transmissions of sensation. So whereas with the old ones, maybe he would not get the same kind of stimulation, with the new ones he will. Some of them actually can be more fun for men—the ones with the extra latex at the top. You put just a drop of lubricant at the top, and what happens during intercourse is that that extra latex at the top rolls around and circulates and massages the head of his penis. Many men find that they get even more stimulation using this type of condom. So rather than just accepting his opinion that he can’t maintain an erection with a condom, offer to try a number of different types and tell him there are some that can make sex even better for him.

Dr. Pat: So what happens on the first date? She should have her grab bag ready, and her speech ready?

Dr. Hilda: She should have at least two or three ready.  [Laughs]  Yes, and her speech ready.  Absolutely. You’ve got to be prepared, like the Girl Scouts.

Dr. Pat: I know one woman whose grab bag includes a condom meant for men with very large penises. And if she’s with someone who doesn’t behave perfectly when it comes time for the condom, she takes out the extra-large and puts it on him, and it just might fall right off. Then she says, “Oh, my goodness! I have no idea what happened! This is the only size I’ve ever used.” [Laughter]

Dr. Hilda: That’s terrific.

Dr. Pat: You know, women have to be in charge of their own sexual power. That is one of the things that I would like us to encourage women to do. We are what men want. And if they have no way to tease us, titillate us, excite us, romanticize us, well they don’t deserve us. We can go home and use our vibrators and be just fine, thank you, and we can also pay for our own dinners. So if a man is not capable of being erotic and exciting out of the bedroom, I’m not interested in him being in my bed, ever. We are very valuable. French women understand this. And I don’t know why American women don’t understand it. Women do need to feel that they have sexual power.

In the next Sex Talk: Dr. Hilda brings in a new batch of vibrators for an adults-only version of ‘Toy Story.’

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