Sexual Health: Sex Matters

Sexy Senior Citizens

2008-07-18T07:38:00.001-04:00

I've been thinking about how sex plays out in "the senior years" lately. I have quite a few sixty and older clients right now and they keep me on my toes.

I was listening to my colleague, Dr. Dean Edell, on his national radio show recently. He was describing a study conducted in Scandinavia of senior citizens seventy and older. Essentially, the study found that many of these seniors were quite content with their sex lives. In fact, they were more satisfied now than they had been ten years ago in most ways that the research had evaluated.

As I listened, I was doing the math and realized that today's seventy-year olds were in their late twenties and early thirties when the sexual revolution was going on. I thought about what might have caused them dissatisfaction in their sixties and why that might have lifted ten years later.

I don't know for sure, but here's my hunch. In the sixties lots of physical changes begin to set in that can derail or frustrate sexuality. It's a time of adjusting to creaking joints, hearing aids, rising blood pressure and eyesight that yearns for arms just a bit longer than they are. The reality of mortality takes a firm hold on life and I suspect that it's psychologically daunting for many people.

Yet, why would seventy-year olds be happier with their sexuality? I've noticed that some seventy-year olds simply refuse to give up. They enjoyed the fruits of what I think of as "the golden age of sex" (lots of sexual exploration coupled with no fatal diseases). Now, at seventy, they fully appreciate the gift that sex is and, "gosh darn it," they won't quit until they have to. So what if there's an ache or pain; the natural morphine of orgasm will chase that away.

Another medical doctor colleague (in his late fifties) has this observation framed on his office wall, summarizing the cycle of life:

Life is graded on a curve.
At age 4, success is not peeing in your pants.
At age 12, success is having friends.
At age 16, success is having a driver's license.
At age 20, success is having sex.
At age 35, success is having money.
At age 50, success is having money.
At age 60, success is having sex.
At age 70, success is having a driver's license.
At age 75, success is having friends.
At age 80, success is not peeing in your pants.

I have no idea when this was written, but given the increasing longevity of seniors, I think that we could easily add another decade of "success is having money" at age 60 and in doing so, find that at 70 "success is having sex." I know that many of my clients would agree and in about 15 years, I hope to agree as well.

Recently, one of my senior citizen clients sent me this:

Two elderly ladies are sitting on the porch, doing nothing.
One lady turns and asks, 'Do you still get horny?'
The other replies, 'Oh, sure I do.'
The first old lady asks, 'What do you do about it?'
The second old lady replies, 'I suck a lifesaver.'
After a few moments, the first old lady asks, 'Who drives you to the beach?'

I really like the built-in assumption that "the first old lady" makes about her friend. I think that we should also make these assumptions and wait to be told that we're wrong!

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Technorati Tags: sexuality, aging

A Compassionate Husband and His High Maintenance Wife

2008-07-03T08:15:00.001-04:00

I was working with a client this week who had come to the realization that he probably needed to end his marriage. Fortunately, there are no children involved.

A while back I had suggested that he read a book called Stop Walking on Eggshells. He did so and then returned to meet with me. I often recommend this book when I suspect that a client of mine has a loved one who has the mental condition called Borderline Personality Disorder (BPD). In his case, I had met his wife and I was rather sure that this diagnosis was accurate, but rather than apply a label to her, I thought that it would be beneficial for him to come to his own conclusion.

He did. And, he was quite grateful for the reading suggestion because it had clarified so many things for him.

Once he finished the book, he dove into its recommended resources list and picked up The ABC's of BPD, Love and Loathing, and Splitting: Protecting Yourself While Divorcing a Borderline or Narcissist. He expressed such great relief about finally getting to a place of understanding his feelings while living with a wife with BPD.

And, interestingly enough, he was now trying to locate an attorney who understood the mental condition of BPD. Why? Because he still loved her and didn't want to abuse or punish her in the way that some divorces can. He wanted his attorney to know what to expect and not select strategies that would likely worsen the process for him and for his wife. He wanted compassion in his divorce.

This man sat in my office like many other men I have met over the years who were coping with a similar predicament. I was struck by his big-heartedness. He, like the others, was kind, patient, understanding and, amazingly, not angry with his wife. These salt-of-the-earth men are filled with compassion that exceeds that of most others. I have often thought that they are among the few who can, for a while (sometimes a long while) make it work with a BPD mate. I felt my eyes water up a bit and saw that his did too.

Partners of BPD individuals cope with the no-win situations that their "high maintenance" loved ones repeatedly manufacture. If there is nothing wrong, they can find something. If everyone's happy, they can find a reason not to be. If it's been a pretty good day, they know how to bring everyone down. They can turn any compliment into an insult. Why do they do this?

The way that experts in this particular field describe it is this: BPD folks have a "hole in their soul." There's an emptiness inside that is almost intolerable. Rather than feel this aching void, they stir up the emotions of those around them with their actions. For a time, the distraction this causes solves their problem. They don't have to feel the "hole." But it only works...for a while.

As we were talking, my client pointed out a section in Splitting for attorneys. I listened and thought that divorce attorneys probably came into contact with an exceptionally high number of BPD clients (or opposing clients). I found myself wishing that all divorce attorneys would read the book with the hoped for result of much less pain for everyone involved. I've heard many stories about "impossible clients" and "drama queens" (and occasionally "kings") from my colleagues who work in the world of divorce law. Here is some material that could really be of help if they would take the time.

All of these resources, plus various forms of support for people with BPD and their loved ones (including parents), can be found at BPD Central. If you are in a relationship with a "high maintenance" person, I think you might find some relief at this site.

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Technorati Tags: Sex Matters, borderline personality disorder, BPD, divorce

Let The Ceremonies Begin!

2008-06-20T07:57:00.002-04:00

On June 17 California began performing marriages between same sex couples. As a Californian for the last 36 years and a former San Franciscan for 22 years, I've been watching this social and legal battle unfold for quite some time.

When San Francisco mayor Gavin Newsome began issuing marriage licenses to same sex couples in 2004, I sensed that there would be some kind of obstruction and eventually there was. Yet, even Governor Schwarzenegger (who is personally against marriage between same sex people) was unwilling to oppose it legally from his elected office.

Groups opposing the decision by the California Supreme Court are now waging a campaign to reverse the court's decision by placing a voter initiative on the 2008 November ballot to ban same sex marriage in the state's constitution. This ballot measure campaign is being spearheaded by the Concerned Women of America.

I am amazed at times by the position that groups such as the Concerned Women of America take. So often the explanation is offered that same sex marriages will weaken heterosexual marriage. I never quite get this.

The divorce rate is rather high in the U.S. (well over 50%), but I don't see the Concerned Women of America setting their sites on fixing that threat to marriage. How about some premarital counseling offered free to couples instead of sinking these many dollars into political battles? Wouldn't marriage be less threatened if marriages lasted? Or if those who intended to marry got a realistic picture of what marriage is? This would involve understanding the nature of marriage and not holding some notion that amounts to a rose-tinted fairy tale. Some people might wisely back away from what would turn into an ill-fated marriage.

Perhaps this battle is about the haves and the have nots. Certainly we've seen other examples of this in history - Catholic priests not marrying and having family in order to keep the wealth within the church's ownership. So, is this about benefits and inheritance, making sure the heterosexuals have most of the money, privileges, and access? I don't know.

What I am fairly certain about, however, is that the folks who participate in these types of initiatives (such as the Defense of Marriage Act, otherwise known to Californians as Proposition 22) are afraid. They are afraid of the corruption of society. Anything that legitimizes the fact that there are people whose sexual orientation is other than heterosexual strikes fear into the hearts of some people. And, this fear equals the fall of society - to them.

I actually see it as the saving of our society. I value these times greatly. I am thrilled that this year's presidential candidates included the array of people it did, from members of the Latter Day Saints to a biracial male to an "old guy" to a post-menopausal female. I am glad that people who used to be disenfranchised now have access like never before. I don't think that all our tasks are complete - far from it! But when California's Supreme Court joins the state of Massachusetts in this manner, we are headed in a good direction and I too am proud of my country.

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Technorati Tags: same sex marriage, California, sex matters

What to Do With Those Sex Toys...When You're a Parent

2008-06-13T15:15:00.002-04:00

Years ago I was on an advisory board for a company that sold sexual accessories. Back then, it only sold its wares through a paper catalog. The Internet became an vehicle for selling sex toys just as my position on the advisory board was ending -- and what a vehicle it has become!

Many years before having this advisory board position, I had run my own small sex toy company called As You Like It (a tribute to my former intention of becoming a high school English teacher). This paid my bills through grad school and gave me incredibly valuable experience speaking in front of groups (ranging from five to a thousand and ultimately on national TV and radio).

In the five years I spent doing in-home presentations of sexual accessories, I met over 7,000 people (99% women). We talked about their difficulties, their pleasures, their mates, and all the other things that women like to gab about when we get into groups. It worked very well to sell products this way because women considered such gatherings both a shopping opportunity and a social event!

One colleague of mine who was finishing up his Ph.D. in psychology at UCSF once commented to me that he thought my talks were the sneakiest form of adult sex education he'd ever seen! I had such fun explaining concepts like what caused lubrication to occur for women and what could interrupt it or ways for women to learn to become orgasmic (explain, not demonstrate) -- the products just sold themselves.

In any event, I digress. At each advisory board meeting, we would be asked what trends were going on culturally when it came to sex. Were there any products that should be included in their line of offerings? Should any new ones be invented?

I vividly recall one of the other advisory board members saying that a product needed to be created that cleverly disguised itself as a container for sex toys to keep them private from children in the household. At that point, I had no children. The idea seemed somewhat esoteric. He suggested that a rather boring looking winter coat have inside it all sorts of zippers and pockets to store sex toys. After all, most kids would pass right by such a coat in their parents' closet.

I now have a five-year old and a nine-year old and I couldn't agree more!!

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Technorati Tags: sexuality, parenting

Figuring Out If a Women Really Wants It

2008-05-28T21:45:00.001-04:00

Lately I've been thinking about the, sometimes thorny issue of consenting to a sexual act. Recently, the topic kept presenting itself to me from different angles.

About a week ago, I was listening to a radio interview of two college-aged women who were present at a party celebrating a win for a college athletic team in the Silicon Valley area of CA. The party was in the small home of one of the players off campus.

These women described what they witnessed and what they did when an 18-year-old inebriated and passed out woman was sexually assaulted in a bedroom by approximately a half-dozen males at the party. On the radio, they were describing how the case played out in court recently to their chagrin, particularly because they were witnesses and yet, had never been called to testify. They went through the gory and frustrating details and it appears that further action may take place in court. Clearly, this passed out woman could not have consented by any definition of law though, unfortunately, this is not as uncommon as we would like to hope.

Then, I was reading an article about a new book, Studies in Applied Interpersonal Communication, by Michael Motley, a University of California at Davis professor. He did an interesting study on how males and females interpret what females say when in the very early stages of sexual kissing.

When a female says, "It's getting late," she means that she wants to stop what they're doing and go their separate ways. If she finished her sentence, it would go, "I should already be home in bed - alone." Most males in this study, however, interpreted this to mean that she wants to skip the preliminaries and go forward a bit more quickly.

Or, if a woman says, "I'm seeing someone else," (meaning that she wants to stop because her affections are really with another man), males tend to think this means, "Keep going, but let's be discreet," or "Keep going, but I want you to know that I'm not making a commitment."

Motley concludes that in their efforts to not offend or upset their male partners with direct and forceful words, women are merely confusing them. He found out that men would prefer to hear it loud and clear, even if it smarts a little bit, rather than trying to read the woman's mind and risk offending her and/or losing the sexual opportunity.

Then, last night I watched the fourth and final episode on VH1 about the sexual revolution covering the 1950s up to the late 1980s. It was a well done piece and, from my view point, accurate. I'd lived through many of the hallmark events they highlighted during my 22 years in San Francisco. Colleagues, friends, and professors told the stories on screen that I had personally watched unfold.

One woman, at Plato's Retreat in New York City, was trying to set a Guinness Record for having intercourse with men in a particular amount of time. She was aiming somewhere in the 80s. When she was interviewed midway through, she commented that she didn't feel sexually fulfilled yet. Then, after her record-breaking marathon was over, she still commented that she could have enjoyed even more. Though she seemed euphoric, she did not seem "chemically altered,"; this was just who she was.

Then I thought about these three scenarios together. I realized that there was a connection between the illegal acts of the multiple rapes at the party, the misunderstanding of female communications during the early stages of sexual contact, and the quite amazing state of sexual desire the Plato's Retreat woman demonstrated. Some young men (and some old) hope that women are insatiable, want it any time and any where, and that somehow having sex with them will contribute to the woman's life, even if she's unconscious.

In each of these scenarios the woman's interest in sex is different. In one case, we don't know what she wanted. And, while it's possible that her idea of a good time is having intercourse with a roomful of young males while she's unconscious, that's not a bet I'd be very willing to take. In the next scenario, we're not talking about rape - it's merely miscommunication and misunderstanding. She might be interested in sex with the male in question, but just not right then. In the last case, she is very eager to go through as many men as possible and it's clear that she does want this experience.

When I consider all these stories, I am struck by how accurate Alfred Kinsey was in the 1950s when he observed that women have a much wider range of variation than men in how they approach sex, what they do, and how they feel about it. So, what's the "take home message" here? Crystal clear communication about sexual activity between people is a must.

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Technorati Tags: sex, communication

Mother's Day Thoughts

2008-05-11T09:18:00.001-04:00

It's Mother's Day. My kids gave me their poems, bookmarks, drawings and handprints they made at school as soon as I got up (they actually let me sleep in). Soon we'll be headed out for some brunch. Then it's over to my mother's room in a skilled nursing facility - called SNF (pronounced "sniff") for short. They have a cat there named "Mr. SNF" and my kids play with him while they wait for me to take care of their grandma.

This may be my mom's last Mother's Day. She's back on hospice care. I say, "back" because I had to take her off of it so that when she fell and broke her leg three weeks ago. That way it could be surgically repaired so that her insurance would pay for most of the hospital stay and surgery. You can't be "fixed" when you have something broken and still be on hospice care at the same time - the ins and outs of the last chapter of life for some.

At this point, there are many things on the table that never were: mortuary arrangements, dispersing of most of my mom's belongings from her assisted living unit room, middle stage Alzheimer's, and wearing a bib to eat. It's all so undignified at times, though I try my best to surround her with a semblance of decorum.

Sex is not on the table for her, though it's clear to me that she loves to be touched still. She is pleasantly affectionate with the CNAs who help her, holding their hands and stroking their forearms when they assist her. For the last five years, I've sent the same massage therapist into my mom's room each week. They've developed a wonderful friendship that comes with spending such regular time together. With each massage come flowers picked fresh from her garden - even when her own son, barely an adult, died last year.

At this point, it's about physical comfort for my mom coupled with the avoidance of pain. Later on, we'll go to my mother-in-law's three-month old grave. My youngest wants to put flowers there. He likes to raise his water glass and offer a toast of "nostrovia" to his living grandma, his dead grandma, and to the uncle who died last week. Close friends had to put their dog down two weeks ago and left their son with us while they transported their dog to vet. My kids created sympathy cards for their friend and then each gave him one of their stuffed dogs to help him with his sad feelings.

Yep, 2008 has been filled with aspects of death and dying. We keep reading books like When Dinosaurs Die and I Miss You to help the kids (and ourselves) with all these endings.

And, ironically, today I've been thinking quite a bit about a comment one of my clients made recently. He's in the computer and software business and was attending a seminar about accessibility - how to make their computer technology work for people with all sorts of abilities and disabilities. One of the presenters at the seminar who was disabled in some way said that while it was true that he had a disability, the rest of the room was only "temporarily enabled." Today, I'm keenly aware of that fact.

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Technorati Tags: hospice, Mothers Day, death and dying, touch

The Steve Wilkos Show: Multiple Tragedies for the Sake of Ratings

2008-05-06T17:56:00.007-04:00

I saw a tragedy on TV a few nights ago. It wasn't in Darfur, Tibet or New Orleans. It took place in a Chicago television studio for The Steve Wilkos Show.

I don't watch much TV. No time - with two young kids, a husband, an ailing mother, my therapy practice and this blog. I happened to be mending a hem and flipped on the TV to pass the time. What I watched really upset me.

Apparently about a week before this show was taped, a four-year old girl told her mother that the boyfriend of her aunt (the mother's sister) had pulled down his pants and put his penis in the little girl's mouth. This man was the father of several children with this aunt though they had apparently not gotten legally married. Then, the little girl told this same story to her aunt when questioned during a drive they went on in the car. The aunt, without questioning her common-law husband about this allegation, took her children and left their home for an unknown destination.

On the TV show, Wilkos (a former Marine, police officer, professional wrestler and director of security for The Jerry Springer Show) badgered each of his guests about their decisions and actions building to a crescendo involving the suspect results of a lie detector test administered by someone affiliated with the show. The "results" did not indicate conclusively that the accused had lied about the contact he'd had with the girl, but there was some question about whether he was telling the truth.

I had some major issues with the show.

During the lie detector interview, questions had apparently been asked about whether the accused had ever had sex with males. It turned out that he had. And, based on the few things he said about it, he was probably more attracted to males than females. But in his Latino culture this taboo was so large he had desperately tried to fit in as a heterosexual by fathering a few children to seal the deal.

The revelation that the accused had these sexual experiences with men somehow made it all the more plausible to Wilkos that he was lying in his denial about the four-year old girl. Wilkos may fancy himself some sort of expert on questioning suspects from his 11-year service in law enforcement, but he is not an expert in the area of sexual offenses. It's a very rare occurrence for a bisexual or gay adult male to be interested in sexual contact with young female children. But, that didn't really matter to Wilkos. In his mind, once you're off the heterosexual path anything's possible.

At one point, Wilkos wondered out loud, "How could a four-year old make this up?!" And rather than have his staff do a little research, he ran full tilt at his target, a man in his twenties at least a foot shorter and probably a hundred pounds lighter - jamming his finger inches from the face of the diminutive accused and yelling into his face with one inch between the tips of their noses.

"How could a kid make this stuff up?" That is exactly what a Los Angeles community wondered when it tried the teachers of the McMartin Preschool in Manhattan Beach, CA in 1983. Yet, when it all came out in the wash, there was no corroboration of the statements made by 46 preschool children that included murders, underground tunnels, ritual abuse, dogs, trap doors, drinking blood, Santa Claus, clown suits and burials right on the preschool property.

It turned out that these children were led by unlicensed social workers (one Kee MacFarlane, in particular) in their interviews. It lasted six years - the longest US criminal trial in history. At a cost to the state of $15 million, it was also the most expensive. No convictions were obtained. Here are two good links about this topic:

This story filled national newspapers for six years. OK, Wilkos was in the Marines and perhaps wasn't in this country, but wasn't anyone on his staff reading the newspaper then? (Silly me, for wondering that. Most TV talk shows have scruples-free producers half my age. They were still running around in diapers then.)

But for one instance, which I'll explore in a moment, the accused man insisted throughout the show that he never did this or anything like it. Of course, many times when an accused perpetrator denies the action of sexual contact, she or he is lying. It isn't something that is always easily admitted.

The one instance was this: After a particularly prolonged session of badgering, the accused said to Wilkos, "Whatever you say, man. Whatever you say." Wilkos leapt upon this and berated him for joking about such a serious matter.

What dawned on me at this point was that this accused man was going through this show and enduring it in the same way that some men sit in the chair of a dunking booth at a carnival. He just stayed on stage and endured one verbal "dunking" after another. Why? There had to be money involved somehow. And, while I don't have the answer to this right now, my intuition still leads me in that direction.

So, how much money will allow a man to be branded (probably for life) as a child molester? How much will compensate him for the likely loss of contact with his own children?

Was it part of "the deal" that he had to stay on stage the entire time in order to receive his fee for participating? He knew why he was coming onto the show. He knew that his sister-in-law would be making these allegations. He knew that her very brawny husband would be right there ready to throttle him.

Did he hope that criminal investigators would see this show for its folly? (Up to the point of taping the show, charges apparently had not been filed.) I don't know. How much could be enough for the loss of his reputation, self-respect, and possibly his children?

I felt for this man. I don't know if he did it or not. Only two people really know what happened - him and the little girl. But even children who are interrogated in particular leading styles by adults who think they already know the answer can get to the point of believing that something that never happened really did.

Wilkos kept circling back to the lie detector test whenever the drama on his stage dropped even slightly. He never minded that lie detectors are not admissible to prove culpability in criminal proceedings (Cal.Evid. Code 351.1). The lie detector test proved everything to Wilkos.

As the show was coming to its close, Wilkos went up to the mother of the little girl and said with pseudo-endearing pathos, "Take care of that baby growing inside you." Yep, she was visibly pregnant. I thought to myself, "How could you? You've just put this woman through the ringer on this stage. No, that wasn't stressful to her or to the baby. How does an hour of non-stop adrenaline affect a fetus?" It was the height of smarminess - and it was tragic for everyone on that set, except Wilkos, his ratings were probably through the roof.

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Technorati Tags: Steve Wilkos, reality TV, sexual abuse, child abuse, homophobia

Sex After Arguing

2008-05-01T11:01:00.001-04:00

I've often been asked about why and how people have "make up sex" - sex after arguing. While reading Esther Perel's Mating in Captivity, I found one of the better explanations I've heard.

She was discussing a couple she had been seeing in her therapy office. James was a man who was overly accommodating to Stella. While James' mother had led him to feel burdened with responsibility and guilt, in contrast, Stella was a graceful, vibrant and independent woman.

Summarizing here with a very large stroke of the brush, Stella had become the keeper of their sex life. She wanted it. James didn't. She wanted to talk about it. He didn't. Stella had reached the point of hating being the one who made it happen, but she did not dare stop doing so for fear that he would do nothing to keep their sexual relationship alive.

As it turned out, James' only experiences anxiety-free sex was when he masturbated where he attended to himself without what he perceived as the pressure of another's demands. His fantasy women were not vulnerable and they could not be hurt by his sexual selfishness. When he had sex with Stella, he couldn't allow this side of himself out because deep down he feared that he would hurt her emotionally. During sex, he reenacted (without needing to) a nonsexual aspect of his relationship with his mother: choosing between attending to himself and having closeness.

This couple was stumped. They had written off their relationship as "bad chemistry." But Perel worked on James' issue of overly attending to Stella - in particular, straightening out the difference between healthy separateness and indifference. If you want all the details of this part, get the book.

This couple did get their sex life jump-started. As it turned out, each time they had sex, it was after they argued. James reported that he was bothered by this.

Here's what Perel said:

"Anger and excitement have a complicated relationship. Physiologically, anger and arousal have a lot in common. Psychologically, too. In your case, I think
the anger emboldens you. It relieves you of compliance, and leaves you feeling
more entitled. Anger highlights separateness and is a counterpoint to
dependence; this is why it can so powerfully stoke desire. It gives you the
distance you need. As a habit it can be problematic, but there's no denying that
it's a powerful stimulant."

I have seen a similar pattern among some clients in my therapy practice: internal conflict related to caring for self over others, a preference for masturbation over partnered sex, unexpressed (or seldom expressed) frustration and anger, and a sexual connection that comes to life after the "negative" emotions are expressed - right after they are expressed, say during an argument.

I have seen caricatured portrayals of "make up sex" in TV and movie dramas. And I do think that most people imagine such a scenario where hateful expression transforms into impassioned loving expression.

But a more sophisticated look at this is warranted. I do think that the physiologic similarities are relevant. When arguments occur, there is a deeply felt self-centered set of emotions experienced by both. Contrast that type of focus and energy with a somewhat tentative sexual style that some couples fall into. For these couples, their best sex may be "make up sex" because during an argument they've just been engaged in the type of self-centered jockeying that can make for sexual thrills. The arguments become a solution to a problem of tepid sex. For some couples, they never progress past this dynamic. But, others begin to understand that their sexual style needs an injection of energy and that it need not be from an argument.

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Technorati Tags: make up sex, Mating in Captivity, sex matters

The Starfish Position

2008-04-14T20:01:00.005-04:00

Yesterday as I sat under a hair dryer waiting for the highlighting bleach to do its magic, I scanned an issue of Glamour magazine since it was within reach once I was under the dryer. I haven't looked at one in more than a decade. I usually bring my own reading material to distract me from the heat, but happened to forget to do so yesterday.

I was really struck by the intensity of the images, different from those in the People magazine that sits in my therapy office waiting room. Sure, there are make up and hair care product ads, but the ones in Glamour just jumped off the page. I sat there thinking about how incredibly difficult it is for teenage and twenty-something females to feel good about their face and body with these amazing images of perfection. Air brushing finished off what actual physical beauty failed to offer in reality.

I was also struck by the sadism of articles on figure flaws and similar topics. If the pictures didn't do the job of planting insecurity, the articles would finish the job. I do understand that magazines are essentially about reader numbers and that playing to people's fears increases readership - yet I found this pretty assaulting.

I know that I'm not writing anything new here - so far.

Later on, I remembered a comment that a client had made that week about some different types of casual sexual encounters. We talked about "Kleenex dates." These were sexual hook ups in which the males essentially saw their female partners as the equivalent of Kleenex - a place to figuratively blow their nose and deposit their semen, nothing more.

Photo Credit: Kyle Flood

Then he brought up another facet of casual sex - a female who is what's called a "starfish." This was a term that was coined to describe that during sex some females merely lay there like a starfish - legs apart and arms outspread with no movement or participation. They provide access to their genitals but there's not much else going on for them nor being done for their partner.

I wondered if there was any connection between the starfish and Glamour magazine. I thought of a few possible connections. Some women think that if they look good, that's all that they need do in order to be a worthy sexual partner. Laying there looking good is the sum total of their participation.

I also thought about how sexualized the Glamour magazine ads are. Obviously, I'm all for sexuality, yet I wondered how many young women find themselves pulled into partnered sex by magazines and other cultural messages before they're really ready, like swimmers in a rip tide. I suspected that some of these women were expert at the starfish position too. For them it isn't so much that they think that it's all they need to do, but instead because they don't have a clue about what they could do.

I'd be interested in hearing from people (probably it would be males predominantly) who have been in sexual situations with women in the starfish position. Was it more about the women thinking, "This is all I need to do" or that they were thinking, "This is all I know how to do?"

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Technorati Tags: sex matters, healthy sexuality, starfish, body image, self image

If Insurance Paid for Marital and Relationship Therapy...

2008-04-03T20:28:00.005-04:00

You may not know that most health insurers do not pay for marital (and relationship) therapy. A relationship that is in trouble does not constitute a medical condition - even though it can have a lot of impact on people. So, if it's not a medical condition, no coverage.

Unless a couple is using a Flex Spending Account (also often called a "cafeteria plan"), into which they have put pre-taxed dollars, they most often cannot pay for their couples therapy with anything except their own after-tax money. Most insurance companies require a mental health diagnosis to cover therapy. This forces mental health professionals into labels that can be arbitrary and not the best description of what is going on.

All the way around, this is unfortunate - especially financially. A study in the Journal of Marital and Family Therapy (7, 2007) found that insurance companies who covered the screening and treatment of marital distress would probably save much more money than they spent. This would mean more money for therapists, lower premiums for clients, and improved relationships for many trouble couples.

Where do the savings come from? It turns out that people use medical healthcare services less after receiving therapy for their relationship problems. One study found that the average couple who went to therapy reduced their use of healthcare more than 20% in the six months following their therapy - regardless of how successful the therapy was! According to this study by the Centers for Medicare and Medicaid Services, healthcare costs average over $7,000 per person per year in the U.S. So, anything that lowers that expenditure by 20% can add up to a lot of saved money for insurance companies.

So, the question was asked, "Is it worthwhile for insurance companies to pay for relationship therapy?" According to Ben Caldwell, the author of the study in the Jouranl of Marital and Family Therapy, the answer is affirmative. It turns out that if health insurance companies paid for therapy for distressed couples, they would save up to $1.48 in later healthcare costs for every $1 they spent.

So, why are things the way they are? Insurance companies need to be convinced that couples therapy can be effective - even as a short term option - and that it will add to their profits. Research that supports this position is starting to emerge. And relationship therapy methods and approaches are continually being refined and honed to offer greater gain for the couple.

The study also found out that tax payers would save money too if marital distress screening and treatment were paid for through governmental sources. A study conducted in Utah found that the taxpayer cost of a single divorce is conservatively estimated at $30,000. This was calculated in direct costs such as food stamps and indirect costs such as more police to combat an increase in crime. If government agencies paid for the cost of marital therapy at about $2,000, every divorce that was avoided would return about $30,000. Even if only 16% of the couples identified as being in distress went on to get therapy, the government would still break even.

This is a no-brainer.

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Technorati Tags: marital therapy, relationship therapy, health insurance, sexual health

Antidotes to Antidepressant Sexual Side Effects

2008-03-24T14:44:00.003-04:00

While at the ISSWSH conference in San Diego, Anita Clayton, MD of Charlottesville, VA, presented research that will prove very interesting to me and to many of the clients in my therapy practice. She reviewed ways to reverse the negative sexual side effects of SSRI type antidepressants.

First, the ways that work for only a few people.

A small number of people who take an SSRI will simply acclimate to the medication and find that they develop a type of tolerance that allows them to function sexually while still getting the benefit of combating their depression. This can take four to six months to occur (if at all) and it works for only about 5% of patients.

Some people will try changing to another SSRI, but this, according to Dr. Clayton, only works with about 10% of patients. In addition, many people worry that if they change from the medication that is working for their depression they will wind up sacrificing the gain against their depression for the possibility (and it's a slight one) of restoring their sexual function. If a patient is willing to risk that situation and make a change, there are also non-SSRI medications that may offer relief from the depression with less likelihood of sexual difficulties: Bupropion (Wellbutrin), and Mirtazapine (Remeron).

Some research on Bupropion has included placebo-controlled trials. This means that these studies involved some patients taking a pill that looked identical to the real medication but did not contain that medication. To get an antidote effect to an SSRI, doses of 300 to 400 mgs. of Bupropion are typically used. Typically, a dose can begin with 150 mgs for one week. Then, 300 mgs. for three weeks and ultimately 400 mgs if needed to get the desired effect. In some cases, the dose of the SSRI can also be lowered when Bupropion is added on.

Buspirone (Buspar) may be selected to treat what is called anxious depression. This type of depression has a restless quality. It can also be added to an SSRI (30 to 60 mgs) to alleviate negative sexual side effects.

SSRIs tend to decrease testosterone levels in both men and women, so some supplementation of testosterone can help -- particularly with issues of sexual desire and sometimes with arousal during sexual activity. Also adequate levels of testosterone are needed for PDE5 inhibitors (Viagra, Cialis, and Levitra) to work.

Cyproheptadine has been studied as an antidote, but it seems to have an effect that is often too sedating for patients. And, on the other end of the spectrum is the use of psychostimulants such as methylphenidate (Ritalin). About 10 mgs per day is often used, but not with patients who are bipolar or possibly psychotic.

Pharmaceutical companies realize the downside of the current batch of antidepressants. No doubt, they are working to develop other medications that don't solve one problem while creating another. Until then, these are some coping strategies that are worth trying for people interested in treating their depression and maintaining their sexual interest and abilities.

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Breast Cancer Survivors and Low Sexual Desire

2008-03-14T15:23:00.003-04:00

Claudia Panzer, M.D., an endocrinologist from Denver, was a presenter at the International Society for the Study of Women's Sexual Health (ISSWSH) . She covered several topics that were relevant to my therapy practice -- among them was breast cancer.

Between my clients and personal friends, I know a lot of women affected by breast cancer. Most of the treatments that keep them alive turn out to be quite devastating to their sexual interest. So, what can be done?

For those women who wish to have a quality of life that includes sexuality, testosterone supplementation has some good potential. Panzer cited studies that addressed the concerns that many women have: Will I feel more like having sex? Will it cause my cancer to return?

Supplementing with a transdermal testosterone gel product like Androgel or Testim (both off-label use) can raise total testosterone levels and free testosterone levels. These can increase libido. Not all women will find this effect, but many do. Of course, depression needs to be addressed in these situations because women with cancer may feel depressed. Testosterone itself may not be sufficient to alleviate the depression and the use of an antidepressant may be helpful. (There can be side effects of SSRI-type antidepressants that are negative for sexuality, but that is another blog post.)

So, what do the studies show?

Women who have PCOS (polycystic ovarian syndrome) have rather high levels of testosterone, but they have no higher occurrence of breast cancer than other women.

When the breast tissue of transsexuals (females changing into males) is examined after a mastectomy, their tissue is comparable to women who have breast reduction surgery. Of course, these transsexuals would have much, much higher levels of testosterone (as an early part of their treatment), but their histology (how the tissue looks under a microscope) is similar to women with "female" (much lower) levels of testosterone.

A study by Adelaide (Dimitrakakis, Menopause 11:531, 2004) showed that women who used estrogen and testosterone had only 115 cases of breast cancer per 100,000 women years while women who never used it had 283 cases.

Panzer summarized her findings (and I am only mentioning a few here) by stating that there is no evidence of increase of breast cancer with use of testosterone supplementation and that it may be protective when low doses that are effective are used . The risk of negative side effects (facial hair growth, deepening of voice, acne, etc.) is low and they are reversible by simply reducing the dose of testosterone. She also stated that liver function, sleep apnea, and aggression in women are "non-issues."

Low sexual desire is a common problem in breast cancer survivors, but there are choices that women can make to promote greater sexual interest if they wish. I know some women who will be glad to hear that.

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Technorati Tags: Sex Matters, breast cancer, testosterone, sex drive, sexual desire, sexual health

Why Do Men Like Eliot Spitzer Seek Out Prostitution?

2008-03-11T07:55:00.000-04:00

I don't know Eliot Spitzer personally, but I certainly have had men like him as clients in my therapy office. How do they get themselves into such a mess?

There are lots of reasons. Some think that because they are rich and powerful, they are above the law. The law applies to others but not to them. By the tone and content of Spitzer's public admission, I doubt that this reason has much relevance in his case.

Some people, by virtue of their life paths (work, friends, coincidence, etc.) wind up having exposure to slices of life that they ordinarily wouldn't seek out. And, just as people can't take their eyes off of a traffic accident, there's a type of fascination that can spring up when one rubs shoulders with sex workers - even when one is trying to destroy their livelihood and making a living while doing so.

Spitzer wouldn't be the first person to walk near "the gutter" and get muddy while doing so. And, like many other hypocrites who have prosecuted and persecuted sex workers, their zeal for doing so is equally matched by their horrified recognition of the over-powering attraction to this facet of sexuality. Dostoyevsky couldn't have invented more conflicted characters than the prominent list of men we've recently seen whose relationship to sex is out of control.

But, what else? Maybe he's like many accomplished men who seldom do anything special for themselves. These are the same guys who spend small fortunes on a Super Bowl tickets or fancy sports cars. And, while these decisions may be insane, they aren't illegal.

And, speaking of sports cars - for some it's the adrenaline rush. Playing along life's edge can be very compelling for certain men. I recall suggesting to one former client that made decisions similar to Spitzer's (also with a lot to lose) that racing cars or jumping out of airplanes (with a parachute) offered the adrenaline rush but no risk of illegality.

Another prominent client who risks a lot, pursues problematic sex in part because of sexual exploitation he experienced as a child and teen. He got accustomed to sex with the risk of discovery and "naughty" written all over it. He finds it almost unbeatable - and we're still working on that. This is different from the man who is looking for an adrenaline rush and so has risky sex as one way to get that rush. This is about preferring sex that contains risk - it's the type of sex he prefers.

The last group of reasons has to do with the style of sex also. Some men seek out prostitution because they do not wish to end their marriage for all sorts of reasons, but they are still looking to have sex that stimulates them. The sexual style of their wife no longer or never did match their own. Some are avoiding a wife at home who can only have sex while drunk. Some are hoping to get oral sex that feels more than obligatory - or any at all! And, it could be that he simply didn't think he could reveal what he truly wanted sexually at home - or if he did, that he'd get it there. Or if he did, how he'd handle her ridicule, rejection or disgust.

And, last there's the issue of what sex means to such a man.

Having sex with drop dead gorgeous 20-something women can be highly meaningful to a man - particularly when in his late 40s, he is invisible to these same women. Intercourse with such a woman lets a man relive what he may think are his most virile years. And, debates about whether Silda Spitzer is "hot" aside - she's in her forties too and has three daughters (and I'll assume gave birth to them). That's a different body than a 25-year old model which is what you'll see at the website for The Emperor's Club. Men who can't face their own aging and mortality sometimes think that aging can be reversed by osmosis during sex. And maybe that's what this is all about.

It takes courage and tenacity to keep on having sex with the same partner and finding a way to make it fulfilling - but that assumes that it was ever there in the first place. And, like the Clintons, we'll probably never know - nor really need to.

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Technorati Tags: Eliot Spitzer, prostitution, sexual health, Sex Matters

PTSD and Sexuality

2008-03-03T15:20:00.001-05:00

Although it is not a requirement for diagnosing a woman with Post-Traumatic Stress Disorder (PTSD), about 90% of them report sexual dysfunction, according to Rachel Yehuda, Ph.D. at the conference for the International Society for the Study of Women's Sexual Health (ISSWSH) I attended recently in San Diego. Many therapists who have clients with PTSD make the assumption that this shows up when women have "psychological" reasons to have low sexual desire and activity. They often think that if the traumatic event was sexual in nature (such as sexual exploitation or rape), of course there would be a sexual difficulty. But, it turns out that loss of libido is present regardless of the type of upsetting event that happened.

Yehuda went on to explain why. In the brain, the amygdala is involved in the emotion of perceiving an event. For example, one might think, "A tiger! I'm afraid!" But, also in the brain is the hippocampus which is involved in assessing the context of an experience. So, one would adjust one's response but noting, "Oh, but this tiger is in a zoo. I'm safe."

In the brain, substances called catecholamines affect what one thinks about a situation. Those thoughts can trigger distress. And, as it turns out, distress can trigger more catecholamines, which can trigger more thoughts and, in turn, more distress. Yehuda stated that if catecholamine levels are too high, this may result in what she called an "over consolidation" of memory and that leads to PTSD. This happens if the event is very distressing or if normal coping mechanisms are not engaged.

It's difficult to engage "normal coping mechanisms" when an event happens that is highly unpredictable and cannot be controlled. These two factors contribute to the occurrence of PTSD. So, the overconsolidation occurs.

So, where does sex fit into all of this?

A woman who can think about a life event and say, "These things happen," will not develop PTSD. But, a woman who after a life event says, "I'm not going to be the same," will develop PTSD.

Women who have PTSD are in a state of being numb. They tend to avoid the feelings of general arousal (not sexual, but more what we think of as alertness and vigilance) because it takes them out of their numbness. That is stressful and exhausting.

Arousal (the sexual kind) is required for sexual interest and response, but it is very difficult for women to choose to be aroused since it requires that they not be numb. It can also bring them closer to the memory in the amygdala of feeling afraid. And, it turns out, they are lacking a safety context because during the stressful event, safety was very much in doubt for them. So, staying numb feels like a safer choice and that makes sex out of the question.

In addition to this dynamic, people with PTSD may also have sleep disturbance, medication side effects, chemical dependency and abuse, and other psychiatric conditions that do not easily predispose a person to choose to be sexual. All in all, sexual lack of interest caused by PTSD must be treated with an understanding of the brain structures and neurotransmaitters, the nature of sexual arousal's similarities to general arousal, and other difficulties that can develop as a result of a traumatizing event.

I received an email inquiry about therapy yesterday from an Iraq War soldier and I have a hunch that I'll be putting Dr. Yehuda's ideas into practice.

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Technorati Tags: PTSD, sexuality, sexual dysfunction

Vaginismus Treatments Done Differently

2008-02-25T15:32:00.001-05:00

I'm in San Diego attending a conference of the International Society for the Study of Women's Sexual Health. We start early and finish late. I'm exhausted, but my brain is satisfyingly full.

This year 25 countries have sent researchers and therapists to present lectures about a vast array of issues that pertain to female sexual well being. I am amazed at the dedication of the presenters and thrilled about the progress that this field is making. There are about three hundred people attending and about 50% are medical health providers (medical doctors, nurse practitioners, physical therapists), 20% solely scientific researchers and the remaining 30% are primarily mental health providers. I don't present - just listen. I prefer to translate the research into information that the average person could possibly use. Not all researchers present the fruits of their work in easily understandable terms, so that's what I do.

I've treated clients in my office for vaginismus (painful vaginal spasms) for many years. The work with these clients is often slow paced. I measure progress in my mind with some equivalent of emotions measured in microns. And, I am OK with this.

The treatment works if the woman sticks with it. If she does her work at home by writing her thoughts in some journal form and uses her insertors regularly, she can take the steps that mature her sexuality. And, I usually strongly suggest that she learn to eroticize what can be a very clinical "getting to know you" session with her genitals. It often takes six to nine months to accomplish full insertion with an insertor that resembles her partner's erect penis size.

So, when Moniek M. ter Kuile of The Netherlands presented her research, I was very interested. At the Outpatient Clinic for Psychosomatic Gynecology and Sexology at Leiden University Medical Center she was permitted to treat vaginismus clients in a uniquely effective and time-sparing manner.

It turns out that 60 women with lifelong vaginismus participated with their sexual partner in a therapist-aided treatment of their condition. Nearly all of the women were able to use insertors that began with very small sizes and gradually increased to the size of their partner's penis. The treatment consisted of up to three two-hour sessions in one week's time in which the woman controlled the insertion of these learning devices into her own vagina while her partner held a mirror for her to see her own genitals. The therapist verbally assisted with guidance and helped the woman to follow through with what she came there to do.

I was very struck with the contrast!

As a licensed marriage and family therapist in California, ethically I am not supposed to touch my clients (other than the occasional handshake or to receive a "thank you" hug). As it is, people with little information about what I do as a sex therapist confuse the nature of my job with sexual surrogate therapists. All I do is talk, draw diagrams and use pictures to explain sexual and relationship information.

So, I sat there wondering if the medical setting of this study somehow legitimized this approach for the women. I wondered if this worked and was accepted just because The Netherlands is a more liberal country. And I wondered if there was a way that I could incorporate this into my practice.

The therapist did not touch the clients. She was just present in the room, keeping the couple on course and offering support. People often comment that I seem fairly placid, calm and easy to be around. Perhaps there is a gynecologist who would join in on this type of treatment. I'll be giving that one some thought. If women could accomplish this in a week's time rather than the better part of a year -- wouldn't that be great?

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Technorati Tags: sex therapy, vaginismus, sexuality

Valentine's Day: Love on Demand

2008-02-12T12:55:00.000-05:00

For as long as I've been writing for readers (other than my college professors), I've been asked to write something about Valentine's Day when the holiday approaches. So, readers of The San Francisco Examiner, onhealth.com, WebMDmagazine and WebMD.com have been subjected to my somewhat contrarian views about the holiday for about fifteen years. Here we go again.

Today I found that I'm not alone when I read Nancy Gibbs' essay, "A Time to Forget," in Time magazine (the 2/18/2008 issue). As she puts it, true romance comes unscheduled, ripens over time, and includes private jokes, sudden kisses and flowers for no particular reason. She wraps it all up with the apt Shakespeare quote: "Love sought is good, but given unsought is better."

So true. I can recall a number of clients for whom Valentine's Day has been a real white- knuckle time. Somehow the burden of orchestrating Valentine's Day has fallen primarily upon men. In heterosexual couples, the men sweat whether they will be viewed as having done enough. Or, maybe they are reminded of it on the radio or get a text message from their significant other "hinting" about it and realize that they've forgotten. They then buy some flowers from those folks on the street corners as they drive home that day. Or, perhaps they forget altogether.

Women are often in two categories: 1) Having high hopes of getting exactly the expression of love they wanted (or something even better and beyond that!) or 2) Wondering if their mate will do anything at all. In same-sex couples, the assigned Valentine's roles get quite blurry and each person in the relationship is free to choose among any of these very uncomfortable positions.

I've found that unhitched couples often do much more when it comes to celebrating Valentine's Day. It's a bit like an audition -- "See how romantic and creative I can be? Now can I actually get the part??" My own dating life had aspects of that.

Once one does "get the part," Valentine's Day can morph in several directions. There's the "newlywed" (legal or via commitment ceremonies for same-sex couples) phase. Special efforts are made to confirm that we're not an old, tired couple. Later, for couples who choose this route, there's the "we've-had-kids" phase when a romantic dinner out requires a sitter and throws off the typical school night routine (unless it happens to fall on a weekend).

Then a strange thing occurs -- children are brought in on the holiday. Kids are writing out a Valentine card to each kid in class and sending them to their parents. For my five-year old, it became an exercise in writing out the names of nineteen kids and signing his name that many times (quite a task!). I had purchased Spiderman cards and he was quite happy with my selection. But, buying his eight-year old brother Spiderman cards was a huge mistake. "Mom, Spiderman is so kindergarten. You should've gotten Harry Potter or Yu-Gi-Oh." Will someone remind me what all this has to do with romance or sexy lingerie? Or love?

Valentine's Day isn't the first holiday to be unnecessarily expanded through clever marketing and never-ending attempts to surprise the public -- even with the absurd (potatoes carved in the shape of a heart available online?). No doubt, there will be electronic Valentine's cards and text abbreviations of "bvf" ("best Valentine forever") soaring through the cables on Thursday.

Valentine's Day has become an event filled with pressure to love on demand -- and that's the very antithesis of romance or good sex. More important than cards, candy and flowers will be hearing, "I love you" on February 15th.

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Technorati Tags: Valentines, love, sex, relationships

The "Tongue Dinger" - A Humdinger!

2008-02-04T14:13:00.000-05:00

A client recently told me about (and showed me) a new sex toy called the Tongue Dinger Night Stroker, a glow-in-the-dark vibrating tongue ring. According to the package, it offered 40 minutes of "powerful vibrating pleasure." And then, when the battery dies, the proud owner can throw it away. Talk about a "consumable!" As I listened to her story, I thought, "Disposable razor blades have nothing over this gadget!"

The "ring" part of this toy is made from some stretchy, rubbery "jelly" type of material and when at rest (unstretched) looks like an overgrown mood ring. The vibration is rather strong for its "Mexican Jumping Bean" size. (Yep, my client hadn't used all of her 40 minutes.)

But, she reported one problem with it. The saliva on her partner's tongue kept causing the ring part to slip off of his tongue. They had tried in vain to "dry" his tongue off, but that didn't work. So, he'd push it on as deep as he could manage, lick away, and then after a minute or two stop when the ring had slipped to the tip of his tongue. She said that she'd just get going with being aroused and then it would be time to stop and reposition that "darned Tongue Dinger."

The vibrations were great, but the interruptions to her pleasure finally got her so rattled that she took the Tongue Dinger from her partner, grasped it between her fingers, and pressed it right where she wanted it while he held her and did other arousing things. At last, all was well for her...

From the packaging, it looked like the developers had had a good time creating this product. There were cute phrases like "Tongue Tired? Let the Tongue Dinger Take Over!" and "Glow Where No Tongue Has Glowed Before!"

But, there was that pesky issue addressed in the fine print: "This product is small enough to be swallowed. Use with extreme caution!" I can only imagine this little hummer accidentally going down the throat of the "wearer." Choking aside (which is a big aside), at least the Tongue Dinger wouldn't be vibrating all the way through the GI tract. If it didn't have that 40-minute time limit, I can only imagine that a bowel movement which brought this device to the outside world again would definitely be a "humdinger!"

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Technorati Tags: sex toys, vibrators, Sex Matters

MTV Wants a Sex Therapist

2008-01-28T09:49:00.000-05:00

Last week a male colleague forwarded me an email that was looking to generate candidates to fill a media position. He thought I fit the description and knew of my experience on camera and on radio. Here are excerpts of what it said:

I'm a casting producer working on an honest and eye-opening new television project about sex and relationships for MTV Networks. MTV is now on a nationwide search for a recognized specialist to moderate a new series that gives parents and children the confidence to talk about relationships, sex and contraception together. The program hopes to create an open dialogue for topics that are never easy to discuss for millions of Americans. This series is designed to foster communication within families by tackling the hardest topic of all with the help of the expert.

In each episode, the expert and one family will work through their issues through group assignments and open, frank discussion. The hope is that the more families talk openly about sex, the more supportive and honest they can be in other areas of their lives. We are specifically looking for a "Dr. Ruth" type.

We're looking to speak with women (in their 50s and up) who are recognized experts in the field of sexuality issues. Candidates can be either practicing therapists, educators, doctors, authors, etc. or retired. We'd like to find women considered to be thought leaders in the field.

We're searching for an expert that is able to facilitate, in a frank, direct, no-nonsense way, discussions about sex, as well as, help design family activities and homework that will promote further conversations.

I immediately replied to my colleague and thanked him for thinking of me, but that I could not throw my hat in the ring right now. As I did this, I commented out loud to my husband in our home office that I'd just received an interesting email. He said, "Forward it to me at my desk."

A few minutes later, he read it and said, "Do you think that you might be interested in that?" I said, "No." He said, "But for the Dr. Ruth part, that's a description of you." (Even when Dr. Ruth is having a "tall day," I've got thirteen inches on her - and no accent.) I said, "Yeah, I know, but I could never be away from the kids that much - and I don't think that we'd like it much either. It's likely to shoot in New York or LA." He said, "Yeah, you're right." And that was that.

Yesterday I happened to read a letter to an editor in a national magazine from a woman who commented that she was surprised that a new host on The View was going to take the job even though that meant that she would be away from her young child to do so. I thought to myself, "I'm with you on that. What is she thinking?"

I realized that not everyone derives the same pleasure and meaning from parenting in a day-to-day manner. I also realized that not everyone derives the same pleasure and meaning from being on TV and somewhat famous. I also realized that I was so clearly in one camp and not the other that I didn't even need to consult my husband before rejecting the idea of a job that separated me from my family. I don't want to be designing "family activities" for any family except my own.

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Technorati Tags: MTV, sex therapy, parenting

How Bicycle Seats Affect Sexuality

2008-01-17T15:56:00.000-05:00

Photo: Uli Harder

Everyone knows that exercise is good for sexual well being, but it turns out that some forms of exercise come with a downside when it comes to sex. I would really like to be reporting on scientific research for both women and men in what follows here, but so far, the evidence-based conclusions have only been completed for men. We can extrapolate a bit for women and I do have some practical tips that might prove useful for dedicated female "roadies."

As early as the 1890s, numbness in the genital area was associated with sitting on a bicycle saddle. Scientific findings during the last 20 years have described the problems in the perineum (the area between the anus and the clitoris or penis, commonly called the "crotch") that can occur due to compression by bicycle saddles. Despite the research, in-person and online testimonials exist touting men who do miles and miles of cycling yet maintain their firm erections. Sometimes even physicians perpetuate the idea that all this cycling won't do any harm. The point is, not every cyclist will have erection dysfunction (ED) from cycling, just as not every smoker will get lung cancer. That doesn't mean there's no risk involved in either activity.

The problems that stem from typical bicycle seats are two-fold for men. There is adequate research that blood flow to the penis is blocked by the pressure of the body weight on the perineum when cycling. Look at "Bicycle Riding and Erectile Dysfunction: An Increase in Interest (and Concern)" in the Journal of Sexual Medicine 2005; 2:596-604 by Vincent Huang, Ricardo Munarriz and Irwin Goldstein. In addition, numbness due to entrapment (pressure that surrounds) of the pudendal nerve is being reported.

So, what's a cyclist to do? Well, the researchers have been busy designing seats that decrease the pressure and decrease the likelihood of cycling-related ED. What they have begun to develop are ergonomically designed saddles that account for urogenital physiologic principles -- in other words, "crotch friendly."

Some early designs were offered. The most notable one had a circular cutout into which the penis fit and which provided some perceived relief to the male cyclist. It turns out, however, that the pressure on the perineum is inversely related to the surface area covered. This means that if there's less of a seat holding up the entire "butt area" there's more pressure to be distributed to the parts that actually have contact with the bike saddle. That means more pressure where you don't want it and the possibility of more ED.

It also turns out that some researchers in Venice, Italy (see "Development of a New Geometric Bicycle Saddle for the Maintenance of Genital-Perineal Vascular Perfusion" by G. Breda, N. Piazza, V. Bernardi, E. Lunardon, and A. Caruso in the Journal of Sexual Medicine 2005; 2: 605-611) have tested a seat that distributes the weight over the buttocks area while including a center open section that does not compress the perineum. In addition, it has a "nose" that tips down (like the beak of an eagle) rather than sticking out even with the main plane of the saddle. This reduces the pressure on the penis and scrotum. The coccyx (tail bone) does not touch the seat either so makes going over rough terrain better and less stressful to that area. The only name I have for this bicycle saddle is the SMP given to it by the Italian researchers.

Perineal pressure on female genitals might very well affect blood supply and nerves. It's reasonable to wonder if it could affect sexual response for women as well. Measurements of erections are often easier to get than measurements of lubrication (the comparable sexual experience of females). So, it may take some time for researchers to develop appropriate devices that allow this to occur for a female cyclist.

Meanwhile, women can help maintain genital health by lubricating the genital folds before cycling. Some suggest Aquaphor, Balmex, Astroglide, or Probe. This helps the labia glide with leg movements and helps prevent irritation, bleeding or chafing from long distance biking. Women with long labia should arrange them after putting on lubricant and make sure to wear bike shorts with padding. Padded underwear can be worn under bike shorts for really long or frequent rides.

So, don't forgo your exercise if cycling is your thing. Just be sure to get up off that seat during spinning classes if it's a narrow seat with a nose. Take this article to your health club and ask them to evaluate their current seats. Look for seats that either have a sloping down ("eagle's beak") nose or no nose at all. If you can't find the SMP seat, get one that distributes the body weight over a greater area and offers pliability.

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Technorati Tags: ED, erectile dysfunction, cycling, bycycle seats, sexual health

End of Year Reflections: Part 3 -- Hospice Options

2008-01-03T16:17:00.001-05:00

The kids were up at 7:30 and the presents were all opened by 8:15! Their playing began and I slipped out to see my mom. We ate lunch together and she opened the presents that I had wondered if she would even get to see. She was happy to be back home among her things and somewhat familiar faces. (I have often said that the one good thing about Alzheimer's is that you're always meeting new people!)

One of the staff, knowing what I do for work, stopped in and said, "May I ask you a question?" I said, "Anyone who works on Christmas Day helping take care of my mother can definitely ask me a question." We then discussed why she was unable to have an orgasm with her new husband and how she could keep up with his level of desire for sex.

Our extended family spent time together again. The kids played with their new Wii, we ate, then we all played Charades, and we eventually called it a night.

The next day, a case manager nurse from the hospital called and said that she had reviewed my mother's discharge. She had brought her case to the medical director's attention and they both felt that my mom should qualify for hospice. So, was this good news or bad news? I wasn't sure how to hold this in my mind.

I said, "We were already turned down for hospice. Why are we being considered again?" Well, it turned out that there are "for profit" hospice organizations and "not for profit" hospice organizations. The first one had been "for profit" and apparently did not want to risk betting that my mother would be dead in six months. Since this was my first contact with a hospice type circumstance, I had no idea that there were different types of organizations within the industry. Now I know.

As it turns out, it's probably a pretty good thing that I have begun my hospice education (which, by the way, seems like a wonderful service for those "in need"). My mother-in-law entered the hospital last night with new problems. Her cancer apparently has metastasized. All the out-of-town siblings are on jets or are already home. That means my husband and I are now on double duty as medical advocates for our moms. What does that mean for sex? That means -- not much.

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Technorati Tags: family, aging, Alzheimers, hospice

End of Year Reflections: Part Two -- Where's The Midwest?

2008-01-02T15:46:00.001-05:00

By Christmas Eve Day, my mother took a very unexpected turn for the better. Still with her 25% cardiac ejection fraction, the hospitalist physician discharged her from the hospital. So, I took her back to her Assisted Living Unit, got her all settled in, and relied heavily on the great staff there to shepherd her through the evening. Ordinarily, she would have been a part of all the events that followed. But, she was really tired and ready to sleep.

Back at home, my in-laws joined our family for our traditional dinner. By then, I had learned the true meaning of multi-tasking and had really lucked out by working ahead the night before. After dinner, we flipped on the computer to track "Santa's path" by satellite. When we first checked, he was in eastern Canada.

My five-year old then took his bath and, before putting on his jammies, peeked at Santa's location on the computer. The adults had retired to the family room when my son came running into the room stark naked shouting, "He's in the United States! He's in the United States! Santa's in the United States in the Midwest!! Who lives in the Midwest??! Do we know anyone in the Midwest? Does anyone live in the Midwest??!" With that, he fell down on the floor in paroxysms of joy. Then someone said, "That means he's close! You better get into your jammies right away and get into bed before he gets here." And, in the wink of an instant, he was dressed and in the bed.

Our side ached from laughing -- and we now had a story that our family lore will never let die.

I checked on my mom and she was sleeping. I wrapped Santa's presents that had been hidden. Ate the cookies, ate the milk and the carrots -- and staggered to bed.

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Technorati Tags: family, tradition, holiday, health