Vaginismus happens for many reasons.  A woman may be highly nervous about having intercourse, particularly for the first time; she may feel shame or guilt about sex, or she may have performance anxiety.  Or, past trauma such as date rape may be to blame.  Repeat infections, such as yeast infections, or dryness during menopause uncomfortable intercourse can also cause vaginismus.  Finally, treatments for gynecological cancers, such as cervical cancer, can also cause vaginal atrophy.

Because it can be so embarrassing, many women fail to talk to a physician about treatment.  Unfortunately, even women that do mention the problem to a doctor often receive a pat on the knee and advice to “just relax.”  Of course, that is much more easily said than done.  There is much more that can be done to help a woman and her partner overcome vaginismus, including the following steps:

1. Find a physician that specializes in sexual medicine.  This is usually a gynecologist or a urogynecologist (a urologist that specializes in women’s problems).  You can ask your own gynecologist or general physician for a referral.
2. Work with a psychotherapist who specializes in problems of a sexual nature.  This may be a sex therapist, or it may be a marriage therapist who has some training in sexual dysfunction.  Identify what makes you fearful, guilty, or shameful about sex, process it, and let it go.
3. Consider a program of dilator use.  A dilator is a cylinder-shaped object that is inserted into the vagina to desensitize a woman to having something “in there.”  Dilators start with a small size and increase to something comparable to a man’s penis.  The physician or sex therapist can give you guidance on how to use them.
4. Try a program of overall physical relaxation.  You can find many relaxation recordings online.  Or do yoga, meditation, or other form of regular relaxation.  Listening to relaxing music can also be helpful.
5. Learn more about sexual pleasure.  You can learn a lot about your own body through self-massage.  Let your partner know what you do and do not like when it comes to touch.
6. Always use lubricant for any type of genital contact.  Water-based lubricants tend to dry out and need to be reapplied, but they can be used with condoms.
7. Don’t give up on sex altogether.  There are definitely couples that have a rich sex life that just doesn’t include intercourse.  (Often it is the wish to become pregnant that brings them into treatment.)

Women with vaginismus shouldn’t give up on the desire to have “normal” sex with their partner.  It may take some time and lots of encouragement, but with the right assistance most every woman can resolve the problem and enjoy sex.

It is a myth that it is always the male partner that has higher sexual desire.  In my sex therapy practice, it is about 50/50 men to women that have higher desire than their partner.  Another myth is that most partners stop having sex once children have arrived.  If couples had a decent sex life before pregnancy, they will figure out a way to regain their sex life.

What causes differences of sexual desire?  The reasons are as varied as what causes differences in participating in different sports or liking different kinds of food.  Some people have a hormonal profile that makes them naturally more interest in sex.  Other people find that sex is a good way to relax, or feel connected, though their partner may not find sex as effective.  Some partners find that their desire to be with their partner never fades, while others discover that their desire diminishes over time.  People differ in how they were raised to view sex.  They also differ in how important it is to them personally.

Differences in sexual desire can cause a lot of friction in a relationship.  What never works is to nag, harass, beg, argue, or avoid the issue.  If you accept that it is okay, even normal, to have those differences and not read too much into them, then you can calmly and kindly discuss how you can both be happy.  Most couples find that simply compromising on how often they will have sex works well enough, while others prefer scheduling so that both know what to expect.  Some couples find that if the high desire partner has his or her needs met regularly, they are happy, whether or not the encounter is romantic or matter-of-fact.

If you can’t seem to resolve your differences, then you might benefit from the services of a sex therapist.  A sex therapist is a psychotherapist with specialized training in sexuality and human relationships.  The sex therapist can help you understand why you are stuck, give you each an opportunity to voice your concerns, and help you work toward a satisfactory solution.  This involves good communication, compassion for your partner, and a willingness to accept differences.

Asperger’s seems to be current vogue disorder.  HBO recently had a documentary on Temple Grandin, the fascinating woman agriculturalist who has written books about her own experience of Asperger’s.  Last year, three movies were released that featured characters with Asperger’s.  Asperger’s, it seems, is everywhere.

But is it? Asperger’s has a short history, because it was only first diagnosed in 1994 by Viennese pediatrician Hans Asperger, the number of people in the U.S. who have Asperger’s is actually unknown.  Many adults may have Asperger’s without knowledge of the disorder.   Today, however, many children are diagnosed sometime in their early childhood.  In any case, Asperger’s is

How does someone know that they or someone they know has Asperger’s, anyway?  People with Asperger’s usually have poor social skills, obsessions, odd speech patterns, unusual posture, and other peculiar mannerisms.  In an adult, the person may have difficulty understanding social behavior that others take for granted, for example, laughing loudly or at inappropriate times.  (One male client with Asperger’s, horribly embarrassed when he told me about his Peyronie’s disease, then went out to the reception area after his appointment and confided so loudly to the receptionist that the entire clinic heard him.)  They may have strange collections, such as one physician with whom I’m familiar who collected all things having to do with bees; even his office was decorated in black and yellow.

When people with Asperger’s speak, they may not make sense, not because they speak gibberish but because they don’t know how to segue into normal conversation.  Generally, they learn how to get along socially by observing and copying others.  Since they don’t do well with change in any case, this only contributes to behavior that may appear strange or robotic.  A common myth about Asperger’s is that everyone who has it is a “genius.”  Not true.  There are people with average intelligence that also have Asperger’s.

Because people with Asperger’s don’t fit in socially, they often apply themselves in school or in their careers.  This makes them stable and dependable, which can be attractive to a partner that is looking to settle down.  Many people who partner with someone with Asperger’s will marry in the belief that feelings and intimacy will grow over time.  While this can happen, more often than not the non-Asperger’s partner becomes disappointed and frustrated.

Sometimes this disappointment and frustration becomes focused in the couple’s bedroom.  While adults with Asperger’s vary, many non-Asperger’s partners find the lover with Asperger’s mechanical and emotionally disconnected during sex.  Even if they have sexual experience, they may not understand what is expected of them, e.g., mutual pleasuring, vocalization, or emotional expression.

Besides misunderstanding social cues and lacking in empathy, the partner with Asperger’s may also be overwhelmed by the sensory experiences of sex.  One man, for example, disliked the smell and feel of his partner’s hair.  Another couldn’t stand the little bumps and irregularities of his partner’s skin and asked her to wear a body stocking when they had sex.  A woman with Asperger’s complained that she felt “completely smothered” by her husband during lovemaking and decided it was better to divorce than to put up with having to have sex.

Is there any hope for couples in which one partner has Asperger’s?  Yes, of course.  If both partners are motivated to change, then they can have a more satisfying sex life, one that makes each partner feel wanted and accepted.  But a satisfying sex life generally starts outside the bedroom.  Partners first need to educate themselves about Asperger’s so that they can understand how it is affecting their intimate relationship.  They need to be able to communicate to each other; both need to develop some empathy for the other’s position.

Sensate focus activities may also be helpful in slowing down both partners so that they can concentrate on what feels good, instead of on performance.  Learning to give verbal feedback about sex without creating defensiveness is another valuable skill.  Being realistic about what may or may not change in the bedroom is another facet of acceptance of the diagnosis of Asperger’s.

You’ll have to wait until January 2011 to read a copy of my book, which discusses how various psychological problems, from addiction to learning disabilities, affect a couple’s sex life, but until then here are some links to resources about Asperger’s that may be helpful to you:

Asperger Adults

WEGO Health on Asperger’s

The National Autistic Society

A word about diagnosis and treatment:  Different people react to a diagnosis of Asperger’s in different ways.  Some people are relieved to discover an identity that answers questions for them.  Others are curious.  Still others are upset or go into denial.  No individual should ever be forced into being diagnosed or treated.  However, therapy can be helpful for people with Asperger’s and spouses or other family members who are trying to understand and give them support.

I have had men in my practice that complain because they last “only” 5-10 minutes.  They report that their partners are dissatisfied with the length of intercourse because they are unable to have an orgasm within that timeframe.  They are shocked when I tell them that 5-10 minutes of intercourse is very good, in fact, longer than the average of about 3 minutes.  In fact, sometimes they don’t believe me; maybe it’s because they don’t know what to tell their wife or partner.

I have many questions to ask a man who lasts this long but still complains.  How long does his wife take to have orgasm with intercourse?  Is she, in fact, capable of having orgasm with intercourse?  (Only about 20% of women have orgasm with intercourse.  Most women have orgasm with direct stimulation to the clitoris, either manually, orally, or with a vibrator.)  Are they spending enough time on foreplay?  Is it time enough for the partner to be highly aroused and ready for orgasm with intercourse?  The answers tell me how to approach treatment, which sometimes is more on the couple’s expectations, sex life and lovemaking technique than on PE.

Of course, there are men that are terribly frustrated because they do only last a minute, if that.  Such individuals are usually very embarrassed and feel they would do just about anything to last longer.  Their PE may be medical, perhaps because of hormones or a prostate infection, or it could be psychological, due to anxiety or relationship problems, or both.

The techniques that I suggest can be found in a variety of self-help books.  Most men that come into my office have tried them without success.  If that’s the case, we explore why that is.

It isn’t all that rare that I have a young man who comes into my office complaining of PE with every “new” partner.  Not to judge anyone for their sexual experimentation, but men sometimes expect themselves to be completely in control with each woman they have intercourse with.  In doing so, they make themselves anxious about their performance and they orgasm too quickly.

What if, I challenge them, you took your time to find a partner that you actually like and are comfortable with?  What if you could tell your partner that you were a bit nervous and might ejaculate quickly the first few times that you are together?

At other times, a man will tell me about a partner who is difficult, critical, or doesn’t like sex.  Why, I challenge, would you want to be close and last longer with someone that treats you so badly?  Is it possible that your body is telling you to be quick and be done?  Or do you need to communicate your distress more directly, instead of hiding it and pretending everything is okay?

For men that are in loving relationships who are frustrated, I do a complete assessment of the problem.  Often they, too, are anxious but never realized that they suffered from any type of anxiety disorder.  Sometimes, though, they are out of touch with their bodies and their sexual needs.  They need to learn how to slow down, not just in bed, but in life, as well.  They also need to communicate to their partners.  Finally, realizing that they can be a great lover, no matter how long they last, can help them to relax and enjoy pleasurable sex with their partner.

• Female sexual pain, such as vulvodynia, vulvar vestibulitis, and dyspareunia

• Vaginismus, or the inability to have penetration with sexual intercourse

• Male erectile dysfunction

• Male delayed ejaculation (ejaculation does not occur)

There are various medical causes for each of these problems. In women, for example, Vulvodynia seems to sometimes be connected to repeated yeast and bladder infections. Vaginismus can be caused by problems such as hormone imbalance or endometriosis.

In men, erectile dysfunction (ED) can be due to high cholesterol or diabetes. Delayed ejaculation can be caused by nerve damage or a stroke.

In addition to medical causes, there can also be psychological causes for each of these sexual problems. Although it is not always the case, women with sexual pain disorders may have experienced childhood sexual abuse, making them more vulnerable to pain conditions in general. Women who have vaginismus may also have experienced abuse, but being raised in a strict religious environment, fears about being sexually active or becoming pregnant, and stress and anxiety can also contribute to the problem.

ED, particularly in young, otherwise healthy men, is often due to performance anxiety, stress, depression, or ambivalence about pregnancy or the relationship itself. Delayed ejaculation can occur when a man was raised in a strict religious home, has unusual or atypical patterns of masturbation, or has difficulty communicating to his partner what is arousing. Fears about pregnancy can also inhibit ejaculation.

Sex therapy can be helpful in a variety of ways. For example, many women who receive both medical and psychological treatment for sexual pain disorders and vaginismus do appear to have a better outcome than medical treatment alone. They learn about their sexuality, relaxation techniques, and ways to make sex more comfortable and pleasurable. A sex therapist can also help a woman overcome fears about pregnancy and labor. A sex therapist can also work with the partner to help them understand their partner’s experience and ways to make sex work better.

Men also benefit from learning how to relax and decrease anxiety over their sexual performance. If the problem is delayed ejaculation, they can learn how to condition themselves to ejaculate during intercourse. The very fact of trying to conceive can make performance anxiety a particular tough issue, so much of the focus of treatment is on that.

Sex therapy is basically talk therapy where the focus is on sexual problems. The sex therapist gives education and homework that can help the couple learn about their sexuality, overcome inhibitions, lessen anxiety, and have a more enjoyable sex life. Sex therapists frequently work in conjunction with a physician and a physical therapist who specialize in sexual disorders.

As for myself, I welcome couples struggling with infertility. As a family and couples therapist who has worked with people with all kinds of medical conditions, as well as being a sex therapist, I can help you with all different aspects of the journey to becoming parents.

There are so many stereotypes when it comes to sex and the mature adult.  I always remember a man in his 30s telling me, “My wife and I need to hurry up and start having a lot of sex, because we’ll be done by the time we’re in our forties!”

You’ve gotta be kidding.

Just because you don’t move as quickly or forget your glasses are on top of your head occasionally doesn’t mean that you aren’t spry enough to have sex.  The body may not be as beautiful, but feelings of love and desire may grow even stronger with a couple that has been bonded for years.  And for couples experiencing romance in their later years, the sparks can still fly pretty high.

Enjoy the article, and let me know what you think!

Sometimes couples disappoint each other in the bedroom and have trouble with forgiveness.  A man’s female partner can’t have an orgasm and he berates her for being unresponsive.  A woman’s male partner ejaculates too quickly and she becomes caustic and critical.  The couple may just have different expectations about their sex life, but be unable to discuss it; they may quietly suffer for years.  The angry partner may also become critical, sometimes, in other parts of the couple’s relationship; at other times, the couple may put a lot of energy into putting up a front to the world that their relationship is really much better than it is.

Can you forgive your partner for their sexual shortcomings, be a good friend, and support them toward change?  Can you let go of your resentment and become compassionate, realize that your partner may be hurting, too?  Sexual forgiveness takes maturity, too.  Your partner perhaps didn’t learn how to be a long-term sexual mate.  You can learn together.  If mistakes or missteps have been made, be patient and above all be forgiving.

But foreplay isn’t just about orgasms.  It is also a way to connect with your partner.  You can take turns giving one another pleasure.  You can choose to be passive and let your partner give to you, or to be active and please your partner.  Or, you can have mutual foreplay, both giving and receiving pleasure at the same time.  It’s more about sharing an intimate, fun experience than about preparation for intercourse.

If foreplay is imaginative, there may be no need for intercourse; orgasms may be experienced in other ways.  Foreplay can also allow you to explore one another’s bodies, to understand what is erotic for each of you.  It is a time to free yourself and be creative, to try out scenarios that turn you on.  You may find out that you enjoy some of the same things, or that you need to make adjustments so that your fantasy is fun for both of you.

Foreplay builds a sense of connection and intimacy.  When someone doesn’t want foreplay, for me as a therapist, I am always curious about whether they are able to be truly intimate with a partner, to let a partner get into what they are really about in the bedroom and to get into their partner’s thoughts and feelings.  Foreplay is one of life’s great free experiences, right there in the privacy of your own home.

Women’s sexual desire is more complex than a man’s.  Especially for women in long term relationships, sexual desire is less driven by hormones, though they do play a role.  What seems to be more important is the quality of the relationship between a woman and her partner; her mood, energy, and stress level; her feelings about herself and her body; and her overall enjoyment of sexual activity.

Also, while men feel horny and then want sex, women in long terms relationships often need some loving before they feel horny.  If a man approaches his wife or partner with his motor on “idle” and gives her some time to warm up without pressure, letting her tune in to her own needs to see if a “no” might become a “yes.”

Another way to help a woman enjoy sex more is to take the time to find out what she enjoys.  If she can’t communicate it verbally, ask if she can show you by guiding your hand with her own.  Encourage her to explore her own body so that she can share what she has discovered with you.

If your wife complains that she doesn’t have any energy, help her out.  If you are feeling amorous, take over a few chores so that she can put her feet up or take a warm bath.  Try doing this regularly, whether or not you are looking for an opportunity for sex.  It’s a fact:  Men that help out have sex more frequently.

There are some rather serious reasons that women may lack desire.  One is that they experience sexual trauma.  Another is that intercourse is painful.  A third would be medical problems, both gynecological and non-gynecological; a woman that has no drive should definitely seek a medical examination.  Problems with depression and anxiety can also interfere with drive.  Finally, changes such as the birth of a child or menopause can have an effect on libido.  These experiences are real and need to be addressed; they just don’t go away on their own.

There is nearly always a reason a woman’s drive goes missing.  Invite your wife to do some detective work with you and then work on the problem together.  If you solve it, great.  If not, perhaps you are both too close to the problem or haven’t considered some of the other many reasons this happens; try using the services of a AASECT certified sex therapist to help you.

It isn’t just men that feel sex is only about intercourse and resulting orgasm.  Women often say that it’s the only part of sex they enjoy.  Perhaps it’s because it’s the only part of sex that has an official stamp of approval as being sex.  After all, most people are taught that “Sex is for after you get married
because it can result in pregnancy.  Since pregnancy nearly always occurs as the result of intercourse, it only makes sense that sex means such an act has occurred.

Of course, there’s nothing wrong with intercourse.  It’s just that it’s very limited.  It requires that both partners be aroused, that the genitals are in good working condition, that the participants have the strength and stamina to follow through with the act.  That is, I think, part of the reason that people think of “sex” as being for young people.

If sex included every act of pleasure, people–both individuals and couples–would be much better off.  Including self-, oral, and manual stimulation would take the pressure off of having intercourse.  It would decrease unwanted pregnancy and disease.  It would make it easier to imagine having sex as one ages, or sex if one is alone.  And if a woman had discomfort with intercourse or a man struggled with erectile dysfunction as the result of temporary illness or stress, then they could still be affectionate and comforting with one another.

If you are someone that balks at the idea of venturing beyond sex = intercourse, it might be interesting to think about why that is.  Is it due to stereotype?  Inhibitions about other types of sexual activities?  A belief that sex is only for procreation, so if one is going to have sex for recreation, it had better be a reasonable facsimile?  If going outside your sex = intercourse comfort zone is truly distasteful, well, so be it.  But it could be that you realize you are holding back from exploring all types of sex, starting with cuddling and kissing.  And then what would be the harm of exploring your sexual potential?