Just a few days ago I posted about persistent genital arousal disorder (PGAD) aka restless genital syndrome. Then SNL did a tasteless skit about it.  What if this was a character portraying someone with Tourette’s disorder?  Would that be funny?  I don’t think so.

If you watch the skit you’ll see that the actress says that pretty much anything can cause PGAD.  Not so.  It seems to have to do with damage to the pudendal nerve.  Although it can have a psychological component, there is also a biological basis for its manifestation.  And even if it was purely psychological, why should PGAD or any other psychological disorder be a target for stigmatization?

Anyway, I left a comment.  Maybe you will, too.

An Australian study confirms what I’ve seen clinically in my practice:  Men that chronically smoke pot can have sexual problems over time, including delayed or premature ejaculation.  Researcher Anthony Smith reported that some men seemed to be self-medicating to help retard ejaculation.

But since marijuana seems to have unpredictable effects, it’s probably not the best drug of choice.  Chronic marijuana use–usually defined as smoking pot 4 or more times a week–can affect a man’s sex drive and his ability to have an erection.  Some percentage of women that call my office about their partner’s lack of interest in sex actually have a partner that smokes pot–not just a few times a week but a few times a day.

With problems like marijuana addiction there is always a chicken-and-the-egg question of which came first, the sexual concern or the drug / alcohol escape mechanism.  In my experience, sometimes there is a lack of sexual knowledge, difficulties with self-esteem, or relationship / attachment problems that interfere with having a good sexual relationship with one’s partner.  Smoking marijuana or using other drugs can help a person deflect, rather reflect, on issues that consequently never get resolved.

Marijuana is a drug like any other.  It’s easy to minimize its effects, which actually seems to be part of the addiction.  Marijuana causes a myriad of changes.  If you’ve ever seen a SPECT scan of a pot smoker’s brain, you’ll see that the blood flow in the brain is really crummy.  And, it takes longer for pot to get out of the brain than almost any other drug.

So the next time you or your partner say, “Well, it’s just pot,” think again, especially when it comes to sexual health and relationship issues.

Two researchers have published a book entitled Why Women Have Sex.  I admit I haven’t read the book, but I found it discussed and excerpted on the ABC website.  The excerpts demonstrate that women have sex for all kinds of sneaky, underhanded reasons:  revenge, pity, to get money or favors, to prove a point, to try sex with someone different, boredom, etc., etc.

Anything new here?  Despite what the researchers say, I don’t think so.  Aren’t these reasons the plot for scores of novels, plays, and films?  I was an English major, but I don’t think you have to have much expertise to come up with a list of at a bazillion familiar works of art that deal with all kinds of reasons that women have sex:  Women in Love, Lolita, The French Lieutenant’s Woman, Gone with the Wind, The Thornbirds, The Postman Always Rings Twice, Fear of Flying, The Group–and those just the classics.

Another problem with the excerpts, as some of the commentators point out, is that it promotes the stereotype that women don’t enjoy sex for the sake of sex–only men do that.   Conversely, it suggests that women are the sole gender that has sex for financial gain, increased status, curiosity, or pity.

Qualitative information isn’t always valuable (neither is quantitative data).  How will this information be useful to a woman that is reading the book?  To a partner?  To a clinician?  How surprising or new or groundbreaking is it that a woman wants to have sex with someone of a different race or socioeconomic class?  What is the model for understanding female sexual desire that comes out of this data?

Or is the real message simply, “Sex sells?”

It sounds like a dream, but it’s really a nightmare:  A woman complains of the sensation of being on the peak of orgasm all the time, or who has orgasm over and over again, never really feeling any sense of completion or relief.

Two items drew my attention to this condition.  The first was a recent article in the Journal of Sexual Medicine and highlighted on the Medscape site that discusses Restless Genital Syndrome.  The second was a woman’s story of having Persistent Genital Arousal Disorder on the site BoingBoing.  They are both the same problem, and they are both medical issues that may or may not have a psychological basis.

As with many female sexual pain problems, women that find themselves in this situation will go from physician to physician trying to find relief.  They may face being told that “it’s all in your head.”  They most likely will experience desperation.  And if they have a partner, they will face frustration because sexual activity may be limited, if it occurs at all.

Sex therapy can play a helpful role for women with this and other sexual pain problems in the following ways:

• Support.  Being able to talk about an intimate health problem with a helpful person who can offer insight and valuable suggestions can help take pressure off.
• Education.  Understanding how one’s emotional and mental state of being affect the experience of pain can begin the process of healing.
• Tools and techniques.  There are many tools that can be used for relaxation, which can decrease the subjective experience of pain.
• Counseling.  Couples affected by these problems often grow frustrated and angry.  Counseling can help couples learn how to communicate more effectively about difficult feelings and situations.

Not all sex therapists are well-versed in helping women (and men) that have sexual problems rooted in a medical condition; you need to ask if the therapist is, as I am, trained in health psychology as well as sex therapy.  You can visit AASECT to find a sex therapist, or the International Pelvic Pain Society to find a medical specialist that may be able to help you.

Yet another sexual myth to explode:  It’s always the woman in the relationship that doesn’t want sex.

Not true.  Not by a long shot.  It may not happen as often, but it happens more often than most people think.  And women are just as affected when their partner doesn’t want sex as men are when their partners turn them down over and over again.

Women in sexless marriages complain of feeling unloved, rejected, and unattractive.  In part because of the myth that “men always want sex,” they sometimes feel even more desperate than their male counterparts.  They experience intense sadness–and frustration.

When it comes to sex, even if you’re not talking about it, you’re communicating something.  When a man withholds sex from his partner, more often than not, he’s expressing displeasure with some aspect of the relationship.  What that is differs from situation from situation.  But getting a man to open up and talk about it directly can be difficult.  Quite often, he himself has no idea why he’s upset.  All he knows is that he doesn’t much feel like having sex, and there the story ends, leaving his partner frustrated.

I do frequently advise that physical problems be ruled out.  Unless you’re trained in medicine, you really can’t tell just by looking or studying someone’s behavior what might be going on in someone’s body.  Low testosterone and other medical problems can interfere with desire.

Also (and here I must admit I gave a big sigh), it can be difficult to convince a man to come into therapy, if a woman thinks this might be helpful.  He may call it “hocus pocus,” accuse the therapist of “just wanting to make money off of us,” or feel too embarrassed to talk about his problems.  Both male and female therapists, if they are worth their salt, understand this and know how to talk to men about their concerns.

Even though this is a difficult situation, it can be important that a woman supports her partner with the understanding that this may be difficult for him, too.  Instead of making threats or saying things designed to hurt, work on the problem together to find a solution.

Looking for some quick answers about women’s sexual health?  Here’s a new resource, Sex & a Healthier You, from the National Women’s Health Resource Center and the Association of Reproductive Health Professionals.  It looks like the site is in its infancy stages with potential to grow.  I’d recommend signing up for the free newsletter to get on-going information from these two excellent organizations.

Many of the articles recommend talking to your healthcare provider, which makes sense–it’s the first stop for a lot of men and women looking for help with a problem.  But you can also make a sex therapist your first stop.  Most good sex therapists can refer you to a physician that has a special interest in sexual medicine.  If you live outside the SoCal area, visit AASECT to find a sex therapist.

Wouldn’t it be fascinating to see a study of couples in sexless marriages that make lifestyle changes?  I wonder what would happen if, for example, partners managed their stress, exercised, and ate a healthful diet.  Would there be less fighting because they were less tense?  Would they feel better about their bodies?  Have more energy?  Feel more confident?

What if some sexual problems could be fixed by eating more leafy green veggies?

A recent article in the Journal of Sexual Medicine reports that, just as men may have trouble with erections if they have high cholesterol, women might, too.  The study found that women who complained of difficulty with arousal and orgasm and high cholesterol might have blocked blood flow to the pelvic area and genitals.  Because there is no medical treatment for women like Viagra, the researchers suggested that changes in lifestyle might help mature women experience more sexual pleasure.

More and more, we are learning that sexual enjoyment is tied to lifestyle.  A study in Brazil showed that just smoking just 2 cigarettes affects erections in men.  Obesity in both men and women can cause hormonal imbalances that affect sexual health.  Lack of exercise and decreased muscle tone can make it tough to find the stamina or energy to have good sex.

Can you think of a better reason to live a good, clean life, at least outside the bedroom?

Tonight was historic for sufferers of vulvodynia and their partners as ABC’s news show, 20/20 highlighted sexual pain.  Dr. Timothy Johnson interviewed my colleagues (urogynecologist Dr. Andrew Goldstein, physical therapist Amy Stein, and vulvodynia advocate Chris Veasley of the National Vulvodynia Association) plus 2 women who have experienced sexual pain disorders.  Those 2 women, plus Chris, were able to cure their vulvodynia and go on to have normal sexual intercourse with their partners.

I was, of course, very happy to see this common but misunderstood set of conditions covered on national television.  I was a bit disappointed, though, that the segment did not include the perspective of a health psychologist or sex therapist.  There are researchers and clinicians that work with women that have pelvic pain disorders and their partners.

Here’s why a sex therapist can be helpful.  The women in the program complained of psychological problems such as feeling inadequate as a female, lacking support from a partner, embarrassment about the condition, and fears about ever being able to have normal sex again.  All of these problems are things that a few sessions with a psychologist can help.  Not only that, but a sex therapist with a background in health psychology can help women with sexual pain to relax and cope better with discomfort.

The fact is, of course, that if women are steered in the right direction by organizations like the NVA, their gynecologist, or an online search, they can find medical help for the problem of sexual pain.  There are surgery, topical solutions, and medications available.  However, in my clinical experience, some women achieve partial relief.  They are able to have more comfortable sex, but not necessarily pain free.  They also are sometimes left with damaged self-esteem.

Also, a study just released in JAMA confirms that chronic pelvic pain is sometimes associated with past childhood sexual abuse.  It isn’t that the pain is in the woman’s head; it’s that past abuse makes her susceptible to this and other health problems.  Physicians and physical therapists, therefore, need to assess their patients in this regard.

Aside from myself, there are definitely other sex therapists that are willing and able to help women with sexual pain; the best resource I know of is AASECT.

Kind regards,

Dr. Stephanie Buehler

An article on ABC News, “Back in the Saddle,” talks about the sexuality of women who have become divorced or widowed in middle age.  According to the women that Susan Donaldson James interviewed for her article, women in middle age have a few worries and obstacles–and a few good surprises, too.

Here are some of the obstacles:

• Embarrassment.  Women may feel ill-equipped to have a sexual relationship with a new partner.  Women in their 50s and 60s may have only had one or just a few sexual partners before entering into a long-term relationship.  If that marriage wasn’t very sexual, they may worry about appearing inexperienced.
• Body image.  Our culture isn’t exactly kind to women as they age, and unfortunately, women begin to internalize these negative attitudes toward their mature appearance.  Women worry that they will look unattractive when unclothed and that the new partner will be unforgiving.
• Sexual function.  Sad but true:  If a woman doesn’t have intercourse, her vagina can actually atrophy, or shrink.  And with menopause, tissues do become drier and more fragile.  If a woman hasn’t been sexually active in awhile, she may be in for a nasty surprise.

And here are some ways to overcome obstacles to sexual pleasure the second time around:

• Just because you haven’t had a partner for awhile doesn’t mean you haven’t been a sexual being!  But if your sexuality has been MIA, you can reconnect with it by watching and reading erotic material, using your senses to enjoy life, and being your own lover with self-pleasuring.
• Take care of your appearance.  You don’t have to get botox injections or a face lift to be attractive. But you do want to look your best.  Start with the foundation of good sleep, eating, and exercise habits.  What makes someone young look appealing is, in part, a glow of health.  Even if you have health problems, you can optimize what health you do have with good habits.
• Talk to your physician. Make sure that your reproductive system is in good shape for sex.  You don’t necessarily want to think about hormone replacement therapy; topical estrogen and nonprescription, OTC preparations can take care of dryness.

Deeper concerns can be a sign of psychological distress.  It isn’t unusual for me to see men and women who have been traumatized by a bad relationship or marriage, their divorce, or its aftermath.  If such fears are preventing you from entering a new relationship then you might do well to schedule some visits with a psychotherapist.

Kind regards,

Dr. Stephanie Buehler

Director, The Buehler Institute

It’s a question I get asked often: Can a sex therapist really help us with our problem?  And, in how many sessions?

In a recent comment, a woman wondered if a man’s low sexual desire was really more about no longer finding their partner attractive, not even a little bit.  She also wondered if the problem could be fixed, and if so, how long it would take.

First, as to the problem itself, low sexual desire can indicate many things, including the presence of out-of-kilter hormones and other biological problems, like an enlarged pituitary gland.  Also, in a study of people with depression, about 70% reported that they had low sexual desire.  Low desire may also occur when a person is struggling with another sexual problem, such as erectile dysfunction or, in either sex, lack of orgasm.

Of course, low desire can also be indicative of a problem in the relationship.  The person with low desire may be angry and unable to express their anger appropriately, so they withhold sex.  They may find that their partner’s lovemaking technique leaves something to be desired.  Rather than communicate, they avoid sex or make excuses.

And yes, as the person who commented said, sometimes it means that the person is so turned off by their partner that they no longer want to have sex with them.  It could be (more…)