Poking around for blog ideas, I found a very good article on the Telegraph website on “The Sexuality of Middle Aged Men” that I thought I’d share with you.  The article isn’t earthshaking; by now, with all of the ads for meds for erectile dysfunction, you pretty much know that ED is the most common male sexual problem, and that it’s okay to talk about it with your doctor.

But what about with your therapist?  Can a pill solve every sexual problem that men have?   If you’re a regular reader, you know that my answer is no, because a pill can’t give you a skill.  And that’s where I think sexual medicine made a left turn at Albuquerque instead of a right.  Here are some of the skills that men can learn from a sex therapist that they can’t get from a pill:

1. You can’t learn how to be a better lover by taking a pill.
2. You can’t learn what will make you more aroused now that you’re older and may need more sexual stimulation.
3. You can’t learn how to talk about sex and communicate with your partner.
4. You can’t explore other types of sexual experiences that don’t require an erection.
5. You won’t learn that it’s okay not to have an erection sometimes and that snuggling isn’t just for women.
6. You may not learn that ED means that you need to relax, to stop and smell the roses.
7. You may not discover that there is more to your sensual life than is going on with your penis.
8. Your partner may never know that you need more direct stimulation to have an erection.
9. You may always wonder whether or not you are psychologically dependent on medication to have an erection.
10. If the pills don’t work, you may not realize that you have other options, or that your problem is more psychological than physical.

ED medications are marvelous for men that have medical issues that cause their problem, such as recovery from prostate cancer.  Other treatments, too, such as injection therapy, can be helpful.  But I fear that too many men are taking medication that really don’t need it.  Psychotherapy ain’t cheap, true, but neither are meds if the cost is missing out on understanding yourself and your sexuality a little better.

Kind regards,

Dr. Stephanie Buehler

Another comment by TK suggesting that being married to someone with a chronic illness can be such a desperate situation that the well partner is tempted to flee.  TK has a point–that chronic illness, including cancer, can and often do put a tremendous strain on a relationship.  And yes, marriages do break up (though I think that 75% number is too high).

Making a choice about staying in such a relationship can challenge one’s moral center.  A few years ago, I was interviewed by a reporter for a newspaper of a very large retirement community in another state.  At the end of the interview (and, I suspect, the real reason for the interview) the reporter asked, “Do you think it’s okay to have an affair if one partner is ill?”

How could I possibly decide that for anyone? How can anyone possibly decide that for him- or herself?  I could no more answer the question for the reader (more…)

TK, I do so appreciate your comment about how chronic illness can wear down the intimate connection between partners, and that in your case, not even 2 trained sex therapists were able to help you.  I can’t say why that is, except that finding a sex therapist who is also a health psychologist, as I am, is a rarity.

We are sexual beings from the moment we are born until the moment we die.  When I worked with teens with cancer, I observed that the need for sex and intimate contact with another human being was sometimes even heightened.  The thought of leaving this life without ever having experienced the sweetness and mystery of sex was almost too much to bear.  And the teens did have sex, as I learned when I walked into one patient’s room to find a little boy walking in circles.  Surprised, I asked, “Who’s little boy is this?”  “Mine!” came the answer from the male teen in the hospital bed.

Although I don’t have the particulars of TK’s situation, I would wonder if intimacy was difficult to achieve because of fears of losing one’s partner.  I would guess that there would be on-going grief, watching one’s mate deteriorate over time.  I think, too, that seeing one’s once strong partner becoming more and more fragile would not be terribly sexy.

The most important thing to know, I believe, is that sex can be more broadly defined than intercourse and orgasm.  We are, as one linguistics professor said, “coitocentric,” overly focused on coitus being the pot of gold at the end of the foreplay rainbow.

Sexuality is more than that.  Sexuality can also be expressed sensually, through touch, sound, scent, sight, and taste.  For couples challenged by chronic illness, sex can be experienced by soaking together in a warm hot tub with jasmine nearby and music playing.  Intercourse may not be possible, due to pain or other factors, but you can probably figure out other ways to have an orgasm, through manual or oral play, or the use of sex toys.

Sometimes being sexual when a partner has a chronic illness or cancer takes a team:  a physician, a nurse, a physical therapist, and a sex therapist.  Each provider has a different role in helping a couple resume or keep their sex life.  However, it is important to realize that your sex life may be changed forever.  You may need to grieve that, too.

I remember reading an interview with Dana Reeves, in which she was asked flat out if she and Christopher had sex.  She said yes, they did.  She added that their sex life might not look like everyone else’s, but it was very satisfying for both of them.  But, you don’t have to be Superman to figure out how to have sex.  Human beings are very inventive when it comes to sex.  Keeping an attitude of playfulness and curiosity can help you have a sex life that may be unique just to the two of you as a couple.

Just learned about a new online learning program from the National Vulvodynia Association about vulvodynia.

What is vulvodynia, anyway, you may be asking yourself.  Vulvodynia is chronic pain that occurs in the vulvar area of a woman’s genitals that doesn’t have an identifiable cause.  That is, when a woman complains about having pain, say, around the entrance of her vagina, and a doctor who examines her cannot see anything, she is diagnosed with vulvodynia.

Because the doctor and patient both see nothing, it is difficult to diagnose and treat.  The fact that it is pain in the genitals just makes things more complicated.  At one time, vulvodynia was thought to be mostly in a woman’s head.

Now it is understood as a chronic medical condition, but as with all chronic conditions and illnesses, there is a psychological component to it.  Why psychological?  Because women with vulvodynia experience anger, shame, and frustration.  Vulvodynia also affects a woman’s sexuality and her relationships.

A sex therapist can be a very helpful part of a woman’s treatment team.  A sex therapist can help a woman cope with the condition, talk about how to have satisfying sex, and improve communication and empathy between the woman and her partner.  Single women can also benefit from learning how to communicate about vulvodynia to a potential sexual  partner.

Dr. Stephanie Buehler

Director, The Buehler Institute

About one-third of the couples who come into our offices at The Buehler Institute have a complaint of low sex drive in the male partner, not the female.  Social myths make it hard to believe that there are so many men who have low libido.  Men are expected to “always think about sex,” ever ready to perform.

When men have a low sex drive, female partners often complain of being extremely confused and hurt.  They feel isolated and unloved.  They talk about a lack of intimacy in the relationship.  Sometimes they are even angry that the person with whom they most want to have sex is physically unavailable.

Why do some men lose their zest for sex?  One reason has to do with physical health, especially testosterone levels.  Most every man who has low drive should have their hormone levels tested, because one of the hallmarks of a low drive in men is low testosterone.

However, you can’t get too caught up on hormones.  There are men whose testosterone tests at low levels who still have a drive, and men with normal levels who don’t care to have sex.  So you need to look at other physical, psychological, and relationship issues as well.

For example, sometimes when a man is out of shape or overweight, he may not only feel more fatigued, but have poor body image.  It’s not just women who get hung up about lumps and bumps on their body.  Second, he may have a poor diet, leading to a lack of energy.  Or, he might not be getting adequate sleep.  Stress, too, can take its toll on a man’s physical and sexual well-being.

Another important physical aspect to be aware of is the effect of some medications on drive.  For example, antidepressants, while helpful, can cause sexual side effects.  This is another reason to check with one’s doctor when drive is low.

Psychologically, a man may have performance anxiety, pressuring himself to please his partner.  After awhile, sex becomes a drag to be avoided at all costs.  He may also have a mood disorder such as depression, which is causing him to shut down, isolate, or feel unable to enjoy things he once liked–including sex.

Relationally, a man may withhold sex when his feelings are hurt.  Men don’t much like to be criticized by day, then expected to perform sexually at night.  A man may also stop having sex when he is the one who is angry.

An additional reason in the “sad but true” department:  A man may stop having sex because he is gratifying himself with pornography, call girls, or having an affair.

Sometimes, there really is nothing wrong with a man’s drive.  The problem is just that the woman’s drive is naturally higher.  But again, because of the myths surrounding male sexuality, the woman with the higher drive may have difficulty believing that the cause of low drive is natural, not personal.

Today I met with one of my favorite colleagues, Dr. Michael Krychman.  Dr. Krychman is a Hoag Hospital physician who specializes in sexual medicine and cancer survivorship, and he is internationally known for his expertise.

As we spoke about the usefulness of sex therapy as an adjunct to medical treatment, Dr. Krychman mentioned how difficult it was for women that have sexual pain problems like vaginismus and that have been sexually abused to come to therapy.

I understand.  Most every woman who comes into my office who has been sexually abused–whether they’ve been diagnosed with a sexual pain problem or not–is not exactly thrilled to be there.  After all, talking about sexual abuse is very difficult.  It brings up feelings of shame, guilt, helplessness, and even disgust.

When women do come in, it is often because they cannot have sex with their partner, either because of sexual pain or because they are being “triggered” and cannot tolerate the physical sensations of lovemaking.

Here is what I know:  If I don’t go slowly, don’t go at the woman’s pace, I’ll lose her as a client.  And that’s the last thing I want to do.  And I have also learned that (more…)

Just got this in my inbox, thought I’d share it with my readers.

Dr. Oz Interviews NVA Board Member about Vulvodynia on XM Radio

XM radio subscribers can tune into Channel 156 from their satellite radios.  If you don’t have an XM subscription, you can quickly sign up for a free trial and listen to the show online: http://xmro.xmradio.com/xstream/index.jsp  

Kind regards,

Dr. Stephanie Buehler, Director

Last Friday I posted an article on the top reasons people make excuses for not having sex.  This week, I’m going to address those reasons in The Buehler Institute blog.

I can certainly attest to the fact that a lot of clients report that they have lost interest in sex because they are so tired.  I’m not really sure what miracle cure they are hoping for, but getting more sleep would be the common sense answer.

Since the answer to being tired is so obvious, could it really be that “I’m tired” means “I’m avoiding sex”?

I think that if you are tired all the time, you need to:

1. Get a medical check-up to rule out problems like thyroid disorder.
2. Figure out how you can cut back on your activities to leave you more time to relax and to rest.
3. Solve any problems that you have with insomnia.
4. Ask for help and delegate more so that you have more energy.

5. If you’re avoiding sex by being tired, try to figure out why that is and solve that problem first

When I used to treat people with autoimmune disorders that are highly affected by stress, I used to find that people were very reluctant to give up activities because that’s what made them feel alive.

Sex can make you feel alive, too.  It is an activity that is designed to help you relax and feel restored, not depleted.  Being too tired for sex really is a sign that something is out of balance.  Even if you are affected by chronic illness, caregiving responsibilities, or a stressful job or home life, you can still have sex with your partner.  Love and support, remember, are good things to have when you are tired and stressed.

How do you keep yourself from being too tired for sex?  Or if you are too tired, what changes might you make?  I’d love to hear from you.

Dr. Stephanie Buehler

Director, The Buehler Institute