“It's a totally ridiculous, completely unsexy word. If you use it during sex, trying to be politically correct– 'Darling, could you stroke my vagina?' – you kill the act right there. I'm worried about vaginas, what we call them and don't call them.”
- Eve Ensler, The Vagina Monologues
Not only do women sometimes have a difficult time hearing the word vagina but talking about their vagina’s is even more stressful for them. So when women begin to experience vaginal dryness, there seems to be such discomfort and shame about what is occurring within their vaginas.
Vaginal dryness is the lack of lubrication often occurring around peri/post menopause; however, certain immune diseases, smoking, breastfeeding, pregnancy, chemo and radiation, medications, and douching can lead to vaginal dryness.
When women transition into menopause, the lack of estrogen effect on the lining of the vaginal walls causes the walls to thin and atrophy. The vagina during states of arousal enlongate and expand along with lubricate allowing for intercourse. As a woman reaches menopause and after, her vagina is slower in the sexual response and dryness may cause intercourse to be painful.
Women may experience symptoms of itching, burning, soreness, bleeding and pain during and after intercourse, urinary symptoms and urinary tract infections. Seeing your healthcare provider for a pelvic exam, pap smear, urinalysis, and lab testing is necessary to diagnose vaginal atrophy but also to rule out other possible causes.
Treating vaginal dryness with estrogen creams, tablets, and rings can be very effective and I prescribe these routinely for women. Options of bio-identical hormone replacement are also an option. I counsel women on the necessary usage of lubricants and moisturizers. Astroglide and Silk are very effective lubricants and Replens is a helpful moisturizer. It is necessary to avoid douching, hand lotions, hot tubs (prolonged and frequent use), bubble baths, perfumes and harsh detergents.
Often women express that it must be time for them to stop having a sexual life because of vaginal dryness. Remember that sexuality is an integrated experience not limited to a physical experience. A woman’s mental, emotional, and spiritual life are also very integral to her sexuality. As we all age, the sexual response may and will take a bit longer to reach, but knowing how to integrate the fullness of a woman’s entire being, not limited to a vagina, is the key to lubricating sexuality into a pleasurable experience. So ladies, despite the idea that vagina may not be a comfortable word, your vagina is designed to be a comfortable place for your pleasure, even when things change and you age.
Take some time to reflect on each of the following thoughts. While you are thinking of these thoughts, bring to mind your ideas about your sexual desire (or lack of desire). Now I want you to hold those images, ideas, and perceptions in your mind and hold your awareness of that desire while contemplating the following:
Your heart is beating, your lungs are breathing, you have five senses with which to perceive your life and a mind to process the inner and outer information. In this moment, realize the preciousness of each of these functions. Bring to the surface whatever sexual desire you have stirring and mingle this with how invaluable and delicate your life is. Direct that sensation of desire and the idea of your precious life into the center of your chest. Breath with this sensation for a few moments.
Next, think of how you’ve had moments in life where your sexual desire would arise and drift, arise and drift, as well as even lack any quality of aliveliness. Think about those sexual experiences and maybe how you’ve been attempting to keep recreating it, sometimes you can, and other times, you feel a sense of disappointment. But nonetheless, you want to somehow capture that desire and keep the cycle going. But you can’t, as the nature of desire is impermanent. It changes. It comes, it goes. Whatever begins to emerge from the center of your chest as you contemplate this, just add some breathe there and let it be.
What I know may arise for many patients while contemplating the transient nature of desire is a sense of sadness, anxiety, frustration, or numbness. Hold whatever sensation and feeling emerges with breathe. It is here where certain patterns and conditions manifest. So as we are very skilled at doing, we “figure out” ways to make our sexual desire more solid, more permanent, continuous. Through the striving and seeking and desperation to capture it, we feel more and more of the same frustration and anxiety. This is a very painful cycle, which makes us suffer and takes us away from truly enjoying our lives.
Because the conditions of this cycle are being weaved, we produce consequences to them. Examine how you have set up certain conditions in your sexual life and the consequences it has produced. Just notice what comes and let go, breathe. Whether it’s the man hooked on pornography that has now led to erectile dysfunction or a woman trying to avoid a sexual advance from her lover that leads to her acquiescing and experiencing no pleasure.
Practice looking at your sexual desire in this way without any judgment or criticism. Next time you find yourself curious about why your sex life is showing up the way it is (and really you could do this exercise with anything going on in your life), contemplate the above reminders and see what the wisdom of your own mind can show you. The wonderful gift in this is that once you tap into your patterns and see how your sexual experiences might not be as enriching as you’d like, you can change the pattern. In the words of Lao Tzu, “If you do not change direction, you may end up where you are heading.”
In this article, professor Allen Frances presents a criticism from Tamara Kayali who discusses how including Female Sexual Arousal and Female Orgasm Disorders (FSDs) in the DSM-5 could be very problematic thanks to the overzealous pharmacology industry. It's no secret that sexual dysfunction is a hot button topic and most of the pharmacology industry is focused on developing the magical pill to fix all your (real and imaginary) woes. Kayali's biggest concern is that of potential "Pharma disease mongering" – the increase in marketing for these magic treatments will increase the number of women seeking treatment for FSD not because they have it, but because they are striving to reach unreasonable societal expectations set by the pharmacology industry. Hopefully when these women seek treatment they consult a sexuality counselor who can work through their experiences and offer a more holistic approach than doctors who have been swayed by the drug companies' marketing ploys.
Read the full article here.
Dr. Oz recently featured a panel of three sexuality experts including medical doctors who addressed the topic of pornography and erectile dysfunction. They mentioned that a growing number of young men have been seeking help for ED and the traditional pharmaceutical treatments are not effective. The cause, they theorize, is a desensitization of the brain and genitals due to a maladaptive pornography viewing habit and an idiosyncratic masturbatory style. They present a great discussion of all the biological and psychological causes and present helpful techniques that can help.
Watch all 4 parts, starting here.
Sexuality counseling is a key tool in assisting individuals and couples to handle erectile dysfunction. There is more to sex than an erect penis! Blood flow, medications and other medical impediments can impact erections, but the body is more than just systems. As a person your thoughts, worries, connections and interactions also affect the body's ability to get and maintain an erection.
You should seek medical treatment and then sexuality counseling for erectile dysfunction as soon as you notice the symptoms. Most people notice an inability to get an erection, lessening rigidity, loss of erection during intercourse or fewer morning erections. Many medications and medical conditions like diabetes, blood pressure issues or injury can change your ability to achieve satisfactory erections. Treating medical causes is only the first step in recovery from erectile dysfunction. I often recommend lifestyle changes including diet, stretching, meditation or exercise to address physical causes of erectile dysfunction.
I find that shifting the individual's thoughts away from penis centered sex to a sensual whole body idea of sex works well. Focusing on connection and satisfaction without pressure to perform a very narrow action can relieve stress while building a positive new outlook on what sex offers to you. Couples who embrace a broader definition of sensuality often redefine their own needs sexually and learn to meet those needs in exciting new ways. Developing a new sexual style can encourage a deepening of connection in body-heart-spirit.
What is Sherri’s approach to FSD?
FSD may include a list of common physical (sensations) symptoms, yet a more comprehensive evaluation needs to include what is happening emotionally (passion), mentally (beliefs), and spiritually (meaning). Because we are a dynamically integrated system of energy, it is essential to include each aspect of being human and how that impacts sexuality. I may begin working with someone who has just had a typical yearly exam, but my questions are more likely to probe the heart and mind aspects left unattended by a medical-only approach. (Don’t worry, I’ll discuss specific treatments for FSD later in this blog series.)
Stress and personal life experiences can become a trigger for FSD or it can work in the other direction. FSD contributes to a woman’s mental, emotional and spiritual stress in a very real and life altering way. Without emotional connection and reassurances that she may not be getting from her sexual partner, a woman’s anxiety may also increase from multiple responsibilities such as work, finances, children, etc.
Gina Ogden, author and distinguished sex therapist, developed the ISIS Wheel of Sexual Experience as a tool for examining the aspects of a woman’s sexual understanding. The wheel divides the idea of a woman’s sexuality into four domains: physical, emotional, mental and spritual with the center being the integrative experience. This tool has proven invaluable in working with my patients. By encompassing and gently examining all aspects of the woman, we are able to look at a broader picture of desire and intimacy.
Female Sexual Dysfunction (or FSD as it is commonly known) is often an umbrella term for what modern medicine calls sexual dysfunctions such as, low libido, low desire, painful intercourse, aversions to sex and difficulty with or absent orgasms. FSD can even be divided into several disorders including low sexual desire or sexual arousal disorder (desire is there, no arousal); orgasmic disorder; and sexual pain disorder.
What we do as clinicians is determine if the dysfunction is persistent or episodic, how much distress it's causing, and if other medical issues (disease, medications, substance use/abuse) are the problems. The DSM-IV (published by The American Psychiatric Association) provides a framework for diagnosis of Female Sexual Dysfunction, however, the labeling of sexuality as a dysfunction is part of the problem. This labeling may engender a harmful sort of shaming around sex and an idea that women need to be “fixed” because they are broken, when the patient lacks only understanding and healing of the heart, mind and body together.
The truth is that women can and do have active, healthy and satisfying sexual lives, but sometimes our bodies, minds and hearts need a little help to overcome bumps in the road.
Let’s discover the myths and truths about Female Sexual Dysfunction.
If you are concerned about your sexual functioning, consult your physician for a complete physical. This will give you a basic understanding of at least one aspect of the interwoven puzzle that is Female Sexual Dysfunction.
In this four-part blog series, I invite you to explore the realities of Female Sexual Dysfunction and develop a little bit of pro-activeness on behalf of your sexual self. We’ll learn about the myths of desire, understand where medical interventions can help and when the power to heal really starts with the woman in charge – you.
Possibly one of the most troubling issues with the group of symptoms called “Female Sexual Dysfunction” is that you might be willing to brush them off as “simply getting older” or “losing your interest.” Your friends might say that it is just what is happening through menopause or perimenopause and there is nothing to be done.
This might be one place where knowing yourself and having someone like me on your side could really change things. Many factors go into a healthy sexuality including the body’s health, side effects from trauma or medicines, emotional stress or change, as well as the heart’s desires.
Sexuality and physical health can be closely related through menopause and perimenopause, but there are a lot of different factors that go into a healthy sexuality. Modern medicine can be combined with yoga, acupuncture and herbal treatments to rebuild your overall health. Remember that your sexual health is important to your satisfaction and happiness as a whole person and not everyone functions exactly the same.
Next we’ll discover the myths and truths about what FSD really looks like!
Telemedicine. Contact by email or call 775-403-5757.
"Throughout my 40s, I sought help from different professionals for perimenopausal and relationship issues. In Sherri, I found a trusted guide to help me navigate the turbulent waters...."