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Female Sexual Dysfunction, Another Perspective

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Hey sex fans,

It appears that my posting of last week, Female Sexual Dysfunction Is A Fictional Disorder, caused quite a stir.  As you recall, I was answering a question from a woman who asked if FSD, or female sexual dysfunction is real or a fictitious “ailment” that is being promulgated to sell pharmaceuticals to unsuspecting women.  I replied; “I think that, for the most part, female sexual dysfunction, or FSD, is a fictional disorder. I also think pharmaceutical companies are trying to hit on a female version of Viagra to treat this imaginary disorder so they can make a bundle, just like they did with as the male version.”

Well, that didn’t sit well with some friends and colleagues. One among them, Dr. Serena McKenzie took the most exception. She sent me a little note: “Your blog on female sexual dysfunction being fictitious is – respectfully – fucking bullshit sir.” Ok then!

I invited Serena to make her case not only to me, but to all my readers. What follows is Serena in her own words.

Flibanserin, the first and only medication available for use in reproductive aged women with low libido, becomes commercially available this week after a rocky and controversial road that led to its FDA approval Aug. 18. The view on the medication whose brand name is Addyi (pronounced ADD-EE) ranges from a historical achievement in women’s health care to an epic failure of commercialized medical propaganda. Despite the lengthy debate that has surrounded flibanserin, what most people want to know is whether it will help their sex life or not now that it is here.

addyi


First Things First

While sexual concerns can be difficult to discuss for many women and their partners, it is important to acknowledge that sex and intimacy are some of the great extraordinary experiences of being human. When sex goes badly, which statistically it does for 43 percent of U.S. women, the consequences can devastate a relationship and personal health. One of the biggest applauds I have for the FDA is their statement of recognition that female sexual dysfunction is an unmet clinical need.

Sexuality Is Mind-Body But Not-Body?

Sexuality is usually complicated, and problems with sex such as loss of libido are multifactorial for most women. Antagonists to flibanserin cite psychosocial contributions such as relationship discord, body image, or history of sexual abuse to be the most pinnacle causes of a woman who may complain of problematic lack of sexual desire, and that sex is always a mind-body phenomenon. While these factors often implicitly correlate to loss of sexual interest for a woman, they don’t always, and you cannot advocate that women’s sexuality is all inclusive of her mind, body, and spirit — and assert simultaneously that a biochemical contribution which flibanserin is designed to address in the brain to improve satisfying sexual experiences does not exist.

(c) Myles Murphy; Supplied by The Public Catalogue Foundation

(c) Myles Murphy; Supplied by The Public Catalogue Foundation

The Biochemistry of Sex

Antidepressant medications that alter brain biochemistry are notorious for having sexual side effects which can be prevalent up to 92 percent of the time, and are known to decrease sexual interest, disrupt arousal, and truncate orgasm in some women. Ironically, flibanserin was originally studied as an antidepressant, and while the exact mechanism of how a medication can impair or improve sexual interest is unknown, it should not be difficult to consider that if biochemical tinkering can crush sexual function, it may also be capable of improving it.

Efficacy Data Dance

Flibanserin is a pill taken once nightly, and has been critiqued as showing only modest increases in sexual desire, with improvements in sexually satisfying events rising 0.4 to 1 per month compared with placebo. However just because flibanserin has lackluster efficacy data, that does not mean it is ineffective, and even small improvements in sexual function can be life altering for a woman struggling with disabling intimate problems. If only 1 percent of women with low libido were to improve their sexual function with use of flibanserin, that equates to 160,000 women, or the population of Tempe, Arizona.

Blue Sky Side Effects

Flibanserin has side effects, and the sky is blue. All medications have pro and con profiles, and for flibanserin the most common consequences of use include fatigue, dizziness, sleepiness, and a rare but precipitous drop in blood pressure. Women may not drink alcohol while taking this medication. Providers who will prescribe it and pharmacies that will dispense flibanserin must be approved through what is called a Risk Evaluation and Management Strategy, or REMS, which means they are educated on advising women on how to take flibanserin safely. While a REMS program is arguably overkill compared to numerous higher risk, common prescriptions which do not require a REMS, it is an excellent opportunity for clinicians who have a background in sexuality to be the main applicants since they are far more qualified to assess proper candidates for treatment as well as continue to endorse holistic measures alongside flibanserin. Women who are interested in trying flibanserin should only obtain it from sexuality trained professionals.

The Proof Is In The Sexy Pudding

If flibanserin is worthless, the marketplace will bury it in a shallow grave quickly. Women will stop paying for it, and conscientious medical providers will stop prescribing it. Yet 8,500 women taking flibanserin were studied, over a 1,000 of them for one year, and the data suggests it will help some. Women deserve to be educated on their options, because sexual health is worth fighting for.

Changing The World, One Orgasm At A Time

We simply cannot overlook how astronomical of an achievement it is to even have a mediocre medication approved for female sexual dysfunction. Women’s sexuality has been ignored by medicine for most of history. At least now we have something to fight over.

The controversy about flibanserin is in fact magnificent, and frankly, the entire point. We must talk openly about sexuality and sexual concerns to improve them, personally for one woman at a time, but also uniformly to embrace female sexuality as a vastly larger societal allowance.

A satisfying sexual life is far more than the restoration of sexual dysfunction, it’s a thriving, multi dimensional, ever evolving weave of psychology, relationships, life circumstances, and yes can include a milieu of biochemistry and neurotransmitter pools.

Is a pill ever going to replace the vastly complicated arenas that fuse into our sexual experience? Of course not — it’s absurd and lazy-minded for anyone to suggest that is even being proposed. But it is necessary and inherently responsible to allow for all possible puzzle pieces to be utilized through the ever evolving navigation of sensuality, intimacy, and erotic fulfillment.

So will flibanserin make your sex life better? Maybe. But considering the conversation about it valuable as well as its use as merely one tool among many options to improve sex and intimacy would be the better bet. Ultimately, we “desire” sex that is meaningful, erotic, and dynamic. The journey of seeking sexual vitality deserves every key, crowbar, heathen kick, graceful acrobatics, or little pink pill that lends its part to the process, no matter how small or big, for the opportunity to discover and embrace a sexual aliveness.

Holistic physician, certified sexual medicine specialist, sex counselor, medical director of the Northwest Institute for Healthy Sexuality

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Female Sexual Dysfunction Is A Fictional Disorder

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Name: Sharon
Gender: female
Age: 30
Location: PA
I’ve been reading a lot lately about FSD, or female sexual dysfunction. Is there such at thing? It strikes me as a fictitious “ailment” that is being promulgated to sell pharmaceuticals to unsuspecting women. What are your thoughts?

I share your skepticism. I think that, for the most part, female sexual dysfunction, or FSD, is a fictional disorder. I also think pharmaceutical companies are trying to hit on a female version of Viagra to treat this imaginary disorder so they can make a bundle, just like they did with as the male version.

body as art

So much of female sexuality is caught up with the cultural context of a women’s role in society — family obligations, body image and patriarchal views of marriage, etc. For the most part, men aren’t nearly so encumbered. So when one talks about female sexuality, particularly when the notion of a condition or a disorder arises; ya gotta ask yourself, what’s going on here?

I too have been noticing a lot of discussion in the popular culture lately about female sexual dysfunction. My first response is to ask myself, who’s raising the issue and why? Sure some women, like some men, experience difficulties in terms of desire, arousal and orgasm, but what of it? Is it a syndrome? Is it really a dysfunction? I personally don’t think so. The sexual difficulties most people experience can be explained and dealt with in a less dramatic way then with drugs?

And here’s an interesting phenomenon; the repeated appearance of the term female sexual dysfunction in the media lately actually gives the concept legitimacy. I’m certain the pharmaceutical industry is hoping that it will. If they can make the connection in the public mind between what women experience in terms of desire, arousal and orgasm concerns and what men describe as erectile dysfunction, then most of the work is done. In other words, I think the entire effort is a marketing ploy.

female sxualityI think we can safely say that, in order to determine what female sexual dysfunction might be, one has to clearly understand what a “normal” sexual response is for a woman. This is where we traditionally run into problems. Sex science is notoriously lacking in this endeavor. One thing for certain, although both women and men have a discernable sexual response cycle, a woman’s sexual response is not the same as a man’s. Even though we can’t say with certainty what “normal” is, therapists are famous for turning difficulties into disorders. And once you have a disorder it becomes the basis for developing a drug therapy. So you can see how this becomes a self-fulfilling prophecy.

Currently there’s a real buzz among clinicians concerning the efficacy of Addyi, the so-called “female Viagra”. But most sexologists, myself included, are unimpressed. Basically, the drug in question is an antidepressant. When I heard that, red flags began to fly. Antidepressants are notorious for their adverse side effects, especially in terms of sexual arousal in both men and women. The second problem with the study was the whole notion of desire and distress. Lots of women experience diminished sexual arousal but are not distressed by it. But if there’s no distress, clinically speaking, then it can’t be considered a disorder. You see where I’m going with this, right? If there’s not a “disorder” there’s no need for a pharmaceutical intervention.FUCK

According to the research some of the women in the clinical studies leading up to the approval of the drug claimed they were less distressed by their “condition,” Hypoactive Sexual Desire Disorder, than they were at the beginning of the study. According to clinical trials of Addyi held in 2013, only 8% – 13% of the women experienced “much improved” sexual desire and only about 2 more satisfying sexual encounters per month were had. In other words, when behaviors were studied, the actual number of satisfying sexual episodes reported by these less distressed women hardly changed of all. This indicates to me that the antidepressant helped lift the spirits of the distressed women, but did nothing to increase their satisfaction with their sexual outlet.

Twice the FDA rejected Addyi for its severe side effects and marginal ability to produce the effect that it is being marketed for. And despite the fact that the drug is now available, those side effects still exist. Women who take the pill are likely to experience dizziness, nausea, drowsiness, fainting spells, and falling blood pressure. Coupled with alcohol and even hormonal contraceptives the odds of these potential side effects occurring increase. Persons with liver ailments, or taking certain other medicines, such as types of steroids are also at higher risk. On the other hand Viagra has very mild side effects that may include headaches, indigestion, blue-tinted vision and in some cases a stuffy nose.

While a man can pop Viagra an hour or so before he plans to have sex, women who are looking for increased sexual desire need to take Addyi daily for up to a month before they should expect to see any effects.

Good luck

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The Heartbreak of Male Performance Anxiety

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I get a dozen or so messages a month on this topic. I’ve written about it in numerous postings and spoken about it in several podcasts, but still the email comes.

One of the real bugaboos for anyone, regardless of gender, is living up to our own expectations of sexual performance. So many things can get in the way, literally and figuratively, of fully enjoying ourselves and/or pleasuring our partners.

The arousal stage of our sexual response cycle is particularly vulnerable to a disruption. And when there’s trouble there, there’s no hiding it. A limp dick or a dry pussy can put the kibosh on all festivities that we may have hoped would follow.

However, performance anxiety can strike any of us, regardless of age, and at just about any point in our sexual response cycle. This is a particularly galling when it seems to come out of the blue. And regaining our composure can be more far more difficult than we imagine.

Today we will be focusing on male performance anxiety.  I’ll address female performance anxiety at a later date.

Here’s Bob, he’s 26:
Doc, this has never happened before. But I couldn’t get it up tonight, and this chick was H.O.T. Now I’m not gay at all, but I haven’t had sex in about 3 years because I was locked up…so I masturbated pretty regularly, about 3 or 4 times a week. But I can’t figure out why I was soft… the only thing I can think of is I ate clams tonight and I’ve never had them before. Could it be that or should I get checked out?

It weren’t the clams, darlin’! And I don’t think you need to get “checked out” either…at least not right away. If you could back away from the situation a bit and stop freaking out, I think you’d discover the source of your problem all on your own.

Here’s the thing—while you were out of commission there in the slammer, you relied, as you say, on jerking off. Okay, cool. We all do what we gotta do. Now the first time you try to score after your release…you go soft. This tells me you have a mild case of performance anxiety. We all get that from time to time.

There’s probably nothing wrong with you or your johnson. You just got the jitters first time you tried to get you some after being away, that’s all.

The anticipation of boning this H.O.T. chick—fueled by some predictable self-consciousness; what with just getting out of the big house and all—pulled the plug on your wood. No surprise there, right?

What I don’t want to see happen is for you to replay the incident over and over in your mind’s eye til that’s all you can think about. If you do, this proverbial molehill will become a mountain. You’ll then bring all this anxiety to your next encounter, setting yourself up for even more disappointment. You can see how this shit can snowball? If you interpret every less than satisfying encounter as a failure, your fears will become self-fulfilling. You’ll begin to avoid partnered sex and you’ll develop a full-blown sexual dysfunction. And your self-esteem will take a nosedive, too.

If you’re preoccupied with your performance, it’s less likely that you’ll be fully present during sex with a partner. This pretty much fucks up your sexual responsiveness and any hope for spontaneity. Why not just relax into the whole sex thing and not try to prove your manhood with your pecker?

Then there’s Steve with a slightly different take on this meddlesome problem:

My partner and I have been together for just over 3 years now in a monogamous relationship. I am the top and he the bottom. Our problem is not premature ejaculation on his part, but his inability to have an orgasm at all. No matter what I try and even if he masturbates, sometimes it is impossible to get him to cum. Is this a medical issue? Have you ever heard of this?

Delayed ejaculation is the difficulty one has ejaculating even with a firm erection and sufficient sexual arousal and stimulation. This problem is not uncommon. For most men, delayed ejaculation occurs during partnered sex more frequently than while masturbating. In fact, 85% of men with delayed ejaculation can usually cum by jacking off. However, in partnered sex, the guy may be unable to ejaculate at all, or only after prolonged partnered stimulation. This problem can be very frustrating and cause distress for both partners involved, as you already know.

What causes delayed ejaculation? Well, it could be a number of things. It could be something as simple as performance anxiety, or inadequate stimulation, or there could be neurological damage.

I don’t want to be too reductionist here, but most of us experts believe that the majority of instances of delayed ejaculation aren’t physical in nature, but rather are the product of psychological concerns. Simply put, there’s a difference between the psychosexual response we have when we are alone and the one we experience with a partner. There’s probably nothing wrong with your partner’s unit. It’s all in his head…or his mind, to be more exact. If I had to guess, I’d say he’s got a real bad case of performance anxiety.

When I see this sort of thing in my private practice, I always begin the therapeutic intervention by calling a moratorium on fucking of any kind. This immediately takes the pressure off the couple. From there we begin to rebuild the partnered psychosexual response one step at a time. We begin with sensate focus training (Sensate Focus is a series of specific exercises for couples that encourage each partner to take turns paying increased attention to their own sensations. More about these helpful exercises in the weeks to come.), stress reduction and relaxation exercises. These applications are designed to reduce performance pressure and instead focus on pleasure. The idea is to get them to stay in the moment; absorb the pleasure present without worrying about what is “supposed” to happen.

Finally we address as frankly and openly as possible any fears or anxieties that they may have—as individuals or as a couple. I have the greatest confidence in this method; it succeeds over 90% of the time.

Ok, let’s recap shall we?

Overcoming sexual performance anxiety is dependent on five simple things.

  • First, a guy needs to be attuned to his sexual response cycle — arousal, plateau, orgasmic and resolution phases. He should know what kind of stimulation he needs at each phase to fully enjoy himself and satisfy his partner.
  • Second, the more worried a guy is about a performance issue, the more likely that problem will present itself. A bad experience in the past can often set the stage for its recurrence.
  • Third, don’t be afraid to talk this over with your partner. Withdrawing from your partner or shying away from sex altogether will only increase the likelihood that the problem will persist.
  • Forth, be proactive! Fearing the loss of your sexual prowess or feeling sorry for yourself is counterproductive. Confront the challenge head on. Employ sensate focus training stress reduction techniques and relaxation exercises to help you push past this temporarily impasse and regain your self-confidence.
  • Fifth, free yourself from the mindset that your dick is the center of the universe. Your manhood or your capacity to be a great lover does not reside in your genitals. Expand your sexual repertoire. Remember, pleasure centers abound in your body as well as your partner’s.

Good luck!

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I’m not that sexually experienced. How can I be more confident in bed?

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Buck up, champ: Feeling a little anxious about your sexual history (or lack thereof) is totally normal. Here are 10 ways to improve your sexual performance without having to have sex first.

by Vanessa Marin

Everyone has anxiety about being great in bed, but when you don’t have much sexual experience that anxiety can feel sky high. For some guys, that concern about experience turns into a horrible cycle: You don’t feel confident about your sexual experience, so you end up not having sex, and your experience level remains the same.

Here’s the good news: Experience is a good teacher, but you can still learn how to be great in bed without it. Here’s how.

1. Put it in context

As a sex therapist, I can tell you that just about everyone has self-confidence issues when it comes to sex—even people with a lot of experience. The insecurities are different from person to person, but they’re insecurities nonetheless. And keep in mind that many of the women you’re intimate with may be inexperienced or insecure as well. You’re certainly not alone.

2. Do your research

You can school yourself on how to have great sex without having any experience whatsoever. I also recommend Guide To Getting It On: Unzipped by Paul Joannides or The Big Bang by Nerve for general sex education topics like STIs and pregnancy prevention, anatomy, communication, and consent. She Comes First by Ian Kerner is a fantastic guide to the art of pleasuring a woman, and I recommend it to almost every man in my sex therapy practice. Come As You Are by Emily Nagoski is a great book about female sexuality in general.

One caveat: Don’t get your sex education from porn! Porn is meant to be entertainment, not education. Porn sex has very little resemblance to real sex. It’s all about angles, lighting, and editing. Most of the moves you see in porn simply won’t go over well in the real world.

3. Take care of your body

One of the best things you can do to improve your confidence is to take great care of your body. Sex is a physical act. Not only do you need endurance, but you also have to feel comfortable and confident in your own skin. You already know what you should be doing—eat right, get enough sleep, and exercise regularly. Exercise, in particular, can also have added sexual benefits, like increasing your sex drive and improving your erections and your orgasms.

Grooming is important too. Wear clothes that flatter your body and make you feel good. Get your hair cut and your beard trimmed. The better you feel about yourself and your body, the more confident you’ll feel in bed.

4. Masturbate

Yes, masturbation can improve your partnered sex life! Most men masturbate pretty thoughtlessly, zoning out to porn while they try to get the job done as quickly as possible. This actually serves to disconnect you from your body, and decreases your control over your erection and orgasm.

Instead, you can use masturbation to help increase your stamina. First, think of how long you’d like to last with a partner. That becomes your new masturbation session length. During that time, really pay attention to your body. Notice what it feels like when you start getting close to orgasm, and train yourself to back off when you’re on the edge.

You can also practice purposefully losing your erection, then getting it back again. This will help decrease anxiety about losing your erection with a partner.

5. Go slow

When you’re feeling anxious about sex, you’re more likely to rush. Lots of inexperienced men have the tendency to jump right to intercourse, but it’s so much more fun to take your time and go slow. Spend plenty of time on kissing, touching, and performing oral sex, and even slow down your physical movements. A slower pace will help dramatically decrease your anxiety levels.

Plus, keep in mind that most women feel more physical pleasure from oral sex and fingering than from intercourse, and a lot of women love being teased. She’ll appreciate your pace, too.

6. Focus on her pleasure

Being fantastic in bed means genuinely caring about your partner’s pleasure. It’s arguably the most important quality in a great lover. If you spend time specifically focusing on her body—taking your time with her, kissing her all over, fingering her, going down on her—you’re going to impress her way more than the guy who has a ton of experience but is selfish in bed. Plus, seeing the pleasure that you bring her will naturally help you feel more confident.

7. Treat her like an individual

I’m all about sharing sex tips and techniques, but the reality is that every woman likes different things. No one technique is going to work for every woman. This is great news for you because it shows that experience only goes so far. We’re all beginners when we have sex with someone brand new. Try to explore her body with openness and curiosity. Pay attention to how she responds to your touch. Does she moan? Does she start breathing more heavily? Does she arch her body toward you? Don’t be afraid to ask her what she wants or likes! One super-simple way to ask for feedback is to try two different things on her, and ask her, “Do you like it better when I do this or this?”

8. Keep it simple

So many men overly complicate sex, especially when they’re feeling anxious. Technique is important, but you don’t need to go crazy trying out a million different things on her. The key to female orgasm is actually consistency, not complicated tongue maneuvers or finger gymnastics. Switching things up usually throws her off and distracts her. Find something simple that seems to be working for her, and stick with it. Increase your pace and pressure gradually, but stick to the same basic technique.

9. Don’t think of it as a performance

One of the biggest mistakes that sexual newbies make is thinking of sex as a performance. They get overly fixated on the idea of maintaining a perfect erection, having the utmost control over their orgasms, and mastering their technique. But the truth is that no one likes feeling like they’re having sex with a robot. She doesn’t need you to perform for her like a circus animal. She wants to feel connected to you, and she wants to have fun. You can do that, even without any prior sexual experience.

10. Have a sense of humor

Sex is never perfect, no matter how much experience you have. Sex can be awkward, weird, and sometimes downright hilarious. You’re bound to try out a position that doesn’t work, bump foreheads, or get a cramp in your leg. Having a sense of humor is so important in those moments. If you can laugh it off, you’ll get back to the fun much faster.

Complete Article HERE!

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Sex education needs to pay more attention to masturbation

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By

Having a wank is bloody brilliant.

It’s the only form of sex that’s 100% safe from risks of STDs. It’s a vital part of learning what you like. It’s a way to enjoy sexual pleasure without the need for a partner or a random hookup buddy.

It’s safe, great, and healthy, basically.

So why is masturbation so rarely mentioned as part of sex education?

If your experience of sex education was anything like mine, masturbation wasn’t mentioned once.

The focus was likely on the reproductive side of things, teaching you about how eggs are fertilised and babies are made.

But your sex education classes also likely had lessons around STIs. You remember – the classes in which they told you to always, always use a condom and showed you a bunch of scary pictures of genital warts.

t’s strange that in these lessons, we were only presented with two options: use contraception or don’t have sex.

Why wasn’t masturbation offered as an alternative – a way to try out sex without any risks?

A lot of it boils down to the complete exclusion of sexual pleasure from sex ed.

The majority of our sex ed lessons like to pretend that sex is had purely for the purposes of reproduction, skimming over things like the female orgasm (because unlike male orgasm, it’s not essential for conception), the existence of the clitoris, and sexuality.

Ignoring pleasure and, as a result, masturbation (a sexual thing for only the purpose of pleasure) can be damaging.

It encourages the idea that sex isn’t about enjoyment, and that painful, unpleasant sex is perfectly okay. Because feeling sexual isn’t mentioned, there’s no suggestion of only having sex when you’re really into it.

Ignoring masturbation, and our desire to masturbate, allows all kinds of unhealthy stereotypes to be upheld.

Girls are allowed to think that wanting sex is weird, or gross, or makes them a slut. By refusing to mention masturbation, we uphold the idea that it’s something to be silent about, to be ashamed of.

Refusing to talk about it means there’s no opportunity for teachers to break down myths, like masturbating making you blind (it doesn’t), or masturbating being morally wrong (it isn’t).

A lack of masturbation mentions also means there’s no opportunity for educators to make sure people are masturbating safely – with the right tools, with clean hands, and with consideration for your delicate bits.

By the time they reach sex education classes, many young people are already masturbating.

But they likely aren’t talking about it, feel ashamed of doing it, or aren’t sure how to do it.

Those who are already having solo sex sessions could do with reassurance that what they’re doing isn’t shameful or unhealthy.

Those who aren’t need to be taught that masturbation is a near-essential part of having a satisfying, healthy sexual relationship – one in which you’re aware of what you like and can guide your partner to get you off.

Being unaware of what pleasure feels like, and your ability to give yourself pleasure, is dangerous. It allows young people to put up with painful, uncomfortable sex that they believe is to be expected, or to believe their pleasure isn’t necessary.

Young people need to be taught about masturbation because it’s the starting point of learning about sexuality and pleasure.

They need to be taught about masturbation so that they know it’s nothing to be ashamed of, nothing to make fun of, and that it doesn’t define them as ‘weird’ or ‘gross’.

They need to learn about masturbation so that they’re able to start exploring sex without needing to involve someone else – someone who may not have their best interests at heart.

If you want your kids to have safe sex, teach them about masturbation. If that feels awkward, that’s a shame, but it’s reasonable. That’s why we need schools to be mentioning masturbation at the same time as sex.

Complete Article HERE!

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