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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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Plays Well With Others

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Name: Jim & Elaine
Gender: Couple
Age: 42 & 38
Location: Denver
We have been happily married for 15 years. We have a good, but pretty vanilla sex life together. We want to spice things up and are talking about maybe looking for other couples online. We’re both in good shape and have very outgoing personalities. Both of us have had one short affair in the past, now we think we want to play together. Thoughts?

You guys want to look for other couples online…for ummm sex? I mean you imply that but you don’t really come right out and say it, do you? I know you are new to this and you are just feeling your way through this unfamiliar territory, but unless you want to look like rank amateurs by other consensual non-monogamous couples, like swingers and polyamorous folks…and that’s what we’re talking about, right? You’d better get comfortable articulating precisely what it is you want, how you want it, and with whom.white on black

If you’ve already begun your online search, you’ve probably already discovered that there are several different avenues for you to pursue. There are, of course, dating and profile sites. There are also sites that feature ads from other non-monogamous couples. If swinging is what you are after, there are exclusive swing parties and more inclusive swinger clubs. And each of these outlets may offer special groupings for the fetish-oriented swinger.

Since you don’t actually say what kind of consensual non-monogamy you’re looking for, let’s talk swinging for now. Like I said, this isn’t the only kind of consensual non-monogamy, but it’s probably the oldest most established variety.

Before you swing, you guys need to decide what type of swing-set you want. If the vocabulary that follows is unfamiliar to you, you have some remedial homework to do before you launch your swing-capade. There is “soft” swinging and “hard” swinging. And bisexually may or may not be an option for you.

polyamory1If you assume that all swingers are open-minded about sex, consider this; lots of swing outlets prohibit male-on-male sex. Personally, I find this extremely bizarre and off-putting, but I suppose it only reflects the prejudices of the popular culture. There are some swing-sets that allow novice swingers to simply to be voyeurs. I can’t fuckin’ figure this out either. Maybe it’s a heterosexual thing.

If you gravitate toward the club-set there are 3 types to consider:

  1. SEX clubs — these clubs allow full-on sex, but only in designated areas.
  2. NO-SEX clubs — allow for lots of exhibitionism and voyeurism, including nudity, but no full-on sex. These clubs are great for meeting other swingers and to set up your own sex dates.
  3. Swinger parties are NO-SEX events, and are usually held in a nightclub or restaurant. Again, you can meet like-minded folks there and set up your own sex dates.

Whichever outlet you choose; make sure you understand the rules and regulations of the get together before you attend.

Like I said, it’s of the utmost importance that you guys decide, in advance, what your limits are. A good number of otherwise healthy marriages flounder at this point. Have a clear and frank exchange with each other on the ground rules of your swinging and then stick to them. Trying to negotiate a change to the rules of engagement during a swing is a very bad idea. That’s not to say that your ground rules won’t change and evolve over time; just don’t attempt to adjust them while they are in play.

Never push your partner into doing something he/she is not ready to do. Be open with each other before, during and especially after a swing. Effective communication is essential. This goes for communicating with your fellow swingers. Be sure to let everyone know that you are newbees to the scene. (Don’t worry, everyone will have figured that out already.) Novices stick out like a sore…hard-on.

Sexy people

Sexy people

Most clubs and groupings don’t allow single men. Most swing-sets are women oriented, to the degree that women set the tone for the swing. That being said, it’s still a man’s world. Men generally dictate the type of sexual expression that will be tolerated — thus the prohibition, stated or unstated, against male on male sex. Female on female sex is, of course, encouraged for obvious reasons. How’s that for a screwed-up double standard?

Most clubs expect full or partial nudity. My swinger friends advise that if you just want to attend so you can ogle others, stay the fuck home! Novice swingers, like you guys, ought to stay together until you feel comfortable being apart. But for Christ sake, don’t glom on to one another like the other swingers have the cooties.

Most of all, take responsibility for your eroticism and your sexuality. Be friendly and good-natured. And don’t try to pretend you’re a more accomplished sexual athlete than you are.

Be advised, you are about to embark on a sexual journey that will take you to the edges of what society regards as appropriate sexual behavior. Don’t be surprised if some of your more traditional friends discriminate against you when they find out about your new activities. Finally, swinging is far less about what you do (sex) and way more about who you are (a lifestyle). To that end, I’d like to turn you on to a fantastic resource. Check out my friends, John and Allie, at SwingerCast.  And be sure to listen to my two-part interview with them right here on my site. You’ll find Part 1 HERE and Part 2 HERE!

Good luck

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Beginning Sex Play — Tips and Techniques

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I most frequent hear from your average Dick and Jane, (or Dick and Dick, or Jane and Jane) who want to spice up their sex life. When they write to me they inevitably describe the kind of sex they’re currently having. And almost universally that description makes this grown man cry. Jeez, the boredom. How can they stand it? It’s a wonder any of them are having sex at all.

big funWhat’s with all the humdrum, run of the mill, we’ve always done it that way mentality? Are ya’ll afraid that if you add a little something new to your sex chore from time to time that the sky will fall? Holy cow!

Today’s tutorial is yet another attempt to motivate you to get off your butts and make something interesting happen in the sex department. We’ll begin today with what was once called foreplay.

First off, I hate the word “foreplay” because it suggests that all the really great sex play activities out there are only a lead up to a single — more important activity — that is fucking. It also implies that ya’ll can dispense with the one in order to hurry up and get to the other. And that, sex fans, is always a huge mistake.

From now on I want you to banish “foreplay” from your vocabulary. Instead let’s start using “Beginning Sex Play.” It says it all. It says it’s at the beginning, but there’s no suggestion that anything in particular must follow.amazing sex secrets

I’m of the mind that we’d all be better served if we thought of sex play as a continuum of pleasure with a beginning, middle and an end. If you ask me, our sex play ought mirror our sexual response cycles — arousal, plateau, orgasm and resolution. That way we’re less likely to overburden one particular activity at the expense of all the others. Get it? Got it? Good!

Experienced sex fans agree; the best sexual encounters include an extended period of sensual play at the beginning of most all sex play. This brings increased pleasure to both partners, and will make whatever else that might follow more satisfying. Just remember, beginning sex play can be a meal in itself.

Beginning sex play brings spice to the encounter because it gets our motors started. Even all you major sex athletes out there, who are perpetually primed for sex, will benefit from more beginning sex play. It will help cool your jets and make the encounter last longer than a firecracker. And I know that you know what I mean!

erotic talkIn our hectic rush-around-world, beginning sex play is particularly important. It helps us transition from the daily cares and woes to the realm of sensual pleasures. The workaholics among us need more time to become fully aroused. Our minds are still filled with the junk of the day, and not yet ready to give or receive pleasure. And pleasuring and being pleasured, I might add, takes a big attitude shift from that of the rest of the day. In fact, if you’re gonna try and approach sex and pleasure with the same mindset as you have on the job or with the kids, give it up now and be done with it. You’ll only walk away from the encounter disappointed.

Beginning sex play primes us for maximum pleasure. Us men folk will have the time we need to come to full erection and the women folk will have the time they need to properly lubricate. (By the way, this is called the arousal stage in our sexual response cycle).

When we stop thinking of beginning sex play as “foreplay” we realize there is no such thing as spending too much time giving and getting pleasure. If beginning sex play evolves into full-on fucking — SWELL. Both partners will be fully aroused and fucking will flow naturally and effortlessly from the pleasure enjoyed at the beginning of sex play.

Beginning sex play can include everything from chocolate and whipped cream to whips and chains. But let’s not get too far ahead of our selves. Let’s start at the beginning of beginning sex play, shall we? beginner's guide

Most people miss out on the pleasure of undressing with and for their partners. Stripping out of, or being helped out of our daily wear and into something sexy or nothing at all can be very arousing. It’s also a visual signal that we’re shifting out of our work-a-day world and entering the realm of sensuality. Stripping is an art form, ya know. We could all learn a lesson or two from the folks who do this for a living, but more about this in THIS tutorial.

Creating the right sex environment is important too. Make sure the room is warm. Proper lighting and music will surely add to the mood. Scents are also important. More and more people are incorporating erotica into their sex play — reading a sexy story together or enjoying some hot porn will make the encounter memorable.

Most women complain that their partners don’t kiss long enough and rush the kissing to get at their pussy. Guys, what the fuck? You want pussy? Use your mouth to maximum advantage kiss and nibble all over everything. Literally devour your partner with your mouth. Believe me, if you do this right, by the time you get to her pussy she’s gonna want to give it up big time.

Hanky Spanky Gift SetBeginning sex play is the perfect time for setting the mood for all that might follow. It’s a time for sharing fantasies, role-playing, dirty talk or some full body massage. Always have some nice lotion available then use your hands, forearms, feet and elbows to knead your partner’s muscles and naughty bits.

Certain areas on the body are more hot-wired than others. It’s your job to find each and every one your partner has. As you massage vary your strokes and touch to stimulate your partner. Roll your fingertips across his or her nipples and behind his or her ears as you kiss him and tease her with your tongue.

If you’re doin things right, your partner will be moaning with pleasure. If she or he starts getting impatient it’s time to bring out the restraints. There’s nothing like some hot erotic bondage to punctuate the beginning sex play.

While your darling is subdued and possibly blindfolded, crank things up a notch. Add different sensations and stimuli, a warm chocolate sauce followed by ice cream. A fur mitt followed by a Loofah. Introduce some sex toys — a vibrator, tit clamps, or an anal simulator.

Don’t forget to check in with your partner from time to time. Ask for some feedback and direction. Do you like this? Or do you like this better? If you presume that you know what your partner likes simply because he or she liked it before, that, my friend, is a recipe for boredom and the dreaded bed death. If words fail you, SHOW your partner what you want. Then encourage your partner to do the same.002

Beginning sex play is not about pressing the right buttons in the right order. It is about understanding what makes your partner tick and supplying and applying those things to their greatest sensual advantage. There are many ways to give your partner extreme pleasure, and it all begins in your brain. Beginning sex play is as much of an art form as it is a necessity. Finally, the basic premise behind all of this is that the great lover is one that gives pleasure because it is its own reward, not a means to getting something else.

Good luck

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New Mommy Woes

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Name: Megan
Gender: Female
Age: 29
Location: Toronto
I’m a new mother and this is my first child. He was born 3 weeks ago, but I am still enthralled with the miracle of it all. So far motherhood has been pretty wonderful. Sure I’m tired, but just holding my son in my arms makes me so happy I sometime cry with the joy. There is a problem, however, my husband wants to resume our sex life, but I have absolutely no interest. I love him dearly and I know I owe him this, but I have no libido. What can I do?

Yep, this is common enough complaint. This is precisely the place where new parents experience the most strain on their relationship. And when you think about it, it’s not all that surprising. Most new mothers are exhausted by the expectations of motherhood. And first babies are the most challenging. Added to these burdens her partner eagerly awaits the resumption of the sort of sex life that was in place before the pregnancy. New mothers often feel like their husband is just one more person to service, one more person with needs and demands that are keeping her from much-needed sleep.

New Mother LoveNew mothers can find sex unappealing for reasons both physical and emotional. If you’re breastfeeding, your breasts are sore, heavy, and leaky. Your body just doesn’t feel sexy, with its stretch marks, cellulite, dark nipples and dark line down the abdomen, not to mention the weight gain and varicose veins. Then there is lochia, the discharge after the birth, which lasts for 3 to 4 weeks and does not smell very good. If you had an episiotomy, the stitches are very uncomfortable and you may worry about infection. Your hormones may still be in a state of flux, so you feel moody or depressed. And you may not have a good method of birth control, so sex is the last thing on your mind!

Some doctors recommend that new mothers refrain from sex until their first post partum examination, usually about 6 weeks after the birth.NewMother

So if you and your husband weren’t warned about all this, you’re probably both totally unprepared. And if you can’t talk about it, there will be trouble ahead. Many new fathers labor under the misconception that once the baby is born, their sex life will return to normal. Besides this being completely unrealistic; it mostly puts pressure on the wife to do, as you suggest, her ”duty”. This is no way to pursue a sex life together.

Of course, new fathers can help their partner move beyond those feelings of sexual disinterest by being an involved parent and helping around the house.

There are loads of sex things new mothers can do that will pleasure their partner that don’t involve full-on fucking. Hand jobs and blowjobs are always welcome. Reading erotica aloud to each other can be fun. Mutual masturbation, or even watching him and cheering him on as he squeezes one out is also an option. But probably the thing that will get your libido back is a lot of touching, massaging, hugging, kissing, and snuggling and not as a prelude to sex, but just for the joy of it. These things, without the pressure to perform will help reestablish the pair-bond between you and your old man, which will inevitably lead to the long awaited fuckfest.

Good luck

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The Great Porn War

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Name: Jennifer
Gender: Female
Age: 23
I am 23 years old and I like lesbian and gay porn. It’s been my favorite since I discovered it a few years ago. But my boyfriend hates the thought of people of the same gender having sex. I don’t like hetero porn, and that’s all he uses. Is there any way I can get him to enjoy my kind of erotica?

porn.jpgYour boyfriend a dreadful drag, huh? What’s he afraid of, do you suppose? Ya think he’s afraid he’ll pop wood while he’s watchin’ gay porn with his girlfriend. That’ll surly to shake his masculinity to its foundation. I mean, it’s one thing for him to get a boner when he’s checking out the queer stuff by himself — and you know he does! It’s another thing all together for him to get hard watching two dudes fuck while he’s with you. It’s clear to me that your BF has issues, darling. And I think you know that too.

Now I’m not suggesting that he has to like everything you like, or that you have to like everything he likes. A couple can have a really healthy relationship despite differences in the kind of smut each prefers. But matters of taste aside, I think a smart chick, like you, knows that porn is as much a political statement as it is a sexual statement.

Here’s what I mean. Most straight porn features male identified sex — exclusively. That’s probably why you, and 90% of your sister women, don’t like it. The producers of most of the stuff in this genre create it with a predominately straight male audience in mind. And you can pretty much count on it exploiting women in the process. Gay porn does not exploit women, for obvious reasons and lesbian porn is the most radical of all. It is unabashed female identified sex. No female exploitation there. Of course, I’m talkin’ about real lesbian porn, not the caca that simulates girl-on-girl sex that gluts the “straight” porn marketplace.

Most straight males get off on hot girl-on-girl action in straight porn, because the performance represents male identified sex. In fact, one of my good gal pals in the porn business often says that girl-on-girl sex in straight smut is about as far away from authentic female sexuality as gay porn, which has no women in it. i just can't

I’m gonna go out on a limb here, Jen and guess that you’re a little too radical for Mr. Whitebread. But if you think that he’s worth the effort involved in loosening him up, start by reassuring him that there will always be a place in your heart for his johnson even when you’re enjoying a sweet lesbo fantasy. If you really want to enjoy yourself with your guy while you enjoy your dyke porn, give him permission to do a voice over for the movie you’re watching together. Tell him you want him to pretend he’s a porn star and he’s gonna appear in the next scene with the two chicks you’re watching. Watch the lezzie scene together and then have him tell you what’s gonna happen in the next scene when he catches the two naughty vixens. Perhaps you could suggest that he roll play that with you after the movie. Ya see, Jen, you’re gonna have to trick the monkey into watching what you want, cuz he ain’t gonna open his mind all by his-own-self.

Deprogramming him of his homophobia may be a bit more challenging, but there are ways. You could start by telling him that everyone knows that no one sucks a guy’s dick like another guy. And so you want to pick up a few pointers from the pros before you go down on him again. When the big cock-sucking scene begins start grabbing at his package. We all know he’s gonna be hard as a rock. Those repressed types are so damned predictable. Now if at all possible start blowin’ him with the same vigor as the dudes in the movie. Blowjobs are the great equalizer. Mr. Whitebread will be enjoying himself so much he’ll hardly have time to reflect on how radical he’s becoming.

lesbian pronIn the end, I don’t think you should compromise and watch hetero porn unless he’s willing to compromise too. Of course you both could watch your chosen porn privately, but where’s the fun in that. Or you could just trade-off one scene of his for one scene of yours. Or compromise with some hot bisexual porn. There’s not a whole lot of really good bi porn out there, but there is some. Just be discriminating. Life is just too short for bad smut.

You could try dueling porn. Two screens, two TVs or a TV and a computer screen, each playing a different type of porn. Or you could really throw caution to the wind and have a full-blown fuck-O-rama — multiple screens with multiple images all going at once. It’s so easy to do these days with the proliferation of computers tablets, phones even, and online porn. And just about every household has at least two TVs and two computers lying around. So knock yourself out, girl!

It’s clear to me, Jen, that you’re gonna have to take the lead in this. You being the more enlightened one. I believe that your arousal will arouse him. And if your fire doesn’t ignite his, simply throw the bum out!

Good luck Ya’ll

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