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Tuesday, October 19, 2010

When it comes to sex...Are you NORMAL?


Last week, I was in Chicago for the annual meeting of the North American Menopause Society (NAMS).  It was a fabulous conference.  I wish that I could summarize all that I learned and share it here, but I will not bore you with all the details.  Instead, I will fill you in on some information from the most interesting (and relevant) lecture of the bunch.

I have been meaning to post all week, but have been unbelievably busy due to the implementation of an electronic medical record system in my office.  It will be an improvement in the long run, but right now it is a form of slow torture.

A PhD. psychologist named Sheryl Kingsberg presented information on sexuality and aging, which was relevant for women of all ages.  She was witty, the talk was stimulating (pun intended) and packed with useful information.  I wanted to share the ideas presented there so I will do the best job I can of summarizing the main points.  She made 3 analogies that I thought were VERY helpful in explaining issues relating to female sexuality.

1.  My wife/girlfriend/partner never initiates sex (so she must not like it...).  This is a common complaint from men.  And it is true.  In general, women can get by on less sex than men.  Let's say that a women is satisfied with having sex once a week, and her husband is satisfied with 3 times a week.  Well, the woman, being the intellectual that she is, can add well and knows that if she initiates sex once a week and he does 3 times a week, that is 4 times per week which is just TOO MUCH.  So, instead, she decides that she will sneak her one time a week in under his 3 times a week and everyone will be happy.  Right?

Well, not necessarily.  Women know that if they start to initiate sex more often, their partner will want to do it more.  So they wait.  However, an important change then occurs.  Apparently, we all have an "external" type of view of ourselves.  So, for example, if you are faced with a dessert table and every time you go to the dessert table you pick a chocolate chip cookie, over time you will realize that you must like chocolate chip cookies because you always choose them. Over time, if a woman fails to initiate sex she may stop and think "if I don't ever initiate sex, I must not like sex."  And it does not help that her partner may question her affinity to sex as well.  But this is not necessarily true.  She may enjoy sex, just on her own schedule, and she may wait for her partner to make the first move, which is entirely NORMAL.

2.  Women have a DIFFERENT sexual response cycle from men.  In 1966, a linear model of sexual response was produced by Masters and Johnson as seen below.
This model starts with excitement and moves through a plateau phase onto orgasm and then resolution.  It often holds true for males but is NOT characteristic of most female sexual response.  For women, sexual response tends to be more of a CYCLE as more recently characterized by Basson.

For most women, it is actually NORMAL to have a low sexual desire.  Women do not typically spend their day fantasizing about the hot sex they may have that evening with their husband (on a side note, they MAY fantasize about their husband cleaning the kitchen, but I digress...).  For most women, AROUSAL usually preceeds DESIRE.  So that means that IT IS NORMAL to NOT THINK ABOUT SEX until you start to do it. And then once you get started, the desire starts and the whole thing is not half bad.


Think about it like exercise.  I hate going to the gym.  Every night before I plan to work out I start to think of any excuse to get out of it.  When it comes time to do it, I dread it.  But, if I actually get myself on the treadmill, sometime about mid-workout, my perception of it changes and I actually get into it and it's not that bad.  And, when the workout is over, I feel energized and refreshed and vow to do it all over again the next day.  But then, the next day I may dread it again.  And the cycle continues...just like sex.

3.  If sex feels good, and it's free, why doesn't my partner want to do it all the time?  Well, like most things in life, when we are young and things are new you may want to to do them all the time.  So, for most couples, the passion that comes with having a new partner means that sex happens often in the beginning of a relationship.  However, over time, this type of new sexual passion will die down as life often gets in the way of constant sex.  Apparently, passion has about a two year window and after that, to keep the passion going, most couples HAVE TO WORK AT IT. However, because men have an innately higher sex drive than women, there is often a discord between partners in how much sex they are satisfied with.

Here, the analogy she made had to do with ice cream.  She gave a great example of a couple eating dessert.  The wife says to her husband, "we have not had ice cream in a while, why don't we have ice cream tonight".  He says "sure, that sounds like a great idea" and they enjoy the dessert for the evening.  Fast forward to the next evening when the wife says, "that ice cream we had last night was so good, lets do it again tonight."  He is hesitant but finally agrees but feels full and fat afterward and thinks he may not want to do it again for awhile.  The 3rd night the wife turns again to the husband and says "How about ice cream again tonight, we can have a different flavor and you'll enjoy it....and I can't enjoy it alone...".  He hesitates, may beg not to do, but she convinces him to do it even though he does not want to.  Well, on the 4th night he has learned his lesson.  He decides to go to bed early saying he has a headache.  Sounds like a familiar pattern.

The reason I wanted to post these anecdotes is to point out how NORMAL and universal these issues are.  The first step in any type of counseling of a patient having sexual issues is trying to normalize the problem and change perception of what is typical.  Often women are coaxed into thinking that the are ABNORMAL because their sexual drive is different than that of their partner.  This is actually very normal and understanding this can relieve much of the distress surrounding this issue.  In fact, sexual problems are only classified as DYSFUNCTION if the issue is causing DISTRESS to the patient.  So, there is NO NORMAL when it comes to how much sex you have.  That, like everything else, is personal and something you will need to negotiate with your partner so that BOTH people are happy and satisfied.

Wednesday, October 6, 2010

All Alone...




I am at a conference in a big city relatively close to home.  On my ride to the airport I realized that I had not been on a plane in over 6 months.  And, while that may not sound long to some, for me, it is an eternity.

I love to travel.  Let me rephrase that.  I used to love to travel.  Now, however, it is easier to stay home.  But this trip is different.  I am at a medical conference preparing to learn about something that piques my academic mind.  Planning to add to my fund of knowledge to help my patients.  And refueling for more blog topics, I'm sure.

Today I realized that I am a changed woman from the person I used to be.  Now, my mind, my thoughts and my ramblings represent the beliefs of a fiercely independent thinker.  But, in other aspects of my life, I am no longer the independent person I used to be. 

I don’t travel alone much anymore.  In fact, I'm rarely ever alone at all for more than an hour at a time.  As a result, I (embarrassingly), do not even know how to get to the airport in my own hometown without my Nav.   When I got to the airport it felt strange not having my husband to direct me.  Or to ask me 1,001 times if I had my boarding pass.  And to check to be sure I hadn't lost my license.  


This time, as in times long ago, it was just me.  In charge of me.  And ONLY me.  I proceeded through each point, checking and rechecking myself to make sure I hadn’t forgotten anything.  I walked through the airport looking around in the stores, taking my sweet time, buying a magazine, drinking a well deserved latte, and eating dinner with no one to attend to.  No chaos traveling behind me.  No unnecessary potty breaks.  No strollers or kid paraphernalia.  

I didn't break a sweat even once.  A strange feeling, indeed.

And now, here I lay in a hotel room with just myself, my computer and the television.  A little slice of peaceful heaven.  No stories or book readers tonight.  No return trips for one more kiss goodnight.  No headphones on my ears to watch Kardashians.  No potential wake ups with bad dreams.  Just me, my blog and my thoughts.  And, hopefully, a well deserved GREAT night sleep.

It sounds wonderful for tonight.  But I’ll be ready for my life back in the morning.


Friday, October 1, 2010

What My Latte Means to Me...

Like most moms I have little free time on my hands.  My days are filled with patients, errands, phone calls, exercise and a preoccupation with schedules.  But there is one short window of time in my day where that all goes away.

My morning is rushed.  My husband gets up at the BCOD (butt crack of dawn) to get dressed and make lunches.  I roll out of bed a bit later at the COD (crack of dawn).  Then, the torture begins as I have to wake the two (teenager like) toddlers who remain sleeping.  They are crabby.  They resist getting dressed.  They call for daddy even when they know he is not there.  They don't willingly brush their teeth or hair.  They run around like maniacs when I try to put on their shoes.  They both want to be carried down the stairs.  Sometimes at the same time.  Then they fight over which toy they want to add to the endless collection that already fills the back seat of the car.

Then it is off to school.  The car ride begins with begging for a video, to which I initially resist, then, ultimately give into.  2 minutes into the video, we arrive at school.  We may still be at the credits.  I can get them inside quickly by motivating them with "last one there is a rotten egg".  I wonder how long they will fall for this one.  Then into the classroom to quickly prepare a large carbohydrate load for breakfast.  2 kisses on the head, good-bye and I'm off.

To my 15 minutes of heaven.  The only peace and quiet of the day.  Music fills my ears.  And if I am not running late, I get my coffee.  Tall soy latte. One splenda.  $3.13 of pure bliss.

It is the one thing that is relaxing in the morning.  Like a quick trip to the beach minus the plane, bathing suit and large bill.  The first sip reminds me that all the hectic-ness will eventually end.  That this moment will not be filled with whining.  Or questions.  Or "can I just ask you one more thing...."

That this moment is just for me.  And it just ended.

Back to the grind!