You
know the cliche: a woman is so uninterested in sex that she makes a shopping list
while making love. Jennifer and Laura Berman see such women all the time, and
it's frustration--not boredom--that brings them to the Bermans' new clinic at
UCLA.
"I
was talking to a woman earlier today about her low libido, which was a result
of the fact that she can't reach orgasm," says psychologist Laura Berman,
Ph.D., who with her sister, urologist Jennifer Berman, M.D., is a founder and
codirector of the Center for Women's Urology and Sexual Medicine clinic. "Because
she can't reach orgasm, sex is frustrating. She feels a hopeless, fatalistic complacency
about her sex life. When she's having sex, her partner picks up on that and feels
rejected and angry, or notices she's withdrawing. Then intimacy starts to break
down. Her partner feels less intimate because there's less sex, and she feels
less sexual because there's less intimacy. The whole thing starts to break down."
Acknowledgement
of sexual dysfunction in America is booming. But with all the attention on Viagra
and prostate problems in men, most people would probably never guess that more
women than men suffer from sexual dysfunction. According to an article in the
Journal of the American Medical Association, as many as 43 percent of women have
some form of difficulty in their sexual function, as opposed to 31 percent of
men.
And
yet female sexuality has taken a back seat to the penis. Before Viagra, medicine
was doing everything from penile injections to wire and balloon implants to raise
flagging erections, while female sexual dysfunction was almost exclusively treated
as a mental problem. "Women were often told it was all in their head, and
they just needed to relax," says Laura.
The
Bermans want to change that. They are at the forefront of forging a mind-body
perspective of female sexuality. The Bermans want the medical community and the
public to recognize that female sexual dysfunction (FSD) is a problem that may
have physical as well as emotional components. To spread their message, they have
appeared twice on Oprah, have made numerous appearances on Good Morning America
and have written a book, For Women Only.
"Female
sexual dysfunction is a problem that can affect your sense of well-being,"
explains Jennifer. "And for years people have been working in a vacuum in
the sex and psychotherapy realms and the medical community. Now we are putting
it all together."
No
single problem makes up female sexual dysfunction. A recent article in the Journal
of Urology defined FSD as including such varied troubles as a lack of sexual desire
so great that it causes personal distress, an inability of the genitals to become
adequately lubricated, difficulty in reaching orgasm even after sufficient stimulation
and a persistent genital pain associated with intercourse. "We see women
ranging from their early twenties to their mid-seventies with all types of problems,"
Laura says, "most of which have both medical and emotional bases to them."
The physical causes of FSD can range from having too little testosterone or estrogen
in the blood to severed nerves as a result of pelvic surgery to taking such medications
as antihistamines or serotonin reuptake inhibitors, such as Prozac and Zoloft.
The psychological factors, Laura says, can include sexual history issues, relationship
problems and depression.
The
Bermans codirected the Women's Sexual Health Clinic at Boston University Medical
Center for three years before starting the UCLA clinic this year. At present,
they can see only eight patients a day, but each one receives a full consultation
the first day. Laura gives an extensive evaluation to assess the psychological
component of each woman's sexuality.
"Basically,
it's a sex history," Laura says. "We talk about the presenting problem,
its history, what she's done to address it in her relationship, how she's coped
with it, how it has impacted the way she feels about herself. We also address
earlier sexual development, unresolved sexual abuse or trauma, values around sexuality,
body image, self-stimulation, whether the problem is situational or across the
board, whether it's lifelong or acquired." After the evaluation, Laura recommends
possible solutions. "There is some psycho-education in there, where I'll
work with her around vibrators or videos or things to try, and talk about addressing
sex therapy."
Afterward,
the patient is given a physiological evaluation. Different probes are used to
determine vaginal pH balance, the degree of clitoral and labial sensation and
the amount of vaginal elasticity. "Then we give the patient a pair of 3-D
goggles with surround sound and a vibrator and ask them to watch an erotic video
and stimulate themselves to measure lubrication and pelvic blood flow," Jennifer
says.
The
identification of FSD has been called everything from the final frontier of the
women's movement to an attempt by the patriarchy to shackle women's sexuality.
But given the success that drugs such as Viagra have had in reversing male sexual
dysfunction, the Bermans found an unexpected amount of criticism from their peers.
"The resistance we got from the rest of the medical community early on was
surprising to us," Laura says, explaining that the urological field in particular
has been dominated by men.
Clearly,
the Bermans will need hard data to win over their critics. Their UCLA facility
is enabling the Bermans to conduct some of the first systematic psychological
and physiological research on the factors that inhibit female sexual function.
One of their first studies suggests that the pharmaco-sexual revolution that helped
some men overcome their sexual dysfunction may prove less effective for women.
Their initial study of the effects of Viagra on women found that Viagra did increase
blood flow to genitalia and thereby facilitate sex, but women who took the drug
said it provided little in the way of arousal. In short, subjects' bodies might
have been ready, but their minds were not.
"Viagra
worked half as often in the women with an unresolved sexual abuse history as in
those without it," Laura says. "So it's just not going to work alone.
Women experience sexuality in a context, and no amount of medication is going
to mask psychologically rooted, or emotionally or relationally rooted sexual problems."
Laura believes the results of the Viagra study counter those who contend that
FSD is simply a tool of pharmaceutical companies to "medicalize" female
sexuality.
"I'm
less concerned about it, because I'm aware that it won't work," she says.
"And in some respects, pharmaceutical companies are closing the divide between
the mind and body camps of FSD. Clinical trials of new drugs for FSD are requiring
psychologists to screen participants, and that is an acknowledgement that an accurate
assessment of a drug's efficacy requires a consideration of the test subjects'
feelings about sex. So these physicians who may not be motivated to bring on a
sex therapist are now motivated to participate in a clinical trial, and then that
model becomes the norm."
Currently,
the sisters are working on MRI studies of the brain's response to sexual arousal,
the place where mind and body meet. And although there is a lot more research
to be done on FSD, identifying it as a problem has already made a significant
impact on how women perceive their sexuality. "Women now feel more comfortable
going to their doctors, and they're not taking no for an answer, not being told
to just go home and have a glass of wine," explains Laura. "They feel
more entitled to their sexual function."
READ
MORE ABOUT IT: For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction
and Reclaiming Your Sex Life Jennifer Berman, M.D., and Laura Berman, Ph.D. (Henry
Holt & Co., 2001)
HIS
& HERS... and how to have them
Hers:
a female orgasm can be frustratingly evasive. While about 85 to 90 percent of
women are capable of having an orgasm, according to Beverly Whipple, Ph.D., vice
president of the World Association for Sexology, only about one-third have had
one during intercourse. That said, it's important to remember that orgasm should
never be the goal.
"In
goal-oriented sexual interactions, each step leads to the top step, or the big
"O"--orgasm," says Whipple. "Goal-oriented people who don't
reach the top step don't feel very good about the process that has occurred. Whereas
for people who are pleasure oriented, any activity can be an end in itself; it
doesn't have to lead to something else. Sometimes, we're very satisfied holding
hands or cuddling. There would be a lot more pleasure in this world if people
would just focus on the process."
Whipple
also points out that the psychological ramifications of dissatisfying sexual interactions
are not often suffered alone; they can cause distress in both partners. "If
one person in a relationship is goal-oriented and the other is pleasure-oriented,
and neither is aware of their own orientation, they don't communicate that with
their partner," she explains. "A lot of relationship problems can develop.
In my workshops with couples, I help them be aware of how they view sexual interactions
and then communicate this with their partner."
TYPES
OF ORGASM
Clitoral
Orgasm
The
most common, they result from directly stimulating the clitoris and surrounding
tissue. What many people don't realize is that the majority of the clitoris is
actually hidden inside the woman's body. Recently, Australian urologist Helen
O'Connell, M.M.E.D., studied cadavers and 3-D photography and found that the clitoris
is attached to an inner mound of erectile tissue the size of your first thumb
joint. That tissue has two legs or crura that extend another 11 centimeters. In
addition, two clitoral bulbs--also composed of erectile tissue--run down the area
just outside the vagina.
O'Connell's
findings, published in the Journal of Urology, show that this erectile tissue,
plus the surrounding muscle tissue, all contribute to orgasmic muscle spasms.
With so much tissue involved in a clitoral orgasm, it's no wonder they're the
easiest to have.
Pelvic
Floor or Vaginal Orgasms
These
occur through stimulating the G-spot, or putting pressure on the cervix (the opening
into the uterus) and/or the anterior vaginal wall. Located halfway between the
pubic bone and the cervix, the sensitive G-spot--named after its discoverer, German
physician Ernest Grafenberg--is a mass of spongy tissue that swells when stimulated.
Because it's difficult to locate, experts have developed a few guiding techniques:
o
Lying on her back, the woman tilts her pelvis upward so that her vulva presses
flat against her partner's pelvic bone. According to the Bermans, this allows
the penis to make contact with the G-spot, simultaneously stimulating the clitoris.
Putting pillows beneath her buttocks makes angling her pelvis easier.
o
Whipple suggests placing two fingers inside the vagina and moving them in a beckoning
motion. The fingertips should stroke the frontal vaginal wall, just where the
G-spot is located.
The
Blended Orgasm
This
can be attained through a combination of the first two.
HER
BENEFITS
o
Pain relief: Orgasms help alleviate menstrual cramps. In addition, studies have
shown that a woman's pain threshold increases substantially during orgasm.
o
Enhanced mood: According to University of Virginia researchers, orgasms boost
levels of the female sex hormone estrogen, which in turn betters your mood and
helps ease premenstrual symptoms. They also release endorphins, the body's natural
painkillers and depression fighters.
o
Increased intimacy: Oxytocin, a hormone that promotes feelings of intimacy, jumps
to five times its normal level during climax.
o
Easier rest: Oxytocin also induces drowsiness. For women, sleepiness comes about
20 to 30 minutes after orgasm. Men, on the other hand, usually drift off after
only two to five minutes.
o
Less stress: Stress in women is highly correlated with arousal difficulties, lack
of libido and anorgasmia, the inability to reach orgasm, according to one 1999
study in the Journal of the American Medical Association. Just 20 minutes of intercourse,
however, releases the lust-enhancing hormone dopamine, triggering a relaxation
response that lasts up to two hours.
His
Physiologically speaking, male and female orgasms are surprisingly similar. The
related problems men and women experience, however, are distinctly different.
"There
are men who can't orgasm, but I think it's less than I percent of men," says
Jed Kaminetsky, M.D., a professor of urology at New York University and director
of the school's male sexual dysfunction clinic. "That's a much less common
problem than premature ejaculation."
A
study published in the Journal of the American Medical Association found that
premature ejaculation is even more common than erectile dysfunction, especially
among younger men. As with most sex-related problems, it affects both partners--some
studies suggest that nearly 30 percent of couples report premature ejaculation
as the most prevalent sexual problem in their relationship. One major obstacle
to treating it is simply defining the problem to begin with.
"It
depends on the relationship," Kaminetsky explains. "If a woman takes
an hour to orgasm and the man can last 40 minutes, that's premature ejaculation
for that couple." At the other extreme, one minute is too short an amount
of time for most couples. "Not too many women are going to climax within
a minute."
Kaminetsky
also sees truth in Whipple's assessment of goal-oriented versus pleasure-oriented
interactions. "Men are very goal oriented; they see a task and they want
to successfully perform that task," he says. "Often that task is to
make their partner have an orgasm. If the woman knows that, she feels like a laboratory
animal--it's not a very sexy thing. That's why women fake orgasms, which is a
sign of lack of communication in a relationship."
PREMATURE
EJACULATION
Rarely
a physiological problem, premature ejaculation can result from over-excitement,
positioning or rate of intercourse. "The roots of it go back to the way men
learn to orgasm, which is typically through masturbation," suggests Kaminetsky.
"A lot of young boys masturbate quickly, because they don't want their mom
to walk in on them. It becomes a trained behavior." To treat premature ejaculation,
experts suggest changing positions, breathing deeply, thinking about something
other than sex or simply stopping for a moment. Here, Kaminetsky offers two additional
techniques for delaying orgasm:
o
Practice this before reaching "ejaculatory inevitability," the point
when ejaculation cannot be stopped; most men recognize it as a sensation of deep
warmth or pleasure: Squeeze the head of the penis for about four seconds or until
the sensation subsides, then resume.
o
During intercourse, the man should press his pelvic bone against the woman's and
rock rather than thrust his body. "It won't be as stimulating for him so
he'll last longer, and it may be more stimulating for the woman."
HIS
BENEFITS
o
Long life: Men who have two or more orgasms a week tend to live significantly
longer than do those who have only one or none, according to research at Cardiff
University in Wales.
o
Less cancer: Breast cancer is rare in men, but once developed, the mortality rate
is high. Fortunately, a study published in the British Journal of Cancer found
that men who have more than six orgasms a month are significantly less likely
to develop breast cancer than are those who have less frequent sex.
o
Healthy hearts: A study of 2,500 men at the University of Bristol and Queens University
of Belfast found that men who have at least three or more orgasms a week are 50
percent less likely to die from heart failure or coronary heart disease.
o
Good health: Having sex once or twice a week also fights off the flu and other
viruses by strengthening the immune system, psychologists at the University of
Pennsylvania recently found.
o
Youthful looks: A study of 3,500 aging people at the Royal Edinburgh Hospital
in Scotland found that those who looked the youngest also had the most vigorous
sex life. The effects were even greater if the subjects were emotionally satisfied
as well.
READ
MORE ABOUT IT: The Good Girl's Guide to Bad Girl Sex Barbara Keesling, Ph.D. (M.
Evan and Co., 2001)
Sexual
Fitness: 7 Essential Elements of Optimizing Your Sensuality, Satisfaction and
Well-Being Hank C.K. Wuh, M.D. (G.P. Putnam's Sons, 2001)
GETTING
CLOSE AND PERSONAL
Bee,
25, Copywriter
Masturbating
is the easiest way for women to learn how to have an orgasm. Women who masturbate
will be a lot more likely to have an orgasm during sex. I think it helps you learn
the actual mechanics of what turns you on, where things need to happen.
Because
the guy isn't going to know that; there's no reason he would. Every woman is different.
Also, the bonding that goes on during sex seems most extreme with an orgasm. It's
kind of like one or both people have gone completely over the edge; they're suspended
in the other person's grasp, and they're completely surrendered to it. That intensifies
any connection.
Gabriel,
25, Musician
There
are guys who don't get a rise out of giving a woman an orgasm and would just prefer
not to have someone else there. I've even heard some guys say they have better
orgasms during masturbation than sex. The mere thought of it astounds me, but
it makes sense if a guy has a fear of intimacy or, even more, a fear of performing.
It probably takes away from his own orgasm if he's overly concerned with his sexual
performance or whether or not she's having one. It's ironic, because an orgasm
during sex is enhanced when it's with someone you truly care about.
GETTING
CLOSE AND PERSONAL
Kamara,
27, Musician
I'm
amazed when I talk to anyone who claims to have never had an orgasm, probably
because I just can't imagine not having them or not being able to have them. At
the same time, it doesn't surprise me: I was raised in a very conservative religious
atmosphere that actually called masturbation "self abuse," and all sexuality--not
to mention orgasms--was beautiful and good only if it happened in a marriage bed.
It takes awhile to expel the load of guilt that piles up around your sexuality
if you're raised in that kind of culture, and I'm sure some people never do. But
there was no way I wasn't going to aim for the prize once I knew what it felt
like. Maybe it depends on your sexual drive--for me the drive was strong enough
that I could never feel guilty about an orgasm for long.
Steven,
28, Veterinarian
Some
guys think sex has to include an orgasm. Orgasms are great, but there's so much
more to sex. An orgasm is more of a physical experience; I guess there is an emotional
aspect, but it's over in a second. I think anybody can give you an orgasm, but
it's the person there after the orgasm that matters. But I think I'm the exception.
DOES
ORGASM EQUAL SEX?
Our
ever-changing definition of sex may hinge more on the climax than on the act itself;
Psychologist L.M. Bogart, Ph.D., gave Kent State students a list of scenarios
in which "Jim" and "Susie" engaged in vaginal, anal or oral
intercourse and either did or did not achieve orgasm. Vaginal intercourse was
considered sex 97 percent of the time, followed by anal intercourse (93 percent)
and oral sex (44 percent). Researchers were surprised to find that orgasm occurrence
dictated whether or not the activity was considered sex. Although the woman was
more likely to label vaginal intercourse sex if neither partner climaxed, when
it came to oral sex, the recipient was more likely to consider it sex than the
partner performing the act, especially if the recipient achieved orgasm--because
the stimulator was unlikely to achieve orgasm. For anal sex, it was more likely
to be called sex if Jim had the orgasm, but it was sex to Susie regardless of
whether she achieved orgasm. In general, the lack of orgasm for women was less
likely to affect her labeling the act sex. Although most sex therapists argue
against using orgasm as an end-all definition of sex, Bogart's study indicates
that orgasm is still an important gauge by which we measure sexual activity.
--Michael
Ross
By:
Michael Seeber Originally published by Psychology Today:Nov/Dec 2001
