When Penetration Hurts: Vulvar and Vaginal Pain

One of the most helpful chapters in Naked at Our Age (coming June 2011) addresses vulvar/vaginal pain, a complex issue. You’ll read real-people stories from women whose vaginal or vulvar pain prevented them from enjoying penetration, or who learned how to renew their vaginal health, plus information and direction for getting your own pain diagnosed and treated. Although you’ll have to wait for the book, until then, these posts about vaginal/vulvar pain will be helpful, and here is a list of websites that offer more information and/or referrals to knowledgeable professionals:

• American Association of Sexuality Educators, Counselors, and Therapists: http://www.aasect.org/.

• American Physical Therapist Association, Section on Women’s Health: http://www.womenshealthapta.org/.

• American Urogynecologic Society: http://www.augs.org/.

• International Society for the Study of Vulvar Disease: http://www.issvd.org/.

• Mypelvichealth.org: http://www.mypelvichealth.org/

• National Vulvodynia Association: http://www.nva.org/

• OObgyn.net: http://www.obgyn.net/

• Pelvic and Sexual Health Institute: http://www.pelvicandsexualhealthinstitute.org/

• Secret Suffering: Helping Women Cope with Sexual and Pelvic Pain (patient site): http://www.secretsuffering.com/.

• Vulval Pain Society: http://www.vulvalpainsociety.org/.

• Vulvar Pain Foundation: http://www.thevpfoundation.org/

• Vulvodynia.com: http://www.vulvodynia.com/

Viagra “not a sack of cement installer”

I’m writing the chapter about cancer and sexuality for my new book, Naked at Our Age: Talking Out Loud about Senior Sex. The stories people sent me about reclaiming their sexuality after cancer treatment fill me with admiration. I looked back at some older posts on this blog that deal with sex & cancer, and decided to bring back this one from 2006. With the prevalence of Viagra use, I think BillyBob’s experience and his thoughts about it are important. – Joan

BillyBob, age 62, has told some of his story previously as a comment here. He recently sent me an email detailing an experience that he wants to share — and he makes an important point:

I started dating a lady I have known for a year, mostly through phone conversations. I knew that she likes sex. Last weekend we went for dinner. After dinner she wanted to go back to my place for a while.

Well, as it turned out, it was the most embarrassing time I have ever had, all because of a misconception some woman have about impotency.

I took a Viagra after we got back to the motel hoping it worked fast! It did its normal thing and got me sexually aroused but not 100%. She knew I had to take it because of the prostate cancer killing my prostate.

Here is where the misconception comes in. It seems that women who do not know about Viagra seem to think if you take it you just get ramrodding hard, and they do not need to do any stimulation. Well that’s just plain wrong. Men still need stimulation along with the Viagra. The drug is not a sack of cement installer.

And I was not about to masturbate myself in order to get it hard. Not in the presence of a woman.

So as it turned out she turned me off instead of on. What a bummer. It was so disappointing. I had looked forward to our meeting for some time. And the possibility of finally enjoying good sex with some one that likes sex.

All a woman needs to know about the drug is that you do things as normally, using stimulation together. So please tell your readers what my experience was.

BillyBob, thank you for sharing this experience. Viagra helps when there’s a physical cause for lack of erection, as you know, but it doesn’t increase libido, or substitute for all those other crucial components of good sex that you (and I, and probably everyone reading this) crave — touching, kissing, bonding, stimulating each other physically and emotionally, enjoying each other’s pleasure as well as our own.

It sounds like most of this experience was missing for you. What a bummer, I agree. I’m sorry you didn’t feel you could communicate your needs and desires to your partner — I don’t know, maybe she would have been happy to help you get aroused if she had understood. It’s hard to understand why she didn’t seem interested in stimulating you just as part of the sex play (with or without Viagra), since that’s a good part of the fun of sex.

I know you were too embarrassed to masturbate in front of her when she didn’t help arouse you, but as a woman, I find it very pleasurable and exciting to watch a man stimulate himself. I don’t know if your partner would have reacted this way, but I’ll bet she would have.

If you see a future or at least a repeat date with this woman, I hope you’ll communicate candidly with her before you get to “the act.” And please continue to write.

Thank you again, BillyBob.

— Joan

Orgasm Inc.: stunning expose of drug for fake disease

I just saw the film Orgasm Inc. You must see it. It’s a powerful expose of the medicalization of female sexuality, specifically the development and marketing of female sexual enhancement drugs based on a made-up “disease”: Female Sexual Dysfuncton (FSD).  The “disease” was created by drug companies so that they could sell drugs and procedures that have not been proven to work and have not been proven safe!

Filmmaker Liz Canner was hired by one of these drug companies, and what she learned was so apalling that she went on to make this expose. I was stunned by it. Some of the reviews call it funny. Though there were some hilarious moments, the aftertaste isn’t funny.

How did the drug companies invent a disease? They asked women questions designed to unearth if they ever had trouble becoming aroused or reaching orgasm (duh, who hasn’t?) and labeled those dysfunctional who said yes to any of the questions. Although women’s sexual responses are complex and based on relationship, health, energy, worries, other medications, and emotional issues as well as physical function, these issues were neither addressed nor ruled out.

The result: a new dysfunction and a drug to address it, both of which were then promoted by highly paid health “experts” on TV news and talk shows. I’m itching to name a visible, well-known “expert” who — although she denied any financial interest in the drug — was paid $75,000 a day for her media appearances on Oprah and other shows. You’ll see her identified in the film.

Below is one video clip — see the official trailer here (I couldn’t embed that one).

6/7/10 update: When I wrote this post a few days ago, Orgasm Inc. was available on Amazon, and today when I checked it, it has disappeared from the listings. This is odd indeed. I’ll keep checking for its return.  It is listed on Netflix, but the available date is unknown, as a reader commented. How frustrating — I really want you to be able to see it. I’ll update the info when this changes — keep checking back.

Erectile Dysfunction: Michael Castleman Talks to Women

Update note: I first posted this interview in June 2007. I have so many new readers now that I wanted to bring it to the forefront, because it’s such an important issue for both men and women. Often men feel they can’t talk about ED with their partners. Women tell me their men seem to emotionally disappear and avoid sexual activity and discussion. Michael Castleman helps all of us understand what’s going on. — Joan

In a previous post, I interviewed Michael Castleman, a sex educator, counselor and journalist specializing in men’s sexuality to answer some questions for men about erectile dysfunction. In this part of the interview, Castleman talks directly to women:

Q: What don’t women understand about erectile dysfunction (ED)?

MC: Like men, few women understand the difference between true ED and erection dissatisfaction. [See Erectile Dysfunction: Michael Castleman Talks to Men for explanation of the difference.] Women also don’t really appreciate how men FEEL when EDis or ED develop. It’s sort of like how women feel when they lose a breast to cancer. You’re still alive, but you feel diminished. A part of your body you took for granted isn’t there anymore, or in the case of men, doesn’t work like it used to. And this isn’t just any part of the body. It’s a body part that in a profound way DEFINES you as a man or woman. For women, loss of a breast raises issues like: Am I still attractive? Am I still sexual? Can I still please a man sexually? Men with ED and EDis wrestle with similar issues.

Beyond this, men have lived their whole lives pretty much taking their penises for granted: See a sexy woman, get hard. See porn, get hard. Think a sexual thought, get hard. Then all of a sudden–and in many men this happens pretty suddenly–they’re in a situation where they expect to have to rearrange their underwear to accommodate some swelling down there, and then….nothing. Nothing happens.

Many don’t understand what’s happening to them or why. But even those who do, me for example, feel surprised, upset, disappointed, depressed. Change is stressful. But when the changes concern the penis, well, men get seriously freaked out.

Now women often (and rightly) believe that men are too focused on the penis. That’s often true. It takes most young men years (sometimes decades) to leave penis-centric sex behind and understand the erotic value and pleasure of whole-body sensuality, a lovestyle more based on whole-body massage than on just sticking it in somewhere. Men who never get there, men who continue to view sex as penis-centered, when their penis stops behaving as they expect, they often think it’s the end of sex, that they’re over the sexual hill, that it’s all over. In my experience as a sex counselor and writer, few women appreciate how diminished men feel as they get used to EDis… if they ever adjust.

Q: Why can’t men express these concerns?

MC: Many reasons. In general, men tend to be less emotionally articulate than women. Men are socialized to be the “strong silent type,” to keep a “stiff upper lip,” to “grin and bear it.” In other words, to deny what they’re feeling and just go on. As a result, men get less practice than women discussing their emotions, and when they do, they’re less skilled than women. Now some women believe that men don’t HAVE emotions because they don’t discuss them. Wrong. Men feel things just as deeply as women. They just are less likely to discuss them, and if they do, they’re less likely to be able to really articulate how they feel.

The two genders have different natural histories of sex problems. With the exception of vaginal dryness, which is easily mitigated with lubricants, most women have most of their sex problems/issues when they’re young. Young women wrestle with the mixed messages that they should be sexy but not trampy, that they should want love/sex, but not want sex “too” much, not be “too” easy. But how easy is too easy? Young women also have issues with orgasm. Many don’t have them and have to learn how to release orgasms.

Meanwhile, few young men have sex problems–other than coaxing women in to bed. The young penis works just fine, thank you very much. Maybe the guy comes too soon (this is the #1 sex problem of young men), but only rarely do young men have problems with erection. Then they hit 45 or 50 and suddenly, the erections they took for granted their entire lives start to fail them. They freak. It’s almost unthinkable. Many Americans found themselves speechless after Sept. 11. It was so horrible, unimaginable. Men don’t discuss their ED or EDis in part because it’s unimaginable–then it happens and they’re speechless.

To many men, having reliable erections is a significant part of what defines them as men. If they have problems in the erection department, some fear that the women in their lives will view them as less than real men. So why talk about it? Why invite her to rub his nose in the fact that he’s less of a man?

Q: When should a couple seek counseling?

There’s no hard-and-fast rule on this. But when a problem festers, when you find yourselves having the same conflict over and over again, when there seems to be no way out, no resolution, basically, when you feel stuck, that’s when to consider counseling.

Now every sex problem is also a relationship problem and visa versa. If the main issue is power/control/decision making or conflict resolution, then a couples counselor is probably the place to start. But if they main problem is sexual–a desire difference, orgasm issues for the woman, erection issues for the man–then I’d start with a sex therapist.

Personally, I’m a fan of sex therapy. This is not self-serving because I am not a sex therapist. But studies show that two-thirds of couples who consult sex therapists report significant benefit within 6 months. That’s pretty good. Men with ED or EDis need to reframe their thinking about sex. They need to get away from porn-inspired sex and explore whole-body sensuality. This is often unfamiliar to men. They often fight it. So going back to a therapist week after week can help keep them on the path to self-discovery.

To find a sex therapist, visit the American Association of Sex Educators, Counselors, and Therapists (AASECT). Click the map of the U.S. and Canada, and get a list of all the AASECT-certified sex therapists in your state or province.

Q: What if the man won’t go?

The woman should go by herself. This is not as good as the couple going. But going solo gives the woman a place to vent. It may equip her with new coping skills that can help deal with the couple’s issues. And she may be referred to some written material, e.g. my book and others like it, that she can litter around the house and hope he picks up and checks out.

Great Sex
Michael Castleman, M.A., is the author of twelve books, including Great Sex: The Man’s Guide to the Secrets of Whole-Body Sensuality and Sexual Solutions: For Men and the Women Who Love Them. From 1991-95, he answered the sex questions submitted to the Playboy Advisor. Visit his website about sex after midlife, http://www.greatsexafter40.com/.