Author: annette-owens

 Sex is like everything else in life—it has its ups and downs. Having seen countless couples over the years struggle to keep their sexual passion at unrealistically high levels, I was pleasantly surprised to see a new approach to sparking sexual desire hit shelves this year.
Enduring Desire: Your Guide to Lifelong Intimacy is different from most other self-
help books I’ve read. Instead of promising gold and green forests (as we say in Danish), it provides a realistic outlook on what to expect from your sexual desire as your relationship matures from passionate beginnings to the long-term.

FOR MORE INFORMATION Check out Helen Fisher’s website, helenfisher.com, for a selection of articles and brief videos. Plus, read her scientifically based take on the anatomy of love and, in particular, long-term love.

In the book, sex therapists Michael Metz and Barry McCarthy present their “Good-Enough Sex” (GES) model. They focus on being realistic about your expectations.

“To think you can have perfect sex every time in any circumstance is pure hype,” they write. “No one has a perfect sex life. Hype sets you up for self-defeating performance demands and disappointment… Sex provides a buffet of experiences: At times, sex is enthusiastic, cheerful, erotic, gratifying and at other times uninspiring.”

But having realistic expectations can only get you so far. Much of the rest is determined by brain chemistry. And recent research has shown that the most important sex organ is indeed located between your ears.

People taking common antidepressants such as selective serotonin reuptake inhibitors (SSRIs) know all too well that brain chemicals can easily interfere with your ability to have an orgasm. Not only sexual function, but even your ability to fall romantically in love can be negatively affected by those medications. Helen Fisher, a biological anthropologist, has done some fascinating research in this area.

She found that romantic love is a basic mating drive in every human. Unlike sex drive, which exposes you to a range of potential partners, romantic love helps you focus your mating energy on one individual.

And there is a specific brain region that is active when you fall in love, and remain in love with that person. This region is part of the “reptile core” of the brain, and is more primitive than our cognitive thinking process and emotions. And it is outside our conscious control.
Think of your brain as hardware and your conscious thinking as software. We can do little about our hardware, but once in a while it’s good to download a software update. And this is where Metz, McCarthy and their GES model come in.

First they give you some easy tools to assess your own attitudes and beliefs about sex. Then they educate you about the many different components (developmental, biological, psychological, relational and psychosexual) that affect your sexual health and satisfaction.

Based on this knowledge, the authors help you set up realistic goals for your sex life. Real lifecase studies help illustrate key points throughout the book.

Try to keep a positive view on things, especially at times when the sexual spark seems to be missing. Try to appreciate the fact that there will be a natural ebb and flow that should not cause you any panic. And try to have realistic expectations. Sometimes good enough is good enough.

Charlottesville’s Annette Owens, MD, Ph.D., is certified by the American Association of Sexuality Educators, Counselors, and Therapists. She has co-edited the four-volume book, Sexual Health (Praeger).

 Most people recognize and know how to meet their basic needs when it comes to doing things like eating and drinking, or turning the heat up or down. And they don’t even think twice about it. But what about when it comes to sex? Do we trust ourselves?

Recently, I attended an international conference where one of the most famous sexologists of our time, Beverly Whipple, was honored for her outstanding research in sexual health.

Whipple is probably best known for co-writing The G Spot and Other Recent Discoveries About Human Sexuality, which quickly became a best seller in the early ’80s. A quarter century later, in 2006, New Scientist Magazine named her one of the world’s 50 most influential scientists.

Whipple received a standing ovation at the conference as she was presented with the Gold Medal of the World Association for Sexual Health, a prestigious honor for sexologists not unlike winning an Academy Award. After giving a presentation about her achievements and methods (like using functional MRIs to study brain activity during orgasm), she was asked a final question about what she thinks is necessary to advance the future of sex research, and her answer was surprisingly simple: The most important thing is to keep listening to women’s voices. Listen to what they like to do when they have sex, and what they don’t like. What turns them on and off. How they experience their own sexuality, and so on. It’s as simple as that.

Too many women, in my opinion, don’t trust themselves when it comes to sex. Instead of just listening to their inner sexual voices, many women (and men for that matter) question their responses and can’t stop asking what they need to fix in order to function “correctly.”

For example, many wonder how to have the “right” orgasm. They ask themselves should it be a full body orgasm, and is it O.K. to have to use a vibrator to get there? Rest assured, any orgasm is a fine orgasm, whether brief and shallow or long and deep, and regardless of how you get there. It’s your sensation, so take ownership of it and enjoy it.

Others may wonder how to be the “right” kind of lover. Again, there is no right answer. If you and your partner enjoy what you are doing, great! If not, talk about it and find out what’s right for the two of you. Learn to trust your inner voice about what you like when it comes to sex.

Here’s another example of the importance of women’s voices that I cannot help thinking about. It goes back to my years in medical school, when one of my pediatrics professors started out every lecture by telling the class to “always listen carefully to the mother.” Her story about her sick child would almost always reveal the correct diagnosis. Only after having extracted important clues from the intuitive mother were we to order additional lab work or other tests, if at all necessary.

Few mothers recognized how valuable their detailed descriptions of their child’s symptoms were. Likewise, few women realize that their sexual sensations and responses are just fine the way they are.

Trust yourself that what you are feeling is right for you. Stop questioning. There is no right or wrong way when it comes to sex—you are much more sensible than you think.

Charlottesville’s Annette Owens, MD, Ph.D., is certified by the American Association of Sexuality Educators, Counselors, and Therapists. She has co-edited the four-volume book, Sexual Health (Praeger).

 We’ve come a long way since the pill was introduced in the 1950s. Today, there are many birth control options available—some of them over the counter (OTC), others prescribed by a medical practitioner (MP). Ask your health provider about which method might be best for you.

BARRIER METHODS

Barriers block the sperm from reaching the egg. They can be either mechanical or chemical. All of these are nonhormonal methods and most of them (except condoms) do not protect against sexually transmitted infections.

The effectiveness is listed in parenthesis following each method as “(perfect use/typical use).” (2/15) means that with perfect use 2 percent of individuals using this method unintentionally get pregnant in a year, while with typical use (which includes occasionally forgetting to use it) 15 percent get pregnant. Different methods can be combined to increase effectiveness, e.g. condoms and diaphragm.

Mechanical barriers

Male Condom (2/15); OTC
Female Condom (5/21); OTC
Cervical Cap (9/16 no baby, 26/32 after childbirth); MP
Diaphragm (6/16); MP
Sponges (13/19); OTC

Chemical barriers

Spermicidal creams, films, foams, jellies, suppositories and tablets (15/29); OTC
Unlike the regular male condom, the female condom is designed to be worn by the woman. A small pouch with two flexible rings at each end, the ring at the dead end fits around the cervix of the uterus and the other ring stays outside the entrance to the vagina, lining the wall of the vagina all around.

Both the cervical cap and diaphragm are fitted by a health provider, since the size of a cervix varies and changes after delivery of a baby. They can be inserted up to a few hours before intercourse and must remain in place for at least 6 hours afterwards in order to be most effective. With good care (wash in mild soap and store in a cool, dry place), these devices can be reused for up to two years.

Sponges are technically both mechanical and chemical barriers, since they contain a spermicide, which is a substance that makes sperm unable to move. Just before insertion, wet the sponge with tap water to activate the spermicide.

HORMONE PILLS

Combination oral contraceptives (0.3/8); MP
Progestin-only oral contraceptives (0.3/8); MP

Combination oral contraceptives (the pill) contain various amounts of estrogen and progestin. To be most effective, they should be taken every day at the same time, as should the progestin-only pills (called minipills).

Birth control pills are not ideal for everyone, specifically women older than 45, who smoke, have high blood pressure, diabetes, high cholesterol, are obese or have frequent headaches.

HORMONE PATCH

Transdermal contraceptive patch (0.3/8); MP
The patch is a hormone-con-taining adhesive that sticks to the skin and has to be changed every week for three weeks. The fourth week is a “patch-free” week, to allow menstruation.

HORMONE INJECTION

Depo-Provera (0.3/3); MP
These are monthly injections into the buttock or upper arm.

INSERTABLE HORMONE METHODS

Vaginal ring (0.3/8); MP
Intrauterine system (IUS) (0.1/0.1); MP

68 That’s the percentage of women who use condoms the first time they have sex with a new partner.

The vaginal ring contains estrogen and progestin and is inserted once for three weeks. The fourth week is a “ring-free” week to allow menstruation. If you’re comfortable using tampons, inserting the ring shouldn’t be a problem. When inserted correctly, the ring cannot be felt by you or your partner.

NONHORMONAL INTRAUTERINE METHODS

Intrauterine Device (0.6/0.8); MP

As compared to the IUS (a small, plastic, T-shaped, pro-gestin-containing stem, which is inserted into the uterus), the IUD contains no hormone, but only copper. Both devices work by preventing the sperm from reaching the egg as well as by preventing the fertilized egg from implanting in the uterus. Both of these need to be inserted and removed by a trained health provider. You’ll feel a mild menstrual cramp during the quick procedure. You cannot feel the device in-side your uterus and it’s a good idea to periodically check whether the small string that is attached to the IUS/IUD remains at the opening of your cervix (at the end of your vagina) to make sure that you have not accidentally lost it.

Charlottesville’s Annette Owens, MD, Ph.D., is certified by the American Association of Sex-uality Educators, Counselors, and Therapists. She has co-edited the four-volume book, Sexual Health (Praeger).

 Quite a few women with uterine fibroids suffer in silence, unaware of how common their condition actually is and not knowing where to turn for help and support.

Between 20 and 35 percent of women ages 25 to 50 have symptomatic uterine fibroids (leiomyomata). And African American women have an even higher chance of developing these benign (noncancerous) tumors and experiencing symptoms at an earlier age. Even more women have fibroids without knowing it. 

As far as sexuality is con-cerned, uterine fibroids typ-ically do not affect the ability to get aroused, lubricate or reach orgasm. But, those who exper-ience symptoms complain of feeling and looking bloated, pelvic pain and pressure, heavy and prolonged or irreg-ular menstrual bleeding, frequent urination, gastrointestinal problems and pain during intercourse. Some women with excessive menstrual bleeding become anemic and feel tired all the time. All of these symptoms can range from mild to severe—and any of them can make the woman feel not only uncomfortable, but less attractive, causing her to put the brakes on her sex life. 

Uterine fibroids also can interfere with fertility. A woman may have problems becoming pregnant or, if she’s already pregnant, she may experience a miscarriage or other complications. 

How do you find out if you have fibroids? If you are experiencing any of the above-men-tioned symptoms, you should ask your health provider. The diagnostic test comprises a pelvic exam, often combined with ultrasound, MRI or CT imaging of the uterus, and will show one or several tumors. Size-wise, these can range from looking like a raisin to a large grapefruit, and they can be located anywhere in the uterus wall or even grow as stalks from the uterus. The latter type can cause much pain if they become twisted. Uterine fibroids depend on estrogen for their growth and usually shrink or disappear following menopause.

Treatment options for fibroids range from lifestyle modifications, acupuncture, anti-inflammatory drugs, hormone therapy and birth control pills to surgery to remove the uterus. In fact, uterine fibroids are now the most common reason for hysterectomy. However, there are now alternative treatment options available, which let the woman retain the potential for fertility by leaving her uterus in place. These include:

Myomectomy: Instead of removing the entire uterus, only the fibroids are surgically removed. 

Uterine fibroid embolization (uterine artery embolization): The blood supply to the fibroid is blocked, thereby starving it and helping it shrink. During this procedure a fine tube is threaded through an artery in the groin and small pellets are introduced to block the circulation.

Magnetic resonance-guided focused ultrasound: This non-invasive, outpatient procedure can cause symptom relief with-in days of treatment, and fol-lowing it, fibroids shrink about 30 percent every six months. 

Currently, UVA has one of the few treatment centers world-wide that offers MR-guided focused ultrasound for uterine fibroids. The Focused Ultrasound Surgery Foundation (fusfoundation.org), located here in Charlottesville, helped to open the center in partnership with UVA, and has a patient support initiative, Fibroid Relief. Visit fibroidrelief.org or call 220-4859 for more information.

Charlottesville’s Annette Owens, MD, Ph.D., is certified by the American Association of Sexuality Educators, Counselors, and Therapists. She has co-edited the four-volume book, Sexual Health (Praeger).

 They define your female curves, respond to your lover’s caress and allow you to nurse your newborn. Sure, they can also hurt like hell just before your period and you may think that yours are either too large or too small. But, trust me, your breasts are precious friends you need to take good care of. 

As women get older and their fertile years pass, their breast tissue undergoes involution, an inevitable change during which the milk-producing system inside the breasts starts shrinking. Because breasts have no muscles, no exercises can prevent your breasts from losing both fullness and shape over time. 

As hard as this reality may be, it’s a small price to pay when you consider even more negative afflictions, like breast cancer. Fortunately, there are preventative steps you can take toward early detection.

Besides asking your health provider about when you should start having regular clinical breast exams and mammograms, it’s a good idea to periodically check your breasts for lumps and irregularities.

Breast self-exams (BSEs) are best performed once a month beginning at age 20 and throughout your lifetime. If you experience changes in your breasts throughout your menstrual cycle, do the BSE during a time when your breasts are not tender.

BSEs may lead to false positive results and unnecessary biopsies (tissue samples) and anxiety, which leaves some women hesitant to perform them. Nevertheless, most health professionals recommend that women examine their breasts monthly, especially since mammograms do not always detect lumps.

Here is how to best examine your own breasts:

Start by looking at your breasts and the entire chest area in front of a tall mirror, first with relaxed arms and then with elevated arms placed behind your head. Look for any changes in size, shape or position of both breasts, dimpling of the skin, nipple changes (e.g. pushed-in or misshapen nipples), redness, swelling or other irregularities. It is normal for one breast to be slightly larger than the other. 

Next, press your arms on your hips (activating your chest muscles under the breast tissue) and then lean forward while you look for any changes since your last BSE. Then repeat the process while looking at your breasts from both sides.

Next, feel for lumps in your entire breast area, which also includes the part of the breast tissue that extends into the armpit areas. Search especially for enlarged lymph nodes in both armpits. This can be done while lying down with a folded towel under your shoulder.

Squeeze and pull the nipples a little to see whether there is any abnormal discharge. Yellow nipple fluid is considered normal. Nipple fluid that is bloody, dark or clear and sticky is cause for concern and follow up. (If in doubt, check with your health practitioner.) While pushing the nipple deep into the hollow beneath it, it is important to note any unusual resistance, hardness or lumps beneath the nipple.

Using the tips of your index, middle and ring finger follow two patterns of moving your fingers over your breasts when feeling for lumps and irregularities in the breast tissue: 

1) Vertical or “up and down” pattern covering the entire breast. 

2) Spiral or ring pattern, making concentric rings that tighten in a spiral, starting on the outer edges of the breast and ending around the nipple.  

For each area, press both softly and harder in order to examine superficial, as well as deeper, areas of your breast tissue. It’s a good idea to keep a monthly diary to document any particular things you may have noticed so you will be able to better follow up and compare the next month.

Charlottesville’s Annette Owens, MD, Ph.D., is certified by the American Association of Sexuality Educators, Counselors, and Therapists. She has co-edited the four-volume book, Sexual Health (Praeger).

An image of it was found on a 13,000-year-old etched plaque discovered during an archeological dig in Enlene, France. Hemingway’s novel The Garden of Eden centers around it. Go to the Metropolitan Museum of Art and you will find ancient Greek vases depicting scenes of it. Pick up the latest issue of Playboy and see yet another variation of the same old theme: Threesomes—sex between three individuals of any gender mix—are not an invention of the 20th or 21st century but, rather, go way back to ancient times. 

Another name for this type of sexual activity is ménage à trois. And many men and women fantasize about trying it out. If you are one of them, there are some things to consider:

Who should the third person be, someone you know or don’t know? What gender should the person be? Do you both need to be attracted to the person? How close will you let the person get to you? How do you think that person might feel afterwards, and do you care one way or the other? Are there any things you don’t want to do or let the other two people do to you? Do you only want the third person to watch you two or should he or she engage actively with you? What if two people pair off for a while and exclude the third person? Do you think you might feel jealousy or guilt afterwards?

In order to make threesomes work, it’s really impor-tant to think hard about where your personal boundaries are and how far you will go. Once the line is crossed, you cannot undo what happened. If one person has even the slightest hesitation, it’s probably not a good idea to carry out the fantasy.

Besides the psychological risks and the ever-present chance of unintended preg-nancy, there is the obvious physical risk of contracting sexually transmitted diseases. If there is vaginal or anal penetration involved, fresh condoms need to be used each time, and dental dams and condoms are recommended during oral sex.

If all of this seems too daunting to you, and in the end it does to many, there are some safe alternatives that may end up being as much—or at least almost as much—of a turn on as a real ménage à trois.  Invite an imaginary third person in the bedroom with you.  You can describe to your partner what you are fantasizing about doing sexually and listen to him or her about what she is fantasizing about. 

Watch an erotic video together and pretend that the real action is right where you are. Hitting the power button afterwards is much easier than escorting your third lover out of your bedroom and hopefully out of your personal sphere and life.

Charlottesville’s Annette Owens, MD, Ph.D., is certified by the American Association of Sexuality Educators, Counselors, and Therapists. She has co-edited the four-volume book, Sexual Health (Praeger).

 

Ask your partner or your friends “What does sex mean to you?” and you might be surprised. What seems like a simple question is not so at all. People often have very different ideas about what “having sex” means.

To some, the answer seems simple—and they often wonder why I ask such a weird question. Sex means intercourse. For them, sex is purely physical with a focus on stimulating each other’s genitals, ideally to the point of reaching orgasm. 

But listen to these answers:

“Commitment, trust, comfort, investment in the other person”; “Pleasure, bonding”; “Physical connection with a lover; being inside each others’ bodies is as close as you can get with each other”; “Something special you only do with your partner.”

Clearly, in these sample responses, the emotional connection to the partner is just as important as the physical component of sex. 

But let’s be realistic. For whatever reason, not everyone is in the situation of having a partner they feel a deep, emotional connection to—far from it. They may be single and still looking for “the one.” Or they may have a hard time becoming emotionally close to anyone. Sometimes it’s only a matter of time before they meet a person they can feel that deep level of connection to.

And sex can work just fine without the emotional part. People who have a one-night stand with a person they hardly know may get enormous physical pleasure out of it and be content with that experience. Or not, because, as we know, sex can be complicated.

Now, does sex always have to include intercourse? Consider this food analogy:

A bowl of plain pasta will satisfy your hunger all right, but it’s really not a good meal until you add the sauce, the spices, a salad, some garlic bread and perhaps a glass of wine. It’s the same with sex. By only focusing on intercourse, you miss out on all the good stuff that could come along with it. 

Think of sex as looking at a restaurant menu of options and then picking a few selections each time. Some days, you may even want to leave the pasta out altogether. And you definitely don’t eat your way through the entire menu each time you are out for dinner.

Too many lovers fall into the rut of repeating the same old routine each time they have sex. Their hands automatically reach out to each other’s genitals, counting on the familiar ways of turning their partner on and often entirely bypassing the largest sex organ we have: the skin.

Instead of rushing straight to the privates, give your lover a delicious scalp massage, or nibble on his ears. Or start at the other end by massaging his (or her) toes and feet. Remember, there’s actually an entire body here you can play with and explore, literally from top to toe.

San Francisco sex therapist Marty Klein has written a book called Let Me Count the Ways: Discovering Great Sex Without Intercourse. He has coined the term “outercourse” for sexual activities that go beyond penis-in-vagina sex.

Here are just a few examples: Talk sexy about what you like

to do together, read erotica together, watch sex films, search for the arousing spots on your lover’s body (some people like

to play “hide the honey” where you place some dabs of honey on your body and let your blindfolded partner discover them and lick them off), get out your favorite sex toys, have oral sex, anal sex, or engage in fantasy play. 

Just see what you and your lover like. There is no right and wrong, as long as no one gets hurt or is pushed way beyond their comfort level. But do free yourself of the old, repetitive ways—at least once in a while.

Charlottesville’s Annette Owens, MD, Ph.D., is certified by the American Association of Sexuality Educators, Counselors, and Therapists. She has co-edited the four-volume book, Sexual Health(Praeger).

 

Why is it that so many women are unhappy with their bodies? How many girlfriends do you have who are on a diet right now? A few weeks ago, I read an article in the Wall Street Journal about cankles, fat or swollen ankles that merge with the calf without a clear demarcation between the two.

These are the latest body parts that have become the focus of attack in specially designed gym classes, diets, and by plastic surgeons. Some even use Preparation H (a hemorrhoid cream that is designed to shrink hemorrhoidal tissue) for instant overnight shrinking of their swollen ankles, to make them appear slimmer. How far have we come?
 
And what about vaginal rejuvenation surgeries? They were up by 30 percent, from 793 in 2005 to 1,030 in 2006 (statistics are not available for later years). Just to be clear, these vaginal surgeries are not medically indicated, but performed only for one reason: to make your genitals look more aesthetically pleasing.

Who determines what’s beautiful, anyway? The photo editors at men’s magazines who Photoshop all images of women’s genitals before publishing? Let me tell you, real vulvas (the part of a woman’s genitals that is visible on the outside, while the vagina is inside the body) come in all sizes and shapes, just like the peppers in your garden often don’t look as ‘perfect’ as the ones you can buy at the grocery store.

Real vulvas are often asymmetrical, the inner lips can be longer than the outer ones (or vice versa), the clitoris can be hidden or it may be protruding. There are simply no limits to the variety that exists. For a fascinating display of the wide range, go to this webpage: http://www.scarleteen.com/resource/advice/betty_dodsons_vulva_illustrations.

Of course, vaginal rejuvenation surgeries are an extreme example of what a few people go through in order to adapt their various body parts to some arbitrary definitions of beauty. Nevertheless, a lot of men and women are unhappy with some aspect of their body. And a lot of times, these insecurities about body image play out in the bedroom.

How can you relax and be comfortable being undressed with a partner if you worry too much about the imperfections of your body? Keeping the lights off, staying under cover, or partially dressed might help, but how much fun is that? Perhaps it’s time to consider whether you really want to hang onto your negative body image.

The book Becoming Orgasmic by Heiman and LoPiccolo has a great section on body image and these authors ask you (among a lot of other things) to consider these questions:

How do you stress the things about your body that you’re proud of? How do you try to hide the things about your body you dislike?

What are the things you don’t like about your body? Are these things you genuinely don’t like or have you accepted the judgment or opinion of another person? If so, who are the people whose opinion of your body concerns you? Do they tend to be men or women?

Where did you get your ideas of what is attractive—your mother, men, yourself, television, magazines?

Have you ever been satisfied with how your body looks? How does or did that influence how you feel about your sexuality?

A woman who is comfortable in her own body is a sexy woman, no matter what size she is. Don’t get hung up on an extra inch here or there. At least, don’t let that stop you from enjoying sex.

One exception, though: If you are overweight to the point that your health is affected (diabetes, heart disease, elevated cholesterol, etc.), of course changing your eating habits and dieting is the right thing to do.

And a final word to mothers of daughters: Think hard about what messages about body image you want to send to your daughter. Does she constantly see you on a diet and complaining about your appearance? Or does she see you feeling good about yourself and the way you look? How you perceive your own body and how you express this will have a huge impact on how she is going to view her own body, now and in the future.

Charlottesville’s Annette Owens, MD, Ph.D., is certified by the American Association of Sexuality Educators, Counselors, and Therapists. She has co-edited the four-volume book, Sexual Health (Praeger).