Author: annette-owens

Hormones get the rap for a lot of things. Plenty of questions surround them, too. Is it true that your sexual desire is closely linked to testosterone levels in your blood? Does the Pill affect your libido? Are bioidentical hormones safer than others? Should women even be taking hormones in the first place?

In this column, we’ll focus on whether it is safe for women to take hormones—a question that has been on women’s minds for the past five years. In early 2002 the Women’s Health Initiative (WHI) study on combined estrogen and progestin treatment in postmenopausal women was stopped prematurely because it was feared that this type of treatment would cause increased risk of coronary heart disease, stroke, blood clots and breast cancer. Understandably, many women became skittish about taking any hormones at all for menopausal symptoms. 

Until that study was halted, hormone therapy was thought to be a safe and effective treatment for menopause symptoms such as hot flashes, irritability, vaginal dryness and night sweats. Then, almost overnight, many stopped taking hormones altogether after they read the alarming headlines. Well, what’s the news since then?

A critical look at the WHI study shows that the women in that study were not really representative of menopausal women, after all. On average, the women in the WHI study were 12 years after menopause. Seventy percent were between 60 and 79 years old. Other factors such as the overall health of the women in the WHI study, the statistical methods used, and the choice of hormone therapy have been criticized, too. Another, better study, specifically designed to answer questions about how well recently menopausal women (age 40-55) tolerate hormone therapy is now being carried out, but we don’t have the answers from that study yet.

This much we do know: Women who start taking hormones closer to the onset of menopause apparently do not experience increased heart risk. And at least two studies show that combining estrogen and progestin may lower a woman’s risk of developing diabetes. Which means, if you are experiencing severe menopausal symptoms, don’t rule out hormone therapy. But you need to discuss your best options with your own health provider.

I recommend reading up on the pros and cons in advance. A helpful website that features a balanced view is the CBSCares menopause website, cbs.com/cbs_cares/menopause/index. The articles are written in a question and answer format that is easy to absorb. It features interviews with several menopause experts, who actually represent different views, which just shows how complex this topic is.

If you want to consult someone who specializes in menopausal issues, I recommend going to the provider list of the North American Menopause Society website, menopause.org to find a local provider. And pick the recent book The Hormone Decision by Tara Parker Pope. As always, getting informed is the key to making good decisions for your own health.

Annette Owens, MD, Ph.D., is certified by the American Association of Sexuality Educators, Counselors, and Therapists. She sees clients in her Charlottesville office (cvillewellness.com) and answers questions online at LoveandHealth.info and SexualHealth.com. She has co-edited the new four-volume book, Sexual Health (Praeger).

What does an orgasm feel like? That’s a question many women have. When someone asks me that, I ask a question in return: "What do you think an orgasm will feel like?" Some women expect to see fireworks when they come or that an orgasm will involve the entire body. Actually, orgasms vary and even seemingly minor muscle twitches in your genitals in response to sexual stimulation count as orgasms.

So what are orgasms? They are best described as more or less powerful releases of sexual tension and arousal, during which breathing and heart rate typically change. The woman experiences muscle contractions throughout her pelvis and genitals, and sometimes in other areas of her body.

Some women, once they climax, quickly lose interest in any more sexual stimulation. Others are multiorgasmic, which means that they can have several orgasms during a single sexual encounter. Some women are one way sometimes and the other way at other times.

There is no right or wrong way to have an orgasm. Freud claimed that vaginal orgasms (during penile thrusting) are better or more mature compared to orgasms achieved by clitoral stimulation. Amazingly, this myth has survived to this day. If you ask me, Freud should have stuck to smoking cigars. He obviously knew little about women’s sexual pleasure.

While seeing fireworks usually is not part of the deal, there are plenty of women who describe their orgasms as euphoric or even spiritual. Over the years, I have talked to women who enjoy feeling almost out of control when they come, though some dislike feeling vulnerable. In fact, not wanting to "let go" can be a barrier to experiencing orgasm. In those cases, I suggest to a woman that she practice letting go while she is by herself. I tell her to pretend that she is having an orgasm and to go through the motions and the sounds without being afraid of what her partner might think.

What else can a woman do if she has never had an orgasm? If she has never explored her own body and masturbated, that’s a good place to start. Learning to have orgasms by herself is usually easier than with a partner. Many women grew up hearing that they should not touch themselves "down there," so they need to give themselves permission to do so and to enjoy getting off instead of fearing it.

Also, using a vibrator can help since it provides much more intense stimulation than a finger or a tongue can do. In fact, women who for some reason have lost their ability to reach orgasm (perhaps due to longtime diabetes, or multiples sclerosis) often can get them again when they start using a vibrator.

A good book on the subject is Becoming Orgasmic by Heiman and LoPiccolo. The authors have a step-by-step approach that has taught countless women how to climax. Betty Dodson has a great educational video, "Celebrating Orgasm," and other educational material available at bettydodson.com. Check out the website sexualhealth.com for an entire channel with articles and frequently asked questions about the orgasm.

The good news is that any woman who wants to experience an orgasm can make a lot of progress on her own. All she needs is the motivation to want to give it a try.

Annette Owens, MD, Ph.D., is certified by the American Association of Sexuality Educators, Counselors, and Therapists. She sees clients in her Charlottesville office (cvillewellness.com) and answers questions online at LoveandHealth.info and SexualHealth.com. She has co-edited the new four-volume book, Sexual Health (Praeger).

Look & feel your sexiest at 20, 30, 40. The hair, the skin, the body, the secrets!

Your top 10 sex questions answered at last.

Looking better than ever.

Skin tight dresses at 50.

These are some recent supermarket magazine headlines. And check out the teen mags:

Hot or not? The pressure to be sexy.

698 ways to look pretty.

Are you sure you’re still a virgin?

10 most asked sex Q’s—answered.

Popular media focuses on appearance and sex from the get-go. And the pressure to be sexy is on. No wonder then that countless women (and men) have come to see me with one goal in mind: to perform better in bed.

Women feel pressure to be able to reach orgasm, to be more interested in sex, to be better lovers. Men worry about their erections and about coming too soon or too late. I can feel the tension in the room; the enormous pressure these people feel is reflected in their body postures and on their faces. I tell them all one thing: “Relax! Forget about performance and pressure. What do you want out of sex? Have you ever thought about exploring new pathways to pleasure?”

Adults rarely play—unless on the golf course or on the tennis court. And even then it usually involves pressure to win or at least to do well. But having sex with your partner is a chance to be playful, to take a vacation from all the daily stress. Even if it only takes a few minutes, it’s a great way to give your body and mind a break from it all.

I once saw a young married couple for whom having sex had turned into a nightmare. He had developed performance anxiety and was often unable to either get or stay hard. This was before Viagra was on the market, so there was no easy quick fix.

What did I tell them? To stop everything they were doing, most importantly to stop trying to have intercourse for a while. Instead I gave them the assignment to create a relaxing atmosphere at home and to free up some time for each other. They were to touch each other’s bodies from top to toe, but to avoid touching their genitals or other arousing body parts such as nipples. I explained that the purpose of the touching was not to be a prelude to intercourse, but an enjoyment in itself. I specifically told them not to have intercourse, but to explore different pleasant strokes and to find areas of their bodies that were pleasurable to have touched and caressed.

I had only five sessions with this couple, and in the final session he talked about the relief he had felt when he had realized that he did not need his erect penis to pleasure his wife. He felt that he had been able to develop his own “tool box” to keep his wife happy in bed. That tool box included whipped cream to be licked off each other’s bodies, oral sex and much more. They had been able to start having fun again, without the need for him to have a hard-on.

Now that the pressure was off his penis, so to speak, his erections came back just fine. But he was no longer panicked by the thought that once in a while and for whatever reason he might not be able to get it up. Both partners had learned how to find pleasure in bed, helping them to overcome the pressure to perform. 

Annette Owens, MD, Ph.D. is certified by the American Association of Sexuality Educators, Counselors, and Therapists. She sees clients in her Charlottesville office (www.cvillewellness.com) and answers questions online at www.LoveandHealth.info and www.SexualHealth.com. She has co-edited the new four-volume book, Sexual Health (Praeger).

A few years ago I received a desperate e-mail from a woman in her late 20s. She had never been able to have intercourse and finally turned to the Internet for help. No boyfriend had ever been able to put his penis into her vagina and she was convinced that she "had bones around her vagina."

It turns out she had no concept of her own sexual anatomy—it had been a taboo topic both at home and at school.

I sent her a link to a webpage with anatomical drawings and explained that the "bones" simply were her tense pelvic floor muscles causing a tight grip around her vagina. (This is not unusual for women who have been sexually assaulted as I learned she had been.)

My advice to her: Find a good time of the day when she was relaxed and alone and could create a comfortable setting in her bedroom or someplace else where she felt safe. She should take a handheld mirror and look between her legs and compare herself to what she had seen on the webpage.

This was a woman who had never looked at her own genitals! She’s not so different from many other women. If you have never examined your own orchid, I invite you to get comfortable and to get your mirror out. Get ready for your anatomy lesson—it could change your life, or at least your sex life!

Put a few pillows behind your back while sitting on your bed (or anywhere else you like), spread your legs, and hold the mirror in front of you. Here is what you will see:

There are two parts to your genitals, the outside area, called vulva (not to be confused with a Scandinavian vehicle) and the inside part, called vagina. Most people call everything "vagina," but you won’t have to make that mistake once you learn the correct terms.  

You will discover three openings, the anus at the very bottom, the vaginal opening in the middle (this opening may be covered by a hymen if you have never had intercourse), and above that a small hole (urethra) where urine comes out. Two layers of skin-folds surround the vaginal opening. The outer one is called labia majora and the inner one labia minora. These "big and small lips" fill with blood when you get turned on. You will see a small rounded structure (the clitoris) above the urethra, immediately under the point where the smaller skin-folds merge (the hood of the clitoris). The clitoris is the most sensitive area in a woman’s body. Gently stroke it and feel for yourself!

The bony area covered with pubic hair is called mons pubis. It’s part of the pelvis that surrounds and protects the sexual organs.

So, what’s inside your vagina? Imagine your uterus looking like a pear with the round part pointing up and the thin part (the neck, or cervix) forming the dead end of your vagina. This is the opening through which sperm gets inside the uterus during conception. The cervix also has lots of nerve endings, which means it usually feels really good when the penis bumps into it during thrusting.

If you insert your index finger about 2" into your vagina and point it up toward your belly button (from the inside), you may be able to feel a cushion-like area that gets congested with blood when you’re turned on. Not every woman can feel this area called the G spot (don’t worry if you cannot—you’re still completely normal!). It too adds to your pleasure when stimulated during sex.

Finally, you cannot see the pelvic floor muscles but you should know about them. They help keep your uterus and bladder from sinking down into your vagina (really!). You can learn to strengthen these muscles by squeezing the muscles you use to stop the flow of urine. Especially if you have had babies or if you suffer from incontinence, it’s important to do what are known as Kegel exercises. And as a bonus, having toned pelvic floor muscles helps being able to form a nice grip around your partner’s penis during intercourse—which everybody enjoys.

Annette Owens, MD, Ph.D. is certified by the American Association of Sexuality Educators, Counselors, and Therapists. She sees clients in her Charlottesville office (www.cvillewellness.com) and answers questions online at www.LoveandHealth.info and www.SexualHealth.com. She has co-edited the new four-volume book, Sexual Health (Praeger).