Sexual Healing by Dr. Margarita Kressin

Single or divorced male, kind to animals, not in prison, good teeth, preferably have a job. More or less.

I was helping my friend go through her eHarmony application. I was amazed at how detailed the questions got: what best friends think of you, the last book you read, "must haves" and "can’t stands" in seeking a mate. Don’t get me wrong. I obviously care that my friend meets a decent guy, so I am glad they get pretty detailed. But I stop to think, this is what it takes nowadays?!

My friends are intelligent, not physically grotesque, have never been arrested let alone been in prison, have all their teeth, are college educated, have good jobs, kind to animals, chew with their mouths closed, and they don’t spit when talking. Really, what does it take?

Within the last two years, I know of three friends who met their husbands through some sort of online dating. I know of four people right now actively going through some dating service. I see ads on TV, hear them on the radio, even read them on the airline magazine I flip through when flying — Just Lunch, Great Expectations, match.com, eHarmony, just to name a few. There are also speed-dating services in order to increase your chances of meeting that special someone. It is playing on odds and statistics that maybe, just maybe, there is that one-in-30-or-so two-minute encounters that you will connect with.

I myself became Dr.-Mrs Kressin as a result of a set-up, so I empathize with my friends having a difficult time meeting other people (good decent people with no criminal record and have all their teeth. I know I’m obsessing about the teeth thing, but my friend just mentioned this, and now I can’t seem to stop looking at people’s teeth).

When you think about it, however, classifieds have been around for a long time. Our online and speed dates are just more sophisticated forms of looking for that special someone. So maybe it isn’t that it has become more difficult to meet someone. Maybe it’s just that we’ve just developed a fancier way to say:

SWF looking for S/DM, NS for LTR.

Sexual Compatibility. How important is this issue? I raise a potentially controversial topic. How much does one disclose to a potential mate about a potential sexual problem? How important is it to “test the merchandise” so to speak, before buying it?

I am not taking a stance whether or not one must have pre-marital sex or not. But I do see a fair number of patients whose husband/wife was their only partner. And in many religions, abstinence before marriage is practiced. So sometimes the problem doesn’t present itself until after they are married. But it doesn’t happen just to this group.

A friend recently divulged to me that she and her husband are having problems in the sexual arena. What surprised me is that they knew they were not sexually attracted to each other before they got married. They loved each other but there was no sexual spark.

Sex is a critical part of a marriage. But we also know that for most marriages, as the couple gets older and the marriage progress, the amount of sexual activity decreases. So does one give up a potential mate, who would make a devoted partner, a loving parent, a spouse for life, for sexual satisfaction?

What do you think?

Remember Jack and Jill? Our couple presents to our clinic wanting us to fix them. I applaud them that at least they came in together. They are at least aware that they both needed help.

Our sex therapist started with them first. All the anger, resentment, frustration came out. They would argue in front of me and our sex therapist. Blame and insult start flying.

At this point, our sex therapist and I agree that sex should be the last thing they should be working on right now. They need to like each other first.

Their first assignment was to spend 30 minutes a day together alone. They are to talk, not argue. They can talk about the weather, how their day is going, the grocery list; it does not matter. They just cannot argue. It was deplorable how much time they spent arguing compared to time they spent talking to each other with civility. It was also shocking how little time they truly spent with each other.
 
Mind you, at this juncture in their life, they are both retired. Jack spent more time on his lawnmower and Jill spent more time with her hairdresser than they did with each other.

This is what they did for the next three months, nothing else. Sometimes we have to start from scratch. Relationships, and sex for that matter, are living entities. They need to be tended to and taken care of. They need to change as life situations change. When neglected, disaster happens … sometimes they start to die. And really, one cannot expect a dying thing to just spring up to life and start jigging.

We have a ways to go for Jack and Jill. It took them 30 years to get their relationship to this point, so an overnight success or a magic pill is just not going to happen. With time and care, we hope to get them to liking each other … and having sex eventually.

Dr. Bruce Campbell had some interesting feedback in his blog, Reflections in a Head Mirror. A reader writes, "As a female I have always worried about passing on a yeast infection to the performing partner, although that never happend to me, it happened so a few people I knew when their husbands came down with a bad case of thrush. ... I would usually get a bladder infection, something I am prone too, after receiving oral sex. After avoiding oral sex, my incidence of bladder infection is way, way down. I really think there is a link, and women seem to have bladder infections a lot."

There was actually some exchange of e-mails from professionals on an Internet community board for ISSWSH (the International Society for the Study of Women's Sexual Health, to which I belong) about a patient who was getting frequent urinary tract infections.

She had the million dollar work-up to rule out stones, reflux, incomplete bladder emptying. Turns out, the patient had a partner who had a tongue piercing. When they cultured the tongue accessory, it came back as the same bacteria that the patient had been growing. So lesson to all of us out there ... yes, oral sex may be the reason a person is having frequent infections. I certianly ask about sexual practices now with my patients who present with frequent urinary or vaginal infections (there are penile piercings, use of vibrators and other paraphernalia as well that needs to be discussed).

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As for Dr. Campbell and his response to his reader, I appreciate his candor and honesty. In his defense, physicians (acutally, most people, not just the medical profession) are embarrassed to talk about sex and sexual practices because of the following reasons:

• It is still considered taboo in our culture
• Frankly, we are not taught how to in medical school
• Because MDs don't want to open the patient's pandora's box (affairs, unknown STD's, fetishes ...)
• The disease the patient has in front of the treating physician is the focus at that moment
• Most MDs are not comfortable/trained/feel competent talking frankly about sex
• If there is a problem, most MDs don't have the training to know what to do (especially when it comes to female sexual medicine)
• Sexuality and fertility are typically the last thing other physicians think about when they are trying to just save their patient's life

 
When I talk to other physicians, I tell them to typically just pass them on to our clinic (or to the Reproductive Medicine Center in cases of fertility questions) or at least give the patient our number as a future resource.
 
This is what we do in our clinic every day. And as much as I don't expect to talk to my patients about their diabetes, high blood pressure or other things, I don't expect other physicians to talk to their patients openly about their sexual habits. There is a difference between asking if they have diabetes or if they are sexually active (what we call screening questions) versus getting into their daily blood sugar levels or inquiring if they masturbate and perform oral sex on a regular basis.

It is improtant for patients and physicians to know that at least at Froedtert & The Medical College of Wisconsin, we have this resource. As an academic medical center, we have that resource and not many centers in Wisconsin or in the United States have a comprehensive program where we treat not just men, but also women.
 

Several people have approached me about an article that came out at the end of July regarding female Viagra. Here is a link referring to the study and the article.

http://www.healthcentral.com/depression/news-257087-31.html


We know that SSRI’s (selective serotonin reuptake inhibitors — a major class of anti-depressants) use is a risk factor for developing sexual dysfunction. The study found that sildenafil (generic name of Viagra) helps with orgasmic function and lack of arousal. Because of the sexual dysfunction caused by SSRI’s, some patients discontinue their use. The study shows that sildenafil improves these sexual side effects. The study was well-done with good patient choices (inclusion and exclusion criteria) and was very thorough in evaluating patients.

There have been past studies showing how sildenafil improves arousal disorder in women without desire (libido) disorder*. It has been shown to help women with spinal cord injuries as well**. Sildenafil is not for low libido or sexual desire issues.

Unfortunately, any of the PDE-5 inhibitors (sildenafil-Viagra, tadalafil-Cialis, and vardenafil-Levitra) are not paid for by insurance for women. And the average cost is about $15 a pill, so this may be prohibitive.

Female sexual function is complex and typically affected by multiple factors. It is promising that more and more research is being done in regards to female sexual function. With each study, we are collecting data, knowledge, awareness, and treatment modalities to help our patients.

*Kaplan et al, 1999; Berman et al, 2003
**Ferrara 2007

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The following is feedback received for this blog: Hello, Somewhat related to this post, I am an internist and have heard that Bremelanotide is a promising medication specifically for problems with arousal. Can you comment on this? Thank you very much. - Jason Thats so wonderful those articles, you get to learn so much! Thank you! - Jeena www.drugdelivery.ca