8
Jun


The only time sex should hurt is when you want it to hurt. Spanking, nipple pinching, and other kinds of rough play have an honorable history among consenting adults. But sometimes sex hurts when you don’t want it to.

Sexual acts themselves can be painful. Causes can be mechanical: tiny fissures around the labia or penile shaft, too much friction due to inadequate lubrication, awkward angles of insertion or containment. Active lesions from STDs such as herpes can make even light pressure painful. More serious physical causes include endometriosis, fibroids and Peyronie’s disease.

Some causes are psychological: Anxiety or anger can narrow the vaginal opening. Even simple touch can hurt when you’re grappling with strong feelings. Our gag reflex can be triggered by smell, sound, making kissing or oral sex an ordeal.

People over 40 often start noticing something new: Sex begins to hurt because it involves stretching, twisting, weight bearing, and aerobic stress. As you age you may have less tolerance, for example, for tilting your neck when performing cunnilingus, hyper-extending your lower back during traditional intercourse, or squeezing and pulling.

What can we do about this? If something aches, move it or rest it. Develop a repertoire of sexual activities that hurt less. Tell your partners what’s uncomfortable so they’ll stop expecting those things. To warm up for sex, stretch, take a hot bath and perhaps some aspirin. At 40 or 50, it’s part of sex.

Coming to terms with our sexual limitations is part of coming to terms with middle age. It’s rarely discussed; people talk freely about having to give up running or tennis, but not about how, say, tendonitis limits their masturbation.

But ignoring these changes can undermine the sex, while exacerbating the pain. Ultimately, having good sex in the shadow of our physical limitations requires that we admit what’s going on, and adapt accordingly. That means finding ways to deal with the grief of losing cherished sexual activities because of joint pain or limited range of motion.

In middle age, grief is a sexual frontier.

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Category : Blog
25
May


There are lots of great reasons to say yes to sex. But there are also times when it’s best to say no.

For starters, it’s usually best to say no if you’re not in the mood. I don’t mean, “I’m not really in the mood, but we’re feeling friendly, so if you do most of the work I’ll get into it.” Rather, I’m talking about times when you’re not going to get in the mood. Perhaps you’re not feeling well, or you’re exhausted or cranky. Maybe you’re nervous about something happening at work or with the kids.

It’s important to say no when you’re angry, and to talk instead. Unfortunately, some people use sex to ignore a problem that they can’t resolve. In fact, some people use sex to avoid intimacy — the kind of intimacy that involves the difficult exploration and resolution of differences that exist in all relationships.

People in new relationships (or one-night stands) shouldn’t necessarily say no to sex —but they should clarify what the sex means before getting into it. If one person thinks the sex is about recreation, while the other one thinks it’s the beginning of a commitment, both will be disappointed. Sometimes one person wants to keep the sex confidential, while the other is so excited (or proud) that discretion is impossible. Again, without a conversation about it, both people will be frustrated.

While a lack of contraception doesn’t require you to say no to sex, it does require you to say no to intercourse. That’s the only grownup way to look at it. Don’t delude yourself about using the “rhythm method” — people who use rhythm are called parents. If you’re not going to use birth control, at least admit it to yourself, rather than pretending you’re using a technique that’s only slightly more effective than wishing upon a star.

People have sex for lots of psychological reasons — wanting to prove they’re normal, that they’re a “real man” or “real woman,” that they’re still attractive. In fact, some people have sex for revenge or as a form of hostility. But you wouldn’t do that, would you?

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Category : Blog
1
Mar


What to say and how to say it

Each week, I speak to both patients and doctors about sex. Unfortunately, they don’t spend nearly enough time talking to each other.

Many patients say they’re waiting for the doctor to open the subject. Besides, they don’t want to embarrass the doctor or give him/her the wrong idea about who they are: “kinky,” “frigid,” a “slut.” Doctors say the same thing. They don’t want to embarrass their patients or offend those who might think they’re being called kinky, frigid or a slut.

When it comes to sex, what should you be talking to your doctor about?

  • Side effects of medications, particularly antidepressants, anti-hypertensives, diuretics and hormones.
  • Age-related changes. While changes in desire, arousal, orgasm and satisfaction aren’t inevitable, you should know what to look for and what to do about it.
  • What to do if you don’t like the way you function. There are simple ways to diagnose sexual difficulties. If your desire, arousal or orgasms aren’t what you want them to be, find out if there’s an organic basis.
  • Making sex more comfortable. Sex should never hurt. Painful sex can indicate a sexually transmitted disease, endometriosis, fibroids, tiny genital cuts or the need for a lubricant.
  • Questions about sexually transmitted disease and contraception — yes, even at your age.
  • Perimenopause. The early stages of menopause usually begin in a woman’s late thirties. A simple blood work-up can indicate where you are in this 10-year process.
  • A referral to a sex therapist, marriage counselor or psychologist. Many sexual issues are best handled by a therapist. Don’t hesitate to ask for a referral.

Health-care providers, like doctors and nurses, are there to serve you. If you’re uncomfortable talking to the ones you have now, get new ones. On the other hand, we all have to educate our health-care providers about our unique sexuality, whether our practices are exotic or ordinary. If all patients teach their medical professionals about sex, all of us would be better off.

 

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Category : Blog
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