Low libido, intercourse pain, orgasm problems?

— Sexual-health doctors are trying to help

Some Canadian doctors aim to address what they call near-total lack of support for women’s sexual health

By Brandie Weikle

A small number of Canadian doctors specializing in women’s sexual health are trying to address what they say is a near-total lack of support for those suffering from common problems such as low libido, difficulty achieving orgasm and pain during intercourse.

“In terms of the juxtaposition with men’s sexual functioning, we are behind and it’s really frustrating,” said Dr. Stephanie Finn of Oakville, Ont.

Finn is one of five Canadian doctors trained by the International Society for the Study of Women’s Sexual Health (ISSWSH), based in Burnsville, Minn.

While help for male sexual dysfunction has been widely available since erectile dysfunction drug Viagra burst onto the scene — approved for use in Canada in 1999 — women’s sexual health has remained largely shrouded in secrecy.

“When’s the last time your doctor has asked you about your clitoris? Like never, and that’s fascinating, right? We ask men all the time about their penises and their function, sexual functioning and such,” she told White Coat, Black Art.

I think that there is generally a lack everywhere of interest in women’s sexual functioning, and I’m happy to say that I think that’s beginning to change.”

A woman stands in front of an exam chair in a doctor's office.
Dr. Stephanie Finn is a family doctor focusing on women’s sexual medicine.

Originally a family doctor, Finn found that so many of her female patients needed help with sexual issues that she decided to focus on sexual medicine, opening her clinic about a year ago.

Part of that work is simply teaching women about their bodies, she says.

“It is really common for women to have almost no understanding of their own anatomy,” Finn said.

“I’ve had women who really haven’t a good idea about where their clitoris is. I’ve had people say, ‘Oh, I’ve always wondered,’ and sometimes I’m slightly surprised by that response in women who are in their 50s.”

Finn offers her patients the option of holding a mirror while she gives them a guided tour of their genitalia. Or she’ll use a 3D model to show patients things such as how the clitoris is actually a wishbone-shaped organ, with only the clitoral bulb visible externally.

An illustration of the parts of the vulva.
Parts of the vulva.

A study published in the Journal of Sexual Medicine in 2023 found that the bulb has around 10,000 nerve endings. That’s compared to about 7,800 at the tip of the penis, according to a paper published in the same journal in February.

A culture of shame

Some of that knowledge gap and reluctance among women to seek help for sexual-health issues is tied to cultural shame, says Dr. Stephanie Hart from Okotoks, Alta., another ISSWSH-trained family doctor.

In North America, vaginas are dirty. Like, I actually had somebody say that to me yesterday,” said Hart, who opened her specialized clinic in 2019.

For some women, that’s simply because they are grossed out by bodily fluids, including those that come out of the vagina, she says.

An exam chair inside a doctor's office.
A chair used for gynecological exams in Finn’s clinic. Many women are uncomfortable with speaking openly about sexual health.

But for others, it’s a morality issue: “You know, ‘sex is shameful.’ That’s a very common attitude that I see people [have]. And kind of unsurprising that people would then have sexual dysfunction when they feel that way about it.”

Despite people’s difficulty talking about their sex lives, these clinics are busy. Hart says she sees 250 new patients every year in her practice, 75 to 80 per cent of them being women, but is referred around 400.

“So every six months, I’m another three months behind.”

Finn said she sees about 15 new patients every week at her Oakville clinic.

A model of a vulva.
Finn often shows her patients a model of a vulva to help familiarize them with their own anatomy.

Most Canadian women do not have access to a doctor who specializes in sexual health. Existing clinics where women have traditionally sought care for sexual health are focused on contraception and infection, says Hart.

These kinds of clinics refer patients to her when they bring up difficulties like pain during sex or low libido, Hart says, as do specialists such as gynecologists.

Help for low libido

Carolina Jara, 57, says she used to be a very sexual person, but since menopause, her libido has tanked.

“My libido went somewhere. I don’t know, maybe back home,” joked Jara, who is originally from Peru but lives in Vancouver.

She says she’s worried about how that can impact her relationship with her husband of eight years. And that part is not a laughing matter.

A close-up of a woman with white earrings and a red top.
Carolina Jara, 57, says she used to be a very sexual person — but now, she is suffering from low libido.

“He still wants it, but I don’t get ignited, I don’t get an orgasm for many years. So it feels more like a duty, more than something that I enjoy.”

There are two medications approved for use in Canada that can be used to increase sexual desire in women: a pill called flibanserin, and a self-injectable called bremelanotide.

Unlike Viagra, which is used on an as-needed basis and acts by increasing blood flow to the penis, both of these drugs impact the brain chemicals that influence mood and sexual appetite. Flibanserin must be taken daily and has been shown to have serious potential side effects.

A pink pill is seen on a piece of paper that shows part of the Sprout Pharmaceuticals logo.
Flibanserin, pictured above, is one of two medications approved in Canada that can be used to increase sexual desire in women.

Critics have argued that libido problems are more a matter of mismatch between the sexual appetites of partners that would be better addressed with relationship counselling.

A non-medical tool for addressing low libido or difficulty achieving orgasm is a class of sex toys sometimes referred to as clitoral suction devices.

“We have wonderful studies actually now showing improved clitoral blood flow and pelvic floor blood flow using these devices,” Finn said. “We know they can make a huge difference for women when they are attempting to achieve orgasm.”

Pain during sex

But sexual-health issues are by no means the exclusive domain of older women, says Finn, whose patients range in age from teenagers to octogenarians.

Talia Steele, 34, suffered for years from pain during sex, stemming from a series of problems that started with a common urinary tract infection.

Woman with shoulder-length curly hair smiles at the camera.
Talia Steele says she had some early negative experiences with male doctors and felt her problems weren’t treated with sensitivity.

Eventually she got surgery to address the issues. But all the poking and prodding, and her history of painful sex, has had lasting effects.

“There’s always that bit of anxiety, never being able to be fully in the moment, always in your head about what’s going on,” said Steele, who is married and also lives in Vancouver.

“Even though I don’t have that pain, those feelings and thoughts still enter my brain at times, and it can be challenging to try new things or come out of my comfort zone.”

Greater Victoria’s Sex Lady discusses sexual health and how teaching it has evolved

One of the challenges with getting care for women’s sexual-health issues is that there’s no established medical specialty for them.

“You take these women with pain [during] sex, for example, and you send them to the gynecologist who would say, ‘Well, it’s not endometriosis,’” Hart said. That might be the end of the road if the doctor doesn’t know about other options that might help.

Hart says she’s on a mission to teach other doctors how to help, starting with asking patients the right questions.

“Like, actually ask if somebody has pain with sex and then know what to do about it if the person says yes. Because patients won’t always volunteer the information if they don’t know that there’s something that can be done.”

Complete Article HERE!

What a sex therapist wishes all couples knew

— Desire doesn’t have to dwindle in long-term relationships, says Dr Stephen Snyder. Here’s the advice he gives married couples in his clinic

By Anna Maxted

How do you keep the passion alive when you’ve been with your partner for decades? Dr Stephen Snyder, the therapist and author whose book Love Worth Making: How to Have Ridiculously Great Sex in a Long-Lasting Relationship is a bestseller, has the answers. Having worked with hundreds of married couples over 30 years, he explains why desire often dwindles over the years — and how to rekindle it.

Don’t expect sex to knock your socks off every single time

If you ask people to recall the greatest sex of their life, most will admit that it wasn’t in the context of a committed relationship. More often they’ll recall something novel, unexpected, or possibly even forbidden. There is something uniquely thrilling about the first time you get naked with someone.

If you seek that kind of thrill within a committed relationship, as many do, you’re likely to be disappointed and frustrated. I tell couples in my clinic, don’t compare apples and oranges. Better if you can learn to listen carefully to your own arousal, and to the particular feeling your partner arouses in you. I don’t think of it as a “spark” — that word is too dramatic. Pay attention to that vibration, and be open to hearing it. You never know where sexual inspiration will come from. Don’t try to control it.

Don’t schedule a time for sex

Many sex therapists advise couples to just “put sex in the diary”. I think that’s a recipe for bad sex. It’s like making a dinner reservation, but when you get to the restaurant you’re not hungry. Instead, I recommend couples schedule a time to go to bed together to do nothing at all. Allow yourself to shift from your ordinary state of mind. You don’t always have to be “doing”. Take a breath and feel the air. If you’re feeling something, maybe express it to your partner. Or turn to them and say: “Hey, talk to me, what’s going on with you?” But keep it simple. Focus on the here and now.

In sex therapy, we call this the 2-Step, where Step 1 is cultivating awareness by going to bed with no agenda except to do absolutely nothing. That gets you ready for Step 2, where you let yourself become physically aware of your partner and notice any erotic feelings that might arise. Stay in the moment, if you can. Don’t try to arouse your partner. Just experience them — their voice, the scent of their hair, the way they feel in your arms and on your lips. You don’t need to feel desire to 2-Step, just a willingness to go wherever it might take you.

If you want lust to last, appearance matters

In my practice, what I hear most often from women is that they like their man to be diligent about grooming. He doesn’t have to be impeccably turned out just to watch TV on a Tuesday, but there’s no reason a man can’t be careful about how he presents himself, even if it’s just getting a nice haircut and trimming ear hair, nose hair, and eyebrows if they’re unruly, and maybe investing in a nice new set of boxers. And what about weight gain? It’s a sensitive subject, but it can matter. How lucky that near vision deteriorates in midlife. Every couple over 40 should have a dimmer switch in the bedroom, since none of us looks quite as good as when we were teenagers.

Truth is, most women in my practice say they’re turned off if a man has a pot belly, which is where most men tend to put on weight. But I haven’t seen much success with women telling their husbands to do sit-ups and watch their diet. That doesn’t seem to work any better with a man than it does with a woman, and it certainly won’t put your partner in the mood for sex. Instead, I recommend for a woman to lie him on his back, where his belly won’t look so prominent. Get on top, and focus on the parts of him that you do like.

Women like to feel passionately desired

Desiring a woman is more than just wanting to have sex with her. Most women crave a kind of erotic attention that has nothing to do with penetration or orgasm. It’s more likely to be from a shared look across a room, or in the moments before a first kiss. At its most intense, it’s feeling irresistible. That’s what makes erotic novels compelling for many women: the hero finds the heroine irresistible. He can’t stop thinking about her. So many women in my practice tell me they need to feel strongly desired. But that’s a tall order when you’ve been together for a long time, you’re busy with work and kids, and you both probably value a good night’s sleep more highly than sex.

I advise husbands, whenever you feel sexually attracted to your wife, don’t waste the moment. Act on it. Let’s say she’s in the kitchen wearing something nice, or changing, or just out of the shower. If you feel drawn to her in that moment, walk over, take her in your arms and hold her like you mean it — which of course you do. Kiss her passionately, inhale the scent of her hair, and say: “Did I ever tell you how attracted I am to you?” Most women in relationships say they need that show of desire more than they need sex.

Accept your partner for who they are

A wise old sex therapist colleague once asked me: “Why do women get bored with their husbands but not with their dogs?” I suspect it’s because most women accept that their dog is just a dog, but many have trouble accepting their husband for who he is. Some women tend to think of their male partner as a project, or a work in progress, and they forget to be thankful for what they’ve got. Most men are like cactus flowers — they don’t need much watering to bloom. Sometimes it’s best to leave your list of projects to the side and find something about your husband to enjoy or appreciate.

Be connoisseurs of your arousal

The happiest lovers savour arousal wherever they find it, whether it’s with a partner, alone, or through fantasy. They pay attention to what their arousal feels like. And happily, since taboos around female pleasure and sexuality have fallen away — and sex toys have improved — fewer women worry about having an orgasm through penetrative sex, making it easier to relax and enjoy the moment.

Cultivating arousal can be like learning to enjoy good wine. You begin to notice its components, like how arousal grabs your attention and makes you forget about non-essential things; how it makes you regress to a more spontaneous version of yourself; and how it touches your core sense of being. Many people spend lots of energy trying to produce strong arousal, as if that’s something you can control. Established couples who have good sex understand that there’s a passive element to it, as if you are riding a wave.

Remember to enjoy each other

In my practice I often ask women what they crave most in lovemaking. For some it’s a feeling of “surrender” with a partner who knows how to take charge. They appreciate a certain kind of male energy — confident, decisive and fully engaged. Many relationships start out with plenty of it, but as time passes the man runs out of steam and becomes inert and lacking in initiative. When couples like this are in treatment, the male partner will sometimes tell me he feels nothing he does makes her happy, so he withdraws to protect himself — which definitely makes her unhappy. And so her unhappiness and his lack of confidence just keep reinforcing each other in a vicious cycle.

The truth is that many men are quite sensitive to their partner feeling disappointed. It’s often worth reminding a man that a woman’s disappointment doesn’t have to be a calamity. It’s worth reminding her to enjoy him for who he is, rather than complaining about who he’s not. Male or female, deep down we all need to be enjoyed. Many men start manifesting confident male energy again once they feel their partner really appreciates them.

Most long-term committed couples don’t get excited together unless they’re going to have sex, which is an enormous mistake. This is a fork in the road early in a relationship. Once the fever of having sex passes, you’re faced with the decision whether to go right or left. Almost everybody goes left; they keep desire toned down, unless sex is on the menu. They don’t wear anything sexy to bed, they don’t play footsie under the table in a restaurant. It never occurs to them that arousal might have independent value. Why save it just for sex? The happiest couples, meanwhile, enjoy feeling turned on together just for its own sake, even if it’s just for a minute or two, even if they’re not going to have sex.

In sex therapy, we call this “simmering”. It’s what most of us did as teenagers — passionately kissing in the hallway between classes, then hearing the bell ring and darting off in opposite directions, feeling deliciously buzzed. In most adult relationships, the simmering is at least as important as the sex — if only because it’s easier to find time for. I suggest, whenever you might ordinarily kiss your partner, consider simmering them instead. Instead of waving them off to work with a peck on the cheek, simmer them goodbye. Hold them tight, feel their body, maybe rumple them up a bit, then send them on their way. And men, if you’re watching TV and your wife comes to kiss you goodnight, grasp her around the waist, pull her down to you and hold her tight. It may well lead to something more later — but it doesn’t have to.

Take responsibility for your own orgasm

Many women still think that if their male partner gets an erection, they’re responsible for relieving him of it. This makes no sense, since no one should ever feel obliged to do anything in bed they don’t want to do. What’s more, we men like being aroused. It’s not painful and if nothing sexual happens, an erection simply goes down. So if you’re lying in bed with your man and he gets excited, it’s totally fine to say: “Nice to know you’re happy to see me, but I’m really tired. OK if we just simmer for a minute, then go to sleep?”

Sometimes, though, he’ll crave an orgasm — just like sometimes a woman might crave an orgasm. He could always go to the bathroom to deal it himself, but it’s cold and lonely in there. The sexually happiest couples tend to compromise with something we sex therapists call “lazy sex”. They kiss, he holds her passionately with one hand, and with his other hand gives himself an orgasm. Some couples tell me they’ve always done this, especially when they were new parents and exhausted, or because their libidos don’t always align. Other couples, when I mention lazy sex, look at me as if I have three heads; as if taking a vow of marriage means swearing never again to touch your own genitals in bed. Obviously that’s a misreading of the marital contract.

Complete Article HERE!

The seven things only a sex therapist will tell you

— If your sex life is awkward, unenjoyable or simply non-existent, a sex therapist shares her top tips to improve intimacy

By

As a sex therapist, I make space for people to let go of what they think should be happening and move towards what they truly desire. I often see clients who are stuck in their sex lives, or not having the kind of pleasure they want. There are seven key things I have learnt in my time as a sex therapist that can help individuals break free and improve their sex lives.

If people avoid talking about sex, it is often for the wrong reasons

It’s so common for people to be avoidant about the topic of sex that the underlying reasons for it are rarely even considered. I have found that at the root of any avoidance or awkwardness there is usually something the individual has catastrophised. They avoid talking about sex as, unconsciously, they believe that doing so could reveal catastrophic truths, such as that their partner totally fantasises about someone else or that others are far more competent in the bedroom than they are. These unexamined worst fears are rarely the reality.

A client may say “I think he really doesn’t find me attractive anymore, since I’ve given birth” and my response is “OK, but what makes you think that, have you asked him? Have you asked what might be going on with him, or been curious about the changes in your sex life?”

If I could give only one piece of advice, it would be to let go of assumptions and expectations and find out what is going on with your partner.

Shame is the ultimate passion killer

Individuals often carry unconscious shame, which can greatly impact desire. Feelings of shame may be linked to negative sexual experiences but shame can date back to childhood. It can be surprising for people to realise that their sex life is being affected by beliefs and feelings originally unrelated to sex. For example, a child may have learnt to be ashamed of their own needs if they were expected to suppress them in favour of other people’s. As an adult, this may cause them to focus only on their partner and to totally disconnect from their own pleasure and enjoyment. In therapy, this relates to what we call conditions of worth: believing that we are worthy only if we meet certain conditions. Unpicking these conditions of worth can pave the way for far greater passion.

One particular client, a single woman in her 30s, was struggling with sexual shame. We talked about a difficult sexual experience and she came to the realisation that the experience had not been consensual. Once she was able to see this for what it actually was, and to think about how her body had felt, the shame began to dissipate. She then reframed the experience as sexual assault. It was a tough realisation, but this alignment was ultimately incredibly freeing for her.

Libido and orgasm type can be changed

Many aspects of a sexual relationship can be transformed by therapeutic work. A mismatched libido is very common but there is great potential for sex drives to become more in sync. There is a playful erotic exercise which can be really helpful: the couple ‘show and tell’ by demonstrating to each other what they like through self-pleasure. Couples find this game-changing for increasing their desire and libido and I highly recommend anyone in a trusting partnership try this exercise.

Similarly, people may have a fixed way to reach orgasm, but this too can change. By spending time focussing on their senses and exploring touch, they may discover, for example, that they can orgasm from nipple play.

A recently divorced woman in her 50s came to see me because she was feeling lost within her sexual self. She had been a wife and a parent for more than half her life and was keen to enter into a new form of relationship and sexual adventure but didn’t know where to start. After working on self pleasure and becoming more aware of her body’s responses, she found that she had a new fantasy life, focussed on being dominant rather than submitting. She went from low confidence and self-worth to loving her body and feeling empowered about having choices; she was reminded that her relationships, and her life, were in her control.

An achievement mindset is not helpful when it comes to sex

Goal-orientated pressure can really diminish sex. This can be particularly apparent for clients who are trying to conceive, as the pressure of timing can lead to difficulty maintaining an erection. But striving to ‘achieve’ can cause psychosexual issues in many other scenarios. People who experience issues such as vaginismus, erectile dysfunction, delayed, early or absent ejaculation will often be feeling a great deal of pressure – from a partner, societal norms, or themselves.

People would be far less concerned about achieving certain sexual goals if they knew the wide variation in people’s experience and knowledge. Some women are unfamiliar with their own genitals; some married couples have never had sex; some men do not know how to perform penetration. I see couples, for example, who have been to the doctors for their struggle with conception; yet when they come to see me and we talk it becomes apparent that penetration isn’t actually occurring. Little to no sexual experience is far more common than many would assume.

Planning sex can be genuinely sexy – plus it reduces the risk of rejection

People tend to expect that there should be total spontaneity in their sex life; that they should be having unpredictable sex every other day of the week, on the kitchen counter; and that it should all just ‘happen’. However, for most people, life simply gets in the way. The expectation of spontaneity also means that sex isn’t talked about beforehand; couples assume they should be completely aligned and just know what each other wants. But this is unrealistic.

People are usually resistant to planning sex, but it can be very sexy and erotic – communication throughout the day about the where and the when can build up the arousal. Equally, deciding in advance not to have sex, feels so much better than one person spontaneously initiating, only to have the other person turn away.

Planning sex was transformative for a couple in their 30s who, when they first came to see me, thought they would never be able to have sex again. The woman had MS, the man had painful arthritic hips, and every time they tried to have sex one or both of them would be in pain and take days to recover. Attempting to have sex had become a tense and sad experience. Initially we worked on building intimacy and connection through non-penetrative exercises, then we thought carefully about their bodies and came up with different sexual positions for them to try including the use of supportive cushions. They were delighted to be able to be intimate in these new ways.

Authenticity, not perceived attractiveness, is what is important

So many people, regardless of gender, have negative feelings about their body, worry about their appearance or about being ‘enough’ for their partner. But it’s not looks that make a satisfying sexual connection: it is feelings – genuine and authentic feelings. Authenticity is the antidote to shame and insecurity and the key to intimacy.

If people are struggling with insecurity we can look at the relationship; whether they are accepted for who they are, and whether they take pride in all that their body does for them. Working with people around their truth, their authentic self, is powerful.

There is such a thing as sex homework

Sex homework can involve journaling, self exploration exercises or whole body massage. But a classic sex homework task is to temporarily avoid penetration. This removes the perceived goal from sex and allows for more focus on sensations and emotions. This can be transformative for people, even if they’ve been having sex together for years.

It is my hope that, regardless of where they are now, people can release fear and shame and experience more joy and pleasure. Which is often easier than they think!

Complete Article HERE!

Sex Advice With An Edge — Podcast #39 — 11/12/07

[Look for the podcast play button below.]

Hey sex fans,

I have a really swell show for you today. We have a nice load of interesting questions from the sexually worrisome. And I respond with an equal number of dazzling, charming and oh so informative responses! Hey, it’s what I do.

  • Edie is hungry to be horny!
  • Trent was traumatized as a kid. Now his wife is afraid to touch him.
  • Rachel got herself a natural man, but she don’t how to blow him.
  • Vic has ‘roids…he thinks.
  • Rav, Jon and Trev get a quickie

BE THERE, OR BE SQUARE!