Tag Archives: sexuality

Many young women mistakenly believe HPV vaccine protects against STDs

Reuters reports on a study published in the Archives of Pediatric & Adolescent Medicine, which found that some young women who have received the HPV vaccine believe that it protects them against STDs such as syphilis and gonorrhea, and indicates that greater education efforts may be necessary. Continue reading

Did you know premarital sex increases the later risk of divorce?

A recently released summary reviews the social science research over the past twenty years and reveals a strong correlation between premarital sexual activity and a significantly elevated risk of marital infidelity and divorce on later marriage. Continue reading

8 Reasons Sex Is Better After 50 (or, “You can have the greatest sex life on earth”)

I think one of the best ministry activities in which Barb and I have worked together during our 37 years of marriage and 53 years of friendship, is our book His Brain, Her Brain: How divinely designed differences can strengthen your marriage. (signed copies for gifts are available here).

His Brain, Her Brain

The topic of sex in the marriage relationship is one that is so critical to the health of the marriage, that we spent two (yes, count ’em, two) chapters on the topic. So, to our readers who agree, and who are near or past that half-centrury mark, we thought you might find this article by Amanda Gardner that was posted on Health.com to be both an encouragement and helpful:

Sex after menopause? Some experts will tell you it’s a downhill ride of waning sex drive and dried up hormones.

Sorry, we’re not buying it. We happen to think there are plenty of 50-plus babes who are rocking it just as much as in their younger days. (See Madonna.) And there’s no reason the rest of us shouldn’t too.

“You’re not bothered by menses. You’re not bothered by kids in the house. You can have sex in any room in the house,” says Irwin Goldstein, MD, the director of San Diego Sexual Medicine at Alvarado Hospital. “You can have the greatest sex life on earth.”

1) No pregnancy worries

Sex in your 40s can be great, but you may still be making school lunches, wiping noses, juggling a career, and trying to avoid pregnancy.

“Forty to fifty is still an anxiety point for many women because you can still get pregnant,” says Margaret E. Wierman, MD, a professor of medicine, physiology, and biophysics at the University of Colorado Health Sciences Center, in Denver. “Once you’re menopausal, that worry is gone.”

Think about it—no tampons, pads, pills, diaphragms, IUDs, or condoms (if you have a long-term monogamous partner). What could be better?

2) Coitus un-interruptus

After 50, your kids aren’t likely to be interrupting any bedroom sessions or waking you up in the middle of the night.

“Time is a huge factor,” says Amanda Richards, MD, an associate professor of obstetrics and gynecology at the University of Miami’s Miller School of Medicine.

“Even menopausal women who are mothers are usually no longer the classic soccer mom,” she says. “Children are more independent, and the couple has more time for themselves and their relationship.”

3) You know what you want

Think Mrs. Robinson in The Graduate. Older babes know what they want in the bedroom and don’t have to be shy about it.

“Menopause is a very defining time for most women, many of whom realize that they have put their sexuality on the back burner for way too long, and if they don’t use it, they will lose it for good,” says Dr. Richards.

“There’s some data to suggest that women become less inhibited as they age, so it’s often a time of relaxation and being comfortable with who you are, and that often improves sexual functioning and sexual performance,” says Dr. Wierman.

4) You may want it more

Experts will tell you that declining hormones could mean you’ll want it less, but that isn’t necessarily so. Desire, once quelled by birth control pills, could resurge, says Dr. Richards.

And if desire is a problem, proper hormone management can help, she says. While long-term use of traditional hormone replacement therapies, which include estrogen and progestin, are no longer recommended due to the heart and health risks, there are other options.

Hormone therapies that include testosterone are being explored as a way to boost libido, says Dr. Richards.

5) You’re financially stable

Now’s the time to reap the real benefits of years of endless mortgage payments: You can have sex anywhere you want in your paid-off home and you can do it in pricey, alluring lingerie, if you want to.

Older women tend to have more disposable income to spend on dinner dates and romantic getaways than they did in their younger years, says Dr. Richards.

You’ve worked hard; now’s the time to spend a little on your love life.

6) Lubricants, anyone?

It’s true that the hormonal changes of midlife can lead to vaginal dryness.

But this can be an excuse to experiment and discover new, more pleasurable experiences, courtesy of the lubricant aisle at your local drugstore.

“Vaginal dryness after menopause may encourage woman to experiment with vaginal lubricants designed to promote vasodilation and thus increase pleasure, such as K-Y Intense,” says Dr. Richards.

7) Your career is stable

Sure, you still may get stressed. But hopefully at this age, you won’t feel as stressed by your job as you did in your 20s, 30s, or 40s.

“Menopausal women are more likely to have achieved their career goals and therefore feel less stressed,” Dr. Richards says. “Stress has a very negative effect on sexual desire.”

8) Spouse problems can be fixed

“One of the worst nightmares for a woman in menopause is to have the freedom to have sex anywhere but to have a partner who can’t perform anywhere,” says Dr. Goldstein.

Whatever the problem—premature ejaculation, erectile dysfunction, low hormones—there’s a treatment, compliments of modern medicine.

Unresolved sexual problems can even have a silver lining. “Menopausal woman may have more mature partners, who, due to performance issues, are open to the use of vibrators for a more satisfying sexual experience,” Dr. Richards says.

Teen Birth Rates Fall After Two Year Increase, Abstinence Education Credited

Poll Shows Majority of Americans Say Abstinence Effective, Want Parents Involved

Multiple news reports are trumpeting the fact that teen birth rates fell in 2008 after increasing during the two years prior, according to a report from the Centers for Disease Control. Immediately after the reports surfaced, backers of abstinence education have credited their programs as making an impact. The CDC’s National Center for Health Statistics reported today that the full birth rate fell two percent in 2008.

Some 4,251,095 babies were born in the United States in 2008, down two percent from the 4.317 million the year before. The birth rate for teenagers aged 15-19 fell by 2 percent as well and the CDC says the decline resumes the long-term trend of falling teen birth rates since 1991 — during a time when abstinence education program were gaining favor. And, the decline was most notable (4%) among teens aged 18-19.

Here are some of the responses to the CDC data, reported by LifeNews.com: Valerie Huber, the executive director of the National Abstinence Education Association, told LifeNews.com today she is delighted by the news. “So that the positive trend begun a decade ago can continue, we should redouble our efforts to help teens avoid all the consequences of sexual activity, including teen childbearing,” she said.

However, President Barack Obama eliminated all funding for abstinence-centered education in his FY 2011 budget request to Congress. “Today’s announcement provides Congress an opportunity to make a course correction by again placing a priority on the risk avoidance abstinence-centered message,” Huber said.

Huber said her organization is appealing to all groups who genuinely seek the best health outcomes for youth to join in encouraging the avoidance of all sexual risk. “Today’s news shows that teens are able to make good decisions, even in the midst of a sex saturated culture. We must assure that they continue to receive tools for achieving the best sexual health outcomes – in order to escape all the risks of sexual activity,” she said.

Obama’s budget eliminates funding for CBAE (Community Based Abstinence Education) and Title V Abstinence Education Program. In Obama’s FY 2010 Proposed Budget, the president calls for at least $164 million in funding for contraceptive-only education. The money includes competitive grants, research, evaluation and authorization for $50 million in new mandatory condom grants to states, tribes and territories.

That was the second time Obama has called for less abstinence funding. In the omnibus spending bill Obama signed earlier in 2009, abstinence programs received $95 million, a substantial reduction from the $151 million they previously received.

Here are some of my blogs on the topic:

Here are more reports about the effectiveness of abstinence education:

Sexual satisfaction is a complex process that vexes many women and their doctors

Continuing our Valentine’s Day theme of sexual satisfaction in marriage, I thought you might find this article from the Washington Post of interest. It’s penned by Daphne Miller, a family physician, who is the author of “The Jungle Effect: The Healthiest Diets From Around the World — Why They Work and How to Make Them Work for You”:

My patient Debra practically waltzes into my office. She is giggling and barely waits for the door to close before she announces: “I am having sex again and really enjoying it. Not only that, but I’m actually having random lusty thoughts.” What a change from a couple of months ago, when sex was no more interesting to her than office furniture. Her husband is also delighted, she tells me. He plans to shower me with chocolates and flowers because I brought his wife back from the land of no libido.

This patient and I started discussing her faltering sex life about two years ago, somewhere around her 49th birthday — a time many women come to me with concerns about their sex lives. There were so many possible causes: her stressful job, her husband’s stressful job, the demands of a rambunctious 6-year-old who still appeared unannounced in the parental bed, her husband’s widening girth, her own steady march into menopause . . . .

I made all kinds of suggestions, and Debra tried them all: couples counseling, more exercise for her and hubby, sleep training for the nocturnal son, stress reduction and mindfulness techniques, aphrodisiacal foods and herbs, and books on improving sexual relationships with terms like “joyful lovemaking” in the title. There were glimmers of hope but nothing substantive.

Finally, we entered the world of hormones. Despite her midrange-normal estrogen and testosterone levels, I gave her an off-label prescription for testosterone: a dab to her buttocks daily. Now, two months later, she comes steaming into my office.

I am happy for my patient (and pleased about the forthcoming chocolates), but her report provides me with yet another vexing data point as I struggle to help women of all ages (and especially those in midlife) who are distressed about the quality of their sex life. According to a recent sexual health study at Harvard, that’s about one in eight women nationally.

A woman’s sexual experience depends on a complex interplay of her neuroendocrine system, her multiple sex organs and any number of social circumstances, and it stands to reason that there might be many places where the process can go awry.

Still, from my inexpert perspective as a family physician, there seems to be no rhyme or reason to treating sexual problems: I see women whose lab results mirror Debra’s yet who have no response to hormones and manage to boost their love life with exercise, therapy, books or lingerie.

Equally perplexing are those with rock-bottom testosterone levels who are off-the-charts randy. Numerous large testosterone trials only serve to further my confusion, as most women who take the hormone report that their love making has increased by no more than two sessions per month.

In an attempt to develop a standard approach, I called Rosemary Basson, director of the Sexual Medicine Program in the Department of Psychiatry at the University of British Columbia in Vancouver. She has interviewed 6,000 women throughout the course of her 22-year career in sexual medicine.

The first step, she said, is to encourage women to change their understanding of sexual dysfunction. Contrary to what is conveyed by the media, romance novels and our current medical texts, Basson’s research suggests that it is normal for some women not to experience desire at the outset of a romp. In other words, if you are someone who would choose Sudoku over lovemaking but actually enjoys sex once your partner gets you going, then you are not disordered. Accepting that, Basson has found, leads many women to report much higher satisfaction with their sex lives.

Of course, this new understanding does not help all women. For those who still feel things are not right, Basson suggests they consider the following question: “What is interfering with your state of mind?” Depression should be treated with therapy and/or medication, pain can be addressed through a variety of therapies, and dissatisfaction with a partner might improve with couples counseling. Poor self-image, which is often a major factor for women who report sexual problems, can be greatly improved through mindfulness therapies.

James Simon, a professor of obstetrics and gynecology at George Washington University, believes that a subgroup — perhaps 3 to 6 percent of all women — suffer purely from a deficiency in brain neurotransmitters. He identifies them as good candidates for flibanserin, an experimental dopamine-type drug that, like Viagra, was serendipitously noted to have positive sexual effects during its failed trial as an antidepressant.

The initial flibanserin trial with premenopausal women produced results that were roughly similar to testosterone, an average of two more “sexually satisfying” encounters per month. (Women in the control group also reported one more encounter per month, so the mere act of taking a placebo can have a libidinous effect.)

When I asked Simon, who is recruiting for clinical trials funded by the drug’s manufacturer, about the significance of this small number, he replied that my question is typical of someone who is not an expert in sexual health:

“For the women who experience this increase, this is a highly significant number.”

I think back to my own patient. What could account for her new euphoria? Was it all attributable to one to two extra sex sessions per month? Or, as Simon asserts, when it comes to raising the female libido, perhaps “one plus one does not equal two,” with behavior changes plus a medication having a far greater effect than either treatment alone.

Basson agreed that a neurochemical drug has the potential to help boost arousal in a small percentage of women, but overall she sounded skeptical. “Look,” she explained, “if there was a drug that was so potent that it could overcome all misgivings we have about ourselves, our sexual image, our uncertainty about our sexual partners, the kids banging at our bedroom door, you could not make it legal. It would be slipped into drinks. What are people looking for?”

Perhaps there is a silver bullet for a select group of women, but the majority will need to be satisfied with a series of small positive changes. As for me, I am not sure if I am any closer to developing a tidy algorithm for boosting women’s sexual health. But I am more at peace with the idea that, like many aspects of our health, it is an intricate affair.

What to Do When Heart Disease Hurts Your Sex Life

This article, from Health.com, will be, I would think, very helpful for married couples where one or both spouses has cardiovascular disease. It answers a number of common questions my patients ask:

If movies and soap operas are anything to go by, sex can be dangerous for people with heart conditions. While research shows that sex can indeed trigger heart attacks in some people, especially men, the odds of literally succumbing to passion are very low. Sexual activity is a contributing factor in less than 1% of heart attacks, according to a 1996 study by Harvard Medical School researchers.

Although heart attacks during sex are rare, no one wants to be among the unlucky few who die while getting lucky. So if you have cardiovascular disease (CVD), or even if it runs in your family, it’s important to ask your doctor what type of sexual activity is safe. If you’ve just had a heart attack, for instance, you should wait three to four weeks before having intercourse, according to current guidelines. And if you have heart failure, your doctor may recommend that you avoid lying on your back during sex, because fluid is more likely to pool in your lungs in that position.

The physical danger posed by sexual activity is probably the least of your problems, however. There are plenty of other ways for heart disease to curtail your sex life. Everything from incision pain following bypass surgery to the emotional stress of living with a heart condition can get in the way of intimacy.

Sexual activity and heart conditions can interact in complicated ways, which can be difficult to tease apart. To make matters worse, heart patients (and their partners) are often uncomfortable discussing their sex lives with their doctors—and vice versa.

“I’ve found that most doctors don’t have the time—or the personality—to talk about sex with their heart patients,” says Edward Chapunoff, MD, a cardiologist in private practice in Pompano Beach, Fla., and the author of Answering Your Questions About Heart Disease and Sex. “They are evasive about it. They won’t bring it up themselves and even if the patient brings it up, a doctor might be hesitant to discuss it.”

So what’s a heart patient to do? Prepare a list of intimacy questions in advance of your next checkup and don’t let your doctor’s squirming deter you. In the meantime, here are some answers to three not-so-frequently asked questions about sex and heart disease.

Is my sexual dysfunction related to my heart?

The link between cardiovascular disease and sexual dysfunction is well established, at least in men. Researchers have known for years that erectile dysfunction (ED) is disproportionately common among men with CVD (and even among those with risk factors for CVD, such as diabetes and high blood pressure). While erectile dysfunction can result from a number of factors, including psychological ones, the majority of cases can be traced to vascular problems.

The shared mechanism linking ED and CVD is believed to originate in the endothelium, the thin layer of cells that lines blood vessels. Risk factors such as high cholesterol, high blood pressure, and cigarette smoking prevent cells in the endothelium from releasing nitric oxide. This compromises the ability of blood vessels to dilate, which can lead to both atherosclerosis and erectile dysfunction.

Atherosclerosis, the hardening and narrowing of the arteries that causes coronary heart disease, can affect the arteries that pump blood into the penis just as readily as those that surround the heart. But endothelial problems can also prevent the so-called smooth muscle in the penis from relaxing properly. In either case, erections become harder to sustain.

How does heart disease or fear of it affect your sex life?

For a long time it was thought that ED was strictly a side effect of CVD and atherosclerosis, but experts now believe that ED may actually precede heart problems. A 2005 study in the Journal of the American Medical Association described ED as a “harbinger” of cardiovascular events. The study, which analyzed more than 4,000 men without symptoms of CVD or ED, found that the men who subsequently experienced ED were nearly 50% more likely than those who did not to experience a cardiovascular event within seven years.

“It’s important to know that just looking fine doesn’t necessarily mean you have a healthy heart,” says Dr. Chapunoff. “It’s important that both the patient and their partner talk to their doctor about any sexual dysfunction, because it could signal a cardiac problem.”

In women, the relationship between CVD and sexual dysfunction is less clear. Although sexual dissatisfaction in women has been linked to peripheral arterial disease, the mechanisms of female sexual function are thought to be less intertwined with the cardiovascular system.

Do my heart meds have any sexual side effects?

If your heart doesn’t cause you problems in the bedroom, the medicine you take to keep it healthy might. Several medications commonly prescribed to heart patients can have sexual side effects in both men and women, including ED and loss of libido. Two kinds of cholesterol-lowering drugs, fibrates and statins, have been linked with ED, but it is mainly blood-pressure medications that are believed to contribute to sexual dysfunction.

Beta-blockers, calcium channel blockers, angiotensin-II receptor antagonists, and diuretics are all associated with ED. Although some experts have argued that hypertension itself is responsible for ED, a 2007 study in the International Journal of Impotence Research found that men taking angiotensin-II receptor antagonists were twice as likely to experience ED than men whose hypertension was untreated. Another study of nearly 1,400 men determined that taking hypertension drugs (diuretics, beta-blockers, methyldopa, or clonidine) increased the odds of experiencing ED by 2.5 times.

Blood-pressure medications are also known to cause sexual dysfunction in women, although the phenomenon hasn’t been studied as extensively as it has in men. One reason for the disparity may be that the most common symptoms in women—loss of libido, inadequate lubrication—are more subtle than ED.

When Liz Saldana, 48, the owner of an online magazine and store in Tampa, Fla., first started taking a beta-blocker, she saw her sex drive shrink significantly. “I went from being a really vibrant woman to someone who could just live without it,” she says. “When my husband initiated anything, my attitude became, ‘Oh damn, do we have to do this?’”

She was too embarrassed to bring up the issue with her doctor. “Initially I thought my lack of sex drive pertained to all of the stress I was under, not to my heart medications,” says Saldana, who was on the beta-blocker Toprol-XL (metoprolol) before suffering a heart aneurysm in July. “None of my doctors explained that it could be a side effect of what I was on.” It wasn’t until she switched insurance companies and got a call from one of the nurses on staff that she finally got to the root of her problem: “She asked a couple of questions that acted as a trigger for me to evaluate my sex drive and realize what was wrong.”

Even though sexual problems are among the most commonly reported side effects from blood-pressure drugs, they have not been well publicized and patients may not realize that their prescriptions are to blame. If you suspect that your heart medications are interfering with your sex life, explain the problem to your doctor and ask about alternative medications. Men may be able to counteract the problem with an ED drug such as Viagra. While they can be potentially fatal when taken with “nitrates”, ED drugs can be safely combined with many heart medications.

Why can’t I get in the mood?

Medications can dampen your sex drive, but psychological factors might also be at play. For one thing, sexual dysfunction is a common psychosomatic side effect of medication (sometimes called a “nocebo effect”). But the emotional strain that accompanies heart disease can also impact your sex life. After a cardiac episode, many patients find that any activity in the bedroom leaves them paralyzed with anxiety. “After a heart attack, not only are you physically weak, but you’re scared that something might happen during sex,” says Dr. Chapunoff.

Saldana is gearing up to have open-heart surgery in the near future. She and her husband of 15 years are sexually active about twice a month, but each time she’s terrified that she’ll have a heart attack. “I experience a lot of chest pains and when things get heated, I can’t have him on top of me,” she explains. “I haven’t shared my fear with my husband, but I’m afraid to lose control for even a moment because it feels like he’s crushing my chest.”

And then there’s the possible role of “depression”. Research suggests that heart disease and depression are closely related; depression is roughly three times more prevalent among heart attack survivors than in the general population. But depression is also independently associated with sexual dysfunction (including loss of libido and ED), which suggests that, for heart patients, both their bodies and their minds may be affecting their sex lives.

Sexual dysfunction that appears to be caused by a heart problem may also be a sign of an underlying emotional issue, according to Dr. Chapunoff. “Heart disease can become the scapegoat,” he says. “People might say, ‘I had a heart attack six months ago, so I can’t have sex now,’ when really it could be unhappiness that they fail to recognize.”

Poll Shows Majority of Americans Say Abstinence Effective, Want Parents Involved

Abstinence-only program helps kids postpone sex

A new Rasmussen poll shows a majority of Americans believe abstinence education programs are effect and a commanding majority would rather have parents than schools teaching sex education, according to a report in LifeNews.com. The survey follows on a new study showing abstinence more effective than sex education.

According to the Rasmussen poll, released yesterday, 50 percent of American adults believe abstinence-only education programs are at least somewhat effective in preventing teen pregnancy. Some 15 percent say they are very effective.

Just 42% of Americans disagree and a smaller 13 percent take the strongest position saying they are not at all effective.

Overall, 68% of adults nationwide approve of health education classes teaching children about sex or abstinence while only 21 percent of Americans disapprove of teaching kids abstinence and 11 percent remain undecided.

“Adults with children are slightly less supportive than those without children of sex education classes in school. Most adults with children at home see abstinence education as effective, while those without children are evenly divided on the issue,” the polling firm pointed out.

Fifty-one percent of men see abstinence-only programs as being effective in preventing pregnancy in teens, compared to 48% of women — making them about evenly divided.

Black Americans are much more likely than white Americans to support abstinence education, the polling firm said.

The poll also found 80% of Americans say it is the responsibility of parents to teach their children about sex. Only 11% say schools should explain sex to children. Rasmussen noted the results are identical to those found last year and in October 2007.

Rasmussen also found that the “vast majority of American adults (76%) believe elements of pop culture such as movies and television shows encourage sexual activity among young people. Only 12% disagree with that assessment, and another 12% are not sure.”

The landmark study released last week found that middle school students who attended abstinence-only classes were less likely to engage in sexual behavior than those who attended classes that combined teaching abstinence and contraception methods.

Students participating in an eight-hour abstinence program showed a one-third decrease in their rates of sexual activity compared to non-participants. Of particular note, students were significantly less likely to initiate sex with the abstinence-centered approach than any other sex education strategy.

Conservative writer Robert Rector also commented on the new report at National Review.

While abstinence helped students, he wrote: “By contrast, safe sex (promoting only contraceptive use) and comprehensive sex ed (teaching both abstinence and contraceptive use) programs didn’t affect youth behavior at all. Students in these programs showed no reduction in sexual activity and no increase in contraceptive use, in either the short or long term.”

Here are some of my other posts on abstinence:

10 Reasons Married Women May Not Have A Satisfying Sex Life

Are you married and yet find that your sexual relationship with your spouse has fallen off or is non-existent? Well, you’re not alone. Men and women today have less time for sex than their 1950s counterparts. And it’s estimated that 40 million Americans have what experts call a sexless marriage (having sex less than 10 times a year). So, what are some things you should consider to rev up this critical area of your marriage?

More Information: Continue reading