Sexual compatibility

A person’s sexual style and preferences are important components when assessing compatibility with a partner.

Unfortunately, people are often hesitant, embarrassed or apprehensive when it comes to evaluating ’sex’ and ‘matching.’  Women, in particular, will be less comfortable than men addressing this issue, typically opting to ‘resign’ to whatever the partner presents/wants, thus lending to sexual suffering and relationship difficulties.

It is quite routine to assess for other compatibilities: education, religion, culture, career, financial standing, family values, appearance, hobbies, food, sports, music — so why not put sexual compatibility right into the mix with equal importance and openness of exploration?  After all, it is an intimate topic with no room to maneuver if incompatible!

Vibrator and orgasm

The patient sat herself in the comfortable chair and said while sighing: “I do not have good orgasms!“

Hmmm, what are good orgasms?

We asked her to explain, and she said: “I can orgasm from manual stimulation to clitoris but they are little orgasms.  I can also orgasm from oral sex but they are not big like the ones from a vibrator.  I want to have the same powerful orgasms from all activities as from the vibrator but I do not want to be addicted to the vibrator!“

What is wrong with loving the vibrator? Just remember that the clitoris needs lubrication, and that vaginal insertion is not a must.

Also, we reminded her, that it is normal to have small and/or big orgasms!  Not bad considering that many women cannot shut down their thinking minds enough to even get to having an orgasm…

The patient was not happy, not even when we reminded her that the mechanical energy and speed of a vibrator cannot be matched by a hand nor a tongue.

We dug deeper and found out that the issue has turned into an obsession, which is stopping her relationship from moving forward because of this unrealistic sexual expectation.

Sad, isn’t?

Anal intercourse

Heterosexual anal intercourse is not a favorite of women as it is of men, although it is being practiced more often than perceived.

Is anal intercourse bad? As with every other sexual practice, anal intercourse is fine as long as it is done consensually (by agreement of both parties) and safely, which includes proper hygiene.

The main reasons women tend to decline anal intercourse include

• The perception of it being ‘dirty’
• The perception of it being ‘degrading’
• The perception of it being ‘unnatural’
• The perception of it not being ’sexually pleasant/arousing/satisfying’

Receiving anal intercourse mandates generous use of lubrication because the anal canal does not provide for it naturally, strict measures for preventing Sexually Transmitted Diseases, and remembering NOT to move from anus to vagina because the anal bacteria is not compatible with the vaginal environment (will cause infections).

Clinically-speaking, most of the women we see prefer NOT to engage in anal intercourse; some religious codes forbid it.

Medically-speaking, regular and repetitive anal intercourse may result in laxity (stretching) of the anal sphincter, leading to fecal incontinence.

Sadly, there are quite a few women who are ‘forced’ to engage in this sexual practice because they cannot say NO to their partner’s insistent request/demand.

So, should you or shouldn’t you? Your choice as per the above.

Sonogram

Ultrasound is a cyclic sound pressure at average frequency of 20 kHz, above the human’s hearing ability.

Gynecologic sonogram works like a sonar in a submarine: it sends a beam out, and if the beam encounters a solid object (i.e. another submarine, a rock, a cyst, a fibroid, cancer) it returns its image by displaying it on the screen.  There are many other uses for ultrasound and you can do your own search for general knowledge.

There are two (2) types of diagnostic gynecologic sonograms that are typically used to visualize the female pelvis:

• Trans-abdominal, which is completely external: the transducer (ultrasound wand, or probe) is rolled on the belly/lower abdomen after the patient has drank enough fluid to fill the bladder that will act as the needed water medium for the sound waves.  During pregnancy (obstetric ultrasound), the amniotic fluid acts as the water-medium while the test is done to assess the development of the fetus; the parents-to-be benefit by being given an image photo of their baby.
• Vaginal, an internal procedure: the transducer is inserted into the vagina and is moved about the organs (uterus, cervix, ovaries, bladder, fallopian tubes) for best visualization.  To provide a water medium, the transducer is inserted into a lubrication-filled protective cover that looks like a condom.  This test provides the best imaging of the internal organs.

Vaginal ultrasound may pose a problem for women who struggle with vaginismus or are just nervous about ‘anything going into the vagina.’  A useful tip: let the person who does the test (the doctor, the radiology technician, etc.) know that you would like to insert the transducer yourself.  Once it is in, have them grab hold of it and proceed with the procedure.

If penetration is not at all possible, ask for a trans-abdominal ultrasound instead, and return for a vaginal one as soon as you have cured your vaginismus.

To learn more about the test and to see what the equipment looks like, click here.

Why Kegels?

Dr. Arnold Kegel (1894-1984) was the gynecologist responsible for introducing squeeze exercises for increasing vaginal muscle tone. The particular muscle, puboccocegeous (PC) is part of a trampuline-like network of muscles that comprise the pelvic floor that supports the pelvic outlet.  Today, these exercises may be known as Kegels, PC excericses, or Pelvic Floor exercises.

When should women do these exercises?

• Regularly, to enhance female genital health
• During pregnancy and after childbirth to facilitate recovery
• In the early stages of organ (uterine, bladder) prolapse to minimize the droopiness
• In case of injury/neurological deficit to restore muscle tone and function
• As an orgasm exercise…

However, contrary to common perception, doing the Kegels does not cure vaginismus, a condition that has nothing to do with the voluntary control of the pelvic floor muscles but rather with a somatic reaction to penetration and/or to vaginal use.

Penis & thrusting

Thrusting during intercourse is the rocking movement of the penis in the vagina, done rhythmically as per the male’s arousal.  It is the flip-side of rubbing the penis to arousal during manual sex or oral sex.

How deep does the penis thrust during intercourse? As deep as the vaginal depth allows, as deep as the male’s desire guides him, and most importantly: as deep as it is comfortable for the woman.

Does the penis come out of the vagina during thrusting, as in going in & and coming all the way out, in & out, in & out?  Most of you will say a definite NO, the penis does not come out of the vagina but rather stays inside during thrusting.

Surprisingly enough, there are quite a few who struggle with ‘what is normal’ and who will expect the vagina to endure their repetitive, rhythmic in & out powerful motions.  For the woman, these quick, ongoing penetrations will activate the tightening reflex of the vaginal ring (introitus), giving her discomfort and painful intercourse (dyspareunia) or even vaginismus.

Gentlemen, please respect vaginal endurance and stay inside when you thrust.  And ladies, do not suffer in silence!

Mikvah & intercourse

Observant Jewish women follow the laws of Niddah, a time when she is considered ritually impure and must refrain from any physical contact with her husband, including sexual abstention. Click here to read more about it.

The end of Niddah is signified by going to the Mikvah (ritual bath) where she immerses in a deep pool while following a particular bathing process for ritual purification.  Men go the Mikvah too for purification for Sabbath and Holy days. Click here to read more about.  Click here to take a Mikvah tour.

It is expected that the couple engages sexually upon the woman’s return from Mikvah (yes, same night), which should be a welcoming transition for the couple having abstained from any contact for nearly 2 weeks.  However, this mandatory engagement is a cause of great distress when the woman is reluctant to be intimate with her husband, or if intercourse is painful (dyspareunia, vaginismus).

Sadly, women will often submit while suffer in silence because they believe that they have no choice/it is their duty/they are the ‘only one with this problem.’  We encounter an endless stream of such cases, which often include husbands who are at a loss too about what to do…

But there is a (halachic) choice!  We urge suffering women/couples to seek religious and/or medical guidance in order resolve the situation and be able to live normally.

About stirrups

During gynecologic exam, the woman is asked to slide down to the edge of the examination table for best visualization of the area and to accommodate the use of the speculum.  This position is medically known as the dorsal lithotomy position.

Stirrups were invented by Bert H Simpson in 1908 and patented in March 1909 – only 100 years ago.  See photo below.

Many women would rather not use stirrups because they cause them embarrassment and much distress.  Are they mandatory?

Apparently not: a 2006 study suggests an alternative to discuss with your doctor: keeping feet on bed.  The study is worth reading.

Vaginismus, returns?

Vaginismus is a common condition that affects women worldwide regardless of their culture, religion, education, sexual orientation, or family status.  Vaginismus is a somatic (body-mind) reaction to fear/apprehension of vaginal penetration.  It happens instantaneously and involuntarily.

Women with vaginismus tend to suffer in silence and shame, thinking they are the ‘only one’ with this problem, which is why prevalence is not available.  A certain measure of anxiety is typically associated with this condition, ranging from minimal to severe, the latter may also include panic and OCD (obsessive compulsive disorder).

Vaginismus is curable and the cure should be life-long as long as the woman follows discharge instructions, which should include specific management of the residual anxiety/panic/OCD.  In other words, once the woman can have vaginal penetrations without a problem, why fear them any longer?

Does vaginismus come back? It can, if the woman did not follow up on discharge instructions and is again ‘allowing’ the anxiety/panic/OCD to regain control and interfere with vaginal function.  Sad, isn’t it? To have gone through a treatment process only to then be non-compliant.

On a good note, it is rare that the woman will regress to a complete vaginismus: she will typically be able to have (some) penetration/s but with trepidation and under the effect of her un-managed anxiety.  In some cases, the vaginismus could remain cured but other somatic reaction/s may appear, such as IBS (irritable bowel syndrome), neck or back aches, TMJ (jaw joint pain), headaches, etc.

Bottom line (no pun intended): vaginismus is a body-mind phenomenon and both aspects must be properly resolved for a life-long cure, a joint effort between a skilled clinician and a responsible patient.

Vagina, sterile?

Women often believe that their vagina is a sterile environment and that special cleaning methods are needed to keep it as such.  If it were true, then men should have sterilized their penises before penetration, right?

Fact: the vagina is not at all sterile but rather a a host to many type of bacteria, all composing the vaginal flora that promotes vaginal health.

According to Ann S Botasch MD, the composition of vaginal flora changes with age, stress, hormonal influence, general health status, and sexual activity, and disruption of this balance will lead to breakdowns such as irritation, infection, bleeding, etc.

So, ladies — make sure whatever ‘visits’ the vagina is clean and that you keep a balanced vaginal flora, but do not worry about the vagina being sterile.