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| 100 Questions & Answers About Women's Sexual Wellness and Vitality: A Practical Guide for the Woman |
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| Written by Michael L. Krychman, MD | |
| Wednesday, 17 June 2009 | |
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1. What is sexual medicine?
Health and Survivorship Medicine located in Newport Beach. There, sexual medicine and health is described as the discipline that seeks  to enhance the lives of patients and their partners through assessment and treatment of the physical, psychological, medical, and surgical causes of sexual and intimacy concerns. Although sexual medicine is not an accepted discipline of formalized medical school study, many healthcare institutions and educational programs are embracing the notion of sexual health and intimacy as an important facet for overall patient quality of life. Sexual health involves many disciplines including urology, gynecology, psychiatry, and other fields of medical study. Many recognize that the interface of medical experience, or the mere fact of going to see a doctor, no matter what the diagnosis, often changes their relationships. Health-care teams now understand that to better serve their patients, the concept of sexual intimacy must be addressed in study and treatment. Sexual complaints are common in both men and women, and failure to have these problems diagnosed and treated effectively can lead to both personal distress and relational disruption. Sexual complaints are independent of race, color, and creed or ethnicity. Women of all races and backgrounds are at risk for and complain of sexual issues. Although much of Sexuality: The feelings, behaviors, and identities associated with sex. 2. What is the incidence of sexual problems and why study them? It is estimated that 43% of all women suffer from some form of sexual problem or complaint. Low desire or hypoactive sexual desire disorders are the most common forms of sexual complaint. The National Cancer Institute estimates that 40–100% of female cancer survivors suffer from sexual problems that cause personal distress. Women with any chronic medical illness including hypertension, diabetes, or endocrinopathies all suffer from sexual complaints. The data do support the fact that as women age, the incidence of sexual complaints increases (however, older women are less bothered by the problems than their younger counterparts are). Although many women have sexual issues and problems, many do not complain and many suffer in silence. Clearly, only women who are bothered or distressed by their sexual healthcare concerns should seek professional medical care and treatment. According to a recent article titled “Survey Says Patients Expect Little Physician Help On Sex.” published in the Journal of the American Medical Association: * 85% of adults would like to discuss sexual functioning with their physician; however, they do not for many reasons. * 71% believe their physician would not want or have the time to deal with sexual problems. * 68% of adults are concerned about embarrassing their physician. * 76% thought no treatment was available for their problems. There is a need for accurate medical information concerning the diagnosis, assessment, and effective treatment of sexual complaints. Busy healthcare providers, internists, and primary care physicians can use this book as part of a comprehensive educational tool to help their patients achieve sexual satisfaction. Interestingly, one act of sexual intercourse burns 200 calories or is about the equivalent of 30 minutes of jogging. Sexual intercourse is an excellent aerobic activity that improves cardiovascular health and releases endogenous endorphins (brain feel-good hormones). Sexual hormones may also influence and lead to lower rates of depression, anxiety, suicide, and infections and may boost immunity, which can increase longevity. Oxytocin and DHEA (which stands for dehydroepiandrosterone), two hormones that are both released during orgasm, may prevent breast cancer cells from developing into tumors. The Viagra-ization of America—with millions of prescriptions and users—has lead to changing cultural stereotypes of middle-aged men and women. Middle-aged women are now viewed as strong, vibrant, sexual human beings. Coupled with this cultural change in perspective on sexuality is more focus on research and emerging treatments of sexual dysfunction. 3. What are the stages of the sexual response cycle? To discuss sexual dysfunction, a primer on human sexuality is essential. Human sexuality is not a static concept, but one that is dynamic and multidimensional. It is a product of interpersonal, biological, psychological, and cultural mechanisms that help formulate an individual’s personal view of sexuality. Each individual has a personal and unique sexual schema; it is not possible to impose a singular approach and view on sexuality that applies uniformly across races, sexes, and ages. Much of what we understand about normal sexual function is based on the work done by William Masters and Virginia Johnson in the late 1950s through the 1990s. Masters and Johnson are credited with characterizing the physiologic and biological changes that comprise the sexual response. Later, with the addition of input from Helen Singer Kaplan, desire became incorporated into the model. Following is a description of the phases of human sexual response. Sexual Desire or Interest Sexual desire is often characterized as innate hunger or interest in pursuing sexual activity. With respect to female subjects, there is often conflicting data as to normative sexual desire. Some emerging research demonstrates that about one-third of women are based in sexual neutrality, which means that they are responsive to sexual cues from their partners or their environment. (For example, she gets the warm fuzzies at the sight of a special bouquet or box of chocolate.) Another third have a baseline of low to moderate desire on a daily basis, and this can be escalated or diminished depending on the situation or circumstances. The final third may operate more like men, with heightened sense of sexual desire and hunger for the pursuit of sexual activity. Arousal The arousal stage of the sexual response cycle is characterized by physical changes in your body. Blood pressure and heart rate become more rapid. Breasts may increase in size and nipples may become erect. The vaginal walls swell, and increased lubrication occurs. The clitoris may become swollen, and the inner two thirds of the vagina lengthen. Arousal or excitement is often accompanied with tingling feelings or inner warmth in the genital areas. Plateau The plateau is described as the peak of sexual pleasure or plateau right before impending orgasm. Throbbing or feelings of fullness in the pelvis may occur. You may also get a flush on your face, chest, and breasts. Orgasm Orgasm is often described as an intense, pleasurable, euphoric, whole-body sensation that is achieved at the peak of sexual stimulation. Rhythmic contraction of the pelvic genital structures (vaginal, anal, and uterine muscles) occurs and an intense feeling of pleasure occurs. Some may have one orgasm and then feel satisfied and complete, whereas others enjoy repetitive multiple orgasms in a row. There are many types of orgasms, including clitoral, vaginal, and uterine orgasms. About a third of women mention that they have rarely or never achieved orgasm from intercourse unless breast and/or clitoral stimulation occurs simultaneously. Some may feel uterine contractions when orgasm occurs; others enjoy the direct pressure of the cervix being stimulated. Recently, twin studies have reported that the ease of reaching orgasm may be genetically predetermined and inherited. Resolution In the resolution phase, heart rate, breathing, and body temperature return to normal or baseline. Blood flows away from the genital and vaginal areas, and you may return to the presexual state of being. Nipples and breasts return to a normal state without arousal. You may feel a sense of euphoria and fatigue. Originally, sex researchers assumed that women were linear in terms of their progression from one phase of sexual response to another: desire leads to arousal followed by plateau, and then orgasm, and finally resolution. A novel cyclic intimacy-based model developed by prominent sexual health care clinician Dr. Rosemary Basson focuses on a more cyclic experience of female sexual response, where the cycle can be entered at any point. Women experience phases of the sexual response in an overlapping, non sequential manner that not only incorporates physical but psychological issues as well. An important issue with this model is that sexual desire does not necessarily precede sexual stimulation or arousal. Women may enter sexual activity by being neutral, and then be motivated to enjoy and pursue sexual intimacy to enhance connectedness with their partners. Others may enjoy sex merely for sexual activity. Sexual activity creates both positive and negative feelings/ motivations toward subsequent episodes. Receptivity and responsive desire (desire felt after your partner has expressed interest) are key elements in the Basson model. Recent data also suggest that some women follow the original stepwise cascade of the progressive concept of the sexual cycle of desire to arousal to orgasm, whereas others follow the circular pattern as described by Rosemary Basson. Women are unique, and you may ascribe to one model or the other in different circumstances. It is important to understand that sexuality is fluid and that perhaps either model suits you. Michael L. Krychman, MD, FACOG, is the Medical Director of Sexual Medicine at Hoag Hospital, and the Executive Director of the Southern California Center for Sexual Health and Survivorship Medicine, both located in Newport Beach, CA. He is presently Associate Clinical Attending at the University of Southern California and the University of California Irvine. He is the former Co-Director of The Sexual Medicine and Rehabilitation Program at Memorial Sloan-Kettering Cancer Center. Dr. Krychman holds licenses from 3 states (CA, PA, NY), and is a board certified OB/GYN. He is a clinical sexologist and AASECT-certified sexual counselor, with a Masters in Public Health and Human Sexuality.
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| Last Updated ( Wednesday, 24 June 2009 ) |
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