 Life,
Health and Sex
Week of 06/27/03: Sex Over 40 
In the video Sex After 50, one of the men says, "Sex
is like fine wine, it gets better with age." The latest
sex survey commissioned by the AARP and reported in the the
September-October 1999 issue of Modern Maturity seems to support
that observation, at least for the majority of people who
are in relationships. True, there are expected changes in
sexual, primarily genital, function for both men and women
as our bodies get older, but these are in fact natural! Women
will eventually stop ovulating, stop menstruating, and may
start experiencing changes in vaginal tissues associated with
hormonal changes. Men will require more direct stimulation
to the penis to obtain an erection, the erection may not be
as hard as it once was, it may take longer to ejaculate, and
the ejaculation may not be as forceful. Fortunately, these
normal physiological changes do not have to diminish the quality
of or the overall pleasure in the sexual experience. But like
wine, sex will only get better with age if it is properly
cared for, appreciated, and savored!
The focus of content under aging will be on learning ways
to cope with predictable life changes -- physical, social,
and relational -- so that we can all enjoy our sexuality to
the fullest! If you're looking for a greater focus on medical
aspects of aging, try searching under Women's Health and Men's
Health. For information on specific disabilities and illnesses
that we are more likely to face as we get older, please visit
Disability and Illness. Contrary to popular belief, aging
is not a four-letter word!
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Week of 06/20/03: When Oral
Sex Becomes A Debate
Reprinted from Vol. XVIII, No. 1 (c) 1999 DKT International,
Chapel Hill, North Carolina. All Rights Reserved. June, 1999
Editor's Note: An article in the December 1998 issue of Sex
Over Forty examined in detail the pleasures of mutual oral
sex. The following article looks at a different dynamic that
often occurs with oral sex - the unwillingness of one partner
to participate.
Oral sex today is part of a broad sexual menu enjoyed by many
men and women. But when one partner wants oral sex and the
other does not, conflicts can threaten even long-term relationships.
What can couples do to solve such a dilemma?
The first step is to talk about it - not in bed but at a time
when you are both alone, calm, undisturbed and have time for
a real discussion.
"Talk about why it's uncomfortable for you," suggests
Sherry Lehman, MA, a marriage, family and sex therapist in
private practice in Cleveland, OH. "Everybody has sexual
comfort zones, and you need to explain why oral sex goes beyond
your sexual comfort zone."
William Stayton, ThD, dean of the Institute for Advanced Study
of Human Sexuality in Wayne, PA, agrees. "Does the person
who does not want oral sex want to like it or not want to
like it?" he asks. Stayton points out that many people
have never tried oral sex and may have wrong ideas about it.
(Please refer to the December 1998 article for reasons people
do not want to participate in oral sex.)
The key issue is whether the man or woman has the desire to
try to like it: If the desire is there, a solution becomes
possible.
Norman Fertel, MD, an obstetrician/gynecologist and marital
and sex therapist in private practice in Brooklyn, NY, said
that conflicts over oral sex are not that different from other
conflicts in a relationship.
"First, you have to ask if this is something you would
call a 'core issue,' meaning that the one who doesn't want
to do it will not do it under any conditions," he said.
"Or is it because they really haven't tried or experimented
with it?"
In other words, said Fertel, determine if the issue is negotiable.
Finding Solutions
If you find that discussions about oral sex have failed and
your partner is still unwilling to try it or does so only
reluctantly and without enthusiasm, you may want to get some
help from a sex therapist to work out the dispute.
"Two people have to learn to deal with conflicts and
learn what it really means to talk to one another," said
Fertel. "By that I mean developing communication skills,
learning to listen and reflect back and be certain that what
you hear is what the other person actually intended."
A therapist also can help you to go slowly, step-by-step to
overcome reluctance and fear. "You don't have to do everything
at once," said Lehman. "Maybe it's just licking
the tip of his penis for a second to start, or maybe it's
just kissing her around her thighs or around the bottom of
her stomach." Couples need to give it time to find out
if they can gradually learn to enjoy oral sex together.
In cases where one partner absolutely does not want to have
oral sex and cannot be convinced otherwise, therapists suggest
finding an alternative. "If she does not want to have
oral sex, he might say, 'I would like stimulation with you
using your finger in my anus. That would be exciting to me.'
In other words, you try to find an alternative that might
be as much a turn-on to him and not as much a turn-off to
her," said Stayton.
Lehman suggests another solution. Compromise and do the oral
sex with a bit of acting and do it gracefully, even if it's
not a favorite activity. "It's not do unto others as
you would have them do unto you," she said. "It's
do unto others the way they would want it to be done."
She Used To, But Now She Won't
One tricky situation occurs when a couple has had regular
oral sex for a while and then one partner suddenly refuses
to continue. This sometimes happens when a long courtship
leads to marriage.
"I had a couple who had been together for eight years
and when he wanted to have oral sex on their wedding night,
she said, 'You know, I really don't like to do that',"
said Lehman. "And he said, 'But you've done it for eight
years.' And she said, 'I know, I knew that you wanted it but
I really haven't enjoyed it. And you wouldn't want me to do
something I don't enjoy, would you?'
Lehman said that dating is a sales job for many people, with
both partners on their best behavior, doing everything they
think their partner wants to maintain the relationship. "And
women, maybe even more than men, do things sexually that they're
not particularly keen about in order to win his favor,"
she said.
If you've been having oral sex with your partner for quite
some time, believing that you both enjoyed it, and you suddenly
find out you've been deceived, your relationship can easily
go into crisis. This is not a good situation: Open discussion
and resolution, perhaps with the help of therapy, is important
for the long-term health of the relationship.
Why Is Oral Sex So Important?
Not everyone cares that much about oral sex, and many couples
do quite nicely without it. But for some people, more often
men, life is not the same without it.
"Some people don't feel their love life is complete if
you can't 'take all of me'," said Lehman. "To them
the lack of oral sex sets boundaries on a relationship, and
there are some people who really do not want those kinds of
limits and will always feel they are missing something important."
In rare situations, the refusal of one partner to perform
oral sex can even end a marriage. Again, it's more often the
man who decides that it's a make-or-break issue. He may be
going through a mid-life crisis or just sensing his age, feeling
that this is his last chance for complete happiness.
"I have a lot of people leaving marriages, and oral sex
is definitely one of the issues," said Lehman. "They
really want it all or at least the chance to get it all."
But with a little work, compromise and understanding, most
disputes over oral sex can eventually be happily resolved.
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Week of 06/13/03: STDs, STIs, HIV/AIDS
Worldwide Hidden Plague: Sexually Transmitted Diseases
by Georgan Gregg
Sexy music in the background, close-up of 2 faces nearly touching.
Eyes close with passion as a long kiss begins and the scene
fades. We know what happened. As children are playing a small
voice is overheard "there was a young man from Nantucket,"
followed by quiet giggles and "shhhhh, not so loud!"
We know what the kids are joking about. We may know that sex
was the hidden agenda in both situations, but what does this
have to do with a worldwide plague?
News reports that 1 of every 4 adults is infected with HIV
in Africa, 1 out of 2 in some countries. Fifty-five hundred
die daily. So far, 11 million have died, more of AIDS now
than malaria. A state of emergency and national disaster has
been declared in some countries. "That's terrible"
Americans think. If an American strolls through a mall they'll
probably pass at least 250 people. And 1 of them will be living
with HIV/AIDS. But, you're an American who has educated yourself
pretty well about AIDS, so you feel safe. Besides, that epidemic
certainly isn't hidden, right?
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But if your mall walk was with 2 other people, 1 of you will
probably get a sexually transmitted disease during your life.
The U.S. has the highest rate of sexually transmitted disease
(STD) among industrialized countries, and higher than in some
developing countries. Somewhere between 12 and 15 million
Americans acquire STD every year. Worldwide, 333 million cases
of curable STD (not including AIDS and other viral STD) occur
annually. "But what's the big deal if they're curable?"
you might well ask. Answer: the fact that there may not be
symptoms, but can lead to very serious long-term consequences
(infertility, HIV/AIDS infection and various forms of cancer).
Institute of Medicine found that 87% of infectious diseases
in the U.S. are sexually transmitted and recommended we "overcome
barriers to the adoption of healthy sexual behaviors."
The Sexual Health Network and Sexualhealth.com offer a "social
vaccine," endorsed by leaders in the fight against this
scourge. No, not an injection, but the single most effective
weapon we have - talking openly about sex. Communication about
sexual health is frequently unsuccessful or absent in our
most important relationships: parent-child, sex partners,
and doctor-patient. Because STDs are so often symptomless,
non-communication feeds the epidemic. Sex partners often have
no knowledge of one another's sexual history and most doctors
do not ask about patients' risk for STD.
Sexually transmitted diseases or infections have so many dirty,
sleazy implications that even when we feel comfortable talking
about sex in general we may still have trouble with this specific
topic. The possibility of having an STD can affect our feelings
about our sexuality, our relationships and ourselves. We provide
a private, professional atmosphere to ask your questions.
Knowledge, life skills and resources are the answer.
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Week of 06/06/03: Orgasm
The question of types of orgasm has been the subject of medical,
scientific, psychoanalytic, sexological, and feminist discourse
for centuries (Gardetto, 1992; Laqueur, 1990; Powers, 1992).
While there has been little concern about the nature of the
male's orgasmic experience which is used synonymously with
ejaculation (Masters & Johnson, 1966), the female orgasm
has been subject to the ongoing debate over the primacy and
validity of clitoral versus vaginal orgasm (Powers, 1992).
Discoveries of the function of the Gräfenberg spot and
female ejaculation (Ladas, Whipple, & Perry, 1982) have
added a new component to the debate over female orgasm. The
focus for males has been on erectile function. The ability
of the male to ejaculate is assumed and the necessity of ejaculation
is not questioned in western societies. The clitoris and the
female orgasm, once framed in the pre-enlightenment period
as the center of female excitement and a phenomenon necessary
for procreation, have been reconstructed over time depending
on the prevailing discourse (Gardetto, 1992).
While there may very well be different qualitative experiences
of orgasm, the question of superiority of orgasm based on
some yet undetermined notion of a "true" orgasm
is problematic and has resulted in injustice to women, to
men, and to people with disabilities like spinal cord injury
when their orgasm experience ran counter to the medical literature.
The traditional definitions of orgasm are based on empirical
observations of non disabled people. These definitions of
orgasm have a tendency to focus on contractions or spasms
in the pelvic or genital region and depend on an intact connection
between the brain and the genitals. They ignore the subjective
experience of orgasm people describe sometimes as euphoric
in nature, an altered state of consciousness, or a spiritual
experience.
Descriptions of orgasm by participants in a research study
of pepole with spinal cord injuries were not dependent on
muscular contractions or ejaculation. The focus was on warmth,
tingling, energy releasing and energies merging. Contrary
to belief expressed implicitly or explicitly in the psychology
and sexology literature, the essence of the orgasm experience
survives even complete disconnection of the genitals from
the brain via the spinal cord for the essence is not located
in the genital contractions.
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Week of 05/30/03: Women's Health
We extend our thanks to Dr. Beverly Whipple for outlining
the issues here. Dr. Whipple's concern for women's health
derives naturally from her over twenty years of helping women
to learn more about themselves and to feel better about themselves,
first as a nurse and a nurse educator, and more recently as
a researcher.
Although there have been many research studies conducted in
the United States concerning health, most of these studies
have been conduced on men, and the findings have then been
applied to women. However, research conducted on men does
not always apply to women. In addition, from 1977 to 1993,
all drugs developed in the United States were tested in men
and the findings extended or projected to women.
This channel will focus on women's health issues as they relate
to sexual health and will include but not be limited to: normal
developmental processes, breast cancer and self-breast exams,
PMS, urinary stress incontinence, depression, eating problems,
the female specific symptoms of HIV/AIDS, osteoporosis, heart
disease, perimenopause through post menopause and the effects
of medications on sexual response. The emphasis will be on
feeling good about being a woman and understanding health
issues that are specific to women.
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Week of 05/23/03: Precum
It is very unlikely, but it is possible to get pregnant from
precum.
Let me start out explaining what precum is and where it comes
from (also called pre-ejaculate or pre-seminal fluid). The
fluid contained in the ejaculate comes from different sources.
Sperm is produced in the testes and transported through the
vas deferens to a storage chamber located behind the bladder.
Neighboring glands (the seminal vesicles) produce and secrete
a significant volume of fluid. Even more fluid is produced
in the prostate, and finally, several glands along the urethra
also secrete fluids. All these different fluids together make
up the ejaculate.
When a man gets aroused, and before he ejaculates, drops
of fluid secreted by some of the mentioned glands are released
at the top of the penis. This is called precum, and the amount
varies between individuals and according to conditions, depending
on general health, the level of arousal, and the time since
the last ejaculation. Precum serves as a lubricant for intercourse,
and it possibly facilitates fertilization by changing the
vaginal pH, creating a more sperm-friendly environment. In
general, a man can produce precum at any time from the point
he becomes sexually aroused until the time he ejaculates.
There is no standard interval of time between the initiation
of precum and ejaculation.
Only on occasion does precum contain some sperm. Although
rare, pregnancies due to precum have been reported. Therefore,
even though the chances are small, a woman can get pregnant
if precum has entered her vagina.
One final word about precum and infection. Some studies have
found HIV in precum, others have not. Therefore, the potential
for HIV infection through precum cannot be ignored. Condoms
can prevent pregnancy as well as transmission of HIV and other
sexually transmitted diseases.
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Week of 05/16/03: Infertility
THE CHALLENGES OF INFERTILITY Aline P. Zoldbrod, Ph.D.
Most of us hope to be able to have biological children, when
we want to, "when the time is right." Even if life
already has handed us other problems of hefty proportions
with which we have dealt, infertility is one of the hardest
life crises for any of us to bear.
Infertility just feels so unfair. Usually, we want to make
a child with another person because we're in love. Life is
good. At last, life is sweet. We (finally!) feel enough attachment,
love, and commitment to another person to want to make a baby
as an expression of that love. The inability to create a child
when we want to seems to strike at the core of life itself.
Our entire future, with its hopes and dreams, seems to vanish.
The world itself begins to feel hostile. Everyone else seems
to be pregnant or have a baby. Everything we see, read and
hear seems to assume that we already have children. Our friends
are proceeding with their lives, but ours has ground to a
halt. Activities that once gave us pleasure feel meaningless,
as we get on a medical merry-go-round of tests and office
visits and "assisted reproduction." Life, day to
day planning, begins to center around medical treatment.
The feelings we have are often unbearable-guilt, fear, anxiety,
obsession, depression, isolation, envy, alienation, rage,
grief, and blame. It feels as if no one understands what we
are feeling. There aren't words enough in the English language
to express the intense distress we feel. When we try to talk
to others, often they don't understand, or they minimize what
we're feeling with platitudes: "it's Gods' will,"
or "just relax."
These painful feelings are especially immediate for women.
Women quickly feel personally inadequate, because the social
role of "mother" isn't really optional in our society.
Ironically, in many heterosexual couples, the experience of
infertility may pull partners apart, because research has
shown that typically, it takes men three years of infertility
to get upset. The major social role for men is "worker,"
not father. In fact, men who are devastated by infertility
often feel more socially isolated than women, since men typically
do not sit around and have discussions about how painful it
is not to be able to father.
We at Sexual.health.com are not going to offer any panaceas,
but there are resources that can help you cope better with
infertility. There are many supports out there-organizations,
groups, books, other websites, but you have to know where
to look. We can help link you up.
There are internal strategies to use, too. The way you think
about your infertility can help or hurt your ability to cope
with it. We have tips for that, too.
We will soon be adding the following topics:
- Grieving and Coping: You Need to Deal with Stress Differently
During Different Stages of Infertility Problems
- Irrational Beliefs About Infertility and How to Stop Them
- Envy and Infertility
- Imagery Exercise for Preparation for Donor Insemination
- Psychosocial Aspects of Male Infertility § Infertility
Prayers
- Tips for Dealing with Pain During Infertility
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