Talk about Sex
I spent a long weekend with old friends out West — hiking, relaxing by the fire, and laughing our heads off — and it was just what the doctor ordered!
Naturally our conversations ran the gamut. Husbands, kids, hormones, and sex. We covered a lot of ground.
So it’s the perfect moment to have handed my newsletter over to my “sexpert” friend, Dr. Rachel Rubin, whose guest post below is barn burner (in the best possible way) — and dovetails with my recent essay about hormone replacement therapy.
But first, a “humble brag.” My alma mater, Princeton University, just published a feature article about me in their print magazine. It nicely encapsulates what the hell I’ve been trying to do for the last 2.5 years! You can read it here.
Second, if you missed the poll I sent out last week, asking you for input and feedback, please let me know what’s on your mind HERE!
And now, giddy up for some sexual healing from Rachel Rubin, MD …
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After more than two years of pandemic, we’re all a little rusty with cocktail party small talk. No, this isn’t the biggest consequence of the pandemic, but some of us need some help in new social situations. I am here to help.
I am a sex doctor. And I’m a heck of a lot of fun at cocktail parties.
I am a urologist who did a fellowship in sexual medicine. Not only am I a board-certified surgeon, I’m also an expert in genitals and how they work. I help people of all genders with issues like low libido, erectile dysfunction, menopause, testosterone, pelvic pain, and orgasm difficulties. I am obsessed with sexual medicine research, education, evidence-based medicine, and I’m a fierce advocate for my patients’ quality of life.
So here are five sexual medicine fun facts that you can use at your next cocktail party. And for those of you wondering: the pun is intended when saying cocktail. You don’t become a penis doctor without a sense of humor.
Weak erections and vaginal dryness are canaries in a coal mine.
These are common problems. They are also super treatable, yet many patients think they are simply something they have to accept with age — and not important enough to see a doctor about. But your quality of life matters! Plus, they can both be signs of other serious health issues.
Let’s start with erections. Fifty percent of 50-year-old men have erectile dysfunction (ED), 60% of 60 year olds, 70% of 70 year olds…you get the idea. But this isn’t just a problem in the bedroom. It’s also a big warning sign for overall cardiovascular health. To have a healthy working penis you need three things: healthy arteries, healthy muscles, and healthy nerves. Penis arteries are quite small compared to cardiac arteries, and if they clog up, the heart arteries may be next.
Men with ED have a higher rate of heart attacks and early death. If you have ED, no matter how old you are, don’t be embarrassed — so do most of your friends. Please go see a doctor who takes this seriously and looks at your entire health history.
Now to vaginal dryness. All women over 50 stop producing sex hormones estrogen, progesterone, and testosterone. This is called menopause, which causes so much more than hot flashes and night sweats.
The vulva, vagina, urethra, and bladder are rich in hormone receptors and require hormones to be strong and healthy. Without hormones, the tissues become thin, dry, and irritated. And the microbiome changes, increasing the risk of urinary tract infections. The lack of hormones in the bladder and vagina can also cause urinary frequency, urgency, and leakage, along with vaginal dryness, pain with sex, and decreased orgasm quality. All of these symptoms typically improve with local vaginal hormones, which are safe for nearly all humans (even those with a history of blood clots, cancer, and heart disease). But many women suffer in silence. They either don’t bring it up with their doctor, or their doctor is not trained in how easy and safe a solution vaginal hormones are!
Dr. McBride recently wrote a great post about this. Read it!
Don’t be a luddite in the bedroom: technology is your friend.
We use technology to make our lives better in just about every way. So why are you still having sex the same way you were in 1982 when Grease was on the big screen, Eye of the Tiger blared from the radio, and the internet didn’t exist?
Sex technology has evolved beyond your wildest dreams, and high-end devices for all body parts allow for quite the variety in your toy box. Often our discomfort talking about sex with ourselves, our partners, and even our doctors prevent us from maximizing how much fun we could be having in the bedroom.
Devices are not one-size-fits-all — literally or figuratively. Andrea Martin, our nurse practitioner, has started a series on our YouTube channel where she shows and talks about different devices to help people feel more comfortable with what’s out there.
What’s the average time to orgasm?
This is a fun trivia question I give to medical students when I lecture around the country. What is “normal” or “average”? This is definitely a case where Hollywood movies and pornography are fake news. But what’s the data?
If you give a heterosexual man a stopwatch, and he enters a partner and times himself to orgasm (I don’t recommend doing this for fun), the average time is 5.5 minutes. That means some last shorter and some last longer.
But here’s where the data gets fun. If you give the women the stop watch, the time changes to 13.5 minutes, and the majority of people asked do not orgasm with only penetration (and 17% never orgasmed at all). This is because of anatomy and physiology. The clitoris is not that close to the vagina, so penetration is not the way to the majority of female orgasms!
Low libido is NOT just about feeling connected and emotional intimacy.
Of course connection matters, but there is a biological basis to low libido. That means you can have a wonderful relationship and a sexy partner, and still have low libido as a result of biological factors. That’s why we believe in a “bio-psycho-social” approach to discussing and treating low libido.
Think about it. Horny teenagers don’t have deep meaningful emotional connections. There is a hormonal, biological thing where they can’t keep their hands off each other. Yet biology is often ignored when it comes to adult relationships and sex after age 50.
But we have a lot of success with bio-psycho-social solutions to low libido. We know hormones work for all genders, and boosting dopamine with various medications can help as well. Not to mention, everyone benefits from sex therapy. No one is so good at sex they can’t get better.
Once again, be sure to talk with your doctor about this.
Botox isn’t just for your face. It works great in the vagina too!
This last one was mostly just to make sure you were still paying attention.
The vagina is surrounded by muscles called the pelvic floor. (Men have a pelvic floor, too.) When these muscles are weak, they cause issues like urinary incontinence; when they are too tight or in spasm, they can cause problems like pelvic pain or pain with penetration. Putting botulinum toxin (a.k.a. Botox) into these muscles, along with pelvic floor physical therapy, can improve the quality of life for people in so many ways.
So there you have it.
What I love about my job is quite simple. I explain to highly educated people (I work in DC) how their “private parts” work. I talk about sex as comfortably as I talk about my lunch. I find that normalizing the discussion about these intimate parts of our health improves pleasure and quality of life.
Plus, I have a ball at cocktail parties.
Oh! To sign up for my mailing list click here. You can also find me on Twitter, Instagram, Facebook, and YouTube.
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Speaking of quality of life, check out fierce advocate for female empowerment, Caralena Peterson, new on the podcast this week!
This week I sit down with Caralena to discuss her new book, "The Effortless Perfection Myth", about the mental and physical health toll of the pressure college-age women put on themselves to be pretty, thin, and accomplished. Together, we break down how exhausting it is to be anything but yourself, that love is not something that you earn, and how getting a B+ is often better than getting an A.
As always, my newsletter subscribers get early access to the pod every Monday night before the official Tuesday launch. Give it a listen now on Apple, Spotify, or wherever you find podcasts. I’d also be THRILLED if you rated the show and left a review! Thank you!!
I will see you next week. Until then, be well.