For centuries, since St. Valentine, February has been anointed the ‘Month of Love’. And when the conversation turns to love and relationships, we should not ignore the fact that physical intimacy and attraction is a very important part of relationships. And that includes sex. Along those lines, sex is a topic that many, including physicians, have a hard time discussing directly. Frequently we talk around the topic. But during this month of February, the Month of Love, we should not ignore that physical intimacy is a very important part of relationships.
Why discuss this topic? Isn’t this something people just “know” about?
In school, we are continually taught math, English and history, because all the knowledge cannot be transmitted in one year. In most professions and careers, we continually work at being better at our jobs. There often are continuing education classes and seminars. We have mentors to help us grow and succeed. There are parenting classes and books to read for parents to improve and become more educated.
And yet, most of us were given minimal to no education in school or from our families about sexual intimacy. We often learned from friends, older siblings or cousins who learned from their friends. Not exactly the experts on this topic. What we do see in the media is often distorted and not factual or helpful for advancing our knowledge about sex. So, continuing sex education may improve your closest relationships and even improve your health.
What actually is sex and intimacy?
Most people equate sexuality with vaginal penetration and orgasms, but sexuality can be so much more.
Sexuality and orgasms do not require two people and do not require penetration for pleasure. Learning about your body and what is pleasurable to you and what is not pleasurable to you may be done solo. For many, if not most women, clitoral play rather than penetration is more likely to lead to orgasm. For some, the anticipation of physical closeness can lead to sexual fulfillment; for others the sensuous experiences with great food or wine or witnessing a sunrise or sunset is fully satisfying. So:
In Sexuality, Step 1 is your relationship to yourself.
Step 2 is being embodied, being fully present in your body.
Step 3: Physical intimacy should start with ‘emotional intimacy’. Emotional intimacy is a degree of closeness between two people that includes sharing of emotions, feelings and perceptions. The best gift you can give your partner this Valentine’s day/season is the Gift of active listening. In a relationship, two people often talk at each other, in duologues—each thinking of what to say next rather than really listening. Intimacy grows exponentially when two people truly listen, accept each other and don’t try to fix or improve each other.
How does Sex change over time and with aging?
Through the decades, we are constantly redesigning and refining our relationships both to ourselves and to our partners.
In our 20s and early 30s, relationships are new; our bodies are young and flexible and our sex drives are often high. We are usually starting to learn about our bodies and our sexuality. Some find they need to de-stress to have sex and others crave sex to de-stress. Women often enter relationships with minimal experience and knowledge about their own wants and needs and desires physically. OMGyes.com is a new website designed especially for women to educate women how to learn to self-pleasure.
Some women are ready to start a family and others delay fertility to advance their education or career. The 20s and early 30s are a time of peak of fertility, so contraception is key if we are not ready for kids. STD protection is paramount as well. Fear of pregnancy and STDs may affect our sexuality. Contraception, especially hormones, may also affect our libido.
As we enter the next decade, many women start worrying about their fertility. Those who have children find it hard to prioritize pleasure and themselves and their relationship to their partner. They are often pressured with time constraints — busy with kids, family and job – and they forget that intimacy can help decrease stress and keep them more balanced and healthy. Woman often sacrifice self-care and ‘relationship care’ for the children and/or the career. And in some cases, we see women put themselves second yet again to their male partner’s wants and desires, including sex.
Other women, who have not yet had kids, start seeing sex as a job – it becomes work to try to get pregnant and is no longer used merely to have fun and feel good or to treat stress. In this information age, technology can be both a blessing and a curse. Using period apps and ovulation kits make sex more robotized, more like work and less like play. For those who are not yet partnered but who still desire a family, dating and sex can become overwhelming and pressured and this does not engender an easy carefree enjoyable sex life.
Sex post childbirth — What am I to expect after having a baby?
With natural childbirth, the vagina changes. The vagina is magical in that it can expand to allow a baby to pass through the birth canal. But afterwards, the tissue may be more lax and even less elastic — especially if there was a tear and repair during delivery. The vagina may feel less sensitive. Some women start to experience some loss of urine with movement such as a cough, laugh or sneeze. This may lead to embarrassment and fear in the bedroom. Also, as our bodies have transformed, our relationship to our bodies and ourselves may have changed too. We often need to practice self-compassion and self-love to reconnect with the ‘new you’. And our partner may also need to adjust their views — you are now a mom and not just a partner and this can affect them too. New moms also often get oxytocin hormone surges with lactation. This fills them up emotionally, and their need for physical closeness with their partner becomes less acute; and so, the partner may feel alienated and shut out; this can negatively affect physical intimacy. And if this is not discussed, it also affects emotional intimacy.
Is there anything I can do to repair my vagina so its more like it was before?
For many years, women were told to do KEGEL exercises to improve the muscle tone of the pelvic muscles; but often, they were not guided correctly on how to do this AND the exercise didn’t always work. In today’s world, there are physical therapists (PTs) that specialize in the women’s pelvis. Ask your doctor for a referral. This PT can help rebuild muscle tone.
Are there any treatments to restore the vagina to its prepregnancy state?
For many years, if the vagina was very large post pregnancy and or the bladder and uterus were pushing in on the vagina, surgery was used to tighten the muscles and fascia. This can still be done today, it is called an anterior and posterior colporrhaphy or repair. For bladder control, there are better surgeries to lift the bladder and control urinary incontinence. But for many women, surgery is too invasive a procedure for them.
Presently there are a plethora of energy based and laser based treatments done in the office that may help rebuild the vagina. One such device, The VIVEVE , simultaneously heats and cools the tissues of the vagina and increases the tightness of the vagina and improves sexual satisfaction. Women notice increased lubrication*
Is the VIVEVE painful? How many treatments are needed?
The VIVEVE treatment is an office procedure. In 30-45 minutes, during which time you can check your emails, watch an episode on Netflix, or chat with our physician, the procedure is finished. It is painless and requires no anesthesia. There is no downtime before you can resume sexual relations. The maximal effect is seen in 3 months and often lasts up to a year or beyond. The procedure can be repeated in one year or beyond. What’s more, we send you home with a vial of medical-grade lubricant used during your procedure which is safe for use during sex.
What about women entering peri- and post-menopause?
Many women in the perimenopause and menopause start noticing a drier vagina and also frequently they have urinary tract symptoms without a urinary tract infection. In one study, this was a common complaint and yet only 40% of women were given treatments by their health care provider. Over the counter products and lubricants do not change the underlying problem and therefore do not halt the progression of the thinning of the vagina. Prescription medicines like vaginal estrogen or DHEA can improve the dryness. Some women don’t like these medicines because they can be messy, they can forget to take them or they are contraindicated medically.
And for postmenopausal women, systemic hormones can also help with vaginal dryness. Estrogen can help perimenopausal and menopausal women gracefully enter into menopause with minimal symptoms, It can be a boon to many women but there are those women who can’t take hormones, such as women with breast cancer.
An alternative to estrogen for many women, is the above mentioned Viveve treatment.
Why do many women sacrifice sex as they age? Why are they so willing to forego their pleasure?
Many women are told that libido declines with age, that as we age the need is less great and the desire is less. But, sex can help maintain youthful vitality and keep people youthful. “You are only as old as you feel.” Living in pleasure and play is a practice but can lead to more happiness and joy and closeness with a partner. The more we exercise, the more we send blood flow to the brain to maintain brain vitality and the same is true with exercise and our sex organs. Also sex itself is exercise. Sex can include touch – light and heavy.
Ecstasy and pleasure is your birthright. Enjoy your life fully — mind body and soul. We do NOT have to accept a ‘WORK First’ mentality, but. We should embrace balance in all areas. Embody your life and prioritize pleasure and play.
IF you have more questions about the VIVEVE, hormone replacement, contraception or want to learn more about how to improve your sex life, Contact Dr. Koopersmith at West Coast Women’s Reproductive Center today
*Krychman M, Rowan CG, Allan BB, et al. Effect of Single-Treatment, Surface-Cooled Radiofrequency Therapy on Vaginal Laxity and Female Sexual Function: The VIVEVE I Randomized Controlled Trial.
J Sex Med 2017;14:215e225. Copyright 2016, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.**