Wellness Letter: Sexual Health News

Sex: A Biopsychosocial Event
By Dr. Stephanie Buehler

Usually when people with sexual concerns contact The Center, they are seeking an appointment with either Dr. Huang or with me, usually not both. Once the patient has an appointment with one of us, they are usually reluctant or hesitant to seek help from the other. However, most patients that I see would benefit from a consultation with Dr. Huang, and vice versa. Overall, sexual concerns usually lie somewhere on a continuum, with some problems being more biological and others being more psychological, but almost none being only one or the other.

Let’s look at a common concern for women, lack of libido or sex drive. Many women who believe that their hormones are to blame are disappointed to learn that there hormone levels are within normal range. In fact, there are women with low hormone levels who experience no problem with drive at all. There are women with normal levels who experience strong drive. While there is a hormone-drive connection, obviously something else may be going on.

What might that be? Consider the following…

Unacknowledged troubles in a relationship. This is fairly common. Are you overlooking serious problems such as spouse who is drinking too much, smoking pot, depressed, going to bed at funny hours, or out of shape? These are definite turnoffs. Is it possible that you have trouble owning and expressing anger? What else might be going on that would cause you to overlook such problems?

Poor understanding of human sexuality. This, too, is common. A female partner may mistake her male partner’s inability to get an erection as rejection. Since her own drive is waning, she says nothing. Pretty soon, the couple’s sex drive has flatlined. If only they had realized that most men’s potency declines beginning at age 25, and that lovemaking must accommodate such changes. And again, is it possible that for this couple there are other reasons that lovemaking has been crossed off their list of pleasurable activities?

Poor understanding of human anatomy. Dr. Huang and I both see women who don’t understand their bodies. They want to have “vaginal orgasms” or are disappointed that they don’t have the movie star orgasms they see in the media. Where do orgasms take place? In the nervous system, of course, and that means the brain! Friction helps, too—but there are women who can attain orgasm with fantasy alone. Also, not all women can attain orgasm, and not all women can have orgasm through intercourse. Women who accept this can still have wonderful sex.

Of course, there can be psychological reasons for problems. If you see sex as a performance, if you are unable to relax, if you have hang-ups, then giving yourself over to an experience may be difficult. If your relationship is strained or your partner’s expectations are unrealistic, orgasm can be difficult to attain.

There can also be physical problems. Diabetes can cause problems with circulation that can affect the genitals. In fact, we sell a device called the Eros which can help to bring circulation back to a woman’s clitoris. There can also be scarring and adhesions. We are optimistic that in 2006 we will have a gynecologist on staff who can examine women to make sure that the sexual anatomy is functioning as it should, as well as a physical therapist who can help women become more aware of their anatomy and how their bodies work.

In the months to come, you will be hearing more about our integrated team approach to treating sexual concerns. Integrated medicine addresses the mind, body & spirit, with each being assessed and treated appropriately. A cafeteria or a la carte approach to treating sexual concerns can be satisfactory, but not superior. We want to provide women (and later, men) with education about human sexuality, with the best in sexual medicine, and with tools to develop healthy relationships that support optimal sex. We know that we will be unique in all of Southern California and even beyond, and we are very pleased that we will be providing this integrated approach to our community.

—January 2006

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