One final question before I share your collective pearls of wisdom on talking to your doctor about sex with the American Medical Student Association members gathered at the Disneyland Resort.  I’ll let you know how the panel goes, but rest assured you have just made a tremendous impact on the future of sexual medicine and made the world a safer place for patients to discuss sexual health with doctors.

Today’s question:  If you could give your doctor one piece of advice on discussing sexual health concerns, what would it be?

If you can’t be honest with me, I can’t help you.  I tell all my clients that at the beginning of the very first session.  I strive to create a non-judgmental environment where people will feel comfortable sharing extremely private information.  Likewise, it is your doctor’s responsibility to make sure that you are treated with respect and to take your sexual health concerns seriously.  The doctor-patient relationship is a two-way street though.  You are responsible for being honest about your sexuality so that your doctor can do his/her job and make important decisions about your health care.

The students gathered at the annual conference of the American Medical Student Association want to know what they need to do to make you feel safe and as comfortable as possible talking about your sexual concerns and what mistakes they need to avoid that might jeopardize your willingness to give them all the information they need to help you.  I’ll tell them, if you tell me.

Today’s question:  Have you ever withheld information about your sexual behavior from your doctor?  What kept you from being completely honest?

Medical education relies heavily on the concept of preceptorships where each student shadows a physician observing the day-to-day practice of various medical specialties.  Experienced doctors can serve as models of professional, compassionate care, but they can also pass on bad habits.

When I speak to the “baby” docs at the American Medical Student Association’s 60th Annual Convention, I want to be able to them give examples of what works and what doesn’t work, when it comes to addressing sexual health, from a patient’s perspective.  Your voice has been the missing puzzle piece in training the next generation of doctors, until now.

Today’s question:  Have you had any positive interactions with a doctor around sexuality?  If so, what made it a good experience?  Describe a negative experience and how it could have been improved.

Jacking, Jilling, whacking, or fingering.  No matter what you call it, masturbation is the most accessible form of sexual expression.  But, thanks to a strict sexual dichotomy it seems that for every pleasure there is often an equal and opposite sense of guilt.

In a recent study reported in the Journal of Sex Research, 20 heterosexual, teenage (16-18) girls from a school in the south of England were asked about what discussions, if any, they have had with their parents about sex and relationships, their relationship histories, attitudes about their own body and masturbation, attitudes about safer sex, feelings of control in sexual situations, and other related issues.  Responses ranged from extremely negative to extremely positive.  Some girls felt that only boys should touch their genitals and even then it wasn’t pleasurable.  Others had unsuccessfully attempted masturbation only to end up feeling dirty, bad, or guilty.

On a positive note, a few of the girls described the discovery of masturbation as being accompanied by feelings of “amazement,” a sense of release, and inner calmness afterward.  Even with a positive attitude a few of these girls had struggled to overcome negative emotions associated with masturbation, however, what all these girls had in common was open communication with their parents.  They reported being able to talk about all topics, not just sex, without embarrassment or discomfort.

Discussions of masturbation tend to be few and far between and this silence only contributes to sexual shame and feelings of disgust.  If we are to move toward sexual health and happiness, it’s about time we began examining our attitudes toward masturbation.

You can start by considering these questions:  What is your masturbation narrative?  Do you find masturbation uncomfortable and uninteresting or rewarding and pleasurable?  If you are a parent, what conversations are you having with your children about masturbation?

Recommended Reading:

“Sex for One:  The Joy of Selfloving” by Betty Dodson

“I Am My Lover:  Women Pleasure Themselves” edited by Joani Blank

“Third Base Ain’t What It Used To Be:  What Your Kids are Learning About Sex Today - And How to Teach Them to be Sexually Healthy Adults” by Logan Levkoff

Yet another chance to listen to Dr. Mark giving the her own brand of shame-free sex information on The Stupid Cancer Show; Monday, June 8, from 6-7pm Pacific.  The Stupid Cancer Show is the voice of young adults with cancer and Monday’s episode is all about sex!  For more information check out:  http://stupidcancershow.com

Cancer sucks.  Survivors rule!

A 2006 report from the United Nations Office on Drugs and Crime estimates that four percent of the world’s adult population uses marijuana annually.  My guess is that some of those people are also having sex while high and that’s why today, on the unofficial pot smoking holiday, 4/20, we will take a look at the interplay of the two.

Marijuana, just like every other drug legal or not, has different effects in different people based on the individual’s body chemistry.  For some, pot is clearly not sexy especially if it increases their anxiety.  A little anxiety can sometimes enhance a sexual experience - think back to when you were younger, making out or having sex in a parked car with the very real possibility that you might get caught - exciting!  But, too much anxiety - racing thoughts, paranoia, feeling like you might have a heart attack - generally serve to take you out of the mood real quick.

On the other hand, getting high can also positively effect sexuality.  Some people report feeling more physical pleasure and connection to their partner(s).  Due to pot’s effect on time perception sex can seem to last forever under the influence.  Also, we know from research that marijuana works as a vasodilator, opening blood vessels which allows more blood to flow to the genitals thereby increasing sensation.

Unfortunately, due to prohibition, there are very few studies on the effects of cannabis on sex.  With approximately 162 million pot smokers on the planet, perhaps it’s time to fully research and understand the sexual effects of marijuana.  For now, we are limited to anecdotal reports.  Care to share your own experience of sex while high?  I look forward to your comments!

Beyond the hot flashes and sleepless nights, for some women menopause threatens the end of sexual satisfaction.  It is true that once the ovaries stop producing estrogen a woman’s sexual and reproductive anatomy goes through some pretty big changes.  And while menopausal symptoms vary from woman to woman, most will experience some degree of vaginal dryness, decreased desire, difficulty achieving orgasm, dulled orgasmic sensations, and possibly even vaginal atrophy.  Luckily you don’t have to suffer or just give up on sex.  There is no one magic bullet that will “fix” your post-menopausal sex life, however, there are several different ways in which to tackle the problem and an integrated approach may be the most prudent one.  I recommend you consider all of your options and choose the best combination for you.

While traditional hormone replacement therapy has fallen out of vogue, due to an increased risk of breast cancer, there are other hormonal treatments available.  Some women, in consultation with their doctor, use a vaginal ring that releases a small amount of estrogen directly into the vaginal tissues.  Similarly, other women may choose to use a cream that contains either estrogen or testosterone.  These products help with lubrication, sensation, desire and the overall health of the vagina.  There are also various herbs that can be used in consultation with an herbalist or doctor of traditional Chinese medicine.  As with all medications, these treatments may not be safe for all women, especially those with a history of hormone-dependent cancer.  But fear not my survivor sisters, there is research underway to determine the safety of some hormonal treatments for us so this story is to be continued.

Of course, we don’t have to rely soley on drugs and doctors to maintain our sex lives.  Remember sex is a “use it or lose it” type activity.  The more sexual you are on a regular basis, solo or with a partner, the healthier and more repsonsive your body will be.  Try Kegel exercises to encourage blood flow to the genitals and increase sensation.  Regular vibrator use will also help with blood flow to the clitoris.  If you’re feeling dry, use a good lube (avoid oil based lubes if you are using condoms).  I recommend getting a sampler pack from someplace like Good Vibrations so you can try different brands and find the one you like the best.  You can increase your desire for sex by reading erotica or watching porn.

Just remember, you deserve sexual pleasure, so don’t give it up without a fight!

Sex is an embodied experience.  It doesn’t matter how you feel about your body, if you’re going to have sex, you will have it in the body that you inhabit today.  Not the one that is 10 pounds or two surgeries from now, but the one that is sitting in front of the computer reading this.  Don’t use an “imperfect” body as an excuse to deny yourself pleasure.

Everyone has things they don’t like about their body.  How often do you feel that your (insert body part here) is too (big/small, hard/soft, perky/saggy, hairy/bare, round/flat, etc.)?  But, just as easy as it is to make a list of the things you don’t like, what would it be like to make a list of the things you love about your body.  Sure, it might be a shorter list, but if you focus on what you like the other stuff tends to fade into the background and lose it’s grip on you.

Have you seen The Simpsons Halloween episode where all the advertising characters come to life and terroize Springfield?  The key to killing these monsters was a little jingle with the refrain “Just don’t look.”  When the monsters were deprived of attention they disappeared.  If you focus on your positive aspects and starve the negative ones your body monsters might just suffer the same fate and free you up to enjoy sex in the here and now.

We’ve all heard it before, it seems like the cure for everything is exercise.  From an evolutionary perspective it makes sense.  Our ancestors were way more active in their daily lives than we are with our cars, TV’s and internet.  Our bodies were designed to move and when we don’t we are rewarded with dis-ease.  Even the World Cancer Research Fund has recently declared that “clean living,” specifically exercise, will dramatically reduce cancer rates around the world.  I agree, for the most part, but must point out that the majority survivors I know, myself included, led healthy lifestyles prior to cancer.  Cancer does not always follow our rules, but there’s another very good reason to exercise - great sex!

Exercise improves your mood, makes your body look hot which makes you feel sexy, helps you sleep so you’re not too tired to have sex and improves your cardiovascular health making it easier for blood to flow into your genitals during arousal which is vital for erections and yummy sensations.  Plus, couples who exercise together tend to stay together.

If you are resistant to exercise, for whatever reason, try living an active lifestyle.  You don’t necessarily have to go to a gym, you can take the stairs instead of the elevator, bike to work instead of driving, go for a walk or do yoga, anything that will get your body moving will help.  Even doing housework counts as exercise.

On the flip side, sex is great exercise especially when it gets your heart rate up.  Exercise for great sex, have sex for exercise, it’s all good!

So you want more sex in your life? Well, what’s your definition of “sex?” Most people equate sex with intercourse. Foreplay? That’s just what you do to get to the sex, right? Kissing? That’s just for teenagers. When is the last time you gave your partner an erotic massage? How often do you send sexy messages to your lover? Phone sex? Dirty dancing?

When you broaden your definition of sex and allow yourself to receive pleasure from various activities your sex life is increased exponentially. In sexologist speak, I’m talking about your “total sexual outlet,” which basically refers to all the sexual/sensual activities you do. If you limit yourself to intercourse you have a pretty sparse total sexual outlet and will probably end up wanting more. If, however, you get pleasure from intercourse, masturbating, cuddling, oral sex (yes, it is sex!), and foot massages then you have multiple opportunities to be sexual that require varying degrees of time and energy making it much more likely that you will be satisfied.