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.

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!

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.

Remember how sex was when you first started having it?  Sure there was probably a little fumbling and bumbling, but despite the inexperience and jitters, your body reacted wildly with little to no effort.  You slowly gained knowledge of exactly what you liked to do, and have done to you, and probably settled into a nice little groove.  Maybe you’ve had to adjust to new partners along the way, but physically there were certain things you could count on.  A light touch here, a firm pressure there, find that spot and stick with it!

What happens when your body doesn’t react the way you expect it to?  What do you do when you have medical problems that alter your sexual interest, arousal or response?  As we age our bodies are slowly losing the ability to function like they did when we were at our prime, and that includes our sexuality.  There’s no way, yet, to stop the ravages of time, but the human body is a remarkably adaptable machine and with a little attention you can ride the waves of change and maintain a satisfying sex life.

The secret is in adapting to any given situation.  Take time periodically to explore your body and take an inventory of what feels good.  Pay attention to your energy level and try to avoid sex when you are feeling tired or fatigued (unless you want to use a quick orgasm to help you fall asleep!).  If you are experiencing pain, explore positions that may be more comfortable for you.  If your favorite body part isn’t functioning or missing altogether, challenge yourself to discover pleasure in another area of your body.

Change is the only thing you can count on in life.  Are you going to adapt or be left behind?