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Women's Sexuality and Sexual Response

In October, our guest expert in Le Club's Ask the Expert segment was Dr. Meredith Chivers, Ph.D., C.Psych., a post-doctoral fellow in the Law and Mental Health Program at the Centre for Addiction and Mental Health (CAMH) in Toronto.

Dr. Chivers is a licensed psychologist and is currently an Ontario Women's Health Scholar research fellow at CAMH. She is also an adjunct professor in the Department of Psychology at the University of Western Ontario and a member of the Coalition for Research in Women's Health at the University of Toronto.

Dr. Chivers's research examines the determinants of female sexual response, female sexual interests, and sex differences in sexual psychophysiology. In contrast to popular myths about women being less sexually responsive than men, she is discovering that, in some ways, women respond physically to a much broader range of stimuli than men do.

Dr. Chivers is also interested in understanding why some women experience a disconnection between their physical and psychological sexual response, whereas men typically do not.

Although she spends the majority of her time doing research, Dr. Chivers also provides assessment and treatment for a variety of concerns relating to women's sexuality and gender identity, including sexual dysfunctions, concerns about sexual interests, desires to transition to the male gender role, and compulsive sexual behaviour.

Here are Dr. Chivers's answers to your questions about Women's Sexuality and Sexual Response:

Q: I can become very sexually aroused with my partner to the extent that I gush fluid, which is neither vaginal secretions, nor urine. Is this 'female ejaculation' and if so, perhaps you could expand upon why this happens sometimes and not others and how/where and what this fluid is.

Unlocking this mystery for me would be wonderful ... I would like to understand and celebrate this phenomenon and not feel uncomfortable or shy. Many thanks.


A: Yes, you are ejaculating and the fluid is not urine, but a secretion from a gland that is thought to be the Grafenberg spot, or G-spot. The fluid is spurted out the urethra during the involuntary muscular contractions of orgasm.

The G-spot is an area of heightened sensitivity on the front wall (on the side closest to your navel) of the vagina, about 2-3 inches from the vaginal opening. The G-spot is thought to be composed of tissue called the paraurethral (or Skene's) glands, similar to the male prostate gland.

This gland is positioned between the urethra, from which you pass urine, and the wall of the vagina, so pressing on the front wall of the vagina will push down on this gland. When pressing on this part of their vagina, women report feeling an area that is noticeably swollen when they are sexually aroused. Stimulation of this area, such as rhythmic pressing with fingers, a penis, or a dildo/vibrator can, in some women, result in an orgasm.

In some women, milky, watery, and slightly salty fluid is expelled during the muscular contractions of orgasm. The fluid is likely a combination of secretions from the paraurethral glands, as well as very small amounts of urine (because the fluid is expelled from the urethra); it is unlikely to be urine if you do not otherwise have trouble with urinary incontinence.

You are likely ejaculating when you receive direct G-spot stimulation during sex, such as stimulation with fingers or a dildo, or during certain intercourse positions, such as straddling your partner (cowgirl position), or when on your hands and knees (doggie-style). Planning ahead can get around the common concerns about female ejaculation: Some women choose to talk to their partners about ejaculating before sex happens so there is no misunderstanding about the ejaculate being urine; others may have a towel handy to prevent a wet spot and to clean up.

There has been little scientific research on female ejaculation. One study estimated that about 80 percent of women believed they had a G-spot and about 40 percent reported experiencing ejaculation, however this estimate is probably high because of the way the study was conducted. What is clear from this research, however, is that not every woman experiences ejaculation, and not every woman has a G-spot, that is, an area of heightened sensitivity in their vagina.

Women have the potential to experience a range of pleasurable sensations from different parts of their genital area, like their their vulva, labia, clitoris, vagina, cervix, perineum and anus. You are a fortunate woman to be able to explore and enjoy your G-spot and the ability to ejaculate, in addition to the rest of your genitals. Have fun!

 


Q: Hello. I have a very unusual question about sexuality, I have had to go on Wellbutrin XL because of interstitial cystitis. It seems to be the only medication that agrees with me, but it has given me a side effect that is off the wall. My sexual arousal is so intense. I feel it all the time and sometimes it is hard to focus. Could you please tell me if this medication causes this effect? I did not notice anything before this medication. I would really appreciate an answer to this. Thanks.

A: It is normal for women to experience transient genital sensations that can come in and out of their awareness, much like how you can feel hungry but, when eating is not possible, you turn your attention to something else. Some women, however, experience genital sensations of sexual arousal (e.g., feelings of genital wetness, genital and pelvic fullness or engorgement, increased tactile sensitivity, breast engorgement and increased sensitivity) that take over their awareness, feel overwhelming and unbidden, can last for hours or days, and are not relieved by orgasm.

If you are experiencing these physical symptoms without feeling like you want to have sex, and without an obvious trigger for sexual response, then you may be experiencing a phenomenon called Persistent Sexual Arousal Syndrome (PSAS) or Persistent Genital Arousal Disorder (PGAD).

Medications like Wellbutrin are known to have affects on sexual functioning. Using these medications is associated with some people feeling less sexual desire or having difficulty with experiencing sexual arousal or achieving orgasm. For a minority of women, however, the medication can do the opposite and increase their physical sexual responsiveness.

How this happens is not well understood. Talk to the doctor prescribing the Wellbutrin about lowering your dose and keep track of your sexual arousal after the dose is lowered to see if your feelings of physical sexual arousal are less pronounced. If you have never experienced this symptom before the medication, it is very likely that the medication is augmenting your genital responses.

You may also want to do some research online to learn more about PSAS/PGAD and other common triggers for unwanted genital sensations. For example, Dr. Sandra Leiblum, an international expert in women's sexuality at the Robert Wood Johnson Medical School in New Jersey, is currently conducting a study of women's experiences with PSAS/PGAD.

 



Q: I am a lesbian in my mid-thirties in a long term relationship with a woman. I have an essentially bisexual past behind me, but have not had a long-term relationship with a man since my early twenties. I am sexually aroused by all kinds of porn: gay male and female, straight, etc.

But my fantasy life is often more dominated by men. In real life, my attraction to men is fleeting and I never act on it. But I have been unfaithful with other women outside the relationship, including an extended affair with one woman. Why do you think there is a divide between my fantasy life and my actual sex life? Is this normal?


A: For women, sexual flexibility, such as what you describe - fantasy content not matching your sexual identity or sexual behaviour - is likely the norm. In my research, I have observed that most women respond physically to a very broad range of sexual films that do not match their sexual orientation. Unlike most men, whose psychological arousal closely matches their genital response, many women have the capacity for their mental and genital sexual arousal to vary relatively independently of each other.

Female sexual flexibility is also commonly observed among sexual minorities, where sexual attractions, sexual behaviour and sexual identity often do not match perfectly. Research on women's sexual orientation has shown that it is not unusual for women who identify as lesbian to report sexual attractions to both women and men, and for their attractions toward women and men to fluctuate over time.

Women can also show flexibility between the various psychological aspects of their sexuality, such as fantasies, sexual responses, and desires for actual sexual behaviour. In fact, it is quite common for women to fantasize about sexual activities that they would never actually wish to occur. For example, a review study published in the mid-1990s suggested that between 20 and 50 percent of women have had fantasies of being sexually coerced. Of course, this does not mean these women actually want to be raped or sexually assaulted, but fantasizing about forced sex - within the safety of one's own mind - can be sexually arousing for some women.

Sometimes, what is considered a taboo can be very arousing to us. For some, the naughtier the sex, the more exciting it is for them. The lesbian community sometimes frowns on the idea that lesbian women can be sexually attracted to men after coming out. I wonder if, for you, being sexual with men is considered taboo, and therefore more sexually exciting, which is why your fantasies more often involve men. It may also be that you are reliving an exciting sexual experience from your bisexual past.

Whatever the reason for fantasizing about men, it is likely that your fantasies are simply that - fantasies. You find them sexually arousing and enjoyable but may not want to act on them. If you are distressed about your fantasies and how they relate to your current relationship, however, I would recommend talking to a counselor or sex therapist. In Ontario, you can contact the Board of Examiners in Sex Therapy and Counselling in Ontario to locate a sex therapist in your city or town.

 



Q: I have been married for several years and continue to experience extreme tension of vaginal muscles in anticipation of sexual intercourse. Rarely am I fully aroused to the point that entry and sex are not painful, even after extensive foreplay and even when I believe myself to be fully aroused. Might I be sending an unconscious psychological message that my muscles are responding to, or is this something I should seek medical advice for? Would you have some suggestions for encouraging a more unified response in mind and body?


A. It sounds like you are experiencing a sexual problem called vaginismus: an involuntary contraction of the vaginal muscles that can make vaginal penetration painful and, sometimes, impossible. Women who experience vaginismus have often had a history of negative sexual experiences, such as previous pain during sexual activity or sexual abuse. When vaginal penetration is attempted during sex, the body involuntarily contracts the vaginal muscles, anticipating pain. It is a similar reflex to blinking when something comes close to your eye. Some women also experience vaginismus while having a routine pelvic examination.

The first step to becoming more unified in your sexual response is to stop engaging in sexual activities that cause you pain. Talk to your partner about your experience of intercourse, if you haven't already. For heterosexual couples, this usually means stopping all sex that involves penetration of the vagina and, instead, focusing on sexual behaviours that do not involve vaginal penetration (e.g., oral sex, stimulating your clitoris, and sensual touching). Sex therapists call this outercourse. This way, you can focus on the enjoyable sensations of being sexual, without the fear that sex will mean intercourse and pain.

Next, you need to learn to relax your vaginal muscles when your vagina is penetrated: you can learn to control those muscles, but it takes practice. To do this, you will usually start by relaxing and putting something very small, like a pinky finger or small vaginal dilator, in your vagina, over and over, until you are very relaxed when you do it.

Once you are comfortable doing this, and don't experience an involuntary muscle contraction, you will increase the size of the object you insert. You will continue this gradual process until you can insert something about the size of your spouse's penis (if your partner is a man) or a dildo/vibrator. Then, you will practice with your spouse inserting fingers or dilators into your vagina, starting with the smallest and gradually increasing the size.

During this process, you will learn several things: to control your vaginal muscles, to relax during penetration, and to trust that your partner won't hurt you.

Treatment of this problem can be relatively straightforward, but it can also be quite complex as couples explore the connection between the vaginismus reaction and their thoughts and emotions about sexuality and the relationship. I highly recommend seeking the help of a sex therapist to guide you and your partner through this treatment. In Ontario, you can contact the Board of Examiners in Sex Therapy and Counselling in Ontario to locate a sex therapist in your city or town.

 




Q: How common is loss of libido, clitoral sensitivity and dry vaginal vault in women post hysterectomy, with the duration of the situation lasting over two years? Do women experiencing this situation just have to accept it as part of the price one must pay to survive?

A: The impact of hysterectomy on sexual functioning depends on the extent of the surgery. Radical hysterectomy for treatment of cervical cancer can be associated with a greater amount of nerve damage than hysterectomies for benign uterine conditions. If an oopherectomy (removal of the ovaries) was also performed, the likelihood of problems with sexual functioning increases. The ovaries produce estrogens and androgens, sex steroids that are key to the maintenance of a women's sex drive, and to maintaining the blood supply to the genitals that keeps genital tissues healthy and able to lubricate.

There are many things you can do to enjoy your sex life again; you do not need to accept your current functioning as a price you had to pay for the surgery! Discuss your sexual functioning and the type of hysterectomy you had with your gynecologist. If you did not have a radical hysterectomy, did not have your ovaries removed, and you are menopausal, then it is most likely that your symptoms are related to your sex hormone levels. Treatments, such as hormone replacement therapies, may be helpful. Talk to your doctor about these therapies and whether they are right for you.

 


Q: I would like to know why is it that I only started to really enjoy sex, receiving and giving, at age 28, and now, at age 36, I am losing interest in sex? Do women lose their sexual desires once they are pre-menopausal?


A: Women's desire for and enjoyment of sex is influenced by many factors; some are physical, but most are not. We often hear that a woman's sexuality peaks in her late 20s or early 30s, however I have not read any convincing research to back up that statement, and have often wondered where this idea comes from. As there is no known physical or hormonal change in the late 20s and early 30s that could explain increase in women's sexual interest, it is more likely that psychological events account for this change. These events probably have to do with learning about your body and mind, and learning takes time.

Enjoying sex is a process of learning about your body, how it works, what you enjoy, and how to communicate those needs and desires to your sexual partners. When you have a new sexual partner, you have to relearn this process to a certain extent as you learn about your partner's body, what they like. Your partner also learns about you, and you both learn how to communicate about sexuality together.

These are processes that take time and experience. When you start to 'click' with yourself and your partner is probably going to depend on what age you started being sexual and how long you've been with your partner. Your enjoyment of sex in your later 20s might reflect this process of learning about your sexuality.

Premenopausal women do not typically lose all interest in sex. Women can continue to desire and enjoy sex throughout their lives, though there are many reproductive changes that can impact a woman's sexuality, such as pregnancy and menopause. Waning sexual interest in the late thirties could be related to a host of factors, both physical and psychological.

Premenopause may be a relevant factor to consider; the decline in ovarian function is gradual and may influence your psychological desire for sex as well as your physical responses. If you suspect that this is the case, that is, you are experiencing other symptoms related to low estrogen such as vaginal dryness or irregular menstrual periods, talk to your gynecologist about hormonal treatments.

There are also a number of emotional, relational, and psychological factors that can affect sexual desire, such as responding to your partner's desire, wanting to express caring and tenderness, desiring emotional intimacy, your self-esteem and body image, concerns related to being sexual (e.g., sexually transmitted disease, pregnancy, pain), stress, fatigue, and so on. It may be that circumstances in your life have changed in such a way to impact your sexual relationship, your energy levels, or how you feel about yourself, and, in turn, have affected your desires for intimacy.

 


 

Q: What can women who are menopausal do about vaginal dryness in order to have an enjoyable sex life?


A: Vaginal lubrication happens when the vaginal wall become engorged with blood during sexual arousal and 'sweats' fluid into the vagina. Sex steroids, like estrogen, are important to the maintenance of blood flow to the genital tissues so lubrication is possible. Factors that reduce blood flow, such as low estrogen levels associated with menopause, or inadequate sexual stimulation, can reduce lubrication.

There are several ways women can cope with vaginal dryness associated with menopause. The first is to use a water-based lubricant, such as Astroglide, which you can buy at your pharmacy, at a local sexual aid store, or online. Saliva also works well, but may not be helpful for deep vaginal dryness. Another solution is to increase estrogen levels using hormone replacement therapy. Talk to your doctor about HRT and whether this treatment would be suitable for you.

 

 



Q: I enjoy intercourse but for the last two or three years, I am rarely able to orgasm. I am in my early 40's and not showing signs of menopause. What options do I have? It's not only frustrating to me but also to my partner.


A: It is perfectly normal for people to not reach orgasm every time they have sex. Unlike the messages we see in magazines, videos, and other media, sexuality is not always about having multiple mind-blowing orgasms, but also about closeness, tenderness and sensuality. That said, a change in the ability to reach orgasm can be very frustrating for a woman and her partner.

Your options depend on the reason for the change in your ability to reach orgasm. It is possible that factors such as medications (e.g., SSRIs, discussed above), stress, mental health, relationship problems, physical health, childbirth, or hormonal changes may be interfering with your ability to climax. Talk to your gynecologist or family doctor to determine if the change in your sexuality was related to a physical factor, medication, or psychological problem.

If there is no obvious physical or psychological problem associated with your change in orgasm, then a change in sexual behaviour may be helpful. Women are, on average, less likely to reach orgasm during penile-vaginal intercourse than other forms of sexual stimulation; only about a third of women report being able to climax through intercourse alone. If you haven't already, you may wish to try other forms of sexual stimulation, such as manual or oral sex, or introduce additional stimulation to your sex play, such as using a vibrator to stimulate your clitoris.

Another helpful approach is for you and your partner to try to focus on the sensual and loving aspects of your sexuality rather than on reaching orgasm. This may relieve the frustration that might now accompany a sexual encounter, which may, in turn, be affecting your ability to have an orgasm during sex.


Thanks to everyone for writing in and sharing their questions.

 

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