How a Sex Therapist Misplaced Her Orgasms in Synagogue -Then Found Them There
Let’s face it. We like to blame sexual problems on our relationships.
How do I know this? I’m a sex therapist. And maybe more importantly, I’m a woman. Of the hundreds of women I see in our practice, nearly everyone blames any issues that come up on her relationship.
Janie’s husband is not interested in sex with her? I’ll watch her sobbing that “maybe he is having an affair, addicted to porn, or disgusted by the five pounds she has gained.” Okay, Janie. Maybe. But here’s another thought. Perhaps he is just temporarily tired, distracted, or perhaps his hormones are low, and none of this has anything to do with you?
Maria has pain with intercourse? She decides that she must not trust her partner or is not sufficiently turned on by said partner, or maybe has abuse in her history that she has blocked out. Well, okay, maybe, Maria. But maybe, just maybe, you just have tight muscles, or need external lubrication or more facts?
This is such a crazy trap, and if you want to know how alluring this trap is, you can look no further than me. I know this better than anyone. I fell into the same trap. Twice. And it took services at synagogue to climb out.
So let’s talk about the first time I misplaced my orgasm. It was 30 years ago; I’m in my early 30’s and struggling with anxiety, which would come and go at different points in my life. Suddenly I find myself unable to orgasm when I’m having sex with my husband or when I’m by myself, for that matter. What the hell was going on? My sex life, like most people’s, had its ups and downs, but having an orgasm was always a sure thing. And now, it was suddenly gone; disappeared like a bowl of jellybeans at a 5-year-old’s birthday party.
Thirty years ago, I was not yet a sex therapist. So I did what any normal woman would do. I panicked. What the hell was going on? I went into what I now term the classic “blame the relationship” game. I assumed that something incredibly problematic was going on in my relationship with my husband, that I was harboring some deep-seated anger, developed trust issues in the relationship, or was so depressed that I couldn’t orgasm.
And once I decided that something “must” be wrong in the relationship, I looked for a hook in the relationship to hang it on. Let’s be honest, folks. Who can’t find a hook that’s a bit wobbly in a long-term relationship? I was often tired and irritated at my husband. We were two busy professionals with two little kids and a crazy life. I was always “mistrusting” him, if you count mistrust that the groceries would be picked up, playdates organized, and birthdays remembered. Whatever.
Objectively, I was no more irritated, angry, depressed, or distrustful than I had been a month earlier when I was still having lovely orgasms. And, ironically, those orgasms were often the one thing that made me less irritated, angry, and distrustful. Sex as a great escape from the craziness of our day-to-day life and a glue for the relationship.
To understand this story, we need to travel back just a few months before the disappearance of the orgasm. I had been talking to a friend in synagogue, let’s call her Sharon, about my anxiety and depression. Here’s what you should understand: as an Orthodox Jew, our Saturday morning services are long. They can easily run for three hours. Sometimes (okay, more than sometimes), I am guilty of talking to friends in between the prayer services. Anyhow, Sharon is a psychiatrist and a couples therapist. She and I often grab a minute during “downtime” in the service to consult on difficult cases. Once, another friend, overhearing us talking about a couple in conflict over his erection issues, leaned over from the next row and said to us: “no one, and I mean no one, would ever believe the conversations I overhear during these services!” But I digress.
Anyhow, on this particular Sabbath morning, a few months before the great disappearing orgasm, Sharon is listening to me go on and on about how my anxiety seemed to be getting worse. (In self-defense, I do get some prayer in between all these fascinating conversations). She told me about a new drug called Prozac that seemed to be getting terrific results. I eagerly bought and read “Listening to Prozac,” and it spoke to me. She prescribed me some to try. I know. Having your friends give you curbside consult in synagogue? Not the best idea. But I was a busy working mom of little kids, and the idea of seeing a psychiatrist on top of my weekly therapist appointments was overwhelming. So, this worked well for me.
About two weeks after I started the Prozac, I remember feeling, “Oh my God. This must be how ‘normal’ people feel.” The continuing cycle of anxiety in my head that would repeat over and over again had finally quieted down. For the first time in my life, when I had issues that were bothering me, I could think about them rationally and calm them down in a way that psychotherapy, much as I felt it helped, did not do. As delighted as I was on the Prozac, it never occurred to me that the Prozac could have been the reason I wasn’t having orgasms. Before you roll your eyes at me, this was in the early days of Prozac, and that information was not widespread.
A few months after starting the Prozac, I’m at synagogue telling Sharon how delighted I was with the Prozac. Then, on a whim, I said to her, “There’s no way that the Prozac could be affecting my orgasm. Right?” She looked at me and laughed. “Well, yeah,” she said, “That is the most common side effect of Prozac.”
So, here I am, 30-year-old Bat Sheva. After months of analyzing my relationship, never-ending late-night discussions with my husband to figure out all of the “issues” that weren’t even there, and after months of wasted therapy sessions focusing on The Problems That Must Exist In My Relationship, it was the Prozac.
Now let’s fast forward. I was in my early 50s and had worked as a sex therapist for 20 years. It was eight years ago, and I was clumsily wending my way into menopause. Once again, the orgasms seemed to be going on a hiatus. Whereas the last time, they had disappeared overnight, this time, they gradually faded away, and the progression wasn’t linear. Sometimes they were fine. Sometimes weak. I’m writing all this by way of excusing myself for once again falling into a similar trap. I can’t be that thick, can I? I started going through a similar relationship issues rabbit hole. You know that adage: fool me once, shame on you. Fool me twice, shame on me.
Except for this time, my husband and I had fewer outside pressures, and our relationship was humming along quite smoothly, thank you very much. And this time, I was a sex therapist and a seasoned one at that. This one hit me over the head faster, but embarrassingly, a second time at synagogue.
Esty cornered me to complain about her diminished libido. As a sex therapist, you get cornered at large gatherings. I’ve had informal consults at weddings, bar mitzvahs, and, I kid you not, once at a funeral. And synagogue? Well, that, pre-Covid, almost functioned as an offsite office.
Anyhow, as I’m talking about her diminished libido, I hear myself talking about possibly having her testosterone checked. And I stop in my tracks. Well, there you go, Bat Sheva. Physician, heal thyself.
What was so striking to me is that I have dedicated my life to debunking the preconceived notions that sexual problems are always a result of relationship issues. And here I was, falling into the same rabbit hole. Maybe it’s good. It keeps me humble.
We women are prone to doing this, aren’t we? Blaming ourselves for so many things: our “mishandling” of relationships and communication, our “over-sensitivity,” our assumption that any problem that arises is a result of something we’ve done wrong. Maybe it’s time for us to acknowledge that many problems may be a result of someone else’s decisions, or actions. Or, as in this case, they may be a result of a medical issue.
Anyhow, this loss of orgasm turned out to be, once again, chemical, and not the result of some unidentified relationship issue. And I think there are three lessons to be had from my crazy stories: not all sexual problems result from issues in the relationship, sex therapists struggle just like everyone else, and God answers prayers in all kinds of interesting ways.
This article first appeared in the Lilith Magazine, Spring 2020.
Botox Injections for Vaginismus?
Using Botox injections to help women who struggle with vaginismus seems radical, but it truly is not!
Once upon a time, maybe 15 years ago, I was working with a patient who was hyperventilating from fear during a dilation session. She sat up on the exam table and said “Bat Sheva, there has to be another way to do this.” And she was right.
I started doing research and set out to find a treatment method for women who are overwhelmed, fearful and panicked at the idea of putting something into their vagina. Or for those women who have not been successful using traditional dilator therapy. And I found a procedure using Botox injections and lidocaine in the vagina.
A woman is put under IV sedation for the procedure which takes about 30 minutes. The medical professional injects Botox and anesthetic in the vaginal walls and massages the introital muscles to break any muscle spasms. Once the muscles are relaxed, a large dilator is inserted. The patient wakes up with the dilator in place.
This is the first step, but it is only a first step. Once the procedure is over, the patient’s brain and vagina need to learn to be friends, communicate and relax. She needs to learn to insert the dilators herself, feel comfortable with touching her vulva and vagina and to relax with penile penetration.
Here are some of my random thoughts if you are interested in finding out more:
- For the right patient it works really, really well! What I have discovered is that for a patient whose pain is primarily tight muscles and who have the fear that goes with the pain, the Botox injections can bypass months of scary and overwhelming dilator work.
- It’s really not such a big deal. The entire procedure takes 15-25 minutes and seems to have little to no side effects at all.
- “Waking up” from the procedure with the large dilator inserted is an exciting and moving experience for women who have, until then, not been able to insert anything into their vagina.
- It will not work if your pain is primarily from hormonal imbalances or structural issues.
- A supportive partner or friend can make a big difference! It’s important to have someone cheering for you.
- If you’re single and avoiding dating because of your fears of sex, this might change your life.
I wish more women with vaginismus knew about the possibility of Botox injections. It could change their lives!
Rethinking the Affair
Every once in a while, a client makes me think through an issue in a new way, or helps me clarify something, and that is one of the most interesting and rewarding parts of my job as a sex therapist. Recently, I had that experience with a wonderful, smart, gutsy woman recovering from an affair that her husband had.
Like many of my clients whose husbands have strayed, they see it as a harbinger that it is time to take care of their sex lives. In some cases, the affair was truly an outgrowth of a sexual problem the couple was having. In many cases it really wasn’t a direct result, but the women feel that it may finally be time to deal with an issue they have long been trying to avoid.
The funny thing we’ve noticed is that often (and counter-intuitively) the fact that the partner has strayed seems to increase the woman’s sex drive. Now there’s a really interesting plot twist, and one we’ve struggled to put into context (and by the way, partners… please don’t see this as a technique to get your beloved back into bed). We’ll often have women saying to us “I hate myself”, or “I am so totally confused, but since I found out about the affair, suddenly my libido is back!”
So what’s going on?
Life and sex are really complicated and this is no exception. But I think the two issues that jump out at me are:
- Your sex drive loves competition. The same rev-you-up hormones (norepinephrine and dopamine) that get your heart pumping in a race can be activated by any type of competition, sex being only one. If you’re the kind of person who loves a challenge, a challenge to your sex drive will fall right into the pattern.
- You suddenly come face-to-face with the reality that you don’t thoroughly and completely know the person to whom you are committed. Ironically, this not totally knowing or trusting, may be one important key to preserving an erotic life with the person you love.
Numerous books and articles posit that trust and intimacy often exist at odds with eroticism. We don’t like to admit that to ourselves. It’s fundamentally scary to live an ongoing existence with someone who we don’t know entirely. In order to stay happy and comfortable in our lives we convince ourselves we really know everything there is to know about our partner; they are an open book. But eroticism needs some shadow. It may grow best is the darker crevices. And that’s an uncomfortable reality for us to face.
Enter my patient. She is typical of a woman recovering from her spouse’s affair and trying to work on her sex life. She talks about her struggle to rebuild trust in her relationship. And this dichotomy of trust vs. eroticism is particularly meaningful and poignant for me to watch.
On the one hand, she feels like she needs to trust her spouse entirely. On the other hand, I wonder if her new found sexuality is partially due to her finding out, deep down, that her husband is truly a separate individual. She may never know him entirely.
This is a painful reality for any of us, this idea that our partner exists in his or her own world, with his or her own thoughts and feelings and insecurities and impulses, some of which we will never ever fully participate in. As a matter of fact it is such a painful idea that most of us would rather live in the fantasy that we can know another individual entirely, even if that might kill our sex life. But the truth is that as much as we may love our partner and as much as they may love us, they are separate individuals living a life and reality apart from us.
And the good news? Reality builds eroticism. So as I watch my patient struggle, I want to reassure her that maybe not knowing and not trusting 100% is painful at times, but it has its upside. And she’s found that in the bedroom.
Not everyone responds well to the pill
In 1961, the FDA approved the use of female oral contraceptive pills (commonly known as birth control pills) and the world has never been the same. Currently there are well over 60 different birth control pills on the market and an estimated 12 million women in the United States using birth control pills. For most women, birth control pills work very well. They are inexpensive, efficient, effective and take so much of the fear of unwanted pregnancy out of the equation. However, there is a group of women who really don’t do well on oral birth control and often the side effects are overlooked, or women don’t even realize that the side effects they are experiencing are from their birth control!
What side effects? It’s clear now that hormonal birth control pills can create low desire, decreased arousal, dryness, and even pain. I have had so many patients tell me they wondered if their birth control pills could be contributing to their sexual problems, but they figured that since they were never told about these potential side effects by their prescribing practitioner then it must be all in their head — and they are angry about that. And who can blame them? “Why wouldn’t my doctor tell me?” or “I would have stopped the pill years ago when this first started if I had known that this could be a problem,” they will say. Sometimes the problem has been going on for years and they are just now realizing the cause.
So, ironic as it may seem, the little pills you started because you were having sex, are now what could be the reason you don’t want sex anymore. Birth control pills suppress hormones in your body to prevent you from ovulating and preventing pregnancy. But they also suppress your natural production of androgens, specifically testosterone. They also increase production of SHBG (sex hormone binding globulin), a protein which will bind to testosterone and make it unavailable for your body to use. Testosterone is the hormone most closely linked to driving a woman’s libido. The birth control pills reduce your testosterone levels significantly. (This is also why birth control pills will help clear your skin).
Women are starting birth control pills at younger ages, and it is not uncommon for women to be on birth control pills for 10–15 years. While it is perfectly safe for women to stay on birth control pills for many years, it is unclear what kind of effect this long-term use has on a woman’s libido. Some research has shown that even after discontinuing use of birth control pills, women still have not regained their libido.
If you’ve been looking for a non-hormonal birth control, there are a few options you can consider:
- Condoms and diaphragms (yes, they are still making diaphragms although they can be hard to track down.) are good straight-forward options.
- Some IUDs are completely hormone free. And even the ones that do have hormones, only have “local” hormones, that should not affect you systemically.
- As of September 2020, the FDA-approved a vaginal gel contraceptive (Phexxi) which is significantly more effective than spermicides. It is a cream that is made of lactic acid (which is naturally produced in the vagina and is found in dairy products like yogurt and kefir) and potassium bitartrate (used in cooking as cream of tartar) It’s inserted into the vagina (with an applicator) an hour before intercourse. It keeps the vaginal pH levels steady and moderately acidic, which effectively kills any viable sperm.
So, here are the most important take-aways:
- Birth control pills work for many women with no side effects.
- If you are having symptoms of low desire, problems with arousal or pain in your vulva/vagina and it seems to correspond with starting to take birth control pills, you are not crazy. It probably is related to them.
- If you discontinue the birth control pills it may help the problems but it may not be enough. You may need additional help to “fix the problems.”
- There are definitely options out there if you want to explore non-hormonal methods of birth control. You just have to keep an open mind.
I have so much more information about this in my book Sex Points. You may want to check it out.
Joint Pain and Sex
If you suffer from arthritis or other joint pain,
have no fear, a fabulous sex life can still be yours for the taking. I know it feels like you will never be able to having great sex, but with a bit of planning, extra pillows and, above all, a sense of humor, you can take back your sex life.
- Positions will need to vary depending on where the pain is experienced. You need to support the affected area with a minimal amount of movement. Ironically, the classic missionary position will work best if the woman is experiencing pain, and women on top will work best if a male partner is experiencing pain.
- Pillows and cushions are your best friend, as the real key is keeping the areas that are in pain, supported. There are excellent “wedge” shaped cushions that can help support the back, the legs, the arms or neck if that is necessary.
- Move slowly. Especially if you are just trying to get back to a sex life, move slowly with your partner and express what is going on. Do not ignore pain!! If something hurts, shift, and try something else. It’s doable.
- Get yourself a light vibrator. Note, I didn’t say smaller… or weaker.. As we get older we need higher levels of stimulation to reach orgasm, and for women this often means a stronger vibrator which is chargeable and not battery operated. Check out the weight of the vibrators before purchasing them. There are any number of light weight, chargeable external vibrators that can be your best friend.
Please don’t give up on your sex life because of arthritis, or other joint pain. Do what we all do when you see a bump in the road. Reroute.
It happened again today.
I saw a patient who is in a long-term relationship with a man she loves very much. He is warm and caring and gentle and loving. Their sex life is good… (it wasn’t when she first came here, but now it is). She and her husband have sex 1–2 times a week. She gets turned on and has orgasms and for the most part enjoys it, except…. Except that there is a part of her that doesn’t really want gentle and loving sex all the time. There is a part of her that wants to be grabbed and thrown on the bed. There is a part of her that wants her husband to tie her hands above her head and push her against the wall and take her from behind. There is a part of her, the part that got turned on when she was reading 50 Shades of Grey, that wants something different from the gentle, loving sex she is currently having. And she doesn’t know what to do.
This is not a unique problem. Believe it or not, I see it fairly frequently. It doesn’t always go this way. Sometimes it goes the other way. A woman wants gentle loving sex and her husband is aggressive and more demanding than she likes and that’s a big issue also. And men get stuck in this dilemma as well. But more often than not, the problem I’m presented with is that a woman wants rougher sex than she is currently having. I suppose it makes sense on a number of fronts. We choose a partner for many reasons but hopefully a part of that is to find someone who can support us, love us and take care of us. Partners who are loving, solicitous, and gentle often rank up high in the relationship department. That doesn’t necessarily mean that they rank up high in the rough-sex department. Also, I think we live in a society that assumes that women want a certain kind of sex. Your partner, one of the enlightened, egalitarian set, might assume that rough sex is just not kind enough, supportive enough or romantic enough. He might think “of course she wants gentle, loving sex”. Isn’t that what every woman wants? That is our cultural assumption.
In the end, we make our decision to marry (or get into a long term relationship) for a myriad of reasons and great sex might not necessarily be at the top, or a certain kind of sex might not necessarily be at the top. And let’s be honest, our lovers might not naturally understand what we want and it may be quite different from what we want out of the bedroom. So what’s a person to do?
As far as I can tell, you have two options:
- Talk to your partner and see, if they are open to the change. They may just be waiting for you to say the word. Alternatively, they may be taken aback that you want things that feel non-too- PC and that may take some negotiating. Or, it is possible that they like, or are more comfortable with, calmer, less “rough” sex and it may be difficult to change style. In any event, it’s worth a try.
- Or, if your partner really can’t/won’t consider a change in sexual direction, you always have the option to have sex in your head when you’re with them, and that can be a different kind of sex.
Okay, let’s look at the first option — see if you can talk your partner into getting with the program. This seems like the more obvious of the two approaches and it is the optimal choice. It also might prove to be the more difficult option. Talking to your partner about this means coming clean as to what you really want, even if you are a tad embarrassed to admit it. Women seem to have an awfully hard time admitting to themselves, let alone telling their partners they want them to be dominated or that they want to dominate. It’s so culturally frowned upon that it takes an unusual person to recognize a desire to be thrown on the bed and controlled. Admitting it out loud is twice as difficult. But if you want this to work you have to own that part of yourself, understand it is normal and natural.
And now you have to communicate to your partner concretely, not in generalities. Saying “I’d like you to be rougher or take charge more,” might not get you anywhere. I suspect you’ve probably even tried that already. What you probably need to do is describe, in graphic detail, exactly what you want them to do to you, when and how. And I know, that’s a bummer, because part of the charge of this kind of sex is letting go and letting someone else take charge and here you are feeling like you are back to controlling everything again. Conversely, if you would like to be more aggressive, own that and talk about it. Or, if you want to role play, dress up as an alien or tie your partner up, own it.
It’s also important to accept that you might not get exactly what you want, but you will get a closer version than you might be getting now. And who knows? If you’re really lucky, you may unleash something in your partner that allows them to run with it. Maybe they will find a part of themselves that, until now, they’ve kept wrapped up. You’ll never know until you try.
And unfortunately, “really trying” does not mean one vague, theoretical conversation. “Trying” in this case means passing along books, DVD’s, raising the issue while you are having sex, making specific suggestions and keeping them coming. And all this means you need to make sure you are comfortable with this part of yourself and don’t start backtracking and back-pedaling. “You know I didn’t really mean it when I said I would get a kick out of sex in the parking lot.”
And another small warning. When you are having this conversation make it absolutely clear that there has been nothing fundamentally wrong with you love life until now. That you do really and truly enjoy the other kind of sex, the kind that you have more regularly. It’s just… this is something new that you really want to try and build in.
The second option, having a different kind of sex in your head, is much easier and definitely more comfortable and I’ve seen it work for a myriad of couples. This is the option where you say, tonight I really need a different kind of sex, so while my body is definitely on the bed with my lover, my brain is in my car where I’m trying to get out of ticket with a controlling and angry cop.
Before I get jumped on by a host of angry sex therapists who are horrified by my suggestion that you don’t always have to stay present in your body with your current partner each and every time you make love, let me clarify. Yes, it is likely your love life might suffer if, every time you are with your partner, your brain goes on vacation with someone else. You may find yourself having a difficult time staying with your body and its normal reactions and at some point your lover is likely to catch on if you are “away” during every sexual encounter.
But that’s not what I’m saying. I’m suggesting that sometimes, using your brain to access a different kind of sex than what is actually happening in your bedroom can be a liberating and erotic experience. And even though your brain is hanging out with dominating aliens, a stranger you just met in the bar or the brother of the guy in 50 Shades of Grey, your body is safely at home with a loving partner. What I’m saying is that there is nothing at all wrong with you, or your relationship if you sometimes fantasize about a very different, erotic encounter somewhere, far, far away, while still enjoying the tactile sensation happening right now in your very own bedroom. It’s normal. It’s natural. It’s not having an affair with your imagination, and it is definitely not disloyal. If anything, using your brain to spice up your love life and keep you coming back to the same person and the same bed every time — that’s the important part.
So there you have it. Own the kind of sex you really want to try and then make it happen in reality or make it happen in your head. Either way you don’t have to give up on the kind of sex you want!