03/23/17

Body Banter

Sex Ed for Grown Folks: Vaginal Dryness & ED

By Dr. Uchenna Ossai  

Dr. Uchenna Ossai is a sex-positive pelvic health physical therapist, sex educator and counselor. Her sexual philosophy centers on pleasure and audacity while acknowledging the role that gender, race/ethnicity, and biology have on sexual development and expression. She spends her days treating people with both sexual and pelvic floor dysfunction, and her evenings educating the masses everything that has to do with “sexytime.” She embraces being unapologetically real, happily crunk, and deliciously kind. 

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If life functioned as a romantic comedy, then sex would would be preceded with a 20 second montage of you and your partner sweetly holding hands while ice skating in Central Park, followed by 10 seconds of intense eye-gazing, then 10 more seconds of kissing and foreplay in front of a fireplace until you both finally assume a sexual position and BAM! Orgasm. End scene. Back on planet “Reality”, things are a bit more complicated. Our bodies are spectacular storytellers of our daily grind, and that can have a negative impact on our sex lives in the form of erectile dysfunction (ED) and vaginal dryness (VD).

When it comes to ED, the rumor (and mythical misconception) mill is always quite active. One of the most common myths is that ED is primarily related to a partner’s level of attractiveness. Thus, my response to that assumption would be a rip-roaring, “No. Nope. Nah, son!”

Why? Well, because it’s simply untrue. It's also worth noting that the absence of ED is not an indication of sexual satisfaction or the absence of sexual dysfunction. I know pretty surprising, right? All that said, it still doesn’t diminish feelings of inadequacy or embarrassment for the two of you when ED finds its way to your bedroom. 

Interestingly, some similar factors that can cause ED also contribute to vaginal dryness (VD). VD can wreak havoc on your sex life, self-esteem, and body image. With there being so much beautiful distinctness with women's bodies and sexual expression, why can’t we hold room for those differences when it comes to vaginal lubrication? Where did we get the message that our vaginas constantly need to be a flowing brook? Here are some of the factors that can cause VD:

  • Decreased sexual activity

  • Menopause

  • Breast-feeding

  • Inadequate level of arousal

  • Frequent douching

  • Poor sexual context

Did you know that approximately 2% of men under 40 have of ED? In fact, there's a significant expectation of underreporting among young men because the occurrence of ED has always been linked to old age as well the social stigma. ED among men under 40 has been linked more to psychological distress in comparison to men over 40, where the cause is more related to biological factors.

The truth is, sex is so “extra special” in it’s complexity. Meaning, there are multiple factors that contribute to our sexual function, and these factors can be placed into categories of biology, psychological, sociocultural, and interpersonal. ED is simply the result of categorical failure or conflict. Here are some specific indicators that can contribute to the rise (no pun intended) of ED:

  • *Cardiovascular disease (high cholesterol, hypertension, etc.)

  • *Tobacco and Excessive Alcohol use

  • Diabetes or Metabolic Disease

  • *Medication (antidepressants, antihypertensives, anti-anxiety, etc.)

  • Obesity

  • *Psychological factors (depression, general and performance anxiety, etc.)

  • *Culture and religion (religion and cultural underpinnings shape how we view and participate in sex and express our sexuality. Depending on the message, sexual activity can sometimes spur feelings of guilt, shame, or stress/anxiety that can suppress the physiological response to arousal).

  • *Work and relationship stress and distress

  • *Hormonal Deficiencies (testosterone for males, estrogen for females, thyroid for both).  

*Factors that also cause vaginal dryness.

Sexual context is the situation in which sex takes place. For example: Let’s say that your purse that was holding your new IPhone and $500 cash got stolen; and your partner is trying to rub your booty between your emotionally charged verbal rants of misfortune. How do you think that situation would end for you and your partner? If the situation isn’t quite right, the vaginal brook cannot and will not flow. Capeesh? Now that you have the facts, you’re probably wondering how to move forward, right?

  • Educate yourself, please. Education is the great equalizer. This is especially true in sex education. Many of us have so many misconceptions about sex that often result in unnecessary distress and heartache. Life’s too short to have bad sex, people. Take a live “Sex Ed for Grown Folk” class, get a private lesson from a sex educator or therapist, or check out a sex ed channel on YouTube or Instagram. Get learnt!

  • Revisit your definition of “sex”.  What is the gold standard?  Penetration, right? Wrong, boos. The gold standard is pleasure.  For those of you who are experiencing VD or whose partners are struggling with ED, consider taking penetration down from its “ideal sex” pedestal and replace it with pleasure. There are MANY ways to achieve optimal pleasure (kissing, sensual touching, talking “dirty”, enhancing intimacy, fantasizing, seduction, etc.), and penetration is merely one of them.

  • Don’t be cruel. As you can see, there are a laundry list of factors that can cause ED and vaginal dryness. So stop being so hard on yourself (and your partner) for not living up to the sex standard of Olivia Pope and President Fitz or Jake Ballard in Scandal. There is no need for apologies. If there is equipment malfunction, do the diagnostic work.

  • Get out of your head and stop thinking (and worrying) so much.  Don’t kid yourself. When your brain is thinking, “Is my hair appointment at 3 or 4pm tomorrow?” or is preoccupied by the worry that your tummy rolls are a bit more pronounced than usual during sex, you can’t enjoy it. Figure out how to press the “Pause” button on your daily grind during sexytime. This is when a chit chat about sexual context with your boo can be quite helpful. The less work your brain has to do, the higher your sexual pleasure will climb and hopefully the brook will flow a bit better.  

  • Make some lifestyle changes. If your diet is full of sugar, sodium, and booze, consider scaling back a bit for better blood sugar regulation and hormonal function.  Adequate blood flow, heart function and stress management is essential for sexual function; so quit the use of tobacco products and get started on a regular, moderate-intensity exercise routine (brisk walking, hip-hop dance class, bike riding, etc.).

  • Create a new sexual pleasure map and review the context in which you have sex.  If the buttons that are being pushed during sex are not “blowing your skirt up”, than it is time to investigate new buttons.  Also remember that sex and pleasure are all about the context in which you are having it in.  If you are not “feeling the moment”, neither will your body.

  • Use lubricant! The sole purpose of lubricant is to make sex easier for you.  Using lube should not be viewed as a failure of your femininity, masculinity, or personhood.  Nor does it mean you are a hot mess in bed. Take a beat and remember, not everyone is built the same so don’t be afraid to experiment with different products until you find something that works best for you and your partner. Just avoid lubricants with warming agents, glycerin, and parabens.

  • Don’t forget about your pelvic floor. For both men and women, your pelvic floor is central for sexual function.  If your muscles are too tight or have low tone and poor strength; it can compromise blood flow and fluid exchange, which translates to difficulty with erections and lubrication.

  • Get a little help from your medical professional friends. Sexual dysfunction is complicated. Now that we understand that sex is more than just “hand on genitals → aroused → penetrate” and involves the interplay of biological, sociocultural, psychological, and interpersonal factors; the key to long-term management is through a multidisciplinary approach. Depending on the issue, get guidance from a pelvic health physical therapist, urologist, ob-gyn, urogynecologist, and/or sex therapist.  

 *~What other sex education topics do you think we should cover next? *~