For Women Only

For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life

This is, at heart, a book about the female sexual response. We believe that what women and their partners learn here will eliminate much anguish and despair and help them enjoy more sexually satisfying lives. For Women Only also reflects the enormous change in the treatment of women's sexual problems in the last three years. Our book grew out of this exploding new field, and we are privileged to have played a part. Female sexual dysfunction is at last on the table a recognized and often treatable disorder, which affects the general health and quality of life of millions of women around the world.

What you read here is based directly on our work when we were co-directors of the Women's Sexual Health Clinic at Boston University Medical Center. Thanks to the help of our mentor and role model, Dr. Irwin Goldstein, the pioneer and leader in the field of male erectile dysfunction, this clinic was an enormous success.

We are sisters and started the clinic together, which was the realization of a longtime dream. We had talked for years about the possibility, particularly as Jennifer, a surgeon and anatomist and one of the few women urologists in a nearly all-male field, became convinced that women could benefit from the same medical attention to sexual problems that was given to men. Laura, a sex therapist and psychotherapist heavily schooled in anthropology, enthusiastically supported Jennifer's views.

We opened our doors in the summer of 1998 and have not caught our breath since. The clinic was among the first in the country to offer comprehensive treatment, both physiological and psychological, for women suffering from sexual dysfunction. We have made it clear from the beginning that while we could learn a tremendous amount from the treatment of male sexual dysfunction, we were not going to subscribe to the initial efforts of many physicians to define "female impotence" in masculine terms. We treat women with female sexual dysfunction in terms of four newly classified categories -- hypoactive sexual desire disorder, sexual arousal disorder, orgasmic disorder, and sexual pain disorders -- as well as a wide variety of other problems. We also offer sex therapy, couples therapy, educational counseling, medical treatment, and surgery. We answer frequently asked questions: What is orgasm? How can I enhance my sex life? Am I normal? How can I get my partner to fulfill my sexual needs? Our work is exciting and rewarding. With new medical technology and medications as well as existing psychotherapy treatments, women now have more options than ever before.

Clearly, help is needed for women as much as men. Studies estimate that more than half the women over age 40 in the United States have sexual complaints. In early 1, the National Health and Social Life Survey published in the Journal of the American Medical Association released a report showing sexual problems to be even more widespread: the survey found that 43 percent of American women, young and old, suffer from some sexual dysfunctions significantly higher percentage than that of men, who suffer at a rate of 31 percent.

And yet for most of this century doctors have dismissed women's sexual complaints as either psychological or emotional. In the nineteenth century, the Victorians believed that "good" women had no sexual desires at all. Even now, in our supposedly enlightened era, it is still shocking for us to hear how many doctors, female as well as male, tell their female patients that their problems are emotional, relational, or due to fatigue from child rearing or their busy jobs, and that they should take care of their problems on their own. Many doctors tell older women that these are not real problems at all, just something to accept as a normal part of aging. This is particularly true of older women, although women of all ages have reported this to us.

We hope this book will serve as an antidote to what women have heard for decades. The problem is not "just in your head." You are not crazy, or alone, or fated never to have an orgasm or feel sexual again. Of course, we don't dismiss the importance of psychological factors. But in our experience with our patients, who come from all over the United States and the world, and from all age groups and cultural backgrounds, most problems tend to have both medical and emotional roots, and feed on each other. Our goal in this comprehensive handbook on sexual health is to help the whole woman.

In our clinical work we have always worked as a team. Jennifer conducts the medical part of our patient evaluation and treatment. She is also in charge of our laboratory research, including a recently completed study funded by the American Foundation for Urologic Disease on the smooth muscle function of the vagina and clitoris. This research helped us better understand the mechanisms underlying female sexual arousal responses. Laura is the clinic's psychotherapist. She has a Ph.D. in health education and therapy, with a specialty in human sexuality. She interviews and evaluates patients both before and after Jennifer sees them, and determines if they have emotional problems or relational conflicts that require treatment on a longer basis. Laura helps them get a sense of the larger picture of their lives, and provides ongoing therapy to individuals, couples, and families if needed.

Both of us feel that women's sexual complaints are still neglected by the medical establishment, and that many of the same health problems that cause erectile dysfunction in men, such as diabetes, high blood pressure, and high cholesterol as well as many medications used to treat these conditions, can cause sexual dysfunction in women. Most women also experience diminished sexual responsiveness and loss of libido at the onset of menopause, and many have sexual complaints after hysterectomy or other pelvic surgery. Although drug companies have worked for years to treat male impotence, they are only just beginning to recognize female sexual dysfunction as a medical problem. Even female sexual anatomy is not completely known or understood. It was not until 1998 that an Australian urologist, Helen O'Connell, discovered that the clitoris is twice as large and more complex than generally described in medical texts.

The fact remains that there has been a great deal of psychological research but almost no medical research into the sexual response of women since the groundbreaking work of William H. Masters and Virginia E. Johnson in their laboratory in St. Louis, Missouri, in 1966. Masters and Johnson were the first to describe the physical changes in the vagina during sexual arousal, which they observed and filmed in volunteers with a small vaginal probe and a camera attachment. We have begun where Masters and Johnson left off.

We have adapted the more sophisticated technology of our day: pH probes to measure lubrication; a balloon device to evaluate the ability of the vagina to relax and dilate; vibratory and heat and cold sensation measures of the external and internal genitalia; and high-frequency Doppler imaging, or ultrasound, to measure blood flow to the vagina and clitoris during arousal. Ultrasound, which has been widely available since the 1970s, has never before been used to evaluate genital blood flow when a woman is sexually aroused. Currently, even more sophisticated instruments are being developed to evaluate female sexual arousal, response, and function. These include probes to measure vaginal, clitoral, and nipple sensation and computerized equipment to measure vaginal anatomy and physiology in the office. MRI, or magnetic resonance imaging, is even being used to determine what areas of the brain are responsible for arousal and orgasm.

One of our most important findings is that a physical problem -- a decrease in blood flow to the vagina and uterus, perhaps as a result of aging, hysterectomy, or other pelvic or vascular surgery may be a cause of a diminished sexual response just as diminished blood flow may affect male sexuality. Some women have sexual complaints after hysterectomies and often are told by doctors that they are simply depressed. We believe that in some cases injury to the nerves and blood supply to the genital area may be the cause or be contributing to the problem. Jennifer is in fact developing the same nerve-sparing pelvic surgery for women as is available for men who undergo prostate surgery. Furthermore, we are beginning to realize the important role testosterone plays in female sexual function and dysfunction..

Our goal in this book is to arm women with the information they need about their bodies and sexual response and to provide them with a full spectrum of options for treatment. Our hope is that women will take this book to their doctors, give it to their partners, or share it with other women. It is written without jargon, by women, for women. Clearly, the options will continue to grow as more research is done in this field, and it is also our plan to update women with the latest information.

We are in a new era of women's sexual health -- perhaps feminism's next frontier. Sex is central to intimacy, to who we are, to our emotional well-being and quality of life. Doctors have assumed for years that as long as a woman is able to have intercourse without pain, all is well. That is simply not the case. The fact that sexual education has rarely been a part of physicians' education and training has further aggravated the problem. Most male physicians have only their personal life experiences to help them understand female sexuality. We hope that this book will also help bridge that gap and encourage early education in sexuality for physicians and health care professionals in training and help educate those currently in practice.

It is high time for women to receive the same attention as men, and to demand treatment, not only for pain but to increase their sexual pleasure.

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