Although much of sexual health is psychological, it is also very much about the body. Let’s get to the physical stuff!

First up: female anatomy and orgasm. For a long time, scientists knew surprisingly little about the clitoris. This organ contains thousands of nerves that give women sexual pleasure. It’s shaped like a triangle and it’s bigger than you think.

“We don’t see the majority of the clitoral tissue,” says Rowen. “It’s deep, and it wraps around the vagina.”

Does this mean that vaginal orgasms and clitoral orgasms – the latter once deemed inferior by some male doctors – are in fact the same? Rowen says scientists aren’t studying this enough to be sure. She suspects that female orgasms involving vaginal penetration engage more muscles and thus cause different sensations, even though the nerves involved are likely similar. What we know for sure is that most women need external clitoral stimulation to reach an orgasm.

A lot of young women come to me and say, “I may have orgasmic dysfunction” because their partners say, “My last three partners had orgasms during sex.” There’s something wrong with you. No there is not.

Tami Rowen, MD ’09, MS ’07

“People don’t understand that, says Rowen. “A lot of young women come to me and say, ‘I may have orgasmic dysfunction,’ because their partners say, ‘My last three partners have had orgasms during sex. There’s something doesn’t go to your house. No, there isn’t.

Unfortunately, many things can spoil a woman’s sexual pleasure. Some women taking hormonal contraceptives find that their libido drops; Rowen attributes this to the high dose of hormones needed to stop ovulation. And as women age, menopause can bring on a host of unpleasant symptoms, including vaginal dryness and low libido. Fortunately, says Rowen, the progesterone and estrogen used in hormone replacement therapy are much less potent than those in the pill, so they don’t curb desire.

Women looking to increase their libido have relatively new prescription options. One is Addyi, a drug originally studied as an antidepressant. (Note for women already on antidepressants: many of them suppress sexual desire. This also applies to men.) Although there has been some controversy over the effectiveness of Addyi, Rowen says the most of his patients who try the daily pill decide to keep taking it.

There’s also Vyleesi, which indirectly affects dopamine, a neurotransmitter that fuels our quest for pleasure. You’re supposed to inject it under your skin — yes, with a needle — about 45 minutes before sex. On the plus side, you find out if it works quickly, whereas Addyi can take weeks to get started.

And the men? There are well-established options to help them get or keep an erection. You’ve probably heard of Viagra, one of the most popular prescriptions in the United States. It stimulates blood flow to the penis.

But Shindel notes that the ability to get an erection isn’t always the issue. Some men simply have a low libido, which may be more mental and emotional than physical. However, the problem can get worse over time.

“The analogy is, ‘Who wants to play baseball if you know you’re going to hit?'” Shindel said. “They don’t want to fail. It becomes a vicious circle.

“But the pills work in many cases to help stimulate the erection response regardless of arousal or libido. A lot of men regain their confidence. It’s psychological, but real.

In older men, surgery or radiation therapy for prostate cancer can damage the nerves and make erections especially difficult. If nothing else helps, surgeons like Benjamin Breyer, MD, MAS ’11, professor of urology, can implant a device in the penis. When the patient wants an erection, he simply pumps a small bulb into his scrotum – ta-da, science! Other promising (but still experimental) solutions include shock wave and stem cell therapies.

“We see a lot of men in their 50s and 60s,” Breyer says. “It’s one of the most rewarding things about our job – helping men get back to where they were before cancer. For many people, it helps them feel more normal.

Still, Breyer thinks everyone should know that there are far less invasive ways to improve their sexual function.

“Anything that’s good for you overall is also good for sexual health: exercise, eat well, rest, relax,” he says. “Mental health, hormonal health, vascular health…all of these things intersect and lead to sexual well-being.”


Stock Photos: colored pencils: Light Field Studios; drooping flower: EasyBuy4u; origami: Ksenia Ivanova/Mandrixta; calla lilies: Floortje

Although much of sexual health is psychological, it is also very much about the body. Let’s get to the physical stuff!

First up: female anatomy and orgasm. For a long time, scientists knew surprisingly little about the clitoris. This organ contains thousands of nerves that give women sexual pleasure. It’s shaped like a triangle and it’s bigger than you think.

“We don’t see the majority of the clitoral tissue,” says Rowen. “It’s deep, and it wraps around the vagina.”

Does this mean that vaginal orgasms and clitoral orgasms – the latter once deemed inferior by some male doctors – are in fact the same? Rowen says scientists aren’t studying this enough to be sure. She suspects that female orgasms involving vaginal penetration engage more muscles and thus cause different sensations, even though the nerves involved are likely similar. What we know for sure is that most women need external clitoral stimulation to reach an orgasm.

A lot of young women come to me and say, “I may have orgasmic dysfunction” because their partners say, “My last three partners had orgasms during sex.” There’s something wrong with you. No there is not.

Tami Rowen, MD ’09, MS ’07

“People don’t understand that, says Rowen. “A lot of young women come to me and say, ‘I may have orgasmic dysfunction,’ because their partners say, ‘My last three partners have had orgasms during sex. There’s something doesn’t go to your house. No, there isn’t.

Unfortunately, many things can spoil a woman’s sexual pleasure. Some women taking hormonal contraceptives find that their libido drops; Rowen attributes this to the high dose of hormones needed to stop ovulation. And as women age, menopause can bring on a host of unpleasant symptoms, including vaginal dryness and low libido. Fortunately, says Rowen, the progesterone and estrogen used in hormone replacement therapy are much less potent than those in the pill, so they don’t curb desire.


Curious to know how menopause can impact women’s lives – sexually or otherwise? Brizendine’s latest book, The Upgrade: How the Female Brain Gets Stronger and Better in 40s and Beyond, comes out in April.


Women looking to increase their libido have relatively new prescription options. One is Addyi, a drug originally studied as an antidepressant. (Note for women already on antidepressants: many of them suppress sexual desire. This also applies to men.) Although there has been some controversy over the effectiveness of Addyi, Rowen says the most of his patients who try the daily pill decide to keep taking it.

There’s also Vyleesi, which indirectly affects dopamine, a neurotransmitter that fuels our quest for pleasure. You’re supposed to inject it under your skin — yes, with a needle — about 45 minutes before sex. On the plus side, you find out if it works quickly, whereas Addyi can take weeks to get started.

And the men? There are well-established options to help them get or keep an erection. You’ve probably heard of Viagra, one of the most popular prescriptions in the United States. It stimulates blood flow to the penis.


Tom Lue, MD, Tanagho Professor of Clinical Urology at UCSF, discovered how the body traps blood in the penis during an erection and advanced our understanding of nitric oxide, which is crucial for the functioning of Viagra and similar drugs. .


But Shindel notes that the ability to get an erection isn’t always the issue. Some men simply have a low libido, which may be more mental and emotional than physical. However, the problem can get worse over time.

“The analogy is, ‘Who wants to play baseball if you know you’re going to hit?'” Shindel said. “They don’t want to fail. It becomes a vicious circle.

“But the pills work in many cases to help stimulate the erection response regardless of arousal or libido. A lot of men regain their confidence. It’s psychological, but real.

In older men, surgery or radiation therapy for prostate cancer can damage the nerves and make erections especially difficult. If nothing else helps, surgeons like Benjamin Breyer, MD, MAS ’11, professor of urology, can implant a device in the penis. When the patient wants an erection, he simply pumps a small bulb into his scrotum – ta-da, science! Other promising (but still experimental) solutions include shock wave and stem cell therapies.

“We see a lot of men in their 50s and 60s,” Breyer says. “It’s one of the most rewarding things about our job – helping men get back to where they were before cancer. For many people, it helps them feel more normal.

Still, Breyer thinks everyone should know that there are far less invasive ways to improve their sexual function.

“Anything that’s good for you overall is also good for sexual health: exercise, eat well, rest, relax,” he says. “Mental health, hormonal health, vascular health…all of these things intersect and lead to sexual well-being.”


Stock Photos: colored pencils: Light Field Studios; drooping flower: EasyBuy4u; origami: Ksenia Ivanova/Mandrixta; calla lilies: Floortje