Getting to Pleasure: Welcome to My Blog
It is a crisp fall morning in Albuquerque, New Mexico where teenagers are walking to their classes at an urban high school. Students in this neighborhood come from diverse backgrounds: supportive families, abusive families, undocumented families and over six percent of the students are homeless with barely any family at all. I am a nurse practitioner staffing a school-based health center, a small clinic located in a free-standing building near the school that provides healthcare for adolescents.
Students visit the health center for a wide variety of services, but this morning they all come seeking some type of sexual health care: a 16 year old on birth control pills for a follow-up; a 17 year old recently out of a two-year, abusive relationship during which she suffered a concussion and countless bruises; a closeted gay male who’s Tinder hookup the previous night went tragically wrong; a college-bound senior who fears she is pregnant. These are my patients: tender, lost, strong, confused. They come to me in need of something - birth control, testing for STIs or perhaps an adult to help them think through their mounting fears and confusion. Bearing witness to their stories of suffering and resilience is a gift to me even as, or perhaps because, it breaks my heart over and over again.
Allow me to tell you about the 16 year old on birth control pills. Marisol has been having sex with her boyfriend for five months. She felt ready when they started; she was a junior after all. She also worried that if she didn’t sleep with him, he would find a girl who would. Unfortunately, her boyfriend refuses to wear condoms. Like so many heterosexually active teenaged girls I see, Marisol does not particularly like nor understand sex, and she has never had an orgasm. During this visit, I gently introduce the concept of masturbation to help her to learn about her body, but she interrupts me with a disgusted look on her face. “That’s gross. That’s a thing guys do.”
Though some young women (or folks socialized as women) find pleasure in partnered sex, Marisol is hardly an aberration. When I began asking my patients about sexual pleasure, pain and orgasm, I learned that less than half of my female-identified patients had had an orgasm, either through masturbation or with a partner. I learned that many girls thought touching themselves was offensive, and that masturbation was only for boys. I learned that many girls were disappointed by their sexual experiences. I learned that many felt like they were the only ones who didn’t enjoy sex and presumed that something must be wrong with them. I learned that they engaged in sex passively, letting their partner direct the sexual interactions. I learned that they had tried to imitate what they saw women do in porn. I learned that few could talk about sex with either their sexual partners or even their friends.
Then, they graduated from high school and left my clinical practice. What happened for them? Did sex get better? When? How?
How do women learn to have enjoyable sex? For most, it doesn’t just automatically happen. It is a journey. Enjoying sexual pleasure occurs easily for some, takes decades for others and completely eludes a small minority. Women learn how to have good sex. Although they may enjoy their early sexual experiences, most women derive more pleasure and satisfaction from sex after they have had a fair amount of experience. Getting to pleasurable sex is a journey of learning and empowerment on many levels.
During the latter years of my adolescent medicine practice, my own menstrual periods were becoming irregular. The dreaded menopause loomed, and I was scared. I worried about the impending physical changes in my body. I feared I’d become depressed as my hormones waned, locked into the worst moments of feeling premenstrual. I was also terrified that, just like my periods, my satisfying sex life would become irregular and eventually cease. I wondered, what happens to women’s sexual pleasure after menopause?
I certainly had friends who were struggling to adapt to sex in their changing menopausal bodies. I knew this because, like with my patients, I asked. I heard from my friends about dry vaginas, painful sex, lack of desire, aging bodies, and erectile dysfunction among their partners. At times, my menopausal friends voiced the same issues as my teenaged patients: sex to please their partners; sex that hurt; and infrequent orgasms. It sounded bleak. Were some women actually sexually thriving in menopause? If so, what factors support sexual pleasure in menopause?
Welcome to my blog where I will explore topics of how women discover and maintain sexual pleasure throughout their lives. I explore topics such as masturbation, communication, pleasure as a social justice issue, dating in later life, menopause, sex during illness, talking to teens about sex and more. Look for the sexual life stories in which women of myriad backgrounds and identities reveal their paths toward sexual pleasure.