One of the biggest areas of misinformation in sexuality is around orgasm, especially the idea that orgasm happens in the genitals. It doesn't. It primarily happens in the brain and central nervous system. We can feel the effects of that genitally (as well as in the rest of our bodies) and orgasm can happen because of stimulation to either of those areas, or any other area of the body, but still, it's actually not really about genitals.

Which, of course, always makes answering this question, which those of us who work in sexuality hear a lot, pretty much impossible.

Another area of big-time misinformation is the idea that we can separate vaginal stimulation from clitoral stimulus: we can't. The clitoris is both internal and external (it's WAY bigger than it looks like it is), and what we feel with vaginal stimulation is also partly clitoral, just not the parts we can see on the outside. So, when we're talking about genital stimulation, the fact of the matter is that if we're ONLY talking about genital stimulus -- the vulva, the vagina or the anus -- it's entirely possible NO one who possesses a clitoris has ever reached orgasm without some kind of clitoral stimulation, be it internal or external.

You can read more about both of these issues over here: this is a piece based on a lecture I give to medical students each year.

Most women do NOT orgasm when all that's been going on is vaginal stimulation. And many who do only orgasm that way infrequently.

The best way to reach orgasm is whatever way or ways you enjoy doing so. I know that sounds pat, but it's not, particularly when we know how many people's sex lives have been bummed out by trying to conform to someone else's ideas or standards rather than by just going with what feels good to them as individuals.

By all means, if you want to try and reach orgasm during vaginal stimulation, but that doesn't do it for you, you can add other kinds of stimulus to whatever you're doing at the same time -- be it with your clitoris or other body parts -- or fiddle with activities and positioning to get more of the kind of stimulation you find gets you off.

But there's also no reason we need to try and get off in a way that we just don't.

I loved connecting with you again in this forum! We are the Birthday Twin Sex Gurus!

I just had to give you a thumbs up for the "Clits Up" comment. I hope it catches on. If I hear a group of women toasting with a "Clits Up!" at a bar, I'll be smiling from ear to ear.

lf you have compromised yourself, this is a clue that you aren't happy with relationship, friends with benefits or not (though it certainly sounds like the former). lf you don't want to do that again because you're compromising his trust, then don't do it, but go ahead and end the relationship. lt sounds like it's not a long-term, serious thing. What have you got to lose? lf the friendship is in jeopardy as a result, then someone isn't being clear about their intentions. You know which one that is, if not both. That's easy enough to remedy.

Thank you so much for being one of our wonderful contributors!! You are well loved. Guys and gals, please don't forget to throw a thumbs up her way, both for this post and her many others.

ROCK!

Susie. I sent your show an email five or six years ago. You advised me to break up with the guy I was then seeing and not to settle, and to find someone who met all my needs. I wanted to let you know that I took your advice and I've been happily married for three years to a far more suitable partner.

So - thanks! Your advice made a huge difference in my life.

You've been one of my heroes for twenty years, ma'am.

You are a young woman, and are just starting to realize how these kinda things don't Follow A Plan.

Sex is one of the things that sometimes sets a course and where love begins. Sometimes not. YOu haven't broken any cosmic law. You're just going to find out what it's like to not have a predetermined outcome. Enjoy the ride!

To the first: Yes, early on in the history of this problem. It wasn't much use because it turned out my problem was physical, not psychological, but it was okay I guess.

To the second: Yes, for the emotional fallout of dealing with pain during sex. She was good.

To the third: Yes, I've gone through several gynos, two specialists, a couple physical therapist types, a weird PA, and now my MD who isn't a women's health guy but is treating the underlying problem.

Confirming that no study has ever shown a change in mood with Paragard. The MIrena is different because it does have (very, very low) hormone in it.

The Paragard is a safe and low risk device. However your uterus is smart enough to know that there is something there that it wasn't supplied with at birth. With every period the uterus is contracting some to get the lining out and also experiencing some hormone influence that causes an inflammatory type response. SO- with the IUD there you are made more aware of all that. Squeezing uterus meets piece of plastic.

Most women do not experience a change in their cycle following the first 2-3 months of "getting to know you" between the Paragard and uterus.

BTW- Lots of aggressive lobbying has delayed the decision on what will happen to Take Charge until next March. WRITE to your reps!

So I'm a guy. perhaps I shouldn't be here, but here's my perspective.

If your guy is anything like me, he's had way, way, way more sex with himself than he has had with partners. And that self-sex was not about communication. He was not writing dialogue for a novel, he was rubbing one out. This is even worse if he had religious parents or a childhood bedroom without a door.

That masturbation was about concentrating on what felt good for himself, as well as not getting caught / embarrassed. Ask yourself what you know about his sexual history and especially his degree of experience with partners. For me, I was masturbating for well over a decade before I ever had partnered sex. I was pretty awful at communications during sex and probably still am if I'm being honest about it.

I want to assure you that at least for me, a lack of communication has nothing to do with malice but instead was/is about an honest lack of practice. Perhaps I'm just projecting here, but is your guy perhaps on a scale toward Asberger's? Is it sometimes hard to pull him out of his daydream even when you're not having sex with him? Does he talk too fast, or mumble and you have to concentrate or have him repeat what he just said?

You'll have to decide how much this is something you're willing to work on him with, versus something you cannot deal with.

As for talk being a boner-killer for him? Have you actually tried? There could be some really fun non-penetrative sex play there. Use your imagination. Have a full conversation with him, with no clothes, and see where this supposed boner border could be.

And one last thing. You can have partnered sex without a boner. If he can't talk, put his mouth to some good use in another way. Let him get to hear the feedback that his mouth can produce.

Some of the bacteria associated with bacterial vaginosis (BV) create an odor. When there are a lot of those bacteria and the smell is persistent we call it BV. However I see plenty of women with your complaint who have just a slight imbalance that is only notable with a change in pH from semen.

Wanna know the chemistry? Why not? The pH level of vagina's and semen are different. The semen pH causes the cells that are pH sensitive to break down. This releases an amine based molecule which causes a distinct odor. To many noses this is a "fishy" smell but others might find it familiar as bad BO or stinky feet, etc. After a little bit of time (and probably unrelated to washing) the amines wash out with normal vaginal mucous.

You could go in and ask specifically for someone to screen for BV (a pH, a whiff test and a look under the microscope for clue cells).

And I agree with Heather about the condoms- no semen, no odor.

Women with frequent BV symptoms can take an antibiotic on a regular basis to knock back the offending bacteria to tolerable levels. (some studies show effectiveness from a one day treatment once a week to a one week treatment every month and many options in between).

Which of these rules of yours have you broken?

You had sex with someone you don't love?

You had sex with someone who doesn't take the relationship seriously?

You had sex with someone where you don't see long-term potential?

How I'd answer would really depend on which -- or all -- of these things is the deal here.

Semen is alkaline, vaginal secretions are acidic. There's a reason for that when someone is trying to make babies, but otherwise it can be somewhat annoying sometimes, because it does change the pH, which yep, creates a change in scent. Washing likely makes no difference, because (hopefully!) you're not washing the inside of your vagina. The vagina is a self-cleaning organ, so after a couple days, it tends to flush itself out, and thus, you're back to your own scent.

Some people dig that change, others don't notice it, and others don't like it and find it big-time yucko. Ho sensitive a sniffer someone has likely plays a big part in this.

If you don't like it -- and it's clear you don't -- I've got a really easy answer for you: condoms. If your partners wear condoms, then you don't have to have this issue. Seriously, wasn't that easy?

I doubt you're allergic if you're not having any symptoms of allergies: one can be allergic to semen, though it's rare and you're not describing anything that suggests that. But this is one of those things that, if in doubt, you can always check into with your sexual healthcare provider.

Guide to Getting it on is great.

Claire (co-owner of Babeland) and I wrote a book called Moregasm that is a general sex manual, skewed toward the ladies. It came out this year, lots of pictures, easy to read, wry.

Those are my two faves.

When you have those thoughts of "jumping out the window," you know, that's really your own self making the jump. We always reflect on our own worst fears and imagine other people inhabiting them.

I don't know how old you are, but you probably aren't looking to date some 18 year old football team hero who's never had an injury, the Golden Adonis. As famously quoted in "Some Like It Hot,"--- "Nobody's Perfect." You are going to be meeting men who've had their own share of life.

I love Heather's thoughts about "asshole screening" and living it up, a little bit.

I will also tell you something I've learned from married couples, where the woman has been thru this. INEVITABLY, the husband or lesbian spouse who HASN"T had surgery is DYING to make love with their spouse, and it's the partner with the mastectomy who's putting them off.People who like you and love you want to get their hands on you. You are a whole person, a whole lover to them, not just a tit. REALLY.

REALLY.

A million cheers to you for hanging in there and coming through with your wit fully intact!

You know, I've often felt like having something like disability, a previous trauma or something radically different about the body can sometimes be a boon in dating and finding sex partners, because it can really help to screen out the assholes a bit. Superficial people need not apply, couldn't deal, and that's hardly a bad thing, because who really wants to deal with them in the first place?

If you haven't connected with other women in the same place, I'd suggest doing that. I don't know what's out there locally, but if there's not a good support group/coffee klatch already, g'wan and make one. Being in good company with this will likely keep your spirits up and give you a place to dump your frustrations AND hear from folks as they deal with this in their own dating and mating lives. Also, if you haven't read cancer survivor Kris Carr's books, they might be good ones for you.

I'm not so sure that if you fill folks in in advance it'll be quite as shocking as you imagine. By all means, I think a heads-up will make you feel a lot more comfortable and be able to help you get a sense of who can deal and who can't before you actually have to deal with them in your bed, but I'd have some faith in folks who seem like they can when you put it on the table. Of course, it's a lot easier to worry about people in the abstract than it is about people you actually know and have a real sense of. So, this might be less daunting when you know, specifically, who you're dealing with.

But I'd also honor whatever pace you need in this and with any potential new partners. It sounds like you're pretty nervous about someone else's reactions, so give yourself enough time with anyone new to build some comfort -- with them, with yourself -- before you jettison into terrain that has you quaking in your boots.

One last suggestion? Do something wonderful for your body, if you haven't already. Some women post-mastectomy get tattooed, for instance, turning their body change into a pretty cool metamorphosis. Get a new sex toy: you're feelign sexual again, so how about you start with you? Getting back together with your body by yourself will probably amp your confidence. How about a day at one of the Olympus spas or the Little Red Spa, where you can have a place to refresh and unwind and where it's safe to be naked in your wonderful, super-survivor body around others?

It's entirely possible that vocalizing takes him out of the enjoyment of the moment. I tend to be very nonverbal myself, if I'm really into it.

I have to disagree with your premise that complete silence cannot be fully healthy. It might be unnatural to you, but we all have our little quirks.

If you insist on vocalization during sex, you may seriously interfere with his enjoyment/relaxation of it. Do you need the vocalization that much?

Dr Philip Welch. He works out of Swedish. I had major "lady problems" since I was 12. The problems regularly got in the way of life. Then, last summer I went to him at the recommendation of a friend who works at a local woman's clinic. They send their patients with complicated issues his way. I felt totally weird and traitorous going to a man, but everything has turned out great. For the first time in 22 years I feel really good. And, in case you're wondering, I am on BC now. But it's a low-dose IUD that hasn't given me any annoying side effects and I feel the best I've felt in my entire adult life. Never found out the "why" of my lady problems (we did some serious digging around, even checking to make sure I didn't have some rare blood disorder), but I am finally okay with that. The problems don't exist, and I feel *good*.

If you've never had a kid, your doc may measure your cervix to see how the insertion will go. Otherwise- get the copper only IUD. It is amazing. Your periods and cramps will be worse for a while but it is SO WORTH IT. I tried every single hormonal BC and couldn't handle any of them. (crying, crazy, headaches, cramps, did I say crazy?) I'm also allergic to latex and the polyurethane condoms gave me bacterial infections. If you're in a monogamous relationship- the copper IUD is the way to go. Some ladies try the hormonal one because it does a better job of stopping your periods but your body isn't supposed to have those hormones or it would be making them for you. Good luck!

I'm no expert and I don't stand behind this opinion, but I think maybe you should try not using ANY toys and just go with your own mind and manual stimulation for a try. I would say just try turning yourself on with your own thoughts or with possibly *gasp* visual stimulation. Find out how to touch parts of your own body that will turn you on. Caress yourself or pinch yourself, or whatever. As someone else said, real arousal is not about what is between your legs, but what is between your ears.

Try picking up a copy of "Sex is Fun" by Kidder Kaper...and leave it laying around. Make sure you read and leave a bookmark sticking out of the pages at the chapter on talking during sex, making noises, or giving your partner feedback.

Unless he's totally clueless, this should give him a really good nudge in the right direction.

Here's the simple part: yes, he can learn to better communicate than he has been, and improve both of your sex lives in the process.

But you had to know it was more complicated than that. :)

Ideally, the whole of our sexuality is authentic: it's about us, it feels like who we are, it's self-expression that's unique and highly personalized, and that includes the ways we communicate and/or vocalize during sex with others.

We don't all have the same communication styles, though, and don't all find that any one way of communicating is what we're best at or what we feel most comfortable with. So, in a partnership (or triad, or group, whatever), one person may be very skilled and at home with verbal communication, while the other may be more of a visual communicator, or more at home with body language. Perhaps obviously, not everyone even has the ability to communicate in some ways. We can't really change our talents and our comfort when it comes to how we each best communicate and feel most comfortable doing so, even though most of us can certainly hone our skills in all kinds of communication.

A lack of vocalizing and verbalizing doesn't have to be radio silence in sex...so long as everyone is communicating in SOME way. And what I'm hearing is that not only is your guy not engaging in any kind of verbal communication, it sounds like he's not engaging in any, or much, communication of any type at all. You're right: at best, that's a recipe for less-than-awesome sex, and at worst, a recipe for disaster. It's also clear that YOU want and need more communication than is going on, and would like some of that to be verbal.

The best route to a non-defensive response is the oft-cliched but ever-useful "I" statement. "I really want and need more communication," not "You're completely silent during sex and that's unhealthy." The things you're saying here? Say them to him (with diplomacy). Talk together to try and come up with strategies to best communicate, and do your best to be flexible, making clear that if verbal communication isn't something he feels he can do yet or which feels natural to him, you're down with him trying to do that a little more, but both of you also trying some other modes of communication. It'd probably help to accentuate the positives here. What does more/better communication mean, on the whole? More pleasure, more fun, less worry, less stumbling, more connectivity, more intimacy for both of you.

I also think it's always sage to consider compatibility with things like this, especially if he just really won't even try to communicate with you, or just isn't at the point in his own personal and sexual development where he feels comfortable doing so. if you've already had these kinds of conversations a gazillion times and keep hitting a dead end...well, you may be at one. It may be that this just isn't the sexual partner for you, especially if when it comes to something so major -- communication is WAY bigger than "this thing" -- you're either very different or one of you is very stuck.

I have not seen a sex therapist before. However whenever I change doctors for primary care, I always ask questions about sex. I pay attention to how the doctors responds to my questions. Is she or he uncomfortable talking about giving a blow job, are they uncomfortable talking about fisting? If they are I go look for another doctor. I've been lucky so far, I have a good MD and PA. This is a good question as I'm getting ready to graduate from the University of Oregon majoring in psychology, and then I'll apply for a counseling program. Or even a Social Work program. I joined AASECT because ultimately I want to be a sex therapist. This is a second career.

I'm a huge IUD fan! I got my first one at about your age, before I had my kid, so my experience could be comparable.

I had maybe 4 or 5 months of heavier and more painful periods (with bad cramps) as my body adjusted, and then I never thought about the IUD again. I had no emotional/mood side effects at all.

It's so amazingly low-maintenance and low-impact, doing just what it's supposed to do (prevent pregnancy) without other hassles (hormonal changes, having to remember to do something regularly).

I got another IUD after I had my kid, and my body accepted it pretty much immediately. In my opinion, no other form of birth control lives up to it!

(Don't forget, though, that it won't protect against STDs.)

In many years of doing contraceptive consults, I have never heard mood issues come up at all with the ParaGard. I've also never heard any healthcare providers in the field bring this up. I'd be interested to see where you've read about this association.

I put an email into a provider who inserts a lot of IUDs and does a lot of IUD followups, and she verified that mood changes are not one of the common associations with the ParaGard in scientific studies. She said that copper toxicity can occur with oral intake of copper, which can have effects on moods, but that the ParaGard is not known to have enough copper to cause issues.

Mood changes are also not mentioned in the patient or prescriber information for the device, which you can check out yourself via links at the bottom of this page.

I also don't understand the cramping and bleeding or spotting to be associated with hormonal changes, but simply with the fact that there is a device that has been placed inside the uterus which yes, the body at first "reads" as something that isn't supposed to be in there in terms of often needing some adjustment time (though this tends to be less of an issue with women who have been pregnant before, particularly those who were pregnant past 9 or 10 weeks).

I hear you about the super-sadness of likely TakeCharge changes. It's such a great program, and I connect people with it all the time, especially young people and people on-street. I've used it myself, as have partners of mine.

My best advice to you with milking it for all its worth while you still can is to remember that you can get ANY BC method you want on it, and more than one if you want. So, if you don't want to use hormonal methods, go ahead and try the IUD, but you might also want to get fit for a diaphragm or cervical cap, too, so you can have one of those handy in the case that the IUD doesn't wind up being something that works for you and that you choose to retain.

No, to the first question. I have briefly spoken to my MD about sexual issues when I observed that a particular generic medication was having a huge effect on my sex drive, but she didn't respond verbally, just filled out the form to make my insurance give me the brand name. I certainly have sexual issues I might need help with (who doesn't, right?), but I can't imagine taking them to my MD. However, I also have several huge, debilitating health problems, so a lot of less urgent stuff gets thrown under the bus in doctor visits due to prioritizing.

If you have nasty cramps, then you've got to try dong quai (http://www.umm.edu/altmed/articles/dong-quai-000238.htm). It's a Chinese herb traditionally prescribed for menstrual pain. For me, this stuff works reliably while the usual Western painkillers don't work at all.

Never. I've been in HMOs, so everything gets put in a central file, and I have no assurance such information won't be shared with my job's HR department.

As for MDs, they barely have time to go over the basics in an office visit, let alone discuss sexual matters. Anyway, as gatekeepers, they'd refer to mental health, but with no guidance about who's good with certain issues.

The HMO's publication never, ever mentions sex, except for STD testing as part of regular exams.