The other problem with doctors not asking about sex is women who have medical conditions that interfere with their sex life, typically conditions that cause pain with sex, end up minimized. Many women suffer for years not realizing they have a medical problem that has a diagnosis and treatment.
How Much Sex Are People Really Having?
Surveys tell us that overall satisfaction with sex life is not that high: 49 percent of heterosexual women, 47 percent of lesbian women, and 49 percent of bisexual women state they are happy with their sex life. It’s not much higher for men—although the respondents who were the happiest in this study were, no surprise, heterosexual men (but even then, only 51 percent were satisfied).
There is a lot of pressure to say sex is the most important thing. Despite many people saying publicly and privately on surveys that sex matters to them more than almost anything else in life, the reality is that the average amount of time people spend having sex is about four minutes a day. That is probably less time than most people spend grocery shopping or staring into the fridge—and I know which activity I prefer!
The key piece of information here is that dissatisfaction with your sex life seems to be a very common experience.
Why the disconnect?
Why are people having less sex than they desire? It’s possible people think they should be wanting more sex due to societal expectations, so they answer surveys with an idealized answer (hey, there are times when I have lied about my weight on an anonymous questionnaire). Admitting a truth to yourself can be very hard. We also all tend to want more of the things we enjoy. Not everyone is in a sexual relationship, and many people are in relationships that just aren’t working but they haven’t yet figured out a path forward. Most people are not good sexual communicators, and sometimes the sex is just unsatisfying. People also don’t prioritize sex, some women have medical conditions that make sex painful, and of course libido waxes and wanes.
Basically, it’s complicated.
Sexless relationships are also more common than people think. A sexless relationship, meaning no sex in the past 6–12 months, affects up to 15 percent of couples. There is less data on non-marital relationships. Society almost always lays the blame on the female partner in a heterosexual relationship, but it can often be the man.
The Sexual Response Cycle
Physically, from a pure stimulation standpoint, the clitoris is the most important anatomical structure for female sex. This doesn’t mean that some women don’t orgasm with nipple stimulation or anal stimulation; this just means the clitoris has specifically evolved for sexual pleasure, and almost always when other erogenous zones are stimulated there is also a clitoral response. Interestingly, the area in the brain that responds to nipple stimulation overlaps with the area that responds to clitoral stimulation.
The classic model of sexual response is a linear progression first presented by Masters and Johnson in 1960. It has four phases: excitement, plateau, orgasm, and resolution. This model has been criticized for not including desire (if you dislike your partner or they turn you off, getting excited may be a challenge). Another model was proposed that added desire to the sequence, but both of these models are male-centric and assume a specific, preset sex drive. This completely neglects many reasons women report wanting sexual intimacy: for example, emotionally connecting with their partner, trust, affection, safety, and respect.
A circular model has been proposed (by Dr. Rosemary Basson in 2000) that endorses the concept that a satisfying sexual encounter does not require starting with a spontaneous sexual drive or desire. This model also incorporates other factors besides physical stimulation that women report contribute to sexual arousal and satisfaction, such as feeling secure, being desired, or a sense of well-being. The circular model accepts that women may not always have a high spontaneous libido and that some women engage in sexual activity initially to feel intimacy or connectedness, and desire kicks in after arousal.
The Basson model supports the idea that sex drive can be spontaneous, but that it can also be the result of a complex interaction of many physical and emotional stimuli and that desire can be spontaneous as well as responsive. It also acknowledges that for many women, intimacy is an important sexual concept.
I often tell women to focus less on the idea of spontaneous libido and more on the idea of satisfaction (emotional and physical)—and, of course, fun and sexual pleasure. Lots of people get hung up on spontaneous libido, which to be honest seems like a response to a specific male fantasy. I prefer to think of sex as a party. It doesn’t matter if you received an engraved invitation or were invited by text. It doesn’t matter if you took a limo, drove your car, took the subway, or walked. What matters is you were at the party and you had what you consider to be a good time.
Physical changes with arousal and sex
Increased blood flow to the vagina and vulva causes clitoral engorgement, vulvar swelling, and vaginal transudate (wetness or lubrication). The lower third of the vagina may tighten, and the upper two thirds may dilate. The top of the vagina and the uterus elevate or lift slightly.
Orgasm is the rhythmic contractions of the muscles that wrap around the vagina (the pelvic floor muscles). These contractions are a reflex, meaning your nerves and muscles are coordinating the action without conscious input from your brain. This is similar in many ways to having your knee hit with a reflex hammer—your knee moves because a reflex has been triggered, not because your brain is consciously telling your knee to move. Contracting your pelvic floor muscles voluntarily (Kegel exercises) doesn’t trigger orgasm, but many women find that purposely contracting these muscles can increase arousal. I sometimes think of this as priming the pump, along the lines of warming up your legs before a run or your car on a cold day. Give it a try!
Female orgasm—the contractions of the pelvic floor muscles—typically lasts 5–60 seconds. The muscle contractions occur at approximately 0.8-second intervals (so one right after the other), and for many women each successive contraction is longer, but weaker. The general range of contractions, number-wise, is 3–15. Orgasm is accompanied by a feeling of well-being and/or release of tension. What is fascinating is that both women and men describe the feeling of an orgasm with almost identical terminology.
For some women, the clitoral glans can be too sensitive to touch directly during foreplay or sex as it has the highest density of nerves. Women who find they can’t tolerate a vibrator or direct manual stimulation against their glans may find that a tongue works fine or that they can handle the stimulation if they put a piece of soft fabric between the vibrator or fingers and their clitoris. Fortunately, as the clitoris branches around the urethra, extends into the vagina, and is beneath the labia, it can be accessed for stimulation in many creative ways that don’t involve direct contact with the glans. For example, a vibrator with a larger surface area pressed up against the vaginal opening may stimulate the crura of the clitoris. It’s fun to look at the size and location of the clitoris and think of different approaches to stimulation.
Some Sex Facts
Lesbian women are more likely to report that they usually or always orgasm during sex (86 percent) compared to heterosexual women (65 percent). This is proof that a penis is in no way required for satisfying sex, nor is it the judge of female sexual satisfaction.
The ideal duration of penile penetration during heterosexual sex according to a survey of U.S. and Canadian sex therapists was 3–7 minutes (1–2 minutes was considered too short, and › 10 minutes was considered too long).
In one study, heterosexual couples reported an average of 11–13 minutes of foreplay and 7–8 minutes of intercourse, and men thought both the foreplay and the penetration lasted longer than the women did. Both men and women reported wanting more foreplay and more intercourse.
What’s