Prime Time - Jane Fonda [98]
Medical Insurance Coverage
As beautiful as the outcome of a couple’s sex therapy can be, a systemic problem stands in the way of this sort of therapy being broadly available. Sex therapists and urologists are concerned about managed health care and Medicare, which has meant that doctors rarely have more than six or seven minutes to talk to patients. As Dr. Perelman points out, how can the doctor, in a few minutes, “take a history, do a diagnosis, figure out what is going on with him, figure out what is going on with her? Does she need a referral to a gynecologist, does she need hormone supplementation, does she need to practice dilating herself so she might be a little more comfortable with intercourse?”
Medical-Psychological Combination Therapy
Understanding that just writing prescriptions and giving out pills isn’t enough for many people, Dr. Perelman wants to work with the pharmaceutical companies to develop and disseminate an easy-to-replicate, affordable model of therapy that provides both the medical options and the counseling in combination to create a sexual tipping point. He sees it applying to women as well as men, and he feels that due to the drop-off of men who regularly refill their prescriptions, the pharmaceutical companies may be motivated to fund such work. In a field dominated by penis fixers, it would be a huge paradigm shift to move into the areas of relational intimacy, especially male intimacy, which heretofore has been all but ignored.
The Women’s Part of the Equation
If it is the need to develop intimacy that is ignored in men, in women, especially older women, what’s ignored is understanding their sexuality. “The problem is that there hasn’t been nearly enough research done on women’s sexuality,” says Dr. Louann Brizendine, a neuropsychiatrist at the University of California, San Francisco. During our interview, Dr. Brizendine told me that several years ago she worked on a segment for CNN with one of her female patients who was around sixty-five. CNN wanted to explore the issue of women’s brain and sexual function during menopause. The news editors cut it. “They were okay with the estrogen and the ‘keeping the brain healthy’ aspects,” Dr. Brizendine told me, “but they didn’t wander into the sexual area that we had done. My patient was a little bit miffed. She felt it was really important for women to know that you can keep yourself and your body and your mind and your sexual organs healthy and have a good sex life with your partner even when you’re older and that it takes knowledge about what to do and what not to do.”
Dr. Brizendine smiled as she related one of the best things about women she sees who have crossed the menopausal divide. “The kids are out of the house,” she said, “and they are into the next phase of their lives, and that is about how they can maintain their brain function, their sexual function, their libido. They are still very much interested in sex, but so often they come to me with very out-of-balance hormones. There has to be a hormonal balance in your brain and in your sexual organs so that all the parts are working.”
Men’s sexual issues are visible, they are external, and they make up a large part of a man’s sense of himself, and perhaps that is partly why the research funds favor men. Women’s sexual parts are inside and may be neglected if—or as long as—doctors and researchers think that the erection is the be-all and end-all of sex. This is bad enough on a personal level, but it becomes a virtual nonstarter when it comes to studying older women’s sexuality.
Women’s Hormone Replacement
As you may recall, in 2000, the Women’s Health Initiative issued findings that hormone therapy (HT)—that is to say, replacing the decreasing levels of estrogen in women approaching menopause—did not prevent heart disease and, in fact, increased cardiovascular