Sometimes you find that orgasm expertise is hard to, well, come by. Good gynos ask you about your sex life--current partners, one or more, male or female, contraception (or lack thereof)...and about the sex itself. I'll ask my patients if they are having any problems with sex, like pain, and I'll leave the question open for them to answer as they wish. I know how to address some problems--about discomfort during sex, or lack of natural lubrication. But if I hear problems about orgasms, I don't always know what to say.

My hesitation in giving advice is ironic, since there was a time when gynecologists were responsible for actually giving their patients orgasms. In the 1800s, women were often diagnosed with hysteria; while the diagnosis came from many symptoms, it was thought to be a consequence of deficiency of sexual gratification. The cure? Doctors performed manual genital massage until the patient experienced the "hysterical paroxysm" (otherwise known as the big O). This practice was considered therapeutic, and completely non-sexual in nature, since no penetration was involved in the act (arrrgh). And since these women could never be cured, doctors became tired of providing ongoing treatment (I think my patients are dating some of their descendents). Thus, the vibrator was born. And once these technological wonders were available for home use, women's orgasms were back under their control. (Rachel Maines details this history in her fascinating book.)

Modern gynecologists get training about all aspects of your sexual anatomy, but not about your sexual pleasure. We then draw off what we read, what we hear from our patients, and even our own sexual experiences to give advice. It seems easier to deal with "true" problems like painful sex and never orgasming. And sometimes referral to a sex therapist is needed. But more often than not, a patient in my office just wants some fine tuning to her sex life. So thank goodness for Em & Lo!

Where do you go for sex advice?