Ask Dr. Bob

Sex on the clock, early menopause and obsessive-compulsive disorder

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My problem is, my girlfriend cannot have an orgasm easily (by herself or by me.) When I do it, it takes me around 20 or more minutes by hand and it can be frustrating and tiring. Is there a quicker and more practical way to make her happy?

Perhaps this is an example of made-by-hand not being preferable to machine-manufactured.

Other possibilities:

Take off your watch.

Turn off the TV.

Consider foreplay as a form of aerobic exercise.

Acknowledge that women don’t respond like outboard motors.

Hire a handyman.

Seriously, everyone is different. Arousability varies greatly but has no relationship to desire, passion, love or sexual enjoyment. Your unstated question is: What is normal arousal? Beats me. An hour with my librarian and we both came up empty-handed (no pun intended). Masters and Johnson, the Kinsey report, the latest sex manuals — no one has taken a stopwatch to the party. In desperation I asked a single friend who said that the time can vary between a few seconds and a few days.

It is strange that we Americans tend to measure everything. We have stats for the most putts sunk in a snowstorm, yet we don’t have a handle on the most basic of questions. My friend probably is right, that there is no average time; on the other hand, I suspect that you are caressing the middle of the belle-shaped curve.

And perhaps not knowing what is normal or average is the best answer. Just keep in mind that, unlike most of the rest of our day, time is not of the essence. Consider the infinite difference between fast food and a gourmet meal.

I’ve recently turned 45. Unfortunately, it appears I’ve experienced an early menopause. No period for almost two years, and all the perimenopausal symptoms (night sweats, irritability and anxiety) the previous three years. Since I stopped my period, I have lost my sexual desire completely. I have always been very sexual and enjoyed my sensuality. I am with the love of my life, as of three years ago — and suddenly, no desire. I also experience very little pleasure sexually. Orgasms, when achieved after massive effort, are pretty mediocre.

Leaving aside the possible psychological aspects of menopause, you should seriously consider the pros and cons of hormone replacement. Remember, some of your body’s estrogen is converted into male hormones (androgens). As your estrogen level declines with menopause, so does your level of circulating androgens. Many studies suggest that it is primarily the testosterone level that influences libido and difficulty with orgasm. Replacement therapy can be as simple as a hormone patch.



(On an aesthetic level, I love knowing that male hormones can enhance a woman’s libido.)

A second point (sure to get me more hate mail): My informal survey suggests that a woman doctor specializing in menopause (gynecologist/endocrinologist) might be more attuned to your sexual subtleties. Also, be straightforward with your questions. Many of us physicians are embarrassed because the patient is embarrassed. A no-nonsense approach to your sexual questions often puts the doctor at ease.

A good source for menopausal information is Harvard Women’s Health Watch

Is it possible for a person to have a mild case of obsessive-compulsive disorder? I have been the butt of various “anal” jokes for years, because I have not just a desire for, but a need for cleanliness and order around me. I don’t do anything like wash my hands 100 times a day, or check and re-check the locks on my doors — but I do tend to be rather fanatical with my lint roller, and often arrange items on tabletops and even in the refrigerator so they are lined up evenly and look “aesthetically pleasing.” This fastidiousness also applies to my personal grooming habits — I can easily spend 45 minutes plucking my eyebrows, just to make sure I get every single hair, and if a blemish or spot appears on my skin I can’t seem to help picking at it.

These habits of mine have not prevented me from functioning normally in daily life — I still work, and have an active social and romantic life. However, I’m worried that they seem to be taking up more and more of my time. For example, if I cook dinner, I cannot seem to sit and relax afterwards, even if there’s company over — the dishes must all be washed and put away for me to feel comfortable enough to relax. And my personal grooming habits sometimes keep me awake into the night, long after my live-in boyfriend has gone to sleep. Do these symptoms sound problematic enough that I should seek psychiatric or pharmaceutical help? I’m not sure myself. I don’t mind being a “neat freak” or “anal,” but I don’t want to be ill and not know it.

When is a trait an illness? Recent rat studies suggest that there may be a gene for neatness. If so, how would a rodent psychiatrist (possibly an oxymoron) describe the difference between neat and messy rats? OCD undoubtedly has, at least in part, a biological basis, as do most primary traits. And, lest we forget, we are the sum of our traits.

Watch a neurosurgeon spend an entire day doing microscopic surgery; you want him to be obsessive about every detail. A happy-go-lucky rat probably wouldn’t make a good neurosurgeon.

If the surgeon obsesses over the wound, he is a hero — we refer to him as dedicated. If he obsesses over his reflection in the scrub room mirror, we call for the butterfly nets. If you are the surgeon’s wife, dinner getting cold because hubby is nitpicking in the O.R., you see his anal behavior as a pain in the behind.

For me, obsessive-compulsive behavior becomes a problem when it interferes with a normal life. My suggestion: Don’t worry about labels or being “ill.” Ask yourself and your close friends/lover/family if you/they are bothered by your behavior? The doctor is licensed to push pills, but you are the doctor of your life.

I am manic-depressive. Although I control it with medication, I can generally count on a periodic lull. However, for the past three months, I have not been depressed. I’ve been blue sometimes, but not suffered from depression. How could this be? Is my body chemistry changing? Might I reach the point where I don’t have to take medicine, or am I simply preparing for a great plunge?

Recent PET scan studies have demonstrated metabolic changes in patients with bipolar disorder even during periods of mental calm, which raises the caveat about applying a strict one-to-one correlation between biology and mood. Be careful about how you think about your condition.

Brain chemistry is constantly changing, though certain biological predispositions may remain throughout a lifetime. I don’t think that neurochemistry is sufficiently understood to accurately predict the natural history of any psychiatric condition.

Also, you raise the fascinating question of “blueness” vs. depression. Your comment suggests that you can tell the difference between life’s woes and chemical imbalance. Good for you. It’s important not to lump life’s lumps into the same diagnostic bag.

I would like to put in a plug for fiction. As a doctor listening to a patient, I have a tendency to categorize their emotional state into something handy that I can jot down on my chart. As a novelist, I try to cut out such shallow characterizations, as they obscure the real person. If I know the difference between superficial and rounded character, why do I persist with simple-minded medical explanations such as “He’s depressed”?

Psychiatry is not a science. A good psychiatrist is like a good novelist. A novelist never uses labels, except as satire.

We should all take a lesson when thinking about ourselves and others.

Robert Burton, M.D., is the former chief of neurology at Mount Zion-UCSF Hospital and the author of "On Being Certain: Believing You Are Right Even When You're Not." His column, "Mind Reader," appears regularly in Salon.

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