Among US women aged 45 to 64, 30% have urinary incontinence, one of the conditions that correlate with an increased incidence of sexual distress.4 Incontinence treatments may include behavioral modification, medication, a referral to physical therapy, perhaps surgery, and Kegel exercises.
Physical therapists are masterful in their ability to successfully treat urinary incontinence, but the limitations of time, cost, and insurance coverage are a deterrent to successful follow-through. When performed correctly, Kegel exercises may result in a cure for stress urinary incontinence in 50% to 70% of women.5 Exercise tools can help women isolate the pelvic floor muscles and perform Kegel exercises correctly, but I don’t find them at Rite-Aid or Walgreens. In my office, I can describe how these tools can assist women in doing their exercises, can show them what the tools look like and how they are used, and have them available for purchase.
When vaginal dilators are indicated for vaginismus or postradiation changes to the vagina, I show the patient the dilators and how to use them, and I have them available for purchase.
Now, what about those vibrators?
An Internet-based survey of more than 2,000 women aged 18 to 60 indicated that 52% have used a vibrator.6 In my own (unpublished) survey of more than 100 women, 43% indicated they had used a sex toy or device (about equally in partnered and solo sex). About half of women have experience with a vibrator—which means half do not. That’s in spite of the fact that vibrator use correlates with more sexual satisfaction. It may help with a decrease in latency and increase the intensity of the orgasmic response. I commonly hear women say, “Orgasm takes so much longer and comes and goes so quickly it’s hardly worth it.” Those are the women who may benefit from introducing a vibrator.
A 52-year-old postmenopausal woman presented to me with inability to orgasm, estimating 5 years had passed since she’d last experienced one. She had a diagnosis of multiple sclerosis and was taking a selective serotonin reuptake inhibitor. She had tried a vibrator in the past, without success. As a physician, I knew that she needed a more powerful motor for more intense stimulation. I was able to let her feel the difference and obtain the appropriate vibrator. Imagine her appreciation when she returned after achieving success.
The suggestion that a woman introduce a vibrator into her sexual life is nuanced. It is important that we as providers explore and understand our patients’ concerns, beliefs, and attitudes toward this option. Women may lack information or have misinformation that can be addressed in a sensitive, professional way in the privacy and safety of an office visit.
Once a woman understands the benefits a vibrator may offer, how does she proceed? I live in a community that does not have a “sex shop,” and I don’t feel comfortable referring patients to one that is 30 miles away.
Google offers 23,000,000 results for “vibrators.” Amazon provides 400 pages of products. Adam and Eve, a leading online “sex toys” shop, offers 524 vibrators. To get to the options, a patient would need to navigate some distasteful images, guess at quality and safety, and wouldn’t find much relevant health information.
Three years ago I attended an Adult Novelty Expo. I can attest to the variety of products on the market, most of which I would never consider advising a patient to use. Some can give off an awful “toxic smell,” which I would prefer my patients not have in contact with their genitals. Some are extremely complex—one vibrator introduced at the expo boasted 42 different functions with 8 control buttons. A small, curated selection of safe, well-designed, and effective vibrators is welcomed in my office.
Providing vibrators for purchase in the office can bypass confusion
Part of what patients value is that they can evaluate and purchase these products with privacy, confidentiality, and convenience in a clinician’s office. These purchases result from a safe, nonjudgmental, informed discussion with their provider, in the context of a relationship that has been developed over time.
Feedback from happy customers/ patients. Knowing there is controversy about health-care providers selling products, I’m upfront in asking for feedback from patients and online customers. These are some of their comments:
- “I trust you completely. You have a history of taking a personal interest in my health.”
- “I am personally grateful for the store and have passed it on to my friends, because where else are we going to go for these things? … It seems like another way you are keeping your patients’ health and well-being in the forefront of your practice. You have created a safe place for us to reconnect with an important part of ourselves.”
- “Anyone who comes back to a professional after the first ‘I’ll give him a shot’ visit does so because she trusts that person. If she didn’t, she wouldn’t be there. One of the things she trusts is your judgment.”
- “If you, in your professional opinion and personal experience, honestly believe a lotion, device, or book to be beneficial, there is nothing wrong with saying so (and one can make the case that you are shirking your duties to your readers and patients if you do NOT mention these things).”