Commusings: Is This Normal? by Dr. Jolene Brighten

Hello Commune Community,

American society is a strange schizophrenic blend of Puritan and Libertine, prudish and prurient. We can summon every form of kink instantaneously on a whim in the palm of our hands and, at the same time, feel the need to whisper when it comes to matters of female reproductive health. In many ways, our sexual repression has led to our licentiousness. The extreme begets extremes.
 
While graphic sexuality pervades television shows and magazines like never before, so persists the tiresome dichotomous depiction of women as either virtuous gentleladies or impious harlots, as either Mary or Jezebel.

This polarity makes it difficult to have straight, honest talk about sexuality and health. Today’s essayist, Dr. Jolene Brighten, forges a brave middle way, demystifying what we too often consider taboo. In her new book, Is This Normal? Judgment Free Straight Talk About Your Body, Jolene confronts so many of the questions that women have about their hormonal health, libido, menstrual cycle and post-partum health but have been made to feel too embarrassed to ask.

As the father of three daughters, I am grateful for Jolene’s courageous charge to remove the stigma from sex education.

Here at [email protected] and waxing and waning on @jeffkrasno.
 
In love, include me,
Jeff

Is This Normal?

by Dr. Jolene Brighten

Excerpted from Is This Normal: Judgment Free Straight Talk About Your Body

Why are we afraid to say “vagina” in public? And why don’t we talk louder than a whisper about sex? 

Why do myths like “You can get pregnant any day of your cycle” persist through each generation? And why can’t most people identify the clitoris? 

Simple: We’re not taught about them. 

More specifically, we’re actually taught not to talk about them. 

Society teaches us, from a young age, that our bodies are a great source of shame and guilt, so why would we want to talk about that? Even worse, the medical community has further stigmatized normal sexual desires and practices, pathologizing them simply because they deviate from what is socially acceptable to acknowledge: hetero sex with the intention of making a baby.

In my clinical experience, there isn’t a patient who doesn’t need to have at least their menstrual cycle explained, or their anatomy clarified, or be assured they aren’t the only one who experiences the symptoms they have every week. Menstrual stigma, along with the experience of being dismissed by medical providers, has discouraged women from seeking these answers. 

This leaves a lot of women suffering. While hormone-related symptoms can affect upward of 90 percent of women, 60 percent of them will never seek help from a provider. 

When I first started anonymous “Ask Dr. Brighten” Q&As on social media, I received thousands of questions about sex, far more than any other topic. And it seemed I was getting the questions people really wanted to ask their doctor but hadn’t: Is it normal that I have pain with sex; or why do I smell down there; or is it normal that I want to have sex only a couple times a month? I wanted to understand why women were coming to me on social media rather than to their provider, so I created a survey in which over 86,000 people responded. 

What I discovered was that only 37 percent felt comfortable talking to their medical provider about their sex life. When asked if they felt their provider would judge or shame them for asking sex-related questions, 57 percent reported they did. Only 21 percent felt their provider could address the concerns they had related to sex.

It is a serious problem when many people feel they can’t ask a medical provider what’s normal when it comes to sex. And who can blame them when most of women’s medicine feels like an assembly line of speculum insertions and a quick swab of the cervix. The vagina, the vulva—every last bit of it feels so far removed from sex.

But for those who do manage to voice their questions about sex, the answers they receive from the average doctor often don’t just fail in offering help, but are laced with the provider’s own sexual misunderstandings and internalized shame. 

It’s unsurprising given that inclusive sex education (beyond just STI and pregnancy prevention) is practically void from medical school education, leaving patients to take to the Internet in search of answers. Plus, it’s rare to find medical providers competently trained in sexual health. 

When I look back to my own medical training, which I would classify as sex positive—we attended lectures from medical experts and members of the kink, LGBTQIA+, sex worker industry, and survivors of sex trafficking—but even with that, I was never taught the answers to some of my patients’ more in-depth questions. So after medical school, I decided to pursue clinical sexology and sexual counseling training.

It’s through this additional education that I’ve been able to answer the most heartbreakingly common question I receive daily, also the simplest: “Is this normal?” 

The answer, for the record, is most often “Yes!” 

Cycles that aren’t exactly 28 days? Totally normal. 

Uneven breasts? Normal and healthy. 

Finding you can orgasm only on your own? Normal, but also fixable (if you want!). 

It’s not hard to figure out why so few people understand what the heck is going on with their body, how sexual desire really works, or even basic anatomy. Only eighteen states in the US mandate medically accurate sex education, and thirty-nine require abstinence be taught for pregnancy and STI prevention (twenty-nine of which require the abstinence-only approach be stressed).

If it is not medically accurate then it’s not accurate. And only ten states require that sex ed be inclusive. I know what you’re thinking: surely, these statistics must be outdated? They sound straight out of the 1960s. Sadly, these statistics are from July 2022. 

Regardless of our age, education, or lifestyle, how we think about sex is shaped by society, our experiences, and everyone around us. I hate to break it to you, but no matter how open-minded or independent you think you may be, your perception of sex and what’s normal is not entirely your own. 

Think about a lot of popular TV shows with coming-of-age characters, like The Vampire Diaries, Gossip Girl, Friday Night Lights, or My So-Called Life. These series share a running theme when it comes to sex: making a big deal about virginity and purporting that when a woman loses hers, it’s momentous. While having sex for the first time is certainly a big deal for many people IRL, these shows typically create a tremendous amount of pressure to have the picture-perfect experience. We also never see much in these shows about real-world things like consent, foreplay, safe sex, the need for lube, or the much-feared STIs. 

(Can someone please explain to me how vampires get wet?) 

The influence of these shows, like much of pop culture, sometimes affects us even more than we realize. It permeates my patients’ concerns, social media followers’ questions, and friends’ inquiries at parties with one running theme—when it comes to sex, what’s normal?

Ashley, a thirtysomething epidemiology graduate student and part-time bartender, first came to see me for fatigue, hair loss, and irregular periods. Like so many of my patients, the creeping in of symptoms were easy to ignore amid her busy schedule until they weren’t.

For all new patients, during intake, I do a thorough review of all aspects of health, lifestyle, and diet. One question I ask is whether patients experience any difficulty with orgasm, since the inability to climax can be a sign of an underlying physical or psychological issue. When we got to this one, Ashley dodged the question a bit, explaining the sex schedule that she created to keep her marriage “normal and happy.” 

Every Sunday, she performed oral sex on her husband, and on Thursdays, she and her husband had sex whether she wanted to or not. She believed this is what normal married couples should do, and that without weekly sex her husband would likely cheat. 

You may have heard something similar, as plenty of self-proclaimed online “sexperts” recommend couples do it weekly regardless of mood or anything else that’s going on, in order to create, maintain, or reestablish their sexual spark. While there are circumstances where this can be beneficial, the “should” of this situation was stressful for Ashley because “It’s another thing on my to-do list.”

Now, I’m all for scheduling sex if it ignites a spark for you or satisfies you sexually—but not if it’s done just for your partner, or some arbitrary calendar obligation. Ashley’s sex schedule was a major point of stress in her life. She told me that she often had sex just because she assumed her husband wanted it, that making sure they had sex was part of her responsibilities as a woman and wife, and that sexual frequency was necessary to keep their marriage strong and committed. She wasn’t necessarily enjoying it; rather, “going through the motions.” She instead wanted the kind of spontaneous desire she had felt when she and her husband began dating—before school, work, maintaining a home, and the rest of married life set in.

Ashley’s sex schedule wasn’t the cause of her irregular periods, although the stress of it wasn’t helping. Through lab testing we discovered she had hypothyroidism, which commonly shows up with fatigue, hair loss, and what many patients refer to as “period problems.” After several appointments together, Ashley’s energy was returning, her periods were becoming more predictable, and she was battling to keep the wispy hairs of new growth from popping out of her otherwise well-maintained ponytail. 

Since her primary concerns were improving, I felt OK suggesting she consider having a direct conversation with her husband about their sex life. Ashley took my advice and spoke with her husband outside the bedroom. When she told him about her schedule and its stressors, he surprised her by saying he hadn’t even noticed there was a schedule. 

He even admitted there were instances when he hadn’t been in the mood at all—yep, guys don’t want it all the time, despite society’s presumption of male hypersexuality—and he often went through the motions, just like Ashley did, because he believed doing so would please his wife.

Three months later, Ashley came into my office aglow. Before she even took a seat, she gushed about her sex life. It had gone from scheduled, predictable, and impassive to engaging, sometimes exciting, and most important, satisfying—not every time they did it, but most of the time. And now she had follow-up questions. 

She and her husband now had sex when they felt like it, which she felt correlated to certain times of her cycle. Because she was tracking her periods with me, she had noticed that there were some weeks when they didn’t have sex at all, and others where they were intimate several times. Which is normal. 

You might not be married or partnered, or maybe you think having a sex schedule is weird, or perhaps you would never dream of working part-time through grad school, but I bet there’s part of Ashley’s story you can relate to. That’s because we all have preconceived notions about what we “should” and “shouldn’t” do sexually, like how many times a week we should have sex, how many overall sexual partners we should have, what kind of fantasies we shouldn’t have, and what even counts as “sex.” 

Sociocultural constructs are pervasive and powerful, infiltrating our brains like an earworm, even if it’s something we don’t realize.

Dr. Jolene Brighten is a hormone expert, nutrition scientist, and thought leader in women’s medicine. She is board certified in naturopathic endocrinology and trained in clinical sexology. Dr. Brighten is the author of Is This Normal, a non-judgemental guide to creating hormone balance, eliminating unwanted symptoms, and building the sexual desire you crave. A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones through her website and social medical channels.

Excerpted from IS THIS NORMAL: Judgment-Free Straight Talk about Your Body. Copyright © 2023, Jolene Brighten. Reproduced by permission of Simon Element an imprint of Simon & Schuster. All rights reserved.