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Q. How should I handle a male doctor doing a pelvic exam on my wife? Do I have the authority as her husband to insist this be done by a female physician? I'm not accusing my wife of wrongdoing and I won't deny her medical attention. But is this exam really necessary on a routine basis? Wouldn't I know if something were changing inside my wife?

A. Any woman will assure you that a gynecological exam is not an erotic experience. There's nothing sexual about the procedure for either patient or physician—whether the physician is a man or a woman. The same holds true for prostate and testicular exams.

For many women, having a competent, experienced physician who takes the time to listen and is gentle is more important than that person's gender.

That said, we're concerned that the fear you're exhibiting may be keeping your wife from pursuing appropriate care for herself. It's important that she have a thorough physical exam annually.

Many of the dangers the gynecologist is seeking to protect your wife from are sub-microscopic. They cannot be seen or felt by you or even by your wife. Every six minutes an American woman is diagnosed with cervical, ovarian, peritoneal, tubal, vaginal, or vulvar cancer. More than 178,000 new cases of breast cancer will be diagnosed and 15,000 women will die of ovarian cancer this year.

By the time you or your wife become aware that something has changed within her, it could be too late for treatment. Finding problems early requires the specific training and education a gynecologist offers, and it can even take a doctor several months to diagnose some types of cancer because the symptoms are so vague.

	If we aren't a little selfish, it becomes difficult to truly enjoy sex.

Every woman should have a gynecological exam and a Pap test within three years of first intercourse or at age 21, and thereafter every year until age 30. After 30, if she's had three consecutive normal Pap tests, she should have the test every two to three years, and should continue to have a pelvic exam each year.

Please be supportive of your wife and the physician she feels most comfortable with. She's a precious gift to you, and protecting her health is a responsibility for both of you.

I want to orgasm!
Q. I feel disappointed that I can't have an orgasm. I'm not one of those women who don't mind not having one. Is my desire wrong?

A. There's nothing wrong with desiring to experience orgasm—it's part of how God designed sex to work. If we aren't a little selfish, it becomes difficult to truly enjoy sex. If you aren't pursuing some type of enjoyment, you can quickly shift to "only doing it for him" and then move to not having sex at all.

Not being able to orgasm can be a lifelong problem or develop after a time of being able to reach orgasm. Many studies suggest that 1 in 10 women has never reached orgasm; 1 in 4 women reports orgasm difficulties at some time. Up to two-thirds of women cannot reach orgasm through sexual intercourse alone—there must be direct stimulation of the clitoris.

One other difficulty for women (and men) is the gigantic myth that orgasm involves being swept away in an all-consuming wave of passion, replete with moaning, screaming, thrashing, and writhing. Bells toll, the earth moves … you get the idea. The reality is that a woman's orgasmic response is learned through experience, experimentation, and self-awareness. Orgasms don't "just happen" for a woman who has no knowledge or awareness of her body, no matter how experienced, skilled, or incredible her lover is.

The good news is that you can learn.

First, consult with your physician. There are medical conditions that can affect orgasm (diabetes, hepatitis, kidney disease, ms, pituitary disease, stroke); many medications can inhibit or prevent orgasm (blood pressure meds, tranquilizers, antidepressants, sedatives, alcohol). There are also emotional reasons (anxiety or pressure from your partner, fear of losing control, feeling self-conscious) and relational reasons (anger toward your partner or control issues between you) for having orgasm difficulties.

Work through Restoring the Pleasure by Dr. Clifford and Joyce Penner or meet with a Christian sex therapist. This may be a time-consuming process, but it's definitely worth the investment!

Michael Sytsma, Ph.D., is a minister and founder of Building Intimate Marriages (www.intimatemarriage.org). Debra Taylor, MFT, is co-author of Secrets of Eve (Thomas Nelson). Both are certified Christian sex therapists and co-founders of Sexual Wholeness, Inc. (www.sexualwholeness.com).

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