Category Archives: Female Sexuality

Female sexuality questions

Teen Moms, Get Second Opinions on Your Cesarean Section

ASK DR NOVOA- Just wanted to clarify something. I have had two patients come in this week as transfer patients from other doctors hoping to be able to deliver vaginally after been delivered by Cesarean section. Since I specialize in the Vaginal Birth After Cesarean Section (VBAC), this is not unusual.

Both girls were teens when they delivered their first babies. Both were delivered by different doctors. Each was told that because they were teens they would have to be delivered by C/S because they were high-risk.

To clarify this situation. Teen moms are considered high-risk because of their age. However, teens ARE NOT at a significantly higher risk of delivering their babies by C/S just because they are teens. In the majority of cases, the inability of the patient to deliver vaginally has more to do with the doctor than the patient.

I specialize in high-risk deliveries with a significant percentage of my practice associated with teen pregnancy.

The risk in my practice of a pregnant teen needing a C/S is 5%. This compares to 35-50% compared to the national average.

The bottom line, if you stick to the recommendations of the American College of Obstetrics and Gynecology (ACOG), teens have a 5-15% risk of C/S rather than 30-50% which is what we are seeing.

So moms out there, please advise your friends and daughters to ask questions and get second opinions when you hear you need a C/S. Please keep in mind that it is estimated that 50% of all C/S in the US are unnecessary. It is up to you to ask the important questions to avoid having a surgery that not only leaves a large visible scar but puts you at risk for serious complications now and in the future with all your pregnancies.


Dr. Julio C. Novoa

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Make Him Change or Donate to Goodwill

As an Gynecologist and Sexual Educator, I am often asked by my patients why they don’t enjoy sex or find it difficult or impossible to reach orgasm. After a physical examination and lab work, we discuss the problems they have with their partners or husbands. These types of problems are very common, affecting over 40% of women under the age of 40 and greater than 60% of women over the age of 40. Unfortunately ladies, the problem is not with you, it is with them. My best advice in order to fix an unsatisfactory love life is first to stop trying to change yourself for him and instead ask him to change for you. You will usually find that a man willing to listen to what you want in bed is usually the one you want to keep, and the man that thinks he is “God’s Gift” is the one you should “rewrap” and give to Goodwill. SINCERELY, DR. NOVOA

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Sexual and Reproductive Coercion

The American College of Obstetrics and Gynecology (ACOG) recently published a committee opinion discussing the subject of Sexual and Reproductive Coercion (SRC).

SRC is a pattern of physical violence or psychologically coercive behaviors intended to control a woman’s sexual decision making, contraceptive use, or pregnancy.

These behaviors are examples of intentional attempts of others, most commonly the male sexual partner, to control the sexual and reproductive rights of a woman.

The coercion includes contraceptive sabotage, where a patient’s partner intentionally hides birth control pills, refuses to wear a condom during intercourse, makes holes in condoms, or forcefully removing intrauterine devices or vaginal contraceptive rings in an attempt to get their partner pregnant against their will.

The coercion, however, may also include pressure from family and friends by embarassing or pressuring a woman through guilt or intimidation into having a child before the woman is ready. It also includes forcing a woman to have an abortion or termination of pregnancy.

Sexual and reproductive coercion is commonly associated with sexual and physical violence. One study involving adolescent mothers on public assistance reported birth control sabotage by over 50% of their dating partner.

Recommendations in order to assist patients at risk for sexual or reproductive coercion include (1) offering  hotline numbers and referrals to local domestic violence shelters and agencies, (2) offering long-acting methods of contraception less detectable to their partners such as the IUD, the Implanon or Depo Provera Injectable. (3) When using an IUD, trimming the string inside the cervix in order to prevent the partner from feeling the string or being able to pull the IUD out, (4) Provide Emergency Contraceptive (Plan B) pills and (5) Provide harm-reduction strategies and safety planning.

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ASK DR NOVOA – I have heard to women reach their sexual peak at age 35 while men reached it at age 18. Is this true?


This is a myth which has been passed on as fact for decades. There is no scientific data to support this comment.

Some may believe that measuring sexual hormones may help determine sexual peak, in reality, there is no set minimal value to determine either a sexual low or high.

A relatively new state of sexual health for men, known as Andropause, has been described as the sexual equivalent to the female Menopause.

Menopause, which generally ranges from age 40-50, with an average age of 50.5, is most often demonstrated by the cessation of the menstrual cycle and decreased libido (sex drive).

For Men, the beginning of the decrease in the sexual hormone Testosterone begins as early as age 30. This is most often marked by a decrease in physical strength and endurance, decrease in sexual drive, decrease in strength of erection, decrease in seminal and sperm count, increase in weight from fat and at the same time decrease in muscle size.

For women, the use of hormone therapy to include estrogen and progesterone can not only help with symptoms of the menopause but increase vaginal wall thickness, sensitivity and lubrication.

What is most interesting is that studies have shown that for both men and women, the off label use of Testosterone has been shown to increase the sexual drive.

So ladies, if your having trouble with your man and he is starting to get soft EVERYWHERE, you may want to suggest that he consider a combination of Viagra and Testosterone. But….. remember that just because he puts high octane in the gas tank, doesn’t mean that he will be a better driver.

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ASK DR NOVOA – I have heard that a woman can start crying or may even faint right after achieving an orgasm. I have never seen it happen. Is this possible?


Crying is very common with orgasm.

Fainting is not very common and in some circles very rare requiring a very high degree of arousal. This is why the French call Orgasm, “La Petite Morte” which means “the little death”. It is a reference to the refractory period following orgasm. The term has generally been interpreted to describe the post-orgasmic fainting spells or unconsciousness some lovers experience following orgasm.

Crying or fainting can usually be achieved by either vaginal or oral sex and is most commonly associated with male to female stimulation [Men Don’t Cry 🙂 ].

Fainting can be seen after one orgasm, but is more common when a combination of oral and vaginal penetration is maintained with stimulation continuing from one orgasm to another producing a “stair-step” level of stimulation until an orgasmic plateau is achieved lasting from a few seconds to up to 30 seconds. The techniques to achieve this are varied but are reproducible from one partner to the next.

So guys, this may be the only time that seeing a girl crying may be good. If she starts laughing, better go back to the drawing board. 🙂

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ASK DR NOVOA – I work out everyday and have lost weight, but I still can’t lose weight I gained from my kids and the loose skin from my pregnancies. Do I really need a tummytuck or will liposuction fix this?

Above all else, I want to commend anyone willing to exercise in order to look their best.

Unfortunately, there comes a point that no amount of exercise will be able to get you back to your pre-pregnancy look.

IN GENERAL, if you are in a standing position and you can grab 5 inches or a handful of skin and babyfat from ur abdomen and especially each hip, this fat will rarely retract back to your pre-pregnancy figure. Mother Nature created the body to store fat in case of emergency or in the case of starvation. Your body doesn’t know the difference between a diet or starvation. One of the last places it will eliminate fat are the love handles and lower back. And yet elimination of fat in these areas can give you the “hour glass” appearance that most women look for and consider when they look at a slim person.

The tummytuck and liposuction of the love handles and lower back , a procedure called lipoabdominoplasty and body sculpturing can do what exercise will rarely be able to do, even in tri-athletes. The goal is to give you confidence to wear a bikini.

So, if you are not happen with your look and can grab a lot of skin, consider seeing both a cosmetic surgeon and your exercise trainer for optimal results.

And never stop thinking and living healthy. 🙂

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ASK DR NOVOA – Why do MEN always want to have ANAL Sex?


A survey performed by the Center for Disease Control (CDC) in 1992 showed between 20-25% of both men and women were having anal intercourse. The most recent CDC survey (2006-2008) showed that over 44% of men and 36% of women ages 15-44 who are heterosexual engage in anal intercourse. This means that almost 1 in 3 men sexually active heterosexuals have engaged or regularly engage in anal intercourse. It appears that the popularity of anal intercourse has significantly increased over the past 20 years. The most recent data shows that 1 in 4 couples routinely practice anal sex.

So, despite the fact that the subject of anal sex seems to be initiated more often by the male partner, a significant number of women are requesting anal intercourse. Nevertheless, studies still show that heterosexual men are more likely to request anal sex with their female partners than the other way around. To be specific, we are talking about heterosexual intercourse between a man and a woman, where the man penetrates his partner with his penis in her anus.
Five Common Reasons Heterosexual Men like Anal Sex with their female partners are:

  1. It gives him a sense of power … It may sound very territorial and Neanderthal, but men often state that they enjoy the control and empowerment anal sex gives them. Since anal sex can produce a significant amount of pain, allowing the male partner to penetrate you in this way can represent a complete sign of submission, as well as entrusting your partner not to hurt you while at the same time hoping to pleasure you. If you enjoy it and are able to reach orgasm because of it, this simply caters to the male ego even more than with vaginal intercourse. FYI, the anus has more sensory nerves than the vagina, although most believe that “anal orgasms” are actually due to pressure applied/stimulation to the clitoris or G-Spot.

  2. You trust him … The fact that you let him share a part of you that requires the utmost trust gives him a sense of being special. And it is more than just about participating in a sexual act. If you are nervous about anal sex but you agree to try it, your partner will feel that you are putting all your trust in him.

  3. It’s something new … While vaginal sex is often considered to be the most pleasurable, at some point, everything can become routine. So if and when the topic of anal sex is brought up, most men will be willing or excited to try it. And let’s be realistic, he is going to be more excited about it than you because IT’S NOT GOING TO HURT HIM!!!! It’s like the saying, “If Men had to get pregnant and have babies, the human race would go extinct.”

    Also, always remember the number one rule. Never tell your man you have tried anal sex before unless you are willing to try it with him. Men always compare themselves to other men, so NEVER tell your man anything you are not willing to try again, or he will always feel that he was not as special as your previous lovers. Remember we have very fragile egos!!! So, it is best to let him think you have never tried it before, so it can be new for both of you.

  4. Men love your butt … The three most common areas of attractiveness on a woman, besides her face, are the breasts, legs and buttock. Men often say, “I’m a butt man” or “I’m a breast man.” Thus, anything to do with the buttock can be very attractive. For some men, it is a very exciting modification to the “doggy-style” position.

  5. It’s very tight … The most common reason for wanting to have anal sex, is that the anus is expected to be tighter than the vagina. The anal sphincter is designed to keep the anus almost “air-tight” closed. The vagina has the pelvic muscles to help keep it tight but not closed. No degree of Kegel exercises can make the vaginal and the pelvic muscles tighter than the anal sphincter. For the man, the idea of a tighter opening is often thought that it will produce more pleasure for him.

Although anal sex has now become a relatively common practice, it is still considered a taboo. It still carries a significant amount of stigma, especially for woman who enjoy it. In a loving, mutually beneficial relationship, there is nothing wrong with enjoying anal sex. However, engaging in anal sex does pose problems. Anal sex is associated with an increased risk of transmitting disease, such has Herpes, HPV or HIV. Despite this, and an increased risk of gas and fecal incontinence, there are no significant medical risks associated with anal intercourse.

There are also concerns about keeping everything clean. You should never switch from the anus (A) to the vagina (V) without having your partner completely wash his genitalia. This could lead to fecal contamination of the vagina and a very bad vaginal infection.

Therefore, when having anal sex, just remember the slogan, V to A is ok. A to V, no way!!!!

If discussing or having anal sex is a real turn off for you, consider telling him the following, “I will, if you let me do you first!” That usually makes him change the subject really fast!

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ASK DR NOVOA – How do you tell a man that he is lousy in bed without ruining the relationship?

This question is extremely touchy since most men are not open to criticism, especially about their lovemaking skills. It is, however, important to address this problem because it can only lead to resentment, frustration and the evidential collapse of communication. Lovemaking can be the sincerest and most intimate form of expression. But it is important to make the distinction between having sex and making love. You can have sex with someone you love, but it is not always the case that you make love to the person when you have sex. Bad lovemaking skills can seriously jeopardize a relationship, so it’s important to address the problem as soon as you can.

In the past, men weren’t rated in the bedroom. They were expected to marry virgins who had no one to compare them to. Today, most couples have a fair to significant amount of sexual experience and most ladies know exactly what their man does wrong and why.

When you tell your guy he sucks in bed, it immediately hits him right where it hurts—his machismo, Mojo, Manhood, etc….. Most Men equate a poor sexual rating with their masculinity, and more often then not, he will react badly if he feels he is being criticized.

Unfortunately, there are many factors that affect the sexual performance of a man. They involve an interaction of both physical, emotional and personality skills. The physical has to do with the inability to control exactly how long he can go without ejaculating, which usually represent the end of the lovemaking. This can mean that, without foreplay, the actually time period from start to finish can be as short as just a few minutes. The emotional means, the more excited we get, the faster we may finish. The personality means, that some men are taught that it doesn’t matter if their partner has an orgasm and that it is all about what the man wants.

An even greater problem is that no one really is suppose to be considered a professional lover. i.e. If you don’t know how to drive a car, you can pay someone to teach you. If you can’t ice skate, you can learn from trial and error. But lovemaking is one that can take a lot of learning with absolutely no real way to gauge how good you are unless you are open minded and willing to ask a lot of questions.

Men learn through positive reinforcement and we have to have our egos stroked. Five key NEVERS when teaching your man how to please you.

  1. NEVER mention any other man’s name. The quickest way to start a fight and have something burned into his memory is to give him a name to compare his shortcomings to.
  2. NEVER tell him how many men you have been with. If you have to say anything, three to four always seems like a good number to work with.
  3. NEVER criticize the size or appearance of his penis. A man could really care less if he is fat or balding. But penis size is everything. For men, regardless of how intelligent we are, bigger is always better, and if you have had bigger, it will always be a problem for him.
  4. NEVER tell him that ANYONE was better, even if they are or were. Unless he is completely open minded and willing to learn, he will never get over this one.
  5. NEVER agree to do anything that you know will end up hurting you. Men are stupid and will always push the envelope in a relationship. We simply can’t help ourselves and the subjects of threesomes with your girlfriends, oral sex and anal sex with always come up. If you are not into these things, it is better to be honest up front before it compromises everything you stand for and you end up resenting him. A “Hall Pass” rarely works.

Five ways to let your man know his “skills” leave a little or a lot to be desired.

  1. Tell him what you like….Forget about asking what he likes and hoping he gets the hint. Men are basically clueless and we cannot read your mind. You need to let him know exactly what you like. The best time to discuss the problem is when you both decide to have sex but before actually engaging in intercourse. Remember that once intercourse begins, it may be physically impossible for a man to control himself. Telling him when you both have given each other the signals can be a natural extension of foreplay — a tamer kind of dirty talk. Saying: “I really like when you kiss my neck, but not too hard.”
  2. Show him what you like. Whenever you’re able, give him a demonstration of what you like by doing it to him or doing it to yourself while he watches. Men like it when you decide to dress up and put on a little show for them. A subtle way to show him is to actually take his hand and guide him step by step. Again, this allows for a mutual learning experience and an extension of foreplay. Try to use the word “I” as much as possible. Such as “I really like it when you touch me there or like that.”
  3. Use “instead of” when giving directions. If you don’t like the way he kisses you or you feel like he is using his tongue all wrong, you can say: “Instead of kissing me so hard, try making your tongue softer when you kiss me there.” It is not exactly the same as saying, “Don’t kiss me like that,” but it has the same effect without sounding like you are criticizing him.
  4. Frame it as a game with “let’s try”. If you hate the way he seems to bury his face in the pillow while he pounds you so hard it feels like a jackhammer, try saying, “Hey babe, let’s try slowing it down this time, and kiss me slowly while you do it. I want to see if it feels any different.” It’s not about what he’s doing wrong, it’s about the two of you trying something different for the hell of it. Sure, you already know it’s going to feel better, but he doesn’t need to know that you already know what works.
  5. Give him a shout out. When he follows your directions, make sure you give him verbal cues that he is doing something the way you want. Making natural sounds of pleasure; saying the “YES” word or “Oh, God” or even yelling his name are great ways to verbally guide him and teach him that he is doing something right.

Remember that the goal is for you to teach him what you want. Men are not mind-readers, especially in bed. And we will never know that we are doing things wrong unless you tell us. But try talking to us like we are a child, with constructive criticism without us knowing that we actually are doing something wrong and hopefully turn Mr. Lousy into Mr. Wonderful.

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ASK DR NOVOA – How do you determine bra size?

I was surprised to find out that many ladies don’t know how a bra vs. cup size is measured. Well, here is a general way to determine the measurements.

WITH NO BRA ON, do the following:

  1. Wrap a tape measure around your body just under your armpits, around the upper part of your back. It should lay on your chest just above your breasts. Document the measurement in inches. If it is even, this is your band size. If the number is odd, add 1 to it to get your band size.

  2. Measure around your chest at the fullest point of your breasts. Make sure that the tape measure is laying flat around your entire body and does not sag in the back. Note this measurement in inches.

  3. Subtract your band measurement from Step 2 from the measurement in Step 1. The difference determines your cup size.

A difference of 0 to 0.5 inches corresponds to a AA; 1 inch to an A cup; 2 inches, B cup; 3 inches, C cup; 4 inches, D cup; 5 inches, DD or E cup; 6 inches, DDD or F cup; 7 inches, or G cup; 8 inches, or H; 9 inches or I cup; 10 inches or J.

If you want to have a breast augmentation, IN GENERAL, if you are a 36A: adding a saline implant of 300cc size increases you to a 36B; 400cc to a 36C; 500cc to a 36D; 600cc to a 36DD; 700cc to a 36DDD; 800cc to a 36G.

A great place to go to get an exact bra fitting is Dillard’s. They have a professional bra specialist that makes excellent recommendations.
And Yes, I do have patients who are 34-38 G to H sizes.

Hope this helps. 🙂

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68 year old woman gets AWAKE Breast Augmentation

AWAKE Tumescent Breast Augmentation Surgery performed on a 68 year old woman in El Paso, TX.

AWAKE Breast Augmentation- 68 year old woman

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