Feeds:
Posts
Comments

I don’t know about you, but I care about a lot of things: my profession, my daughters, my friends, my community, my church. Because I care about them, I carve out time for them. My calendar is full, and so is my husband’s with the things he cares about. Often, our respective calendars send us in different directions.

When you’ve been together as long as we have, it’s easy to take each other for granted. We can forget to make time for the one you care most about—each other. We’ve talked before about the importance of putting sex on the calendar if you want better sex, and the same is true of intimacy (yes, there’s a difference, as our friend psychotherapist Mary Jo Rapini explains). To maintain—and deepen—your connection to each other, you need to set aside time in which you focus on each other and have fun together.

How you spend your date night is up to the two of you to decide, and that’s half the fun. I highly recommend that you try something different as a way of avoiding something called “habituation.” New things stimulate the mind, but over time the newness wears off and they become less and less engaging. That’s habituation, and it’s not great for a marriage. Date night is an opportunity to continually introduce the new and keep your relationship interesting. Attend a concert, take a class (cooking, art appreciation, Italian), or learn a new sport together. If money is tight, try one of these ideas:

  • Take the dog for a walk together, and let the dog determine the route
  • Go to a pool hall and play a game of pool
  • Dance to music that was popular when you first met
  • Go to the bookstore and pick out books for each other (no need to buy; the fun comes in talking about why you chose the books you did)
  • Any of Mary Jo’s other 50 ideas for cheap date nights

Regardless of what you choose, try to build in some time to talk either before or after the event. You’ll be surprised at how changing up the scenery and your activities will also change the nature of your conversation.

Date night creates a lovely cycle, really. Spending quality time together increases intimacy, which sets the stage for better sex, which further increases intimacy. So compare calendars and pencil in date night for the next six months. We’d love to hear what you choose!

You ask whether there’s an over-the-counter hormonal cream to restore vaginal elasticity. You’re finding intercourse painful and experiencing dryness.

Vaginal moisturizers will help to retain some moisture, but none of them will reverse the process—which is, medically speaking, atrophy given the loss of estrogen. The combination of moisturizers and lubricants will keep things comfortable for a while, but most women eventually need more.

Localized estrogen or the new pharmaceutical Osphena are effective; either requires a consultation with your health care provider. I’m not aware of any hormone-based medication available over the counter and, in fact, encourage a consideration of your medical history and current factors before use.

Films to Fuel the Fire

When I read the results of a new study showing that couples who watch and then discuss movies about relationships could reduce the likelihood they would divorce, it occurred to me that watching movies that include sex scenes might have a similarly positive effect on one’s sex life.

Friend, it does, and the reason is simple. Sitting down and watching a movie together on any topic—be it global warming, relationships, or sex—creates mindshare for that topic. And when it comes to sex, once you’ve created mindshare, the rest often takes care of itself.

We’ve talked about movies before, and our difficulty in finding them. I’ve been pressed for time the last month or so, so I asked a friend for some recommendations to pass along. She did some research—and a lot of movie-watching—on our behalf and recommends these three movies—movies with real storylines, acting, cinematography, and sex scenes that spring organically from the plot—guaranteed to remind you and your significant other that each of you are not only a spouse, parent, child, employee, or committee chair, but also a lover. (The comments are hers, but she also helpfully included links to New York Times reviews if you’d like confirmation!)

Y Tu Mamá También (NR, subtitles, New York Times review)

Julio and Tenoch, teenage boys in Mexico, can’t believe their luck when Luisa, a (slightly) older woman, agrees on a whim to go on a road trip with them to find a beach. Carnal relations ensue, some more surprising than others, but so does self-awareness. If, at the outset, the movie feels like a Mexican American Pie (the first sex scene occurs 20 seconds in, and the boys have a manifesto that includes “do whatever you feel like” and “don’t marry a virgin”), don’t be discouraged. It gets better. Luisa eventually tires of their immaturity and makes the rules, which the boys agree to follow. Her own manifesto includes “I pick the music,” “You cook,” and “You’re not allowed to contradict me.” Now that’s sexy! And there is a secondary storyline that hints at Mexico’s political and economic landscape seen from the car windows as the threesome cross the country. Sexy, funny, sad, and smart.

Sex and Lucía (NR, subtitles New York Times review)

This movie had me at the premise: Lorenzo is a writer; Lucía is an avid fan. She tracks him down, says she loves him and his novel, and moves in with him that same night. “I always liked people who tell good stories,” she says. “I trust them.” But should she? Lorenzo has a complicated past, and he’s also writing another novel; in the movie, you can’t always tell whether a scene is real or one he’s writing for his novel. No matter. Just enjoy the ride, particularly during the sweet and explicit (yes, both!) photo shoot L&L do together at 28 minutes, and a sexy (Lucía’s) and funny (Lorenzo’s) strip tease a few minutes later. A person might pause the movie there and get down to business with the one you’re with. Later you can resume the film, which gets a good deal darker, and try to untangle fact from fiction over a nice glass of wine.

The Lover (NR, New York Times review)

French Indochina, 1929, is the setting for this story about forbidden love between a French teenager from a dysfunctional family and a wealthy Chinese man who is besotted with her—but betrothed to another. The plot unfolds in a leisurely fashion, giving the story time to build. Looks are exchanged and fingers are tentatively touched, before they give in, but oh, when they do (38 minutes in for about 10 minutes), it’s a beautiful, aesthetically pleasing thing. The lovers are doomed, of course, but until the day of reckoning, they escape their own pain and inflict (primarily emotional) pain on each other. As with Sex and Lucía, to avoid having the plot spoil the mood, pursue your own agenda whenever you’re ready (if not by the 54-minute mark, then certainly after).

In fact, that’s good advice for watching any of these movies. Act now (and now, and ohhh, now); discuss later. According to research, both are good for your relationship.

And we’re always happy to hear from you about movies that stoke your flames!

You ask whether there’s a downside to using saliva as a lubricant. What makes it good for digestion makes it not so good as a lubricant: The enzymes that help break down food can be irritating to the delicate vulvar skin. As we lose estrogen, the vulvar tissue gets more fragile and delicate; what once was fine may become uncomfortable.

I also hear from many women that water-based lubricants don’t last as long as they’d like them to; they prefer a silicone or water/silicone hybrid lubricant for staying power through more foreplay.

That said, if it works for you and your partner, you can keep using saliva for some or all lubrication. Just be aware of the potential for irritation, and wash with a warm cloth after sex to minimize exposure.

The Lowdown on Libido

Once upon a time, you may have felt sexual desire hit with the force of a tsunami—no mistaking the intensity of that jump-your-bones drive. These days, it passes like a gentle drizzle. If it comes at all.

Meanwhile, back at the doctor’s office, one of the most frequent questions this gynecologist hears (and I would agree) is: What happened to my sex drive?

Loss of libido is common. The numbers are all over the map, and I’m not sure that they’re particularly helpful anyway, but many women—and men, too—experience a loss of sexual desire. And this state of affairs can stir up a lot of consternation and unhappiness in the bedroom and beyond.

Lack of sexual desire has a couple of dry, scientific names: hyposexual desire disorder (HSDD) or hypoactive sexual interest and arousal disorder (this one, HSIAD, is relatively new, coined in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM]; can you imagine the discussion at the recent FDA forum?). Despite studies exploring its frequency, causes, and symptoms, no pharmaceutical silver bullet has been found to fix it—yet. And, believe me, having tasted the commercial success of erectile dysfunction drugs like Viagra, pharmaceutical companies are extremely keen on finding a similar blockbuster drug for women.

Loss of libido all by itself isn’t the problem—exactly. If you are content to let your sexual self recede with your youth, and this isn’t disturbing to you or anyone else, then by definition you don’t have HSDD/HSIAD.

If, however, loss of libido is distressing to you or to your partner; if you want to continue enjoying sex with your partner and you mourn the loss of your old sexy self, then you have a problem. According to medical diagnostic manuals, in order to meet the criteria for HSDD/HSIAD, you not only have to lack desire for any form of sexual activity, but this also must cause you or your partner “personal distress and/or interpersonal difficulties.”

Loss of sexual desire is a tough nut to crack. There’s no “on” switch for libido; there’s no one-size-fits-all therapy; there’s no FDA-approved drug. So rather than searching for a quick fix for a waning libido, you may have to take a patient, holistic, experimental, long-distance view of the situation. You (and your partner) may have to adjust your expectations: sex can still be close and satisfying, but it may be different.

Additionally, you may have to take a clear-eyed assessment of your overall health and lifestyle because, like so many things, sexual response doesn’t happen in a vacuum. It’s intimately connected with other parts of your physical and psychological health.

With this in mind, loss of libido can be affected by:

  • Loss of hormones—the loss of both estrogen associated with menopause and testosterone associated with aging. Low libido is a frequent complaint of post-menopausal women and those with surgically induced menopause due to removal of ovaries.
  • Some medications, for cancer and depression, for example, are known to depress libido, as are some recreational drugs.
  • Some illnesses, such as diabetes and kidney disease, can disrupt hormone levels and damage nerves in the genital area.
  • Relationship problems. If you have a rocky relationship with your sexual partner, disinterest in sex is a likely side-effect. Stir in some menopausal changes and you have a discouraging environment for sex.
  • Stress and anxiety. Financial worries, career challenges, family problems. It’s hard to feel open to sex with major life issues on the brain.
  • Abuse, whether physical, sexual, or emotional, especially if the abuse is still ongoing.
  • Obesity, which for the women I meet in my practice has most effect on self-image.

We’ve mentioned before that good sex is good for your health. So, how does losing your libido impact health and well-being? A 2009 study conducted by a team of researchers at University of North Carolina at Chapel Hill sought to answer those questions.

In a survey of almost 2000 women, the researchers found that women with HSDD/HSIAD were more likely to be depressed and dissatisfied with their home lives and their partners, and that they were more likely to have other health issues, like heart disease and thyroid problems. In fact, the effect of HSDD/HSIAD on quality of life measures was comparable to that of other chronic health conditions, such as back pain or arthritis.

Ouch.

So what’s to be done with a case of lost libido? How do you begin to tackle this very real and very frustrating condition?

Fortunately, there’s a lot you can do, from lifestyle changes, like exercising and losing weight, to pharmaceutical regimens, which, while limited, might include estrogen replacement or using testosterone off-label. And while you may have to experiment, in the end, you can be every bit as intimate, sexy, and feminine as ever.

I’ll dig into those details in a future post. In the meantime, your recommended reading is my new book, Yes You Can: Dr. Barb’s Recipe for Lifelong Intimacy. Because that’s what we’re all about here—believing that we can.

Recovery from a devastating disease like breast cancer is a long and challenging road that frequently involves making peace with lots of change—different bodily sensations, altered abilities, different goals and perspectives. Rather than a return to “business as usual,” recovery is often a process of accommodation.

All that adaptation and accommodation applies to sex as well. Sometimes, the goal is not so much to regain the “before” experience as to redefine, along with your partner, what sex means “after” cancer. To start from now with patience and hope, because whatever your starting point, you will improve. That’s the resounding message from other survivors who have faced the same journey: “Don’t give up,” and “You are not alone.”

As you reconstruct the contours of your life, of which sex is a critical part, here’s a toolkit that might help you get started and might also help sex to be more comfortable.

First, some ideas to consider as you begin to reclaim your sexuality:

Self-image is a huge hurdle for most women who’ve had breast cancer, even after reconstruction surgery. Everything feels different, and sometimes there’s no feeling at all. According to a 2011 study of 1,000 survivors of breast cancer, co-author Mary Panjari, of Australia’s Monash University, found that women with body-image issues (and who doesn’t have issues with body image?) were much more likely to report sexual function problems.

Perhaps it’s comforting to know that, while you struggle with the psychological and physical scars of your illness, for most partners, the way you look isn’t a problem. “In our study, we asked women if they thought their partner felt differently about their appearance and the majority said, ‘No different.’ But the women felt differently about themselves,” says Panjari. Again, you’re not alone, and there are steps you can take:

  • Consider finding a support group for cancer survivors, and not just for advice on sex. Some women like them; others don’t, but at least give it a try.
  • Consider couples therapy. As a couple, you need to figure out a path forward, sexually speaking. He may worry about hurting you or pressuring you. You may be consumed by how you look or experiencing loss of desire and sensitivity, vaginal dryness, numbness. And your medications may exacerbate your condition. Finding a sex therapist who can walk you through these changes could be your best gift to yourself and your relationship.
  • Exercise when you feel ready. A regular workout will help you tone muscles, lose weight, and feel stronger and more capable. It gets more blood to your brain and your bottom, and it releases endorphins, the feel-good neurotransmitters in your brain. Simply feeling confident and capable can help stimulate your sex drive.
  • Masturbate. This primes the pump. You can get lubrication going and see what feels good where. “Masturbation is a normal form of sexual activity and release,” says Dr. Marisa Weiss, founder of Breastcancer.org. “I tell my patients it’s a form of exercise and conditioning for the vagina—which has suffered considerable change and lack of use during breast cancer treatment.”
  • Remember: Breasts are only one part of a whole-body experience. Don’t focus on the tree when you have an entire forest to explore.

Now for that toolkit. These are items every postmenopausal woman should have on hand—they’re just more important for breast cancer survivors.

  • Vaginal moisturizer. This is for regular, daily use, not just for sex. It conditions the vagina and keeps the tissue healthy and moist
  • Lubricant. Use this lavishly in your vagina for extra lubrication during sex.
  • Pillows. Lots of pillows for soft support where you need it. If a position feels ouchy, try cushioning the area with a pillow.
  • Erotic movies and other scene-setting paraphernalia—candles, incense, music.
  • Sexy attire. If you need to start out—or stay—clothed for a while, get sexy lingerie that covers the strategic parts.
  • Read the information about vaginal comfort and genital sensation on my website: middlesexmd.com and the very helpful blog posts about sex after cancer by our own medical advisor, Mary Jo Rapini.

 

 

In the last post, I ran up the flag for oral sex—mostly as a way of keeping our repertoire broad and deep as we and our partners face age-related issues with sexual sensitivity and/or function. After all, there are many ways to skin this particular cat.

But, as with any kind of sex, a little technique and creativity can put some spice into what too often devolves into a boring routine. All the tricks in the world, however, can’t take the place of communication and some interest and even excitement about the task at, um, hand.

Some level of communication is fundamental to sexual play and exploration. You can encourage: “I love it when you do that.” You can ask: “Does this feel good?” “What would you like better?” And you can pay attention to non-verbal cues: breathing, muscle tension, sounds, movement.

I’d also like to emphasize that, while it’s good to push your boundaries, if any part of sexual exploration feels really uncomfortable or off-putting, you don’t have to go there. We all have lines, and it’s important for both partners both to draw them and to respect them. But don’t just draw lines, continue to look for ways to keep the intimacy alive.

I’ve had women tell me that fellatio (oral sex on men) gave them a sense of empowerment, because they were controlling the action. By the same token, it gives the guy a break—he’s not in charge, plus he still has a good view of the action, which can be its own kind of turn-on.

With loving attention and communication on the front burner, here are some ways to change up your oral sex technique.

  • Take it slow. Don’t go for broke right away—let momentum build. Start with sensitive areas at the periphery—belly, inner thighs, buttocks. Use light touch, blow, kiss, lick. Take your time.
  • Move in. When you get to the genitals, keep the action soft and slow at first. Cup his testicles in your hand or mouth. Slide your tongue up the shaft of his penis. The frenulum is a particularly sensitive spot on the underside of the penis where the shaft meets the head. Tease a little before you commit.
  • Take a break. If your jaw gets tired, use your hands or your tongue to keep the action going.
  • Cool off. For a surprising change of pace, take a drink of ice water. The change of temperature is startling.
  • Heat and spice. Don’t keep doing the same old thing while you’re in warm-up mode. Use different sensations, change the speed and the rhythm. Build up to a firm, steady rhythm. Even if he isn’t totally erect, he can still orgasm and ejaculate.
  • Avoid the gag. You don’t have to deep-throat. Use your hand on his shaft and only take the head of his penis in your mouth. Then, you can suck or use your tongue creatively while stroking the rest with your hand.
  • Swallow—or not. You’ve probably already settled this, but if you don’t want to swallow his ejaculate, you can tell him to warn you just before he comes.
  • Hold him gently afterward.

Of course, the need for skill and technique apply equally to cunnilingus (oral sex on female genitalia). If your partner could use some coaching, slip him the highly rated “essential guidebook to oral sex,” She Comes First: The Thinking Man’s Guide to Pleasuring a Woman by Ian Kerner.

Women whose men have taken it to heart (and to bed) give it rave reviews.

Kerner also has a female guide to men’s sexuality, which includes pointers on oral sex: Passionista: The Empowered Woman’s Guide to Pleasuring a Man.

Now that you have your required bedtime reading, maybe you want to give each other an occasional pop quiz.

Follow

Get every new post delivered to your Inbox.

Join 341 other followers

%d bloggers like this: