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Archive for July, 2010

Oh, where do I begin? Perimenopause can be a pretty tough transition for many women. It is not only possible but probable that those symptoms are related. Patients with these complaints get a one-hour appointment in my practice to review the signs and symptoms that accompany this transition.

Riding it out is one option. Above all, make sure you optimize lifestyle, with exercise being probably the most important factor. Aerobic exercise of 45 minutes 5 days a week along with 60 minutes each week of strength training is a great goal to set.

I often recommend a book to patients: Dr. Robert Greene’s Perfect Balance. It covers this transition quite well and reviews options in treatment including diet, exercise, and hormone alternatives. It was originally published in 2005, but is still one of the best I have seen.

Good luck! Things will get better!

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My libido woke up.

This week we shoveled out a room to make room for a new hobby. In the unearthing, my husband found my long-lost, autographed picture of Dean Martin:
Dean Martin Autograph
Oh, be still, foolish heart!

My grandmother snagged two of these, one for my sister, and one for me, in Rome, when Martin was shooting there on location. She sent them to us when we were still too young to really understand what Dean could do for us.

But at the time, we were living on a naval base in the tropics, where it was hot, hot, hot. We spent most of our time in the base movie theatre, which had a sound track that ran the same songs over and over and over again between films. That track included “Everybody Loves Somebody, Some Time.” That voice could tease desire out of even a 10 year old. It turns out.

We fell a little in love then, but a lot in love later when we returned to the States and snuck around to watch Dean Martin on his television shows, and Dean Martin movies and listened even more to Dean Martin records. We have loved him ever since.

A quick quiz among a gathering of girlfriends suggests we are not alone. Dean still does it for a remarkably wide age demographic, doesn’t he? I know it included my mother, who would be in her late 70s now. And it extends to friends in their 40s…. I wonder if he could have ever known what lust he could inspire?

Anyway. Dean’s there for you on YouTube, whenever you want him. Here’s hoping he still works for you the way he does for me:

Especially for my sister:

That’s Amore:

Innamorata, sizzle:

Memories are made of this:

Medley with Petula Clark, oh melt:

This reminds me that I need a sequined pantsuit:

That’s just a sampling, friends. Happy memories…

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While writing about intimacy (remember the five ingredients of our recipe for enjoying sex after 40?), we came across a study seeking to understand what people consider to be Great Sex. That is, when we talk about Great Sex, what are we talking about?

In the study, authors Peggy J. Kleinplatz, A. Dana Menard, Marie-Pierre Paquet, Nicolas Paradis, Meghan Campbell, Dino Zuccarino, and Lisa Mehak, interviewed 44 people who self-identified as people who have Great Sex, and 20 sex therapists, folks who help guide people toward at least adequate sex. The resulting paper is entitled “The Components of Optimal Sexuality: A Portrait of `Great Sex,’” and was published last year in The Canadian Journal of Human Sexuality.

The paper itself is a really interesting read, but boiling it down to stock, there are eight components of Great Sex the researchers identified:

Being present.
Connection.
Deep sexual and erotic intimacy.
Extraordinary communication.
Exploration, risk-taking.
Authenticity.
Vulnerability.
Transcendence.

What a list! We’ll make an effort to explore and consider each of these components in upcoming blog posts. But what do you think about this list? Is it complete? Does this list spell Great Sex for you? Does sex always have to be Great to be worthwhile? What attributes must be there for sex to be Adequate?

Please feel free to embellish, add to, or subtract from this list. Argue any points. Suggest different language. Would we modify the list if it were Great Sex for Women after 40? for Women after 60?

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Movies to Turn You On

Not long before launch time, we wrote about our movie night with girlfriends, exploring erotica, and talking about what sort of flicks worked to turn us on… The premise being that as we grow older, using movies and literature and images to “get in the mood” can really help us overcome our skimpy sex hormones to fire up libidos.

In that post, we shared our list of movies that we found hot or naughty or disturbingly sexy, and a friend wrote asking for details on the movies we chose. Here’s a bit about each of them:

A Room With a View
Romance literature depends upon eras when a lot of clothes, social restrictions and sexual oppression offer the perfect fuel to set off explosive passion. Helena Bonham-Carter and Julian Sands’ longing is by turns sweet and frustrating, and always titilating.

Breathless
If you have a tendency to fall for bad boys, Jean-Paul Belmondo is your type. A liar and a thief and a persistant seducer. The film is set in Paris, a classic and masterpiece of the influential director, Jean-Luc Godard and writer Francois Truffaut.

9 1/2 Weeks
Mickey Rourke and Kim Basinger are just bad for each other, and it’s so good. Lots of erotic play. Lots of sex. A terrible relationship. Not so much a feel-good movie here. You don’t hope they end up together in the end. New uses for the jars of stuff in your fridge.

Body Heat
William Hurt and Kathleen Turner in a steamy southern summer film noir. She seduces him, talks him into murdering her rich, oppressive husband so they can live happily ever after. The seduction and heat and sweat between these characters is more than memorable.

The Piano
A movie pairing Holly Hunter and Harvey Keitel made our list of sexiest films? Oh, my, yes. A haunting story of passion and the bargains women make to survive, and to thrive.

Atonement
The lovely, epic novel about class, love, jealousy, malice, and regret is made alive with performances by Keira Knightley and James McAvoy, whose passions are doomed from the start. But they do get off to a good start…

Shakespeare in Love
Find just about anything with a Fiennes in it — Joseph or Ralph — and you’ll likely find a hot film. These boys embody sexuality. Here Joseph is the young Shakespeare, and he’s in love. Gwyneth Paltrow is Viola, a woman mismatched and thwarted. A funny movie with a Shakespearean plot and much of his dialogue. The heat between Fiennes and Paltrow is luscious.

The Unbearable Lightness of Being
Daniel Day-Lewis, Lena Olin, Juliette Binoche. The cast should be enough to recommend the film. The sexy and disturbing triangle of Milan Kundera’s novel, gorgeous Prague, the Soviet invasion. This is one beautiful, erotic, memorable film.

Looking for Mr. Goodbar
Diane Keaton and Richard Gere are hot for each other, and the movie made our list of turn ons for that reason. But their obsessions get the best of them, to say the least. Amazing performances by great actors.

Sweet Land
Elizabeth Reaser and Patrick Heusinger are awkward and beautiful as they work his rural Minnesotan farm. A gorgeous movie whose sensuousness bubbles up from nowhere and nothing. There are so many barriers to this romance, it just has to bloom. And it does. And it’s breathtaking.

The Graduate
Dustin Hoffman loves Katharine Ross and lusts for her mother, Anne Bancroft. Sick? Well, yes, okay. Yes. And really, really sexy too. 60s angst. Remember 60s angst? We do.

Under the Tuscan Sun
The title gives it away: Tuscany. Heat. This film is about escape and discovery. A grown woman’s fantasy come true.

Thief of Hearts
Sexy Steven Bauer has stolen Barbara Williams’ diary. Her dull and predictable life breeds a rich fantasy life in those pages, and now he knows every detail of it. Careful what you wish for, girlfriends…

Vicky Cristina Barcelona
Javier Bardem could stand in the middle of the room and read our grocery list, and that would be enough for us. But put him in a movie with a lot of sexy women and supremely sensuous surroundings, and… why aren’t there more movies like this?

Moonstruck
Ah, Moonstruck. How many times have we seen it? A dozen times? How many media have we owned it in? VHS, Disc, DVD, Digital… and counting… This campy romantic comedy just never gets old. An aging Italian Cinderella in Manhattan gets another chance at love. And she takes it. Cher and Nicolas Cage. Mama Olympia Dukakis nearly steals this movie.

Daniel Craig films
Oh Sigh. His Bond flicks are so yummy. But really, we’ll take him in anything, in or out of a Tuxedo. Out is good.

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If you have pain during intercourse, you need a good, thorough physical exam to start, to make sure there is no obvious cause for the pain with penetration (for example, vulvodynia/vestibulodynia).

If the exam doesn’t identify any apparent physical cause, you might spend some time on MiddlesexMD‘s recipe for sexual health, walking through each component to see what makes a difference:

  • Understand the physiology of menopause so you understand what you’re compensating for.
  • Learn to care for your vulvo-vaginal tissues, including considering moisturizers or lubricants.
  • Compensate for less sensitivity in genital tissues with more stimulation — and more patience!
  • Maintain pelvic floor muscles to encourage circulation and maintain orgasms.
  • Attend to emotional intimacy — because the brain is a vital part of arousal for women.

Our website is structured to help you learn about and address each of these topics; just follow the tabs across the top. You’ll need patience to figure out what combination of strategies will work for you, but continued use of the vagina is recommended for continued sexual activity. Avoidance because of pain only makes matters worse.

Be in touch if you have questions as you explore possible approaches to get past this pain. It’s worth the time you spend!

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The most important thing is usually to re-estrogenize the vagina—with localized, not systemic estrogen. I haven’t seen a single oncologist not agree to allow breast cancer patients to use this. There are a couple of really low-dose estrogen products to use in the vagina; the estrogen is not absorbed outside of that area. Vulvodynia occasionally benefits from the localized estrogen too, or there are some topical options.

A thorough and detailed pelvic exam could help to determine where the pain is arising (vulva, introitus, vagina, pelvic floor muscles, and/or vaginal cuff). Each of these has a different solution, or maybe a combination of options.

A lubricant will help somewhat with sex, but a moisturizer (like Yes) is more important for prevention and long-term preservation (vaginal estrogen can accomplish this, too). Some of my patients use a topical anesthetic in the area. If you have lost some caliber of the vagina—some narrowing, dilators can help restore that. Some women with longstanding pain with intercourse develop vaginismus, in which the involuntary muscles of the vagina go into spasm.

Don’t stop trying! Usually we can restore comfort!

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No!  It’s great that you recognize the value of remaining sexually active, despite your decreasing libido.

As we get older, we have to learn some new techniques to continue to enjoy sex. You can use the MiddlesexMD website to have a discussion with your husband:  Take him to the site.  It will help him understand what you’re experiencing, and that it’s not “about him.”  Review together the bonding behaviors and alternatives to intercourse.

You may find a role for erotica, like DVDs or books. Just this week a woman told me that she keeps a book of erotica nearby. It works really well for her to read from it in anticipation of sex (although her husband isn’t aware she has it for this purpose).

If you’re comfortable with the idea, incorporating a vibrator may help; after menopause we do require more stimulation for arousal and orgasm.

Healthy relationships require intimacy — it’s worth the effort.

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If you’ve missed periods, you are perimenopausal. It’s likely that you are experiencing symptoms of less circulating estrogen. Hot flashes are the most common symptom from that, but the way we experience sex changes too.  Medications taken for other conditions can compound the issue.

It is not unusual to for orgasms to differ in sensation as a reflection of differing stimulation. Using a warming lubricant may help with arousal, or considering localized (vaginal) estrogen could also help. To help with arousal with a partner, you can introduce new techniques or bonding behaviors. With a partner or on your own, you might experiment with erotica—either books or DVDs.  You may want to use a vibrator, or if you’ve been using one and it doesn’t seem to be helping any more, consider one that offers more stimulation.  Our Emotional Bliss vibrators are more powerful than others and may more effectively deliver the stimulation you need. A patient told me recently that she hadn’t had an orgasm in years, but with their Femblossom, she can!

Welcome to this new phase of sexual life!

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Urinary incontinence for women is usually classified as “stress incontinence” or “urge incontinence.” Losing bladder control during sexual stimulation is most likely urge incontinence: The stimulation of the area nerves causes the urge to urinate and then contraction of bladder muscles (for some women it’s just a strong urge, for others it’s actual leaking).

While it poses no risk to you or your partner, it is definitely undesirable! Make sure to empty your bladder just before sexual activity. See your doctor to rule out a bladder infection. Performing regular Kegel exercises may be of benefit. The type, duration, and location of stimulation may influence the urge; more practice may help you better understand cause and effect. Certain positions may decrease leakage (for example, woman on top or side-lying position).

There are medications for urge incontinence that could be trialed just before having sex. Taken 10-60 minutes before sex play, the medication can decrease the urgency sensation and actual loss of urine.

This issue can really interfere with sexual expression, so addressing it sooner than later is important. See your gynecologist or urologist to further discuss which of these options are best suited to you based on your medical history.

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Of course you do your kegels, daily as suggested. You’re probably doing them right now.

No? No. Me either. Nor yesterday. Not while stopped in traffic. Not while commuting. Not while waiting in the grocery line, or any of the zillion times or places I’ve been advised to do them.

And when I do get around to them, I have kegel ADD or something. I’m too easily distracted to do them well enough, thoroughly enough, or regularly enough.

And yet, there isn’t a better, cheaper, more useful tool in our arsenal for keeping our sex muscles fit and our bladders under control.

My last big sneezing fit while at dinner with friends had me renewing my determination to do better, though.

If you’re in my boat, you may want to start with a kegel exercise tool. A set of benwa balls or a kegel weight. Especially for beginners, a little weight in the vagina makes it really easy to isolate the correct muscles, and understand which muscles we need to work. Kegel weights can help maintain patency of the vagina, and they help strengthen orgasms, if you slowly increase the weight of the kegel device over time.

(Note: You won’t want to use the barbell while waiting in traffic or in line at the grocery store. Is that clear, friends? Use these at home, on your own time, please…;-)

Weights in hand, what I need is time and focus and coaching. And ladies, there is an App for that. That is, if you use an iPhone or iTouch, you can download Kegel coaching applications for anywhere from free to about $5. I’ve found three. They’re very different, and all helpful.

Kegeltopia, $4.99. With a Kegel primer on board to help you learn about and understand the exercises, Kegeltopia has several exercise types to choose from — mini kegels, 3-second holds, elevator, and freestyle — and the ability to track your total kegel time over days, weeks, and months. Designed particularly for pre- and post-pregnancy, this is the current Cadillac of Kegel apps. The voice coach is a woman, with a lovely, calm demeanor. She uses chimes to help cue you along, calling to your inner yogi. Nothing to distract you here. It’s all pink and flowery and girly.

Kegel Exercise App, $.99. This is a clever app so generic looking no one looking over your shoulder on the subway or in the grocery line would guess what you were up to. A straightforward timer developed to help prompt you to hold and release your PC muscles for several reps, which is a general guideline repeated by most kegel instructors. I love the simplicity of this app. Love the merciful pause button. The simple two-tone cues for squeezing and resting. I can reset both the squeeze and release time to start out more slowly if the default time is too much, or increase slowly as I get stronger. Also this app feels more appropriate for both men and women. A nice app for doing your kegels together. (Yes, it’s a good idea for men to do kegels to maintain good prostate and urinary health, also to help learn to control ejaculation.) My inner geek likes this app best for the simple functionality and the price.

PC-Fitness App, Free. I think it’s awfully nice that this app writer went to the trouble, and it is free, after all. It’s got three exercise modes, 2-second squeezes with 1-second rests between, 15-second squeezes with 5-second rests between (useful for elevator up exercises, I think), and olympic-level 60-second squeezes with 60-second rests between. You can set your preferred number of reps. There is no pause button. The controls aren’t as intuitive as the one for the simple Kegel Exercise App, but read the instructions, and you’ll find its function out pretty quickly.

Right. Nothing to stop me now…

For more on how and why to do your kegels, here’s our guide.

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