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Archive for April, 2011

The notion of body image has to do with how we feel emotionally about our appearance rather than how others view us or how we look objectively (height, weight, eye and hair color). It’s a complex and many-colored concept that can be affected by things like past experiences (your mother’s long-ago comment about your “cute pudge,” for example, or, more difficult, sexual abuse), by cultural norms, by physical disease or injury, and by our own level of confidence and self-esteem.

According to researcher Marta Meana, Ph.D. from the University of Nevada, in her talk at a recent International Society for the Study of Women’s Sexual Health (ISSWSH), negative body image is the third most common “disincentive to sex” for married women—even if we enjoy sex; even if we might feel like it at the moment. A negative body image is pervasive and potent. Many of us are embarrassed about our bodies to the extent that those feelings invade our most intimate relationships. Case in point: the woman whose husband, in 22 years of marriage, had never seen her naked body.

Granted, it takes a stout disposition to feel confident about our bodies in the face of our youth-crazed, celebrity-obsessed, skinny-jeans culture. Even when advertisers target a “mature” demographic, the models look like 30-year-olds with graying temples. The mantra that “30 is the new 50” perpetuates that unrealistic image against which real people like ourselves, with cellulite, love handles, saddlebags, sagging breasts, and fatty backs stand no chance.

However, for those of us who do manage to feel good about the way we look, it seems that a positive body image is strongly linked to more frequent and more satisfying sex. In at least one recent study, researchers at the University of Austin found “significant positive relationships between sexual functioning, sexual satisfaction, and all body image variables.” Body image variables included things like weight concern, physical condition, and “cognitive distractions during sexual activity”—those irritating thoughts about our bodies that invade our intimate moments.

Another study of older women found that those who perceived themselves as less attractive also reported a decline in sexual activity. (They did, however, report that sex was still satisfying when they did engage in it.)

As we age, then, we’re confronted with an opportunity and a challenge. While we may be more accepting, mature, and confident, we’re also experiencing physical changes that are deemed undesirable by our culture. We can enjoy our evolving maturity and freedom, or we can cop to the cultural myth that labels aging unattractive and unsexy.

If you find yourself distracted by thoughts of your midriff rolls during sex or have the urge to dress–and undress!–in the closet, try these remedies:

  • Get naked in private. Walk around nude. Familiarity with your naked body might help you become more comfortable with it.
  • Get fit. No matter the size of your jeans, exercise makes you look and feel better. It’s also a good way to become more aware of your body—and maybe more appreciative of how well it works.
  • Think positive. A survey conducted by Glamour magazine with Ann Kearney-Cook, PhD, revealed that most women think about their bodies negatively every, single day. And sometimes these thoughts are shockingly negative. This is powerful negative reinforcement. Be aware of your negative thinking and make an effort to break the cycle.
  • Practice acceptance. Self-confidence is a turn-on all by itself. There’s nothing sexier than a woman who is comfortable in her own skin.

While making love with my partner I worried that he would see a hair here, or a flabby spot there, and be turned off. I noticed that he was never self-conscious about a skin blemish or when he gained a few pounds. So I started copying him and concentrated more on the sexual pleasure I felt. I began enjoying sex a lot more, and he noticed. He said it made him more excited, and the result? A great new circle of passion and sex.

from Our Bodies, Ourselves: A New Edition for a New Era, 2005, Boston.

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“I can tell you the movements he’s going to make step-by-step. He can get me off, but it’s sex. It’s not making love.”

–quoted by Marta Meana, Ph.D., University of Nevada, Las Vegas, “When Feeling Desire Is Not Enough: Investigating Disincentives to Sex”

If I had a nickel for every woman with this complaint, I could retire tomorrow. According to Dr. Meana and others who study female sexuality, boredom is the second biggest disincentive to sex in married women. But of all the sexual challenges, this one is the most fun—because the cure requires creativity, lightheartedness, and the willingness to play.

No matter how red-hot the passion once was, over time it’s bound to cool to glowing embers. Left unattended for years, however, that flame will begin looking more like gray ash. Doctors and counselors—and your girlfriends—all have recipes for bringing the romance back into your relationship. I’m not trying to reinvent the wheel, but here are some suggestions I’ve gathered from various sources that look like fun to me.

I would, however, encourage you to take the initiative in this endeavor to reinvigorate your sex life. It’s too easy to take a passive “hurry up and get it over” attitude. You’re half the partnership, so you bear some of the responsibility for your love life. You can be more forthcoming with what feels good to you and what you’d like to try. I’m betting that your partner will be pleasantly surprised and willing to try.

  1. Spend time together doing nonsexual things. For women “it’s not what happens in the bedroom—their desire arises when they are interacting with their partner, just touching, talking, when they go on a hike or a picnic, that starts to get them sexually interested,” said Patricia Koch, Ph.D., Associate Professor of Biobehavioral Health & Women’s Studies at Pennsylvania State University in a recent article. The first step, then, in rekindling the flame is to become romantically reconnected outside the bedroom.
  2. Try self-stimulation. This may sound counterintuitive, but the idea is to “get your head in the game,” not to create a substitute for sex as a couple. Sometimes masturbation can reignite that spark of sexual interest that leaves you wanting more.
  3. Talk about what you like and what you want to try. As a more mature woman, you know what you want; you’re more confident in asking for it. Maybe your partner has some idea to try as well.
  4. Break the mold. No doubt, routine is boring. New places, positions, accessories, and techniques are an antidote to routine. Check out our website for suggestions or this list of romantic movies. Read an erotic book together. You’re only limited by your imagination.
  5. Keep it light. This should be a fun exploration, not a do-or-die ordeal. The goal is to expand your sexual repertoire as a couple, to pleasure each other, to reconnect both sexually and emotionally. You aren’t trying to become sexual athletes or to experience orgasm every time.

So—boring sex? Not to be glib, but what a great problem to have. Its solution lies at least fifty percent in your hands.

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This is the first of three blog posts on the three main reasons women might decide not to have sex, a series introduced last week.

Maybe the kids have flown the coop—or maybe not. Maybe your parents need more attention. Maybe you’re still involved with your career; in fact, maybe you have a big presentation in the morning, and you need to be refreshed and on-point. Is it any wonder that sex is the last thing on your mind?

Life’s demands ebb and flow, but they never go away. And your sexual self is closely connected to all the other flotsam and jetsam of your life. However, if your stress level and the demands on your time are chronic and overwhelming, other important parts of life, such as exercise, time to yourself, and intimacy with your partner are all too likely to fall quietly by the wayside.

Chronic stress, in addition to putting a terrible strain on your overall health, also interferes with the production of hormones that fuel libido. So, even though you may love and be attracted to your partner, lack of time and energy for sexual intimacy will cause that relationship to suffer over time. And, eventually, your desire for sex will dimish, too.

If the demands on your time and energy are draining away life’s pleasures, it’s time for some tough re-evaluation. The stresses may be unavoidable, like caring for elderly parents, but there’s probably something you can do to ease the burden.

To really deal with the “too tired” state of affairs, you need to view your life holistically.  Lack of time and energy for sex is only part of the picture.

  • Take care of yourself first. Carve out some space for emotional and mental rejuvenation, even if it’s as simple as a warm bath or a night to yourself with nothing to do. But don’t expect a one-time splurge to effect lasting change. Rejuvenation takes time and it takes conscious effort. How will you regain (or discover for the first time) your peaceful inner core?
  • Take care of your health. If you don’t have time for sex, chances are you’re not paying attention to exercise or good nutrition, either. Among its many other benefits, exercise improves libido. It makes you more flexible, strengthens your joints, gets rid of aches and pains, and improves your mood. It makes you look and feel sexier. And, yes, all this takes time. Nobody said it would be easy.
  • Talk to your doctor. Is it possible that fatigue is due to an overlooked physical condition? Could your medication be the culprit? Could you be depressed?
  • And finally, pay attention to your partner. Rebuild the intimacy. Touch. Talk. Be creative. Sex doesn’t have to be all-or-nothing. Enjoy the journey; the destination doesn’t matter. Focus on pleasure, intimacy, and connection and the rest will likely follow. And yes, this takes time, too. Doesn’t anything truly worthwhile?

There’s no simple solution to dealing with stress and fatigue—or with their emotional and physical toll on your life. There’s only the desire and commitment to change—to prioritize the most important things, which happen to be your health and your most important relationships. Because, after all those pressing demands on your time and energy have gone away, you’ll either be spending much quieter years with a stranger you used to love or with your lover. Change is hard, but the cost of the status quo, at this stage of life, is unacceptable.

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We are complicated sexual creatures. For us, arousal isn’t just a matter of plumbing; rather, it’s intricately connected to how we feel about ourselves, our partners, and the rest of our lives. There is no “turn-on” pill; there is no magic potion. And while it’s true that the way we experience arousal and sexual pleasure evolves and changes as we age, there’s every reason to expect that our sexual experience can be even more relaxed, adventurous, and fun—just like the rest of our lives—if we pay attention to our overall mental and physical health. Because for us, the kneebone’s connected to the thighbone—everything’s connected.

This concept was brought home to me once again at a presentation I heard at the International Society for the Study of Women’s Sexual Health (ISSWSH) by researcher Mara Meana, Ph.D. from the University of Nevada. Dr. Meana examined the reasons women might decide not to have sex, even if they were aroused and feeling sexual desire.

Of course, those reasons differ depending on the woman’s life stage and personal situation, but what struck me was that the three main reasons that married women gave for avoiding sex were:

  • Fatigue and the need to conserve energy
  • Boring sex
  • Negative body image

Sound familiar?

So, you may like having sex; you may be feeling aroused; you may be attracted to your partner, but you still avoid the time, energy, and emotional vulnerability of intercourse because of one or more of those three “disincentives.”

I think this merits a closer look because boredom, fatigue, and a negative body image are powerful ways to stifle that spontaneous, buoyant spirit we’ve so richly earned at this stage of life. In the next few posts, I’d like to examine these disincentives in greater detail and suggest some ways to overcome them.

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The exercise balls slide out because the muscles of the pelvic floor are weak. Contracting and working the pelvic floor muscles will make them stronger, and they’ll keep the exercise balls in place longer.

Start slowly: You might leave the balls in only a short time, keeping your pelvic floor muscles contracted to hold them in place. (Specific how-to instructions are on our website–and we found an app that helps!) Depending on how much muscle strength you have, you may need to start while sitting or lying down rather than standing.

As with other muscles, it will take weeks to build strength in those muscles, but it definitely happens! Exercise balls or other Kegel tools help by making it easier to tell that you’re flexing the right muscles. And the payoff is big–not only does a strong pelvic floor counter incontinence and hold your organs in place, it can also strengthen orgasm.

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Our last post talked about the side effects of prostate cancer treatments for your partner, including loss of libido and erectile dysfunction, and the fact that both of you are affected. While these problems can be devastating to couples who have always enjoyed a healthy sex life, it doesn’t have to mean it’s all over. The important thing is to work together to find solutions that work.

I recommend three steps that happen to start with E: educate, explore, and experiment.

First, educate yourselves about the range of solutions available that might help with the physical limitations you’re now living with, including drugs such as Cialis, Viagra, and Levitra. Penile implants also have a good success rate. While that procedure may be expensive, insurance will often cover some of the costs. Penile injections are also worth considering.

There’s a lot of information online about these solutions, and several books, too, such as Saving Your Sex Life: A Guide for Men with Prostate Cancer, by Dr. John Mulhall.  Your spouse’s urologist should be able to help, too.  Set aside some time just to investigate what’s out there and what might work for you.

You might also want to consider going to a sex therapist, who can help you in your next phase: exploration. If the above solutions don’t appeal to you, or don’t work for one reason or another, start exploring other ways to satisfy your sexual appetites given your new limitations. A sex therapist is trained to offer guidance and may have suggestions you hadn’t thought of. Even if you do decide to try some of the above solutions, a sex therapist can be a tremendous help and a valuable resource. (Visit the American Association of Sex Educators, Counselors, and Therapists website for references.)

As for experimenting, if you’ve never tried a vibrator, this might be the time to start.  And yes, your partner can be part of the enjoyment. In fact, there’s a wonderful column about this by journalist Michael Castleman, who has written about sexuality for 36 years. He wrote a post called, “Gentlemen, Let’s Welcome Vibrators Into Partner Sex,” in which he says, “vibrators are as natural as music or candle light…” as he encourages men to experiment with their partners’ favorite sex aids.

Of course, oral sex is another option as is mutual hand stimulation. Again, this is the time to experiment and look for alternative ways that are satisfying when penetrative sex is no longer possible. It can actually be very freeing and exciting to experiment. In fact, some couples find they become even closer after they can no longer have “normal” sex.

Remember, too, that cuddling, caressing, and kissing all go a long way to maintaining intimacy. The important thing is to work together to find solutions and not let these physical constraints negatively affect your emotional connection.

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Many women at this stage of life, as well as facing some changes of their own, are dealing with the very tough challenges that come when a husband has prostate cancer. Maybe you’re one of them or know someone who is. Although prostate cancer is very treatable today, it’s still terribly scary.

And if that weren’t difficult enough, along with it may come some major issues regarding a man’s sexual performance, adding even more stress and worry to the situation. Some possible side effects of surgery and/or other prostate treatments include challenges to:

  • The ability to get an erection (erectile dysfunction)
  • The desire to have sex
  • The ability to ejaculate and have an orgasm

This affects men not only physically, but emotionally, too, since men’s feelings of masculinity are often tied to their sexual performance.

And as you probably know, men are not always good at talking about sensitive subjects like this. So they often don’t delve too deeply into these side effects, even with their doctors. Or they may be so distraught about the cancer itself, that it just doesn’t seem important at the time.

But it is important. And that’s where you can help. Communicating about it is the first step to dealing with prostate cancer and its impact on your lives. In fact, prostate cancer is often called the “couples disease” because of its broad-reaching effects in the bedroom—and elsewhere.

So while these side effects may be extremely difficult for your partner to deal with, they obviously affect you, too, especially if you have had an active and satisfying sex life. It can be a devastating loss to you both.

That’s why it’s critical to discuss it. Once you’ve begun living with this type of cancer, you need to acknowledge its impact on your relationship. The good news is, there are lots of ways to maintain sexual intimacy after prostate cancer. So instead of looking at it as the end of your sex life, look at it as a new beginning. (I’ll talk about some solutions in our next post.)

It might also be a good idea to find and join a support group so you can talk with other couples about how they are dealing with this issue. I’m a big believer in sharing ideas, which I always encourage readers to do!

If you’ve had experience with prostate cancer (or similar issues) and have advice to offer others—or if you just want to share your thoughts—please add your comment.

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It sounds like you could benefit from a really good pelvic floor physical therapist. While many physical therapists have some training with the pelvic floor, there are only a few with that specialty. Find out who that person is in your community and ask for a referral to him or her.

Physical therapists will have tools that help them determine the strength of the muscles, which helps them make an informed plan for properly improving the tone; Kegel exercises are just one tool in that process. Sometimes after a trauma there is muscle spasm; part of the therapy may be training certain muscles to relax.

It’s a good approach to see how far you can get with exercise and therapy before you consider reconstructive surgery. Good luck with your continued recovery from your accident!

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Remember that play that premiered a few years back called, “The Vagina Monologues”? Well, I wish someone would write one called, “The Vagina Dialogues” so that women would start to realize that it’s okay to talk with their doctors about their vaginas!

As you know, menopause brings with it all kinds of changes to various body parts, including your vagina.  There’s a very common condition called vulvovaginal atrophy (referred to as VA in the medical world), in which the walls of the vagina become thin, dry, and possibly even inflamed due to a decline in estrogen. (The vulva refers to your external genital organs, including the labia and clitoris.)

Symptoms of vulvovaginal atrophy include:

  • Vaginal dryness, irritation, or burning
  • Burning and/or urgency with urination
  • Urinary tract infections
  • Urinary incontinence
  • Discomfort and/or light bleeding after intercourse

About half of all postmenopausal women will experience some symptoms of atrophy. But often they’ll look at these signs in isolation, not realizing that a urinary tract infection may be directly related to the discomfort they feel during intercourse—and that both might be indicative of vulvovaginal atrophy.

Although treatment is readily available, it has to be diagnosed first. But because women are often too embarrassed to talk with their doctors about vaginal problems, they don’t mention it during annual physicals, let alone pick up the phone when symptoms first concern them.

Instead, they try to treat it themselves, guessing at what might work, not knowing there’s a name for what they’re experiencing. And while over the counter lubricants may offer some short-term relief for dryness, vulvovaginal atrophy is chronic and requires ongoing treatment to address the underlying cause.

Typically, treatment for vulvovaginal atrophy involves some sort of estrogen therapy, in the form of a vaginal tablet or ring or topical cream. But the first step is getting a diagnosis. That’s why it’s so important to talk with your doctor about any changes you experience in your vaginal area.

So please: Don’t be shy and don’t wait. Be proactive and bold when it comes to taking charge of your own body. As with many other parts of life, it’s much easier to maintain healthy tissues and organs than to treat problems long after they’ve begun.

As soon as you feel anything unusual, lubricants don’t seem to work as well, or you begin experiencing any of the symptoms listed above, make the call to your physician. And begin your own vagina dialogues, the sooner, the better.

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What you describe–feeling like your partner is “hitting a wall” when you attempt intercourse, sounds most consistent with vaginismus. A physical exam can look normal; with careful palpation of the pelvic floor muscles, you can feel them tightening, which is what makes the “wall.”

You might go back to your physician with the specific question, “Do my pelvic floor muscles seem too tight?” If that is the case, dilators and/or physical therapy are good solutions. A dilator set will include much smaller sizes–as small as a half-inch–so you can increase your comfort gradually.

Good luck! This is an issue you and your partner can work through.

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