Archive for May, 2011

(But you probably knew that, right?)

I wanted to elaborate a bit more on the Wall Street Journal article I mentioned in a recent post. “The Joy of Researching the Health Benefits of Sex,” (a play on the famous book, The Joy of Sex) talks about what researchers are finding about the physiology of sex and the health benefits that may come along with it—a topic I’m always interested in exploring.

Dr. Irwin Goldstein, a urologist and director of sexual medicine at Alvarado Hospital in San Diego, says some benefits are obvious even without scientific evidence. “When you have good sex, there’s a relaxation response and a satiation response… you lie there and life is great.”

That’s the result of hormones and neurotransmitters that rise and fall during sexual activity, especially dopamine and oxytocin, which we’ve discussed before. That nice relaxed feeling is what sometimes causes people to fall asleep right afterwards. In fact, in a 2006 survey of 10,000 British men, 48 percent admitted to having fallen asleep during sex!

Not that we want to encourage that, but it’s comforting to know there’s a physiological reason for it.

Another researcher, Stuart Brody, a psychologist at the University of the West of Scotland, says all this relaxation can be very helpful in reducing stress in both men and women. In one study, he had people keep diaries of their sexual activities for two weeks, then took their blood pressure while performing a stress-inducing activity such as adding numbers rapidly in their heads. Those who had had intercourse during the fortnight had smaller blood pressure spikes more quickly than those who had no sex at all.

While you’ve probably experienced a peaceful feeling immediately following sex, you may not have been aware that its benefits were so long lasting.

Researchers have also studied sex and its relationship to cancer: Can frequent sex lower the risks of some types of cancer? Although there is evidence that does point to that, most researchers say there are too many other variables in the studies to draw any certain scientific conclusions about it.

The real lesson, says Dr. Erick Janssen, a senior scientist at the Kinsey Institute at Indiana University, is how sex can contribute to our overall well-being. “If you’re having sex in a frequency and in a way that is compatible with who you are, then that’s healthy.”

I couldn’t agree more. How about you?

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Sex Goes Mainstream!

I’m very happy to tell you about an article that appeared recently in the Wall Street Journal about… sex! It’s encouraging to me to see that a traditional business publication like the WSJ is actually broaching the subject; the more we see sex talked about in mainstream media, the better for us all.

Because as I’ve said before, I don’t think sex should be a taboo subject; it’s a big part of our lives. The more informed we are about it, the better.

In the past, it’s pretty much been the domain of women’s magazines, but the articles on sex have often been of the “How to please your husband in bed!” variety, rather than more serious discussions, like how it affects or interacts with your overall health.

I’m seeing evidence that it’s changing. Psychology Today, too, now often reports on sex in a very open way, as do many highly respected websites, including MayoClinic.com and WebMD.com.

I’ve even been invited to appear on local television—and before 9 p.m.!—to talk about the role of sexuality in our lives as mid-life women and how to keep the spark alive in long-term relationships. (I don’t often toot my own horn, but if you’re curious, you can see the video online.)

As for the Wall Street Journal article, called “The Joy of Researching the Health Benefits of Sex,” it covers some of the same topics we’ve discussed here on the blog, like how sex increases oxytocin (the author referred to it as “the cuddle hormone”) which promotes bonding and stimulates endorphins.

I’ll talk more about other medical findings they mentioned in another post; my point here is that I’m just so thrilled to see mainstream media joining in the discussion!  Who knows how many dinner table (or wine and cheese) conversations that story prompted between friends or spouses and partners. The more comfortable we all become talking about sex, the easier it will be for women to feel free to discuss sexual problems with their doctors. And that’s huge.

The discouraging part about the article was what a scientist said about getting funds for sexual research. “If ‘sex’ is in your grant proposal, it’s very hard to get it approved,” said Dr. Irwin Goldstein, director of sexual medicine at Alvarado Hospital in San Diego and editor in chief of the Journal of Sexual Medicine. Bummer: No money, no research, no new information to enlighten us.

But I really do believe that’s changing, and you have the power to help. So I encourage you all to contribute to the discussion. If the Wall Street Journal can talk about how many calories sex burns (about five a minute), so can you!

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Whenever there are neurologic implications to a disease process, sexual response can be affected; these are difficult issues.

I did see an MS patient just recently who had not experienced orgasm in about five years. Some of the medications that treat her MS also interfered with orgasm. Fortunately, she was able to find success with Emotional Bliss vibrators for added stimulation–even though other vibrators hadn’t worked for her.

Emotional Bliss vibrators are designed to have the strongest vibration and stimulation of the products we reviewed. The Isis, Femblossom, and Womolia are three options we offer at MiddlesexMD that all have that stronger power, which is better for older women and those who may have medical conditions like yours, diabetes, or medication side effects.

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As we’ve discussed before, experiencing pain during intercourse is not unusual for post-menopausal women. The general medical term for it, dyspareunia, is defined as “recurrent or persistent genital pain associated with sexual intercourse in either the male or the female.”

And it’s nothing new; “difficulty mating” was mentioned in Egyptian scrolls nearly 4,000 years ago! But just because dyspareunia is a common problem doesn’t mean it’s normal or that you have to live with it. Sex should never hurt. So it’s important to acknowledge and address any pain issues as soon as you notice them. And the sooner you tell your doctor what’s going on—with as much specific description as possible—the better: Early intervention can prevent a bad situation’s getting worse.

What causes the pain? It varies. It might be simple dryness or vaginal atrophy. Or it could be another condition called vaginismus, which is a little more complex.

Vaginismus occurs when the muscles of the vagina go into an involuntary spasm. The resulting tightness prevents or limits penetration and can be so severe that even a vaginal exam or inserting a tampon is impossible. Some women describe it as “hitting a wall.”

The causes of vaginal spasms can be physical or psychological or both. Physically, loss of lubrication and elasticity in the vagina can contribute to it.

The psychological causes are more problematic. What happens is this: Once you experience any kind of pain with intercourse, you’re afraid it will happen again. Your brain reacts accordingly and the anticipation of that pain creates a fear that can actually trigger the spasm. So it’s really out of your control.

The spasms may also be a protective measure brought about by trauma; women with vaginismus may be survivors of rape or abuse. (Well-known sex therapists Masters and Johnson identified this as a psychosomatic illness back in the 1970s.)

The ultimate result is that you want to avoid sex altogether. And that can create a vicious cycle that can wreak havoc not only in your sex life, but in your relationship, too. You no longer want or enjoy sex because of the pain associated with it, and your partner feels rejected and maybe even a little resentful or angry. You feel guilty and you’re both left frustrated, unsatisfied, and unhappy.

The good news is, vaginismus is very treatable, once it’s recognized and diagnosed. In the next post, I’ll tell you what to look for and what to do if you suspect you might have it. In the meantime, if you are having pain, share this information, so your partner knows that what you’re experiencing is real. And that you’re determined to find a solution!

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Vaginismus, a vaginal muscle spasm that prevents penetration, can be part of a vicious cycle of pain and response. If you experience painful intercourse, your natural desire to avoid the pain may be a psychological trigger for vaginismus, which occurs involuntarily.

How do you know whether it’s time to talk to your doctor? The keys are frequency and persistence, but I hate to tell women they need to endure pain for any specific length of time before they talk to me about it. If pain is recurring or persistent, if you take note of it, if it affects your ability to enjoy intimacy, I’d recommend that you talk to your health care practitioner.

Maybe you’ve been avoiding going to the doctor because you’re afraid the exam will be painful, and that’s very understandable. And you’re not alone, believe me! Pelvic exams cause anxiety in most women—even without the added complication of suspected vaginismus. But a trusted gynecologist or menopause practitioner will be very familiar with vaginismus and related conditions and will know how to approach the exam.

If you’re uncomfortable talking about what you’re experiencing with your doctor, consider printing out this post (and the previous one) and taking them with you to get the discussion started. Write down your exact symptoms—where it hurts and when—so you can describe what’s happening. You can also read more about vaginismus; learning about it will help you ask your doctor more specific questions, like, “Do my pelvic floor muscles seem too tight?”

Treatment requires the right combination of physical and cognitive therapies, especially if your condition is psychologically induced vaginismus. In that case, retraining the body and the mind to accept vaginal penetration is part of the treatment. Other techniques may include:

  • The use of a dilator, which can increase your comfort gradually
  • Botox injections
  • Exercise, such as Kegel, and/or pelvic muscle therapy
  • Pain management techniques
  • Relaxation training

It’s also worth noting that vaginismus is common among women who force themselves to have sex when sex is painful. I hope you’re not one of them! If you are having pain during intercourse, please go to your doctor and let the healing begin. Then you—and your partner—can get back to enjoying sex again.

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You say that your husband had a tumor removed from his lip, and you’ve experienced some discomfort since then after oral sex. The only possibility I can imagine that’s specific to your situation is if he’s using topical chemotherapy, a scant amount of which could be transferred to you.

It’s more likely that the saliva is an irritant. As our vulvar skin becomes more thin and fragile, it can be irritated by enzymes in the saliva. You can use warm water–you don’t need soap–to rinse after oral-genital contact. And you may find more comfort by using a lubricant like LiquidSilk or Yes (which is also a moisturizer) at the opening of the vagina and surrounding area.

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Scary, huh?

Being completely vulnerable to another human being can be scary, even if that person is our life partner. Yet, just as sex involves physical nudity, great sex demands a similar level of psychological nakedness. So, vulnerability is one of the eight components of great sex identified by a team of researchers in a study published in The Canadian Journal of Sexuality.

Study participants described this level of vulnerability as “being able to put your entire being in someone else’s hands” or “like jumping off a cliff” and yet feeling safe. It’s a deliberate act of surrender to your partner with nothing held back. And for the respondents of this study, vulnerability made the difference between good sex and great sex.

Vulnerability cuts to the heart of self-preservation. Our instinct is to protect ourselves, to hide just a little, not to completely bare our throats. We may do this because we’re afraid of rejection, or of being ignored, or of being controlled, or because we’ve been hurt in the past, maybe even in loving relationships. We may also be dragging into our adult lives some unexamined anxieties from our childhood—fears that can exert a powerful influence no matter how outdated or irrational they may be. And the bedroom with all its intimacy and nakedness is just the place where these fears, past and present, are likely to intrude.

Acknowledging and examining what holds us back from self-surrender to a trusted and loved partner is a good and healthy exercise. After all, we’ve probably developed more mature ways to handle pain and rejection than when we were children. And these unpleasant emotions can also reveal to us areas in which we still need to grow. What better place to practice trust, vulnerability, and self-revelation than in the midst of a loving relationship?

So examine your barriers to intimacy. What’s holding you back? What are you afraid of? What keeps you from being vulnerable? Then risk sharing those fears. That’s the first important step toward deeper levels of intimacy. You might also practice asking for what you want as well as asking your partner what feels good or what you could do that would be more pleasurable.

Taking the risk of deeper self-revelation can also encourage our partners to respond in kind. But in any case, what do we have to lose? Some outdated fears? A twinge of embarrassment or pain? And we stand to gain a deeper, more satisfying relationship with the person we’re closest to. And, maybe, great sex.

So, go ahead. Jump.

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A while ago, we began exploring the qualities of great sex that were identified in a study published in The Canadian Journal of Sexuality. These qualities were gleaned from interviews with 20 sex therapists and with 44 ordinary people who identified themselves as having experienced great sex. From that material, the researchers gleaned eight characteristics that popped up repeatedly. The list was surprising. Rather than sexual acrobatics or obscure paraphernalia, the list included qualities like connection and authenticity—which would tend to make any relationship great.

One of the qualities we haven’t yet discussed is the willingness to experiment with your partner. Respondents referred to great sex as an “adventure” and a “discovery process” in which they learned new things about themselves and their partners. In the study, however, this quality was often described in a playful, lighthearted context.

Anything we do repeatedly for a long time tends to become routine. We trot along the same worn dog path in which every bump and bend is familiar. After a while, any routine activity, sex included, can become a bore and then maybe a chore. That’s why here at MiddlesexMD, we often prescribe a healthy dose of novelty to spice up the routine—a change of position, place, or props, especially for partners who have been together for a long time.

But great sex goes beyond trying new toys. These respondents seemed to revel in the joyful aspect of experimentation, of trying new things together. Exploring new dimensions of sex wasn’t a test they passed or failed; it wasn’t medicine they took because it was good for them; it didn’t involve one partner trying to “sell” the other on something new. The outcome didn’t matter; how they looked didn’t matter. What mattered was that both partners were engaged in the adventure and were having a good time doing it. Often, too, the exploration uncovered new qualities about the relationship or themselves.

Playfulness has to be genuine, and this joyful experimentation probably also requires another aspect of great sex that the researchers identified: extraordinary communication. But whatever the quality of our communication or spirit of adventure, it’s always possible—and helpful—to be open to new things, to be willing to relinquish the safety of routine and even boredom, and to step into new territory, even if it involves some risk and some energy. And if playing together also contributes to a great sex life, well then, game on.

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I’ve talked before about the benefits of touch and said that we’d give you some tips on how to give a “sexy” massage. Well, here they are!

While professional massage therapists are trained to really work the muscles, our suggestions are more about achieving intimacy in a sensual, relaxing way. So it’s more about technique than strength. Giving a massage requires emotional generosity and presence, so take your time. Don’t rush and enjoy the moment alone together. And let us know how it goes!

What you’ll need: A firm surface, pillows, a clean sheet, warm oil, scented candles (or combine the two in oil-producing massage candles), and soft, romantic music.

  • In a darkened room, with soft music playing and candles lit (but out of the way) have your partner lie face down on a firm, flat surface, such as couch cushions on the floor, with pillows under the neck, knees and ankles. Cover your partner with the clean sheet, pulling it down to expose the specific areas where you’ll be working, starting with the neck and shoulders.
  • Rub a few drops of the warm oil into your hands.
  • Using both hands, start at the bottom of the neck and make firm strokes outward along the shoulder and at the top of the arm. Use long, pressing movements.
  • Press your thumbs in firmly at middle of neck and go round and round in small circles.
  • Use the thumbs to work into the muscles at the base of the neck. Pay attention to any knots or areas of tightness that you find here working firmly and slowly into the muscles, continuing to make tiny circles.
  • Next, lay one hand flat on your partner’s shoulders, then press the other hand on top and rotate slowly.
  • Keep your fingers together and palms in full contact with the part you’re working on.
  • Glide your hands slowly down either side of the spine, back up the sides of the body. Keep your thumbs on each side of spine, using very little pressure in this area.
  • Begin using a kneading motion as you work toward the arms, biceps, buttocks and thighs. Just lift and squeeze the area, keeping your palms in full contact with the skin.
  • For small areas like soles of feet and palms, apply friction with your fingertips. To do this, anchor the area you’re massaging with one hand and use the other to deeply press and rub.
  • Have your partner flip over and repeat the same kinds of motions on the front side, moving down from the top, until you’ve covered every body surface.

Don’t worry about whether you’re doing it “right”! Your goal is to create new ways of connecting through the power of your touch.

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Yes, vaginal dilators will help gently and gradually to assure that your vaginal tissues are stretched. I recommend using them one or two times a day for 20- or 30-minute sessions. The more you use them, the more quickly you’ll get the results you’re looking for.

Dilators come in graduated sizes, starting as small as a half-inch diameter and stepping up to 1 3/8-inch diameter. Take your time, and I’m sure your first experience will be a comfortable one! Congratulations.

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