Archive for August, 2011

Kama Sutra Revisited

If you came of age in the 1960s, you may have had two books on the nightstand: The Joy of Sex and the Kama Sutra. You may have even tried some of those melodic-sounding acrobatics: the “splitting of the bamboo,” the “lotus-like position,” or the “fixing of a nail.”

Or, if you’re like me, you never quite figured out what all the fuss was about. In fact, if you’re like me, you may not know what the Kama Sutra is. So, what is the Kama Sutra, anyway, and could it shake up a humdrum, middle-age bedroom routine or give you ideas for new techniques now that you’re not quite up to dangling from the chandelier?

Well, sort of.

For starters, the Kama Sutra is old. It was written in about the Third Century AD in northern India and is considered one of the oldest Sanskrit sacred texts in existence. As such, it gives scholars a fascinating peek into daily life and morés of that time. Its subject is Kama, or the pursuit of pleasure, which is the third goal in life for Hindus. (The first is Dharma, or virtuous living, and the second is Artha, material prosperity.)

The Kama Sutra is as much about the details of gracious living as it is about sex. It’s a systematic and unabashed compendium of the good life in that time and place. Here’s an example:

Now the householder, having got up in the morning and performed his necessary duties, should wash his teeth, apply a limited quantity of ointments and perfumes to his body, put some ornaments on his person and collyrium on his eyelids and below his eyes… Having then eaten betel leaves, with other things that give fragrance to the mouth, he should perform his usual business.

The most intimate details of sexuality are dealt with in the same level of detail and objectivity. There are chapters on attracting a wife, the relationship among one’s wives, relating to the wives of other men, and relating to courtesans. The chapter that gripped the Twentieth Century imagination, however, is the chapter on sexual union. Here are sections on types of kissing, biting, scratching, and “ways of lying down.” And here is where the illustrated sexual positions on your youthful nightstand came from (except that the original text wasn’t illustrated). Also, although we in the West have tended to confuse them, the Kama Sutra has nothing in common with Tantric practices. The first is a treatise for gracious living; the second is an ancient spiritual practice that includes “sacred sexuality”—a foreign concept if there ever was one to modern sensibility.

So, how might a middle-aged woman many centuries removed make use of this text other than as a doorstop or a curious read about a long-ago time in a faroff place? Well, not surprisingly, we inventive Moderns have taken the “naughty bits” from this ancient text, dusted them off, and updated them. So you can find “Kama Sutra” positions for every day of the year, some of them quite amazing.

If you’re looking for ideas that don’t require contortions worthy of a Chinese circus, try these sources:

  • Somewhat racy with photo demonstrations by live models, this article gives you 10 positions that can be achieved by almost anyone
  • A little light on content, but these positions are middle-age approved
  • Or, you could get the actual text in this modern translation by Alain Daniélou. If you want illustrations, go with this one.
And of course, you may choose not to pursue any of these ideas. As I’ve said before, sometimes spending some time just thinking about intimacy is enough to get you started!

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I Am Woman…

A while ago, a comment from a reader on one of my blog posts gave me some food for thought, and I’ve been digesting ever since.

“To me, sexuality = feeling strong and attractive and powerful and desirable,” this reader commented. “It’s important to feel like that with my man, but it’s also important to feel that way for me. And if I’ve ‘got it going on,’ it enhances my sexual relationship with my husband, too.”

So why is it important to feel confident and strong just for ourselves, and how is that connected to attractiveness and sexuality?

For starters, let’s just acknowledge that it’s darned hard to remain strong and confident as we grow older in a youth-and-beauty-crazed culture. At some point, the culture might have it, we’re not “hot” anymore; we’re not even lukewarm. We may be viewed (or view ourselves) as outdated and expendable. “…the fact remains that at midlife, women can feel invisible – or at worse, unattractive,” says psychologist Susan Quilliam in an article in the “Daily Mail.”

The good news, however, is that even in the face of such powerful negative messages, women seem to come into their own at midlife. While anecdotal evidence supports this surge in confidence, research backs it up as well. In several longitudinal studies, women over 40 reported feeling powerful, productive, and in control of their destiny. “I think middle age for everyone involves a sense of ownership of one’s self and clarity about who you are,” said Abigail Stewart, professor of psychology at the University of Michigan in an article in More.

So, despite negative cultural messages and what the mirror tells us, we manage to develop a sense of greater serenity, confidence, purpose, and productivity as we grow older. Research suggests that our emotions become more positive and stable as we age. We’ve weathered some storms. We’ve gained some perspective, even wisdom. We’ve “got it going on.” And that feels pretty good—just for ourselves.

But what does this have to do with sexuality? Or with better sex?

Sexuality—our “womanness”—is part of our essential nature. It’s our personhood. We can no more separate ourselves from our sexuality than we can cut out our heart. So, if we are confident and evolved as a person, it’s as a sexual female person, whether or not we are sexually active.

And if this confidence and maturity makes us attractive to men (and it does), we are probably also regarded highly by women as well. Also, when we are sure of our place in the world, we have the emotional energy to look outward; we can be empathetic and interested in others—and that’s attractive, too.

“People of all ages love a confident woman, one who knows her own mind and can stand up for herself. Especially, it seems, the males of this world,” writes blogger Leslie Dowden for Fabafterfifty. “The point I’m labouring to make is that a confident woman is attractive to everyone, and draws people to her—no matter what her age. But I also know that with age comes even greater self confidence—for me anyway.”

Since most of us could use a little emotional pick-me-up occasionally, here are some suggestions for cultivating greater self-confidence:

  • Look your best—as you define it. Confident sexuality isn’t about looks or clothes, but being well-groomed makes you feel good about yourself. However, once you’ve completed your toilette for the day, put away the mirror and don’t look back.
  • Cultivate gratitude. Gratitude and its sister, abundance, can revitalize your experience of the world. You can’t be grateful and indulge in self-pity at the same time. Admit it, you have a lot to be grateful for!
  • Laugh. If nothing else, a good laugh releases endorphins, which are natural pain relievers and mood enhancers. But a sense of humor is also an attractive quality, and it helps you to see the glass half-full.
  • Write your own script. You are the author of your life. Only you can write it, and it’s never too late to revise. So no more excuses! You’re responsible and in control.
  • Act with confidence until you feel it. No one feels confident all the time in every situation. Sometimes, you just have to pretend. And sometimes, the very act of pretending gives you the confidence you need.

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Some women do have sudden severe headaches precipitated by sexual activity, and often at the time of orgasm. They’re called benign orgasmic headaches, and they seem to be caused by a reversible cerebral artery spasm. While they’re not life-threatening in any way, they certainly can be a disincentive to having sex!

A beta-blocker taken before sexual activity is likely to prevent the attacks. This is the class of medications often used to treat hypertension or to prevent migraine headaches. Talk to your primary care provider about a prescription. This treatment works very well for most women, and has few if any side effects.

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Testosterone, of course, is the hormone that makes guys hairy, muscular, and sexual. But testosterone isn’t only for guys. Women produce it, too, but at much lower levels, and for us, the effects are less linear and more subtle: More testosterone doesn’t necessarily mean more libido. Yet, in many studies, a little touch of testosterone has been strongly linked to a better sex life for women.

So, what’s the big deal about testosterone, anyway? What’s its role in women’s sexuality, and what are the pros and cons of testosterone therapy for women?

First, a refresher: The most common cause of pain with intercourse for the peri-menopausal and menopausal woman is vaginal dryness that comes from the absence of estrogen—in medical terms, vaginal atrophy.  The solutions are to restore vaginal estrogen (available by prescription) or restore moisture with regular use of non-hormonal, over the counter options, like Yes or Replens.

So while estrogen is primary, we also produce testosterone—mainly in our ovaries, and only at about one-tenth the level as in men. Testosterone levels peak in our 20s and early 30s and steadily decline until, surprise!, we’ve lost about 80 percent of our testosterone-producing power after menopause. Women whose ovaries are removed are also cast immediately into “surgically induced menopause.” While we may still be sexual creatures, we’re no longer procreative creatures, so the hormonal stream is reduced to a trickle.

Enter testosterone therapy. Testosterone may be one rabbit in the bag of tricks that addresses the single biggest sexual complaint in women: lack of interest. Testosterone has been called the “hormone of desire” for women. “Women need estrogen for lubrication and comfort during sex. But they need testosterone to feel desire in the first place,” according to author and “Today” show correspondent Judith Reichman  in a 2005 “Washington Post” article. In many studies over the years, replacing testosterone has been linked to greater sexual desire, more intense orgasm, and improved sexual performance in women. There’s evidence that it might also improve muscle tone and increase energy levels and mental acuity.

Yet, it’s still only available “off-label,” meaning that there’s no pharmaceutical brand approved by the Food and Drug Administration (FDA).  Testosterone can be prescribed by using the male FDA-approved products, at significantly lesser dosing regimens, or by compounding at pharmacies. Testosterone, in natural or synthetic form, is available in long-lasting injections, pellets, patches, and transdermal creams or gels. Oral testosterone or testosterone pills are not recommended because they are metabolized by the liver and the possible changes that result from that.

Testosterone therapy remains controversial. Unlike in men, there’s no direct relationship between libido and blood testosterone levels in women. A woman can have a good sex drive with low testosterone or no interest in sex with high testosterone levels. Additionally, appropriate levels of testosterone for women have been hard to establish since we produce so little of it. Measuring testosterone levels in women is difficult, because of the very low levels and other factors that affect the circulating testosterone. The use of testosterone in women is usually well-tolerated but side effects may include acne and unwanted hair growth. The phase III clinical trials for testosterone use in women appear as though testosterone use in women will be safe, but finalization of these studies and FDA approval are still pending

Before beginning testosterone therapy, it’s important to address other causes of loss of libido, such as depression, medications, painful intercourse, lack of emotional intimacy, or chronic stress. But, if lack of interest in sex or the inability to experience orgasm continues to be a problem for you or in your relationship, testosterone therapy might be something to explore with your health care provider.

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If you can comfortably insert any size tampon, you don’t need much more space to allow for intercourse. I use two fingertips as a rule of thumb; that is, if I can insert index and middle fingers during an exam, I can assume intercourse is likely to be comfortable. The only time I’ve done surgery to enlarge the vaginal opening was when only a Q-Tip could be inserted–a definitive intact hymen.

What you might find helpful is vaginal dilators to help to extend the elasticity that you already have. The graduated sizes of dilators, regularly used, can gently stretch the tissue to assure comfortable penetration. I’d certainly try that before opting for surgery!

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Gimme Some Skin!

Other than bemoaning wrinkles and slathering on moisturizers at night, who among us pays attention to our skin? Yet, that tough, resilient, and underappreciated mantle that covers our entire body performs a variety of complex and vital functions, not the least of which is to make sex the delicious experience that it is.

Our skin protects us from outside invaders, regulates our body temperature, and acts as the brain’s window to the world. Its outer layer (the epidermis) is stain-resistant and waterproof, yet it is thinner than plastic wrap. The middle layer (dermis) is a web of hair follicles, tiny blood vessels, glands that excrete sweat, oil, and hormones, and nerve endings—lots of them.

“Indeed, the skin is a powerful interface between the mind, the body, and the external world,” writes Dr. Bernardine Healy in US News and World Report. “The emerging concept of a neuro-immuno-cutaneous-endocrine network recognizes the skin as an almost independent, untamable intelligence.”

Not only is our skin the body’s largest organ, but all those nerve endings also make it incredibly sensitive to touch, and we humans need touch in order to thrive physically and emotionally. Touch releases  oxytocin, called the “bonding” or “cuddle” hormone. Some researchers suggest that men may need loving touch more than women, who tend to have greater opportunity for cuddling in the normal course of events.

Due to this exquisite sensitivity, our skin, then, is often considered the body’s largest sex organ. “At the very heart of sex is our need for touch,” writes Sandra Blanton in her doctoral dissertation. And touch is at the heart of our skin’s function. This concept gives us an expansive new erogenous zone—a giant sexual playground—to explore in bold and subtle ways.

Here are suggestions for beginning the discovery:

  • Soft touch. Lightly run your fingers over your partner’s arms and legs or the nape of the neck. This kind of light touch “activates the parasympathetic nervous system, inducing a relaxed state,” according to Barbara Keesling, PhD. It also feels good.
  • Close your eyes. Losing one sense (your eyesight, in this case) makes the others more acute. As you caress your partner (or vice versa), experiment with intensifying skin sensations by shutting down one or more senses. Enhancing the experience is the element of surprise—the inability to anticipate what’s going to happen next.  
  • Tease. The skin on the inner thigh, the belly below the navel, the breast around the nipple, the small of the back—the “almost” zones—is particularly thin and sensitive. Explore with hand or mouth these areas around the target without actually going in for the kill. The anticipatory buildup is incredibly erotic.
  • Be a little painful. As sexual excitement mounts, endorphins are released. These chemicals make us feel good, and they act as natural pain-relievers. At this point, a little spank, a light scratch, a pinch create both an element of surprise as well as increasing blood flow to the skin. As Kinsey Insititute researcher Debby Herbenick writes, “It hurts so good.”

In the end, of course, nothing beats the lusciousness of full-body contact, when all those neural connections are igniting, whether in anticipatory passion or in the tranquil delight of afterglow. Makes you grateful for a little skin, doesn’t it?

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A burning pain upon penetration is a classic symptom of vulvodynia (also known as vestibulodynia). The cause is not well understood, but it’s more common in low-estrogen states–like menopause. The diagnosis is made by a careful examination of the area near the opening of the vagina or hymen; the area appears somewhat reddened and even touching lightly with a Q-Tip will cause discomfort.

I have seen significant improvement with “re-estrogenizing” the vagina, which is done with prescription localized estrogen that is absorbed only in the tissues in that area and does not circulate in significant levels throughout the body. Another successful option has been a compounded (custom-formulated by a pharmacist) topical combination of estrogen and testosterone, applied to the area twice a day for 12 weeks. These two options can also be beneficial in combination.

Finding the right practitioner who is familiar with this condition is critical. A gynecologist will be most helpful, and I recommend finding one who is NAMS (North American Menopause Society) certified and in your area by searching their website by zip code.

It is highly likely that this can be successfully treated and sex will be comfortable again!

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Admit it, ladies. When it comes to menopause, we’ve sucked up all the oxygen in the room. We’ve cornered the market on attention, research, and therapies. So when men exhibit hormonal symptoms, such as decreased libido, confusion, irritability, fatigue, and insomnia, we chalk it up to a “midlife crisis,” wait for the red convertible, and hope it doesn’t include the 20-something girlfriend.

Many men experience male menopause (or andropause), and all men lose hormones as they age, albeit more gradually than women but with similar effects. Men’s testosterone levels decrease by about one percent per year after age 30. By age 70, testosterone levels are about half what they were at their peak. Even in younger men—in their 40s, 50s, and 60s—the effects of low testosterone can result in mood swings and problems with libido and with maintaining an erection. For most men, this is a severe blow to self-esteem, and it often becomes the pink elephant in the bedroom—denied and overlooked only with very selective vision.

During this life passage, our support is a critical factor in how well our men weather it. “Without an understanding partner, these problems may result in a powerful combination of anxieties and doubts, which can lead to total impotence and sexual frustration,” write Drs. Caroline and Andrew Dott on their website. And if our man is having problems with libido and mood swings, guess what? Our sex life just went south as well.

The reality of male menopause and how best to treat it is still frontier territory—a lot is unknown and a lot of discussion is ongoing. Hormone replacement therapy for men, while promising, is still in need of long-term research. However, for men without underlying emotional or physical problems, testosterone therapy may help reverse the more distressing symptoms of andropause.

As with women, however, the first task is to eliminate any underlying physical or emotional condition that could contribute to loss of libido, impotence, and the symptoms of male menopause. Whatever a man’s testosterone level, if he is obese, if he drinks or smokes or is inactive, his sexual performance will be affected. Smoking and drinking can actually damage, sometimes irreversibly, the nerves and blood vessels in the penis. Certain medications can also affect sexual performance.

The good news is that sexual performance is strongly linked to good overall health for both men and women. Men who are active and who exercise regularly report greater sexual satisfaction than inactive men. So in the course of helping your partner through this phase, you may both gain a healthier lifestyle.

During this challenging time of change and adjustment, it’s important to be aware that your partner could be experiencing many of the same hormonal changes that you are and that your understanding and support is critical. Consider:

  • Educating yourself. Broaching the subject of the physical and emotional changes you’re noticing in your mate is a very touchy subject. Read books like Surviving Male Menopause: A Guide for Women and for Men by Jed Diamond.
  • Breaking the silence gently. Encourage your partner to talk to a doctor or counselor, but expect resistance. It will take time for him to process and acknowledge the very uncomfortable changes he’s experiencing. Denying that there is a problem doesn’t make it go away.
  • Changing the family diet. If you haven’t already, now is the time to adopt the healthful eating habits that will serve both you and your partner well during these transitional years and beyond: low fat, lots of fresh fruits and vegetables, whole grains… you’ve heard it all before.
  • Modeling healthy habits. You can’t steamroll your partner into self-improvement, but if you set the example by working out regularly and not smoking and drinking, maybe your partner will decide to join in. If nothing else, at least you’ll feel better.

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“Your most powerful sex organ doesn’t lie between your legs,” the famous sex researcher Alfred Kinsey is reported to have said. “It lies between your ears.” (Or, of course, as Dumbledore said to Harry Potter, “Of course it is happening inside your head, Harry, but why on earth should that mean that it is not real?”)

This has some interesting implications for sex—and for everything else in life.

Your brain is your personal Grand Central Station with gazillions of nerve impulses arriving and departing, docking, disconnecting, and releasing armies of little chemical messengers, like dopamine, oxytocin, and serotonin, into your system. In fact, these neurochemicals are what makes sex—or drugs or food—so irresistible.

Yet, you are more than your neurochemical impulses. You make choices; you can direct the course of your thoughts and actions. And therein lies the potential for harnessing that big brain power to improve not only the quality of sex you have, but also the quality of your life.

Begin with thoughts. “As you think, so you shall become,” goes the adage, so begin training your mind to think positively. Happy thoughts, sexy thoughts, visualizing yourself as a powerful, confident, attractive woman, actually recreate the circuitry in your brain. You can become happier and more powerful and confident, simply by rewiring your brain with a different kind of thinking. On the other hand, “when you’re immersed in swarms of negative inner dialogue about yourself and how you think and feel about sex, you’re grinding your sensory responses down to nubs,” writes Natalie Geld in her blog. So the first mental exercise—and it isn’t easy—is to harness the power of your thoughts.

Practice mindfulness. We’ve written about this a lot because it’s so important. We all experience the nonstop nattering of our chatty left brain; we’re all familiar with the distractions of tomorrow’s deadline or yesterday’s meeting that intrude on sex, sleep, and quiet evenings at home. Distraction is built into our fast-paced, multi-tasking, fragmented culture.

Mindfulness, on the other hand, is the mental practice of being fully present in the present moment, of installing an off switch in your left brain. It’s a discipline rooted in Eastern spirituality that immerses you in the present without distraction or judgment. You can practice mindfulness anywhere, but what better place to begin than when you’re making love? For one thing, nothing is sexier than someone who is completely focused on you; for another, it encourages your partner to respond in kind.

In one study conducted by researchers Lori Brotto and Julie Heiman with the Kinsey Institute, women who had been treated for gynecological cancer were given a “phychoeducational intervention” to help them reestablish sexual desire and arousal. One component of the intervention included mindfulness training. “In particular, the women reported the mindfulness component to be most helpful,” write the researchers in their report.

Paying attention to the present moment engages all the senses: the smell of your partner’s breath, the flecks of color in his eyes, how his skin feels against yours. Relaxed attention allows to you to release stress, which in itself can make sex more pleasurable. “Distracting thoughts, stress and worry are enemies of orgasm,” writes Debby Herbenick, a researcher with the Kinsey Institute.

Some ways to develop a more attentive, mindful approach to life:

  • Do yoga. Besides developing strength and balance, yoga is all about clearing the mind of distractions.
  • Practice meditation. Whether a religious exercise or simply a way to relax and relieve stress, the purpose of meditation is to develop the ability to focus on the moment.
  • Pay attention to everyday activities. Next time you walk, wash dishes, eat a meal or perform any simple, repetitive task, don’t turn on the iPod or television. Don’t multi-task. Simply pay attention. Focus on the taste, sights, and sounds around you.

While sexual problems often have physical origins, don’t discount the power of the mind in contributing to their resolution. Positive thoughts and mindful activity can make sex better, and they can make life better.

“Our ability to achieve an erection or ability to attain orgasm is far less important than our thoughts about those abilities,” writes psychotherapist Elisha Goldstein, PhD. “More often than not, unsatisfying sex is caused by the mind.”

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Today, more and more women over age 50 are finding themselves sharing their households with parents and/or grown children. A recent article in the Atlantic magazine, “Grandma’s in the Attic, Junior’s in the Basement,” talks about the big jump in multi-generations living under one roof, from grandpa or grandma who move in to adult kids who move back.

The article cites a recent Pew Foundation study estimating that 16 percent of the U.S. population now lives in multi-generational households—the largest share since the 1950s. Reasons range from economics to caring for elderly parents.

These findings made me think about how complicated it can be for women in that situation to keep their sex lives alive and kicking. If you’re married, having a romantic evening (let alone having sex) presents all kinds of logistical problems. Knowing that your 78-year old mother is in the next room is not exactly an aphrodisiac.

If you’ve got grown children around, they can be even worse: Even a hint of parental romance can still gross them out (although they should know better!)—and curtail any action on your part.

To make matters worse, this multi-generational living may not have been your first choice; it may be happening just when you were starting to really enjoy being alone with your partner again, comfortably settling in as empty nesters.

So what’s a sexually active, post-menopausal woman to do? Make an effort, that’s what.

Go on an overnighter every few months, even if it’s just to the hotel downtown. Or ask friends if you could borrow their cabin in the woods some weekend.

Yes, it might take some planning ahead, but that in itself could be exciting (as those Viagra ads imply). So when grandma goes to visit your sister and your kids are out on their dates, make your own date to “meet in the bedroom” once the coast is clear.

Or be spontaneous and grab any moment that presents itself. Make a game out of it.

The point is, if you have a healthy sex life, don’t let these new circumstances ruin it for you. Good sex is not something to let casually slip away. And the way to keep it is to keep at it, making a commitment to get together in spite of your situation. Make it a priority; put it at the top of your “Things to do” list once in awhile!

Because, remember, having a good sex life is good not just for your relationship but for your overall health. If you do get caught by an older or younger resident, tell them you were just “exercising”!

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