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Amp Up Your Sexy for Autumn

Autumn can be a tremendously busy time of year when work ramps up and social obligations resume. Or it can herald a return to peaceful calm after summer frenzy.

Full disclosure: There’s nothing peaceful about autumn for me! My appointment calendar is booked solid. No fewer than three healthcare conferences are on MiddlesexMD’s schedule in the next five weeks. That’s almost a rockstar schedule! (Well, maybe an aging rock star.)

So, whether your summer is an interlude or a frenzy, autumn is nonetheless an opportunity to reevaluate your relationship, sexually speaking, and recalibrate your sizzle, if necessary.

Long-term relationships have two (at least) universal pitfalls. One is boredom; the other is neglect. Occasional boredom is the almost inevitable result of familiarity and routine. It’s the same-old, same-old. It’s our guy in oversized sweatpants with a three-day scruff; it’s us in our stained muumuu and uncombed hair. And it’s the sexual routine that is as exciting as day-old coffee.

Hard to recall those days when we could hardly wait to rip the clothes off each other, hey?

Add a stressful job, social obligations, aging parents, kids in high school or university, and the absolute last thing on our minds is sex. The first thing is sleep. So, maybe we don’t even know if we’re bored because our sex life is over there in the corner gathering dust.

“As therapists, we can vouch for the fact that when people get out of the habit of loving in a sexual way, it can be extraordinarily difficult to get back into it,” writes therapist Christine Webber and Dr. David Delvin in this article.

Your assignment, should you choose to accept it, for this autumn is to reinvigorate romance, and ultimately, your sexual relationship with this person who, once long ago, made your heart beat faster.

Notice that there’s a hint of obligation here. A robust sex life might begin with spontaneous combustion, but it requires regular and conscious refueling to keep the flame alive over the long haul.

So, the first step is to want to revive your sexual relationship badly enough to make the effort and to commit to tending the flame. Here are some tips to get started.

Anticipation is a powerful aphrodisiac, and it’s one of the first casualties of a long-term relationship. “…living together…can take the anticipation out of sex. And anticipation is not just utterly delicious in itself; it’s a useful tool for heightening your passion during the act—when you finally get to it,” write Webber and Dalvin.

You can heighten anticipation by:

  • Scheduling sex. Put it on your calendar—both of you. Then you can begin to prepare—and fantasize—in advance. What will you wear? What will you do? What senses will you pleasure: what tastes, scents, textures might you incorporate? Will there be surprises? Maybe new toys? Maybe you’ll discover a new position to experiment with?
  • Prepare for your date night. Take a fragrant bath. Shave. Moisturize. Scent. Clear your mind of distractions, stress, and worry.
  • Send sexy notes. Leave them in odd places. Describe what you’re going to do to him or her. Sext like the bad girls. Email. Keep sex on the brain during the ho-hum (or hectic) work day.

One woman writes: “My husband resisted getting a cell phone for years. After becoming a small business owner, he finally caved and bought one. …After I had sent him a couple of steamy texts, he came home and said, ‘Boy, I never thought I’d say this, but I sure love cell phones!’ ”

  • Become foreplay aficionados. Nothing builds anticipation like foreplay. And you need a lot more these days, anyway. So, take your time. Tease. Play. What’s the rush?
  • Abstain. Forbidden fruit is always sweetest; the anticipation makes it so. You can touch, kiss, pet, cuddle—but no intercourse until some agreed-upon future moment.

Play. You’re only limited by your imagination here. Your date night could involve a variety of role plays: Arrange a tryst at a local bar. Arrive separately and “meet” each other. He (or you) might have conveniently reserved a room nearby. Go to a romantic movie separately and meet in the back row—make out just like you used to.

Here’s a list of adult games for both spice and romance, and honestly, they sound like fun!

Do it his way. Focus totally on pleasuring your partner. Do exactly what he wants—even if it’s not your cup of tea. Your task is to lovingly provide unforgettably erotic experience. Plan to fill in the gaps in case your partner’s imagination runs dry.

Next time it’ll be your turn.

Change it up. Nothing beats boredom like a change of pace. Try different times—lovemaking in the morning, an afternoon delight. Do it in unfamiliar, maybe even [slightly] dangerous, places—on the floor in front of the fireplace, in your back yard at night, in the bathtub.

Get away—or stay at home. It’s always fun to make reservations for a weekend getaway—a nice hotel with an in-room Jacuzzi. Dinner by candlelight. A sexy, maybe erotic, film. Room service breakfast in bed.

But it can also be delicious to spend a weekend away—at home. Clear your calendar. Turn off the electronic gadgets. Get the cleaning and laundry done ahead of time. Stock up on luxurious and tasty treats that may also be known for their quality as aphrodisiacs.

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Ever since Flibanserin was shelved after FDA rejection, the search for the next drug to treat lack of libido in women has been mighty low-key. To be sure, there were legitimate concerns about Flibanserin’s effectiveness, but as I’ve said before, we need more treatment options for women who suffer from hypoactive sexual desire disorder (HSDD).

Now, three years later, initial trials on another pink Viagra drug, which are actually two drugs (Lybrido and Lybridos), are just winding down. The results look “very, very promising,” according to Adriaan Tuiten, the drugs’ developer. If all goes well in the next phase of clinical trials, a pink Viagra could be on pharmacy shelves by 2016.

And that would be something to celebrate.

As I mentioned in my last post, HSDD is common; it’s complex; and it has confounded therapists and researchers for decades. Unlike pills for erectile dysfunction, low libido in women isn’t just a matter of hydraulics—increasing blood flow to the genitals (although it’s partly that).

Therapists and physicians have debated long and hard over female sexual desire—what creates it; what kills it; even what it is. Sexual desire probably has as much to do with our brains and our emotions as it has to do with our plumbing. And, possibly, desire may even be connected to the way women are hard-wired for sex, commitment, and monogamy.

It appears that women like novelty maybe even more than men. And while women don’t tend to be more promiscuous than men, they do tend to fizzle out, sexually speaking, more quickly and persistently within long-term relationships. They just lose interest.

“Sometime I wonder whether it [HSDD] isn’t so much about libido as it is about boredom,” says Lori Brotto, a therapist who has worked extensively on female libido, in this article in the New York Times magazine.

It’s also about loss of hormones that we experience—right about now.

This doesn’t mean that women who suffer from loss of libido don’t love their mates. It doesn’t mean that they can’t become aroused or even experience orgasm. It does mean that the sexual attraction, the heat and fizz, the interest in being sexual has waned or disappeared.

You know, the old “not tonight, dear. I have a headache” routine.

Every night.

Make no mistake, for many women this is a real heartbreak. “How much easier it would be if we could solve the problem by getting a prescription, stopping off at the drugstore and swallowing a pill,” writes Daniel Bergner, author of the forthcoming book What Do Women Want?

This next frontier may be attained if Tuiten’s sister-drugs for HSDD —Lybrido and Lybridos—continue to be as effective as early trials suggest.

The two drugs affect three chemicals thought to be involved with sexual desire and arousal in women: testosterone, dopamine, and serotonin. But each drug takes a slightly different approach.

Both have a testosterone coating that melts in the mouth and enters the bloodstream quickly. Lybrido then works something like Viagra, increasing bloodflow to the genitals, which may heighten a woman’s awareness of her own arousal, releasing a resultant cascade of dopamine, the neurochemical of passion, in the brain.

Lybridos, on the other hand, use an anti-anxiety drug, called Buspirone, instead of the Viagra look-alike. After the testosterone rush, Buspirone temporarily suppresses the production of serotonin, a “higher order” neurochemical that creates feelings of well-being and self-control. Squash the voice of reason (serotonin) and perhaps passion (dopamine) will gain the upper hand. Or so the thinking goes.

Preliminary results from these trials were recently published in The Journal of Sexual Medicine. The next round will involve a much larger study.

“Perhaps the fantasy that so many of us harbored, consciously or not, in the early days of our relationships, that we have found a soul mate who will offer us both security and passion, till death do us part, will soon be available with the aid of a pill,” writes Bergner in the Times article.

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In the beginning, there was passion. Your feelings were almost painful. You wrote long letters and sent silly gifts and spent hours in whispered conversations on the phone. A lifetime ago. Remember?

Then came the long familiar years. You settled into a cozy, secure routine. You finished each other’s sentences; you knew the next move, the habits, the vulnerabilities, the quirks and preferences.

But what happened to the passion?

Psychotherapist Esther Perel has spent her career studying the sexual language of long-term, committed couples. She’s pondered the dynamics of the love/desire dialectic, and she’s identified the qualities that keep the sexual spark alive over the years. In a recent talk, she discussed her work with exceptional lucidity. You may intuitively know what Perel has to say, but few of us have articulated it so clearly. In any case, it’s good to be reminded—and challenged.

Desire and love are paradoxical. They’re mutually exclusive. Love, says Perel, is to have. It’s associated with security, with safety, with roots and foundations. To love is to know the beloved and to be known. But this contented intimacy isn’t a necessary component of good sex, “contrary to popular belief,” says Perel.

To desire, on the other hand, is to want. Desire craves adventure, novelty, risk. We desire mystery, the unattainable, the 50 Shades kind of guy.

Trouble is, we want both love and desire. We want security and passion. Intimacy and mystery. Safety and risk. So how can these opposing drives coexist in a marriage? How can we settle into the mature love of a long-term relationship without losing the hungry edge of desire that brought us together in the first place? How can we achieve the ideal of a “passionate marriage,” which fans the flame of desire within the intimacy of commitment?

As she studied couples around the world, Perel asked them when they found themselves most attracted to their partner. She heard variations of the same theme:

  1. When they reunite after an absence.
  2. When watching the other from a distance when the partner is completely engaged in an activity. “When I look at my partner, radiant and confident, [is] probably the biggest turn-on across the board,” says Perel.
  3. When there are no demands and no needs.  “Caretaking is mightily loving,” says Perel. But, “it’s a powerful anti-aphrodisiac.”
  4. When there is some novelty or newness. “When he’s in his tux,” said one person. Substitute cowboy boots, or a toolbelt, or motorcycle leather.

In these situations, there is a shift in perspective from the familiar to a sense of separation and distance. It’s the Proustian “voyage of discovery [that] consists, not in seeking new landscapes, but in having new eyes.”

Desire is a dialog we have with committed love. It’s a duet, a dance. The dynamic may be paradoxical, but both are necessary if a long-term relationship is to remain vital. It’s the language of poetry and mystery rather than of process and technique. Desire is more complex than bedroom gymnastics.

From her experience in studying and counseling couples, Perel has distilled several qualities that erotic couples seem to have in common. These aren’t on many “how-to” lists; they have more to do with essence than with activities. They may not be easy to incorporate because they’re not as straightforward as establishing a “date night.” But the concepts she delineates are worth some thought.

  1. Give each other some erotic privacy. Maybe this is the space that preserves mystery. It allows the other some personal freedom to explore. It acknowledges that you aren’t joined at the hip; that there is difference and distance. “Erotic privacy may mean different things to different people,” writes Pamela Madsen, author of Shameless. “It may mean the privacy to look at pornography and not share some desires with our partners. It may mean the possibility of exploring ourselves within agreed upon boundaries without our partners.”
  2. Foreplay isn’t optional. It isn’t a five-minute, pre-sex duty. “Foreplay pretty much starts at the end of the previous orgasm,” says Perel. These relationships cultivate a sense of erotic anticipation.
  3. Check the “good girl” at the door. Desire is selfish. You aren’t responsible for organizing or orchestrating. “Responsibility and desire just butt heads,” says Perel.
  4. Passion has seasons. Like the moon, it waxes and wanes. It will return, but keep on having sex in the meantime. “Willful, non-spontaneous sex,” says Madsen.

“Committed sex is premeditated sex,” says Perel. “It’s willful. It’s intentional. It’s focus and presence.”

To hear Perel’s talk in its entirety, visit the TED website here. This twenty minutes may be the best gift you could give your relationship today.

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Diabetes has slightly more impact, statistically, on men’s sexual function than on women’s, but about half of both are affected. There are multiple reasons, most likely, which include neuropathy (impaired nerve function), vascular disease (narrowing of blood vessels for less circulation), and possible psychological issues. In women, that combination translates into lower interest, slower arousal, less lubrication, more difficulty experiencing orgasm, and the possibility of pain with intercourse.

As you often read, diabetes is a rapidly growing epidemic in the U.S., with obesity as the number one risk factor for developing the disease. Once again, maintaining overall health is vitally important to preserving sexual health.

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When “intimate massagers” are placed between the flannel pajamas and the birdhouses in the Vermont Country Store catalog you know that vibrators have gone mainstream! The ad rightly points out that sometimes, as we age, we need a little more help getting where we used to go effortlessly.

As I’ve said before, regular stimulation helps keeps our sexual organs responsive and functional, and the stimulation might have to be stronger and longer. That’s where a vibrator comes in handy. The steady stimulation it provides tones the muscles and reinforces the nerve and vascular pathways to your genitals. But using a vibrator can also help you learn where you’re sensitive and how you respond to different stimuli (which will improve your lovemaking). It can get you aroused during foreplay, and it can be a gentle way to “cool down” afterward.

A vibrator is an equal-opportunity toy, and it can be a useful aid for couples as well. In this post, we’ll discuss some features to consider before buying a vibrator, and we’ll offer some suggestions for your first session or two.

Generally you want your first vibrator to be a versatile, multi-function machine until you know more specifically what you like. Perhaps choose a wand-style vibrator that can stimulate you internally and externally. (Some do both at the same time.) Typically, models with a  good rechargeable battery last longer and deliver stronger vibrations than those with disposable batteries—but there are some nice exceptions; check for motor strength. Opt for a vibrator with variable speeds so you can change the level of stimulation.

Some women use a vibrator in the bathtub, so you might consider a waterproof model. If noise is an issue, that might factor into your decision. You also have a choice of materials, from stainless steel and hard plastic to soft, fleshlike silicone. Some users recommend starting with a hard plastic model that doesn’t mute the vibrations and is easy to clean. If you want a less direct sensation, you can cover it with a towel or hand cloth.

Don’t spend a lot on your first vibrator until you know what you like. Better to be out $40 than to spring for $80 and find out you don’t like vibration at all. (Some women don’t.) After a few practice sessions, you might end up ordering several vibrators for different uses—small, discreet numbers for travel, say, or multipurpose gadgets for vaginal and clitoral stimulation.

Once you’ve received your first vibrator, however, take some time to get acquainted. Remember that part of the object is to learn about your own body—what stimulates you, where the sweet spots are, how you like to be touched.

Set aside a few hours of undisturbed time when you can relax. You might want to start in the tub. You can set the mood with music, a glass of wine, dim light, scent, even candles. You could read a sexy story or watch a movie that turns you on. Begin exploring your erogenous areas gently with your hand—labia, clitoris, nipples, vagina, thighs, belly, noticing the various sensations and what spots are more sensitive.

Lubricate your hands, genital areas, and the vibrator. (Don’t use silicone lubricant on a silicone vibrator, however). Turn it on and feel the sensation with your hand. If you have variable speeds, start with the lowest one. Place the vibrator on your thighs. Try your nipples if you like stimulation there. Place it on your perineum (the space between your vagina and anal opening). Move on to your labia; place it on your clitoris.

Try various speeds. Let youself become aroused, then back off. Your orgasm will be more powerful if you let the arousal build. Can you orgasm clitorally? Can you orgasm more than once? Do you need more stimulation or a higher speed?

Maybe that’s enough for one session. Or maybe you want to move on to the vagina. Insert the vibrator (assuming you have a wand-style model) and move it around. Try different speeds. Can you find your G-spot? Try clitoral and vaginal stimulation simultaneously. (Use your hand and the vibrator.)

For many women, the clitoris, labia, and first few inches of the vaginal opening (the vestibulum) are the most sensitive.

Use your vibrator to stay “in shape” between lovemaking sessions or to “warm up” beforehand. But let’s not neglect the new possibilities a vibrator brings to couples’ sex as well.


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In past posts we tried to identify books and movies that we thought were hot—the kind of stuff to turn on a more discriminating, mature woman. It wasn’t easy. In the normal course of things, women are simply not turned on by straight-up porn. And sometimes, even if a woman is physically aroused, she can be mentally repulsed.

Experts agree: the arousal/desire circuitry in a woman is complicated.

For men, it’s simple. A two-minute video clip, a sexy photo of a favorite star, a crotch shot, and he’s off to the races. “Give a guy an erection and he basically wants to use it,” writes sex counselor Dr. Ian Kerner, columnist for CNN. “In men, porn initiates the ‘sexual-circuit’ very quickly.”

Guys tend to view porn by themselves; their comments on online sites tend to be monosyllabic: “Hot!” Often, their porn consumption is unpremeditated—they might see a racy photo, and they search for more stimulation, basically to “get it on.” And virtually all men consume porn. In an effort to understand the impact of porn on men, a researcher from the University of Montreal looked for a sample of young men who had never viewed porn. According to Kerner, he couldn’t find any.

By contrast, the process for women, according to the co-authors of A Billion Wicked Thoughts: What the World’s Largest Experiment Reveals About Human Desire, “are not explicit scenes of sexual activity but character-driven stories of romantic relationships.”

Neuroscientists Ogi Olgas and Sai Gaddam screened the enormous amount of data available on the Web to analyze who goes where and views what. Unsurprisingly, they found that only 1 in 50 subscribers to major porn sites were women. “In fact, the main billing company for porn sites flags female names as potential fraud, since so many of these charges result in an angry wife or mother demanding a refund for the misuse of her card,” writes Olgas.

The female version of porn, according to Olgas and Gaddam, are “fan fiction” sites that peddle racy romance novels. Literally millions of women across the globe visit these sites to read and discuss the stories. The most popular of these is FanFiction.net. Discussion boards and comments on the novels are often long and probing, examining character and plot—it’s very much a group experience. Women can also be turned on by sexual scenes outside their own orientation—women having sex, for example, whereas straight men tend to stick with the flavor they like.

The times may be a-changin’, however, as women find their own voice in this formerly men’s world. We wrote about the new, couples-oriented porn format on the Playboy channel. There are also porn sites for women, and even a Feminist Porn award. And women seem to be seeking them out for the same reasons men do—to “get in the mood,” for pleasure, to learn new tricks.

For a girlfriend guide to the world of erotica for women, check out sex therapist Violet Blue’s The Smart Girl’s Guide to PornYou could also check out the queen of literati porn, Rachel Kramer Bussel, for her popular anthologies of sexy writing as well as her own four-alarm work. Happy hunting!

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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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As we age, along with everything else we lose (our keys, our glasses, our hearing), it’s common to lose sensation in our genitals. Less sensation makes it harder to achieve arousal, which can lead to becoming less interested in sex. Blame it on lower hormone levels. One easy, inexpensive, and often fun way to stimulate the genital area is with warming oils or lubricants.

There’s a reason why when we become aroused, we feel “hot.” Blood flows to the genital area, creating a flush of warmth. Warming oils or lubricants are products that cause a chemical reaction when applied to the skin. They create a sensation of warmth that simulates the heat of arousal. It’s intended to feel good and to give us a little “leg up” to actual arousal.

Warming oils and lubricants may contain minty or peppery ingredients, or they may contain natural herbs, spices, or even vitamins that cause that a warming chemical reaction. Some may have added flavors or colors.

Use these warming products on healthy, intact tissue; don’t use them if you have any irritation or abrasion in your genital area. It’s also important to test a small area to make sure you like the feeling and don’t have an allergic reaction.

Warming lubricants that are water-based can be applied as you would any lubricant—a generous tablespoonful to your own or your partner’s genitals.

Warming oils are intended to be used only externally. Inside, they’re not conducive to good vaginal health, and they can also degrade the latex in a condom. You can spread warming oils on the labia, over the clitoral hood, and around the vaginal area. Some women like to include their nipples. Men like it, too, but avoid using oils on the penis if there’s a chance of vaginal penetration.

In addition to their practical function, warming lubricants or oils can add an element of shared pleasure to your sex life. And that can be arousing, too.

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