Posts Tagged ‘female sexuality’

Women are not men. No surprise, right? In many parts of our lives, we know that.

When it comes to sex, though, many of our expectations—and those of the experts who advise us—are still based on expecting that men and women are more alike than not. And women are not men.

There’s an important implication from the model for women’s sexuality I’ve shared before, the one developed by Rosemary Basson, of the University of British Columbia. Women are not men: While men quite predictably experience desire and then arousal, women don’t. Sometimes, actually, women don’t experience desire until midway into lovemaking.

No big deal, you’re thinking? I wish.

Unfortunately, the messages we’ve internalized affect the way we behave and what we believe about ourselves. I’ve talked about hypoactive sexual desire disorder (HSDD) before, and it’s something I regularly talk about with women in my practice. There are hormonal changes, reactions to prescriptions, and other factors that can lead to HSDD, which is real and deserves attention from researchers and pharmaceutical companies.

But sometimes what we wish we could fix with a pill is actually the fact that we’re women, not men. If we, as women, expect to respond sexually as men respond, we’re more likely to misread our reality as “lack of libido.”

Which leads to the other reason I think understanding Rosemary’s model is a big deal. I talk to women who are at some point in a vicious cycle: They don’t experience interest as they used to; some physical changes have made intimacy uncomfortable or even painful; they begin to avoid sex; the physical changes continue; and intimacy becomes even more uncomfortable. How do we reverse this sequence? Or avoid the slide into it?

We can start with the reasons—beyond the hormones that drove us at 27—that we might want to be sexually intimate with a partner: to please him, to experience closeness, to cement our relationship, as an apology, a thank-you—or because we want to feel our own liveliness, sensuality, and power!

And then we can trust that desire will come into the picture, if we’re having the kind of sex that arouses us. Michael Castle wrote about this in Psychology Today: “Sex that fuels desire is leisurely, playful, sensual….  based on whole-body massage that includes the genitals but is not limited to them.”

Castle says women often complain that men are “too rushed, and too focused on the breasts, genitals, and a quick plunge into intercourse.” That kind of lovemaking doesn’t allow space for women to experience desire. He points out, too, that leisurely, sensual sex is also recommended by sex therapists to men dealing with premature ejaculation or erectile dysfunction. Happily, the kind of sex that fuels women’s desire is also good for their partners.

Women are not men. We can recognize, internalize, and celebrate our difference. We can be sure we’ve communicated with our partners what we like when we make love. We can let go of any expectations except our own. We are women.

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It’s going on eight years since I transformed my medical practice. I studied and became certified by the North American Menopause Society as a menopause care provider, and while welcoming patients into my practice, used their questionnaire — a thorough document that makes it easy for new patients to give me a comprehensive view of their symptoms and health histories.

On that eight-page-long form there are just a few questions for women to answer about their current and past sexual experiences:

  • Do you have concerns about your sex life?
  • Do you have a loss of interest in sexual activities (libido, desire)?
  • Do you have a loss of arousal (tingling in the genitals or breasts;
    vaginal moisture, warmth)?
  • Do you have a loss of response (weaker or absent orgasm)?
  • Do you have any pain with intercourse (vaginal penetration)? If yes, how long ago did the pain start? Please describe the pain: Pain with penetration? Pain inside? Feels dry?

I continue to be amazed by the responses from my patients. Sixty percent of my patients have experienced a loss of interest in sexual activities, 45 percent have a loss of arousal, and 45 percent a loss of sexual response.

And when I talk to them, they are

  • Perplexed—because they don’t understand what’s changed.
  • Disappointed—because they expected there to be more.
  • Frustrated—because they don’t know what to do about it.

And when you carry those numbers from my practice to the rest of the country–well, more than 44 million women are aged 40 to 65 in the US alone. Some 6,000 of us reach menopause every day. And at least half of us experience sexual problems with menopause. Probably more.

That’s a lot of disappointed women. And a lot of disappointed men, too.

But you know what it means? Those symptoms you think are setting you apart, making you the odd woman out? They’re not unusual. You’d be more unusual if you sailed through perimenopause and menopause without symptoms.

So speak up! Talk to your health care provider about what you’re experiencing. Read sites like ours to learn more about your options for compensating for changes that aren’t making you happy. Talk to your friends and sisters about your experiences.

We don’t give up reading when our eyesight weakens—we snag some cheaters from the drugstore. We don’t have to just accept the changes if we don’t want to. We’re smart, resourceful, and can do what it takes to live the lives we want to live.

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For every reader of a study, there’s a different headline. That’s my conclusion after reading The Lancet’s publishing of the findings from the British National Surveys of Sexual Attitudes and Lifestyles (NATSAL).

I’d been intrigued by an article in The Guardian that suggested Britons are having less sex because of the struggling economy and too much technology. I think either is credible. I agree with Kaye Wellings, of the London School of Hygiene and Tropical Medicine, when she says that “there’s a strong relationship between unemployment and low sexual function [which] is to do with low self-esteem, depression.” And common sense tells me that it’s hard to be aroused by a partner with an iPhone in his hand.

But when I read the full research report, there were other things that spoke to me.

This is the third time the full research has been done, using comparable methods so that trends can be examined over 60 years. And this is the first time that the eligible age range went beyond 44 years—all the way up to 74!

And that’s a very good thing, ladies, because we haven’t stopped having sex just because we’ve passed our mid-40s.

In fact, that one change to the study’s design led to two of their most notable conclusions:

  • That sexual lifestyles have changed substantially in the last 60 years (which sounds elementary, my dear Watson, but they can tell us exactly how!)
  • And that “research into the sexual health and wellbeing of men and women in later life—who now have increasing expectations of sexual fulfillment—and make up a growing segment of the population—is a neglected area.”

Well, yes! And I’m grateful to see conclusions like those from well-respected research projects!

A couple more things struck me as I read through the details, because they resonate with my experience as a menopause care provider. The frequency of sexual encounters does decrease as both men and women grow older; among women 65 to 74, intercourse is happening about a third as often as among women 25 to 34. There is, though, still a variety of sexual experiences among the older women, including oral and anal sex.

I note that men over 55 are more likely to have a partner of the opposite sex than are women at the same age, and yet men of that age are three times more likely to self-stimulate than women are. Now, I know that sexual behavior depends on many things, including social norms and attitudes.

But I also know that women are uniquely “use-it-or-lose-it” creatures. When we’re without partners, we can’t assume that our sexuality is stowed away to be taken out again at some later date. I encourage women to think about self-stimulation, because orgasm is good for us physically and mentally, and it helps us maintain patent vaginal tissues.

Given the numbers, I know it can’t happen for everyone, but I’ve seen enough women find a second love to think it’s worthwhile to maintain our sexual health. Not because a woman needs a man (that whole fish without a bicycle thing), but because sometimes the right woman and man find each other. And it’s a whole lot easier to maintain your sexual health and capacity than it is to reclaim it.

Because data show—British researchers proved it—that “sexual health is a key component of well-being,” even for those of us over 44, and even for those of us currently without partners.

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The more I work with women in my practice, the more I recognize that the science of human sexuality is young. For most of the last century, we assumed that men and women approach sex in roughly the same way.

Crazy. But there it is: The science is young.

Older models (Masters & Johnson, Kaplan) theorized that sex for people happens in a few neat, linear stages, beginning with desire, proceeding next to arousal, then orgasm, and finally satisfaction.

But it doesn’t always work that way, particularly for women, and especially for women over 40.

More recent researchers who focus on women’s sexuality, confirm that really, women do not experience sex in this simple, linear way. We sometimes skip phases. Our reasons to have sex are many and often complex.

We can be perfectly satisfied with sex that does not include orgasm, and we can reach orgasm without desire. We are flexible that way.

I continue to refer women to work done by Rosemary Basson, MB, FRCP, of the University of British Columbia. Basson formalized a new model of female sexuality that is now widely accepted.

She offers two key insights. First: Female sexual desire is generally more responsive than spontaneous. That is, we are more likely to respond to sexual stimuli — thoughts, sights, smells, and sounds — than we are to spark an interest in sex out of thin air (Men, on the other hand, specialize in this).

Another key insight: Emotional intimacy matters to women. That doesn’t sound like a news flash, but in the realm of the biological sciences, it’s news, trust me.

So Basson drew a new model – not a linear series of steps, but a circle that includes both sexual stimuli—the thoughts that trigger a woman to take an interest in sex, and emotional intimacy—the emotional payoffs of the experience that lead her to want to come back for more.

Rosemary Basson's model of female sexual response

Rosemary Basson’s model of female sexual response

I love Basson’s model and use it every day in my practice to help my patients understand how sex really works for us.

We need to understand that it’s okay and it’s normal that we don’t always start with desire. And as we enter menopause, and our hormone levels drop, spontaneous thoughts about sex and responsiveness to opportunities for sex diminish for most of us. That’s natural and normal too.

If you don’t like the situation, and you want to feel more sexual, more responsive, Basson’s model gives us the hint: We need to stimulate our minds. The more sexual stimuli we receive, the more sexual we feel.

So, this is worth thinking about today, a worthy discussion to have with your partner: What makes you feel sexy? A juicy romance novel? A James Bond movie? Erotic art? Pretty underpinnings? A romantic dinner?  Having your partner empty the dishwasher?  Spend some time thinking about that. Maybe make a list. And then provide for these things. Sexy is as sexy does.

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Let’s start with anatomy and etymology, shall we?

The clitoris is a small button-like protuberance located at the top of the labia minora (the “little lips” inside the vulva). Clitoris comes from the Greek word kleitoris, which may mean “key” or “latch” or “hook” or from a word meaning “side of a hill.”

The clitoris, as it turns out, is a tremendously important organ for sexual pleasure in females, but because its anatomy is so hidden and its purpose so inscrutable, only recently have imaging techniques begun to reveal the breadth and depth of the clitoris.

  1. The clitoris and the male penis are “homologous,” which means they have similar biological structures. They’re made of the same stuff. Like the penis, the clitoris has a very sensitive head or glans (that’s the part you can see peeking out), a shaft that extends into a woman’s body, an external hood that is like the foreskin. But there’s also a whole bunch of stuff inside, and that’s now referred to as the “clitoral network”—a complicated internal structure that winds around the vulva and into the vagina and is composed, like the penis, of erectile and other tissues.
  2. The clitoral network has perhaps twice as many nerve endings as the penis (about 8,000 vs. 4,000), and when aroused, may affect 15000 more, making it extremely sensitive and critical sexual pleasure. In fact, some sources suggest that the G-spot is really part of the clitoral network.
  3. Genetic makeup, steroid overdose, and testosterone use can cause clitoral enlargement, which is called clitoromegaly.
  4. The clitoris becomes larger after childbirth, and it stays sensitive throughout the lifespan, including after menopause, although both Dr. Barb and Dr. Oz say you have to use it or lose it. (Hear that, gals!)
  5. The clitoris is the only human organ that has no function other than sexual pleasure.
  6. Other female mammals also have clitorises of various sizes. (That of the female bonobo is big enough to “waggle” when she walks, according to this article.)  Female spotted hyenas are the only mammal whose clitoris is used for urination, sex, and birthing young (ye gads!), making both sex and birth quite challenging and acrobatic for hyenas.
  7. In cultures that practice female genital mutilation (FGM), the clitoris and sometimes all or part of the labia minora is ritually cut off, often unhygenically and without anesthetic. The practice is rooted deeply in some Middle Eastern and North African cultures and has to do with ideas about purity, modesty, and female sexual desire.
  8. As you might imagine, the clit has accrued a lot of colorful names: rosebud, cherry pit, love bud, nubbin, doorbell, bald man in a boat. In some Middles Eastern countries, it may be called a sesame seed, lentil, or chickpea, depending on its size.
  9. During sexual arousal, the entire clitoral network becomes engorged, just like a penis. This includes tissue within the vagina and labia minora. Everything swells.
  10. Most women (something like 70 percent) can’t orgasm with vaginal stimulation alone, which leads us to the necessity of clitoral stimulation to dependably orgasm. There are lots of tricks to help this along.

Stay tuned. We’ll follow up with another installment.

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Libido is a tender blossom. A cold blast of hormonal change. A whiff of illness or the wrong medication. Even routine and long-term sexual ho-hum can cause libido to wither like a sweet pea on a frosty morning.

The whole notion of female sexual desire and what causes it to bloom or to die on the vine isn’t well understood (like a lot of female sexuality, actually). But low libido in women is extremely common, according to the few studies done on it. Low libido conservatively affects between 8 and 12 percent of older women—those of us who are in the midst of or beyond the “change.” Other experts say that all women experience low libido at some point in their lives, and I wouldn’t quibble with that statement.

It even has a not-very-sexy name: hypoactive sexual desire disorder (HSDD).

To be clear, the textbook definition of HSDD goes like this: “a deficiency or absence of sexual fantasies and desire for sexual activity. The disturbance must cause marked distress or interpersonal difficulty.” (My italics.)

In other words, it ain’t a problem until you (or your partner) say it’s a problem. Low libido isn’t a disorder per se unless it’s making you or your partner feel distressed, dissatisfied, guilty, or otherwise unhappy.

Interestingly, while sex drive does tend to diminish as we age, most older women are less distressed about it, “resulting in a relatively constant prevalence for HSDD over time,” according to this report by Dr. Sheryl Kingsberg, a friend of MiddlesexMD.

To some extent, women expect to lose their sexy juice after a certain age because that’s what our American culture tells us to expect, according to Mary Jo Rapini, a therapist and MiddlesexMD advisor in this article for Fox News. Older women aren’t expected to be sexy. They’re expected to be invisible.

Yet, says Mary Jo, women shouldn’t passively accept this state of affairs just because they’re reaching midlife. “Accepting low sex drive because you’re getting older is the same as accepting drugs to control your diabetes when you could change your diet, exercise, and lifestyle regimen.”

For many women, however, low libido is a problem, causing all kinds of guilt, distress, and relationship disturbance, which may either be intense and unrelenting or intermittent and mildily distressing.

If good sex is correlated with general sense of well-being and higher quality of life and self-esteem, it’s not surprising that ongoing sexual frustration can negatively affect health and well-being. Dr. Sheryl mentions several studies that associate HSDD with health problems. In one such study, for example, “women with HSDD experienced large and statistically significant declines in health status, particularly in mental health, social functioning, vitality, and emotional role fulfillment.”


HSDD can be caused by a whole bunch of physical conditions, ranging from certain medications to certain illnesses to, yes, age-associated hormonal changes. But many women struggle with HSDD because of emotional issues, and that’s the focus of Mary Jo’s article. In her experience, the emotional causes of low libido are often relied to stress, relationship and intimacy issues, or to problems with self-esteem and body image.

“Addressing the emotional causes of low libido should be the first step you take in addressing why you no longer desire sex, your partner, or your intimate life,” she writes.

Mary Jo suggests some honest exploration, perhaps with a therapist, to get at the root of these emotional problems:

Are you stressed or depressed? Are you struggling with self-esteem or poor body image? Do you feel emotionally connected to your partner? Can you talk about sexual issues? Is there a history of abuse or infidelity in your relationship?

As with so many sexual matters, the causes of HSDD are complex, intertwined, and challenging to unearth. The cause could be as straightforward as adjusting a medication or as difficult as changing an unhealthy lifestyle or honestly assessing emotional issues.

If loss of libido is troubling you, tackling the underlying causes may also be a journey toward greater overall emotional and physical health, because just as sexuality is woven into the very fabric of emotional and physical well-being, you can bet that what affects sexuality is also affecting other parts of life as well.

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Ladies, we have one more tool in the belt.

Last month, the US Food and Drug Administration (FDA) approved a new drug to treat the vaginal and vulvar pain associated with loss of estrogen in older women.

That pain is called dyspareunia, and it’s caused by the changes in the vagina and genitals that occur when we lose estrogen during menopause. As we’ve said (often), our vaginal tissues become thin, dry, and fragile as our estrogen levels decline, which can make sex very uncomfortable. Dyspareunia is common, and it doesn’t get better on its own.

Until now, treatment options have included using moisturizers (regularly) and lubricants (before sex) or replacing estrogen, either topically in the vagina or through hormone replacement therapy.

Now there’s a pill that you take once a day.

Osphena is called a “selective estrogen receptor modulator,” or SERM. Although it’s not a hormone, it works like one in that it affects some estrogen-sensitive tissues, like the vagina and the uterine lining (the endometrium). The vagina will thicken and become less fragile while other tissues, such as the breast, are affected very little.

In a 12-week trial of almost 2,000 women here in the US, the researchers saw a “statistically significant improvement” in the pain level of the women who took it compared with a control group.

Of course, there’s no free lunch when it comes to pharmaceuticals. Some common and less-serious side effects include hot flashes, vaginal discharge, muscle spasms, and sweating. But a few uncommon and more serious side effects include blood clots, stroke, and vaginal bleeding that can indicate cancer of the endometrium.

That’s why the drug comes with a black box warning from the FDA, and why the FDA advises taking it in the smallest amounts and for the shortest time possible.

It’s also uncertain whether the condition will reverse itself once the drug is stopped.

Despite the scary black box, I’m thinking that Osphena gives us another option. It might not be our first choice for long-term use. It still isn’t the magic bullet for all menopausal ailments.

But it might provide a little short-term boost, for example, to make a woman with severe dyspareunia more comfortable until the moisturizers or the topical estrogen kicks in. And until her renewed sex life helps rejuvenate the vagina because sex, in case you forgot, “is beneficial for maintaining vaginal health,” says Dr. David Portman, lead researcher in the Osphena trials for safety and effectiveness.

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I was sitting in a tiny hut in Mexico talking with a dignified older gentleman. Outside the ramshackle house, the sun shone on the empty desert. The ocean lapped the nearby shore. There was no traffic, no noise, no shops, no phones.

“The Americans, the Germans, and the Japanese are the hardest-working people in the world,” the man said.

First, I was startled that someone in this very remote place would be so astute. Then I wondered: Is this a good thing?

With all our mobile toys, we don’t ever have to stop working in America. We can be connected 24/7. Maybe we can squeeze in a few extra obligations after-hours. Or, we might be caring for parents and children, and sometimes spouses and grandchildren. Even if we’re retired, we’re programmed to run hard and fast.

But look what it’s doing to us. We’re stressed; we’re overweight; and we’re dog-tired.

Sex life? What sex life?

Ian Kerner, a well-known sex therapist, cites a recent study by the National Sleep Foundation in which one-quarter of American couples say they’re often too tired for sex.

Mary Jo Rapini, one of our medical advisors, recalls encouraging a couple to take time for a romantic getaway. “Oh no, who’ll plan that for us?” they asked. Well, “usually the couple enjoys planning these things together,” she said.

“We don’t have the energy,” they responded.

Think of sex as the canary in the coal mine. It’s one of the first things to go when life gets out of whack. But if you ignore that quiet little loss, pretty soon the bigger stuff suffers, like good health and relationships.

If sex is just another obligation, or you’re too tired to even think about it, you need a life/work balance adjustment.

If you don’t have some other physical or psychological problem, such as a thyroid condition, chronic fatigue syndrome, serious relationship issues, or hormonal imbalance, you shouldn’t be too tired for sex.

So, if stress, overwork, overcommitment, and the general pace of life, has killed your libido, consider this:

Allow time for sleep. Right now. Nothing else matters if you’re chronically sleep-deprived. Re-assess your involvements. Try to delegate tasks. Cut back on work. (Doctor’s orders.)

“A good night’s sleep every night—more so than exercise and a healthy diet—keeps our sexual engines humming,” says Barry McCarthy, PhD, a Washington, D.C., sex therapist.

Give yourself an hour to unwind before going to bed in the evening. Turn off the TV and all the other screens. “It’s terrible to have a television in your bedroom, which should just be for intimacy and sleep,” says sex therapist Sherri Winston.

Spend that time relaxing with a book. Share a cup of herbal tea. Cuddle with your honey. Take a bath.

Exercise.  Regular, moderate exercise is part of the work/life balance thing. Can you walk 30 minutes a day? Maybe with your partner? Can you find a gentle workout video? (My favorite now is hot yoga, but I have friends who spend 20 minutes a day with our old pal Jane Fonda.)

Exercise makes you feel better. It helps you lose weight.

And guess what? It helps you sleep better.

De-stress. Yeah, I know this sounds impossible. But you have a choice: You can continue to worship at the altar of overcommitment, at which you will offer up your health, your intimate relationships, and your quality of life.

Or you can bring your life into a healthy balance, and probably live longer—and have a lot more satisfying sex.

Need more persuading? Stress releases cortisol, a hormone that decreases testosterone, of which we women have precious little in the first place. Thus, stress directly hammers our sex drive even before the sleep-deprivation sets in.

Follow your rhythms. If you’re exhausted at night, why not have a little afternoon delight? Or maybe sex in the morning? Testosterone levels naturally rise a little then, so that might be the opportune moment to turn up the heat. Caress and cuddle at night and save the sizzle for the morning.

Just do it. You know how you may not be in the mood, but a little nibble on the ear, a little stroke on the thigh… and, well,… maybe…

Libido is like a puppy. Give it some loving, and it will follow you home. And sex begets more sex. You have to do it to want it.

When I recall the tranquility I felt in that simple hut in Mexico, I wonder if we somehow took a detour on the road to the good life. Maybe we can learn something about simplifying, cutting back, enjoying the little things, and loving each other from people who don’t have many possessions, but who probably sleep very well at night.

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More from the Trenches

In a previous post Dr. Susan Kellogg Spadt, a MiddlesexMD medical advisor, described some of the impediments to sexuality that she sees affecting women as they age. The list, which began with internalized ageism, sexual scripts from our families of origin, and low self-esteem, continues in this post…

Performance anxiety. Men aren’t the only ones who worry about “performing.” All those physical changes to our sexual apparatus that are discussed on MiddlesexMDvaginal dryness, pain, reduced sensation, lack of interest—can contribute to performance anxiety for women, too.

As one 52-year-old woman said, “I can no longer tell how my body is going to behave. It makes me nervous in bed.” As with men, this inability to trust or predict how your body will respond can affect your ability to enjoy or your desire to have sex. Some women (and some men) just decide not to be sexual anymore.

Women need to know that there is help for these physical changes—again, all the things discussed on the blog and the website—such as moisturizers, lubricants, vibrators, and dilators. These tools can help us remain comfortable and familiar with our changing bodies, so that we’re less anxious when we’re with our partner.

Depression. Older women get depressed at somewhat higher rates than younger women. That’s what the research says. Not only that, but the side effects of some antidepressants include decreased desire, vaginal dryness, and delayed orgasm.

So what’s a woman to do?

Talk to your healthcare provider. You need counseling for the depression, and if medications are affecting your libido, discuss alternatives with your provider. It’s not easy, but you could end up feeling better and enjoying sex again.

Lack of attraction to partner. Yes, I hear this from women—the spark is gone. They just aren’t attracted to their partner anymore.

Maybe the relationship was always difficult or lacked physical intimacy, and the couple stayed together for practical reasons. Or maybe physical changes due to the partner’s aging or illness have affected the woman’s physical attraction. According to the literature, this happens in both women’s heterosexual and lesbian relationships.

Fantasy is one way to mitigate the “turnoff.” Use your imagination to turn the frog into a prince. Sex therapy may be another aid to establishing intimacy.

Lack of partners. There’s no sex without a partner. Duh! Demographics and life expectancies being what they are, the older we get, the fewer our options for partners.

Some of us may be able to date casually or to self-pleasure for sexual release, but for others, this may not be an option. Again—no easy answer.

Making peace with the situation. “Normal” covers a lot of ground. And while we clinicians are always seeking to define it, the fact is that “normal” for one patient may be very different for another.

Despite all the impediments and changes, I’ve found that women generally find their way to a sense of equilibrium with regard to their sexuality. And we clinicians have to respect that.

You define what’s normal for yourself. If you are at peace with your decision to abstain from sex, then abstinence is normal for you. Likewise, if you choose to be sexually active well into your nineties, then that’s also normal.

However, if you experience frustration, anxiety, discomfort, or pain regarding your sexuality, then you should bring this up with your healthcare provider. We can help, and sometimes the solutions are simple.

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Our culture sends lots of messages about sex, through TV shows and movies, articles, girlfriend talk, and “wisdom” from our mothers (some of it really was wise!). Some of these messages become self-perpetuating, whether or not they have any basis in fact. Here are three in particular that I hear and wish would go away:

  • Men like sex more than women do.
  • Men are always ready for sex.
  • Men should always initiate sex.

What I don’t like is the ways in which these statements can be internalized in ways that affect women’s own sexuality, that lead them to second-guess or doubt what they’re really feeling or wanting. Every woman’s sexuality is individual—and, to be fair, every man’s is, as well.

Let’s take those statements one by one.

There was a time when women were reputed to “suffer through” sex, just to keep their husbands happy. There wasn’t a lot of understanding of the mechanics of women’s pleasure, which, thank heavens, has changed by now. The women I see in my practice like sex and recognize it’s an important part of their lives—which is why when they have problems, they’re looking for solutions.

The other issue I’ve got with us thinking men like sex more than we do is that we’re more likely to let them off the hook. For foreplay, for example, which we need more of as our hormone levels change. What we certainly have in common with men is that we both like good sex, although our definitions of that may differ. And that, by the way, is one more reason to talk about what we like and what we’re willing to do.

Men “always ready for sex” is another one that makes me crazy. Call me a radical, but my experience says that men are people, too. Where I see this one get women in trouble is that in the absence of open communication about sex in a relationship, we start to imagine reasons why our partner may not be in the mood. We miss cues about his overall health. We start to look at ourselves more critically, to notice the extra pound or the new sag, to lose perspective on the inevitable imperfections in our relationships, even to have a sneaking suspicion, sometimes, that our partner is finding affection somewhere else. Stop! Ask! Men get headaches, too, and they get distracted by deadlines at work, projects in the garage, and family drama.

And that brings us to the final “myth,” that men should always initiate. That is the way most of us were raised: We had to wait for the boy to call, stand on the sidelines until he asked us to dance, see when he would attempt that first kiss. Whether or not that’s still true for our daughters and granddaughters, it certainly doesn’t need to be true for us in our relationships. Did you feel some sympathy for those poor boys, facing the potential of rejection? Did you feel some envy for their position of power?

Well, it’s about time to share both in your relationship, if you haven’t already. If you’re in the mood, show your interest by taking the first step. Flirt. It’s fun, it’s empowering, and it will send all kinds of arousal cues to your body. And there’s nothing more “ladylike” than that. Your partner will be flattered and receptive (and if not in this moment, see above: he’s human, and there will be another time!).

I’m not going to debate whether these messages are myths or truisms. What I will do is encourage you to live your own script. Set aside what doesn’t fit for you, regardless of how many times you’ve heard the messages. Sex is a wonderful part of an intimate relationship, and both partners can invest equally in keeping it vibrant! It’s one of life’s greatest pleasures. And that’s a message I’ll keep spreading.

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