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Posts Tagged ‘intimacy’

Surely this has happened to you: You read one article, and it leads you to another. From that second article, you’re pointed to another. Before you know it, you’ve spent an hour diving into a topic that wasn’t quite on your to-do list.

Today I’m glad I did. The first article was “A Good Sex Life Can Help Older Couples Cope with Illness and Other Difficulties,” in the Washington Post (a long title, but you don’t have to read the whole article to get the point). That led me to the full research in The Journals of Gerontology. And a reference in the full research prompted me to seek out an earlier article by researcher Adena M. Galinsky, published by the National Institute of Health.

That article, published in 2012, is called “Sexual Touching and Difficulties with Sexual Arousal and Orgasm among U.S. Older Adults.” The author defines “sexual touching” as “non-genitally focused sexual behavior,” including “but not limited to, kissing, stroking, massaging, and holding anywhere from one part to the entirety of a partner’s body.”

This, ladies and gentlemen, is foreplay, and what I love about this article is that it presents empirical data of its importance! With more foreplay, both men and women experienced fewer “difficulties with orgasm, sexual pleasure, and sexual arousal” and more physical pleasure in their relationships.

We all have “sexual scripts,” Galinsky says, which we learned growing up and tell us, without our thinking about it, how to be intimate. Depending on where and when you and your partner learned about sex and romance and relationships, your scripts may not include much sexual touching. If that’s the case, it’s time to call “Rewrite!”

Having the time and the cues of desirability, safety, intimacy, and arousal are critical to us in midlife. If we don’t have them and still expect our bodies to respond as though we’re 20, we’re setting ourselves up. And we can fall into the downward spiral I’ve talked about before: We’re uncomfortable or unsatisfied when we have sex, so we’re unmotivated for a repeat performance. Because we’re not having sex, it’s less comfortable next time we try, so we put it off longer. We may begin to wonder if there’s something wrong with us, which is the opposite of feeling sexy. And before we know it, we’ve abandoned a part of ourselves that made us feel loved and lovely and powerful—and our partners quite happy!

You can talk to your partner about a collaborative revision of your “sexual scripts.” You can share this guest post by a “man friend” of MiddlesexMD, or this “Open Letter: How to Really Turn Me On” to start the conversation. And then, you know, one thing can lead to another. In a very good way.

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You may be among the 4 percent who won’t experience orgasm–who, for some reason, simply can’t, under any circumstances. It’s more likely that you’re among the 96 percent who can. When a woman tells me she’s not sure if she’s experienced orgasm, I say she probably hasn’t; it’s fairly obvious when it happens.

Most women need direct clitoral stimulation to reach orgasm; what we see so often in movies, of partners climaxing together through intercourse alone, is rare in real life. Beyond that, there’s plenty of variation: Some women may need an hour of clitoral stimulation; others may experience orgasm through brief nipple stimulation.

I recommend that each woman know her own clitoris, because degrees and types of pleasurable stimulation vary among us. Vibrators are very effective in stimulating the clitoris, and spending time yourself, exploring in a relaxed environment, will help you advise your partner on what feels good. Soothing or arousing music or a sexy scene from a movie can help, too.

When you’re ready to go further, you can try internal stimulation, which leads to orgasm for about 30 percent of us. A vibrator like the Gigi2 can be used both externally and internally, so you can place it in the vagina (use a lubricant to be sure you’re comfortable) and see what happens.

While chances are good (about 96 percent good!), there’s no guarantee of orgasm. And because being focused only on orgasm can actually inhibit your ability to experience it, I hope you’ll enjoy the intimacy and other sensations along the way!

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Q: Is rough sex normal?

There is really no definitive definition of “rough sex”; even resources devoted to BDSM (bondage, discipline, sadism, masochism) leave the field pretty open. Every individual has her own experiences, preferences, and reference points for deciding what’s pleasurable and what’s not, what’s intense (in a good way) and what’s scary. Sharing a sexual event is the ultimate act of making yourself vulnerable–to each other. You should never, ever, not for a moment feel unsafe in that encounter, but rather feel surrounded by your shared and reciprocal respect and love.

If you’re asking the question, I suspect you’re in or close to uncomfortable territory for you. Please take things very slow and make sure your “sexual voice” is heard loud and clear.

To ask your own question, use the pink “Ask Dr. Barb” button top and center on our website. You’ll receive a confidential reply via email, and your question may be used as the basis for a Q&A post here on our blog. 

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Here’s the scene. A “mature” couple is sitting companionably together in the living room, reading. He looks over the top of his paper.

“Hey, Snookums, you look remarkably fetching tonight. Want to get to bed early?

She, thinking: Oh, lord, he hasn’t seen me naked since I gained the last five pounds. Fat on top of cellulite. Saggy bags over saddlebags. “Well. Hmmm. Just let me finish my… knitting. I have to finish my knitting. Then I’ll be right in, honey.”

He, thinking: Yeah, knitting. Bet she’d be ready to jump the bones of some musclebound hunk with hair instead of a bowling ball and a six-pack instead of a whale gut.

And what he does not dare to articulate even to himself is whether she might also be left unsatisfied with his, um, slightly spongy and not-so-reliable accoutrement.

So they sit, each in his or her own corner, licking the wounds of engrained insecurities and missing out on the sweetest years they have left together. All because they misinterpreted each other’s insecurities because they were so completely snowed under their own.

The song may be different for each of us, but too often, the dance is the same.

Body image is powerful no matter what side of the gender gap you fall on. And while men rarely discuss their insecurities, in one study, 38 percent of men would sacrifice a year of their lives for the perfect body—a higher percentage even than women, according to this article in the Guardian.

“These findings tell us that men are concerned about body image, just like women. We knew that ‘body talk’ affected women and young people and now we know that it affects men too,” said Dr Phillippa Diedrichs, who conducted the study of almost 400 men in Great Britain.

While women focus on losing weight, men obsess about losing muscle. While women struggle with vaginal dryness, men struggle with losing their ramrod hardness. While women worry about their stomachs, thighs, and boobs, men worry about their stomachs, muscle tone, baldness, and man-boobs (moobs).

Blame the media. Blame your mother. We’re old enough now to identify and grapple with our own insecurities. And to get over them, already.

No matter how good you look, you’ll eventually become invisible in a culture that is focused on youthful beauty. In her poem I Met a Woman Who Wasn’t There, Marge Piercy writes:

The CIA should hire as spies
only women over fifty, because
we are the truly invisible.

This makes some women feel free and unburdened, and it makes others desperate to turn back the clock, fueling the cosmetic surgery industry, which has grown 77 percent in the last ten years, according to a 2012 AARP article. For their part, men may turn to Rogaine and Viagra and red convertibles—and cosmetic surgery, but in the end, we all—men and women—have to make our peace with growing old.

Because that train is coming, like it or not. And it’s a whole lot nicer to ride out the last adventure of our lives in the same berth.

Here are a few ways to do just that:

Send your body some luv: “The mind is the most powerful beauty tool in your makeup bag,” writes a woman in this article.

Stop the negative chatter, says MiddlesexMD advisor, MaryJo Rapini, who writes frequently about body image issues. In this blog post, MaryJo lists 15 things you should say to your body, such as: “You are my body, and I claim you, and I will take care of you.” And: “I love the way you make me distinguishable that someone can recognize me by my voice, my eyes, or the gait of my walk.”

Do sensual things for yourself and with your partner: Have a massage. Luxuriate in a scented bath. Go all out, if you can, with a week (or a weekend) at a spa. When your body is touched respectfully and sensually, it helps you to remember how good it feels.

Have more sex. The more you have, the better—the more sensual and sexy—you feel.

“Give yourself over to the pleasurable experience and sensation of sex itself, drawing on the depth of your emotional connection with your partner. Issues with physical imperfections can melt away in the face of this focus on mutual sharing of pleasure,” suggests this article from the North American Menopause Society (NAMS).

Keep your body healthy and moving. Forget about looking young. Focus on being healthy. “Consider exercise and weight loss as aphrodisiacs,” says the NAMS article. “Exercise is like Miracle Gro for your brain and body,” says the AARP.

Get the picture? As you age you simply will not feel good about yourself unless you exercise moderately and eat healthfully. Exercise helps keep blood flowing to your brains and keeps your joints lubricated, not to mention keeping your muscles toned, strengthening your bones and boosting your immune system.

What are you waiting for? Get off the couch.

Be gentle with each other. It will just take longer for your man to get an erection, and it doesn’t have anything to do with his attraction to you. And he needs to understand that you’ve been conditioned since childhood to believe that youth equals beauty. You need to hear that he still finds you irresistible.

If you have a same-sex partner, you’re looking in the mirror at your mutually aging bodies. Make sure you each know that’s okay.

As Dr. Eleanor Hamilton, author and sex therapist, writes in this beautiful article, “They both need to reassure each other that their love and the intimacy they share and the long years of increasing trust that has built between them are far more important ‘turn-ons’ than the young, sleek, over-eagerness of youth.”

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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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Life is scary after a heart attack. You’re not sure what to expect. You may be depressed. You’re probably on several medications. You may be confused about what you’re allowed to do and when.

Like sex. When is it safe to have sex again?

Chances are, your cardiologist hasn’t discussed that topic. For one thing, your doctor is probably more concerned with saving your life at first, and then with the details of your recovery, like rehab and medications. When to resume your sex life just isn’t high on the radar of topics to discuss post-surgery.

And for another, most physicians don’t bring up the S-word at any time, as we’ve discussed before. But a new study of women who have had a heart attack confirms that “most women don’t have discussions with their doctors about resuming sex after a heart attack, even though many experience fear or other sexual problems,” says Emily Abramsohn, one of the study’s researchers, in this article from Medical News Today.

Patients are often uncomfortable broaching the topic, and their caregivers also hesitate to bring it up. Their partners may also be afraid to do anything that might cause pain or induce another attack. “I had to convince my husband that I wasn’t going to die in bed,” said one woman in the study.

Now, new guidance for doctors from the American Heart Association (AHA) encourages doctors to discuss sex with their post-surgical patients and to advise them about when it’s safe to resume their sex life and how to do it.

The guidance, which is based on a review of scientific literature and is the first statement of its kind from the AHA, acknowledges the importance of resuming an active sex life. Sex is a return to normalcy and re-establishment of intimacy, and as such is an important element in the healing process.

Along with the position statement from the AHA, a new study from a group of researchers at the University of Chicago surveyed 17 women who had survived a heart attack within the past two years. The average age was 60. The study found that:

  • Most women were fearful about resuming their sex life
  • The doctors discussed sex with about one-third of their female patients
  • Frequently the conversation was initiated by the patient, who generally found the information to be unhelpful
  • Most women began having sex about a month after their heart attack; all but one had resumed sex within six months

The AHA guidelines could clear up some hesitation and confusion among physicians as to what, exactly, to tell their patients. The guidance states that sex is safe for most patients who are stable and without complications. If you can climb two flights of stairs, you can probably have sex, which is considered only moderate exercise.

But if you’re scared or unsure, then ask. “Know that you’re not alone in having fears surrounding sexual activity,” Abramsohn said. “And if you are concerned, bring it up with your doctor.”

“Dr. Ruth” Westheimer even weighed in on the topic in this article, “What I suggest is that people write down their questions and send it to the doctor in advance of their appointment. That way they’ll be sure the question gets asked, and the doctor will have had time to get prepared to answer it.”

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I always thought of Tantra as one of those Eastern practices, vaguely connected with the Kama Sutra, and having to do with chakras and energy and contorted positions.

While it does involve some of these things, turns out that Tantric sex plays to the strengths of older people. We aren’t in a hurry. In fact, we’ve had to switch our focus from a quick, hot fire to a slow burn. From intense passion to warm intimacy. From fireworks to steady candlelight.

Tantric practice is all about taking your time and learning to be vulnerable. With Tantra, the journey is the destination.

Dr. Susan Kellogg Spadt, a MiddlesexMD advisor, defines it this way: “Tantric sex originally developed as a form of Eastern yoga practice, the goal of which was to use sexual energy to enter a higher spiritual realm. Although it is an ancient practice, this type of loving has undergone a recent resurgence of popularity.”

The main elements of Tantric sex are a focus on the breath, the alignment and flow of energy (specifically sexual energy), and attention to the partner in the present moment. You’re not in a hurry with Tantric sex, nor are you lost in fantasy world. You’re relaxed and present.

While I’m no expert in the practice, here are a few techniques drawn from Tantric sexuality that might energize your lovemaking.

Prepare the space. Since Tantra is based in spiritual practice, consider the place where you have sex as “sacred.” How would this space look and smell? How would you prepare the environment? Would it feel mysterious or would it be full of light? Would it look lavish or spare and uncluttered? Would it have music or the sound of chimes? Or silence?

You should make it as beautiful and natural as possible. You might have candles or incense burning. You might decorate it with soft fabrics, maybe silks, maybe beautiful tapestries.

Prepare yourselves. Spend some time decompressing from whatever might occupy your mind. Loosen your muscles, especially those in your jaw, neck, and shoulders. Maybe take a bath so you’re soft, relaxed, and sweetly scented.

Clear your mind of any preconceptions. Expect nothing. You are here with your beloved. That’s all, and it’s enough.

Breathe. Unsurprisingly, breath is central to this practice as it is to many Eastern traditions. Breath releases and directs energy.

In Tantric sex, you breathe in tandem with your partner. Face your partner and breathe deeply, fully, and consciously. Breathe together-you breathe each other’s breath.

Don’t hold your breath or let your breathing become shallow at any time. Concentrate on full, relaxed breathing throughout sex. According to the Tantra, this allows energy to flow unimpeded through your body.

Maintain eye contact. In fact, keep your eyes open throughout your sexual encounter. Breathe together and look into your partner’s eyes. This will probably feel strange and challenging.

Here is an account from a woman who attended a Tantric sex class with a platonic friend who was simply doing her a favor by accompanying her. The instructions were to “think about what this person looked like when they were first born… before they were wounded… what they will look like when they die.”

“Looking into Jeff’s eyes, I felt like I was watching the movie of his life. I saw my friend in a way I rarely see anyone; with all his vulnerability, fear, pain, and joy. It was unsettling but strangely beautiful. I felt cracked open and began to cry.”

If this is the experience of two friends, what might happen between committed lovers?

Get into position. There are lots of Tantric postures, but the one commonly mentioned is the Yab Yum position in which both partners sit erect and the woman sits on her partner’s lap, wrapping her legs around his or her waist. Then, according to Susan Kellogg, “The woman actively rocks forward and back, using her pubococcygeus [pelvic floor] muscles to “milk” her partner’s penis, creating high levels of sexual arousal.”

Don’t hurry. Don’t lose focus. Keep your breathing slow and relaxed. Eyes on your partner. Only tense the muscles you need to use and consciously relax everything else. Be present in the moment. Express what you’re feeling—pleasure, pain, discomfort, joy, connection—either in words or sound, any sound.

Direct your energy. A Tantric saying is, “energy flows where attention goes.” This means that you have control over the flow of energy depending on what you’re paying attention to. If you’re focusing on genital sensation, that’s where the energy goes. But if you pay attention to your entire body, this is where your sexual energy will flow. Powerful, whole-body orgasm is a hallmark of Tantric sex.

Finally, after fully exploring and experiencing this exchange and flow of energy, this intimacy with your partner, according to Susan Kellogg, “Tantric joining… ends when partners, at the point of orgasm, join in a close embrace, usually mouths sealed and fingertips in full contact. Each partner powerfully contracts the pubococcygeal muscles and ‘draws’ orgasmic energy from their genitals up through their pelvis, abdomen and throat to an area in the middle of the forehead known as the third eye that is the center of ‘spiritual enlightenment.’ ”

Not surprisingly, entire books are written about Tantric sex, and larger cities may offer classes on the practice.

Now if you’ll excuse me, I have to stick my head in the freezer.

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I never knew what it meant to prime a pump until I watched a plumber work on one at my cottage. To prime a pump means to pour a little water into its fill cap to create suction and, with luck, to pressurize the thing so it draws water rather than spurting air.

The hydraulics metaphor may be more appropriate for men, but I’m betting that some of your orgasmic pressure has leaked out over the years, too. Or, maybe it wasn’t very dependable to begin with. According to some studies, from 25 to 50 percent of women have trouble achieving orgasm.

There are, however, ways to repressurize your orgasmic system—techniques that may help get the sexual juices flowing again. It’s not magic—there is still no pink Viagra that guarantees an orgasm, given that the female sexual response cycle is a lot more complicated than a water pump.

If your orgasmic mechanism needs a little priming, here some holistic ways to repressurize.

  1. Exercise. (I heard that groan.) Good orgasms require good circulation to keep all that oxygenated blood flowing to your genitals. Aging does a number on the blood flow and nerve endings in the genital area, making them sluggish and less responsive.  Exercise helps maintain good circulation. It also keeps blood circulating nicely to the brain, which, as we’ve said, is really your biggest sex organ.
  2. Kegels. C’mon. These are easy and painless (there are tools available), and they do you a lot of good. Kegels tone and strengthen your pelvic floor muscles; those muscles keep you from leaking urine when you sneeze as well as holding your internal organs in place. Strong pelvic floor muscles also create a firm “vaginal embrace,” which is nice for your man, but also gives you a more powerful orgasm.
  3. Check your medications. Several categories of drugs are libido killers, including some antidepressants, but also some drugs that reduce cholesterol and high blood pressure. If you suspect that your meds may be messing with your sex drive, talk to your doctor.
  4. Masturbate. You need good circulation down there, right? Self-pleasuring helps. It also helps you identify what you like and how to “do it” the way you like it—so you can tell your partner.
  5. Get a vibrator and other sex toys. There are all sorts of physical reasons to use a vibrator. (See #4 above.) Toys may help you release some inhibitions and learn to play.
  6. Drink a little (not a lot.) Sharing a little pre-sex cocktail can create a cozy sense of intimacy and also help lower your inhibitions. Drinking too much is a libido-killer. Share a glass of wine in front of the fireplace and move the action to the bedroom—or keep it by the fireplace.
  7. Fantasize. Think of it as your personal romance novel. You can sleep with anyone you want and do anything you want. You’re only limited by your imagination. Fantasy helps some women “get into their heads.” Try it.
  8. Positions. If you’ve been using your vibrator, you know where your sweet spots are, and the missionary position often misses them. Try the back entry “doggie-style” position which is good for hitting the G-spot, although not so good for the clitoris, or try sitting on his lap, which is good for all kinds of things.
  9. Foreplay. If you take seriously Esther Perel’s statement that, for erotic couples, “foreplay pretty much starts at the end of the previous orgasm,” you may extrapolate that good sex arises from consciously introducing sensuality into your relationship in a sustained way. Touch. Snuggle. Sextext. Write love notes. Introduce beauty and sensuality into your life that might leach into lovemaking as well.
  10. Have sex. This cannot be repeated too often. The more you have it, the more you want it, and the better at it you become. As one happily married husband said: “Practice, practice, practice.”

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The Wrong Kind of “Hot”

Now that the FDA advisory panel has pulled the plug on two nonhormonal drugs to treat hot flashes and night sweats, what’s a grumpy, sleep-deprived, sweaty, menopausal woman to do?

For most of us, hot flashes are uncomfortable and inconvenient. For some of us, hot flashes are debilitating and make it hard to sleep or function normally. And except for hormone therapy, no treatment regimen is guaranteed to alleviate them.

So, chalk up yet another inhibitor to sex (as if we needed one). It’s hard to feel “in the mood” when your nightie’s soaked and sweat is running down your back—and this is pre-foreplay.

It may be possible, however, to manage the frequency and intensity of hot flashes with some simple home remedies. For some women, these techniques work well; for others, not so much. As in so much of life, it’s a matter of experimenting until you discover what works for you.

These more natural approaches fall into four categories: lifestyle changes, identifying the triggers, controlling your environment, stress management, and botanical remedies. If you’re bothered—or handicapped—by hot flashes, a combination of these might help. Even if the cure isn’t perfect, your overall health should improve. In the long run, that’s a whole lot better than popping a pill.

Lifestyle changes

A generally healthy lifestyle goes a long way to making you feel better all over. You’ll mitigate other problems, like diabetes and obesity, and you just might find your hot flashes are less frequent and intense as well.

A healthy lifestyle includes

  • A diet of high-quality, fresh fruits and vegetables, whole grains, low in fat and processed foods
  • Regular exercise that gets your heart-rate up and doesn’t injure your joints: brisk walking, swimming, free weights, yoga, tai chi
  • Losing weight, if necessary. You may have put on some menopausal baby fat (haven’t we all?), but be aware that a higher body mass index is related to more frequent hot flashes, according to the North American Menopause Society (NAMS).

Identifying triggers

While hot flashes are maddeningly unpredictable, they often seem associated with certain triggers, which are unique to every woman. Try to identify yours. Common triggers include

  • Caffeine, alcohol, and cigarettes (even passive smoke may be trigger one)
  • Anxiety, stress, and stressful situations
  • Hot drinks and spicy foods. If you’ve ever watched someone eating a habanero pepper, well, that’s enough to give you a hot flash right there.
  • Stress
  • Hot, stuffy, or crowded rooms
  • Activities that produce heat—ironing clothes, washing dishes, strenuous exercise
  • Did we mention stress?

Managing stress

Stress is linked in several studies to more frequent hot flashes, and you can bet they’ll happen at the most inconvenient times. When you’re heating up at a stressful moment, remember that, while embarrassing and uncomfortable, hot flashes aren’t life-threatening or even particularly noticeable to others. A few inconspicuous comfort measures will help you get through the moment, even in tense situations:

  • Breathe. Instead of panicking inwardly, consciously take deep, relaxing breaths.
  • Get up and walk around.
  • Open a window.
  • Try meditation, massage, yoga, relaxation or other therapy.
  • Maintain a sense of humor. You have to admit, the whole thing is kind of funny.

Conrolling the environment

Because the hormonal changes you’re experiencing have temporarily (or not so temporarily) messed with your body’s temperature-regulating mechanism, you can compensate (in part) by controlling the ambient temperature. Some easy ways to do this include

  • Keep the house, especially the bedroom, cool and well-ventilated.
  • Cotton (or fibers that wick moisture away from your skin) is your friend. Use cotton bedclothes and keep a spare pillowcase handy. Or, check out cooling bedsheets like those at DriNights. Keep a clean, cotton t-shirt beside the bed.
  • “Keep a frozen cold pack under your pillow, and turn the pillow often.” (From NAMS)
  • Check out the Dry Babe website for a line of “absorbent sleepwear for hot mamas.” These could lead to a little heated action of their own.
  • Wear clothes in layers that you can shed or add as necessary.
  • Carry a pretty Oriental fan in your purse.

Botanical remedies

Finally, a few botanicals have been associated with relief of hot flashes. Again, research is inconclusive: Some women are helped while others aren’t. But the remedies are relatively safe and free from serious side effects. You could try:

  • Black cohosh. Already commonly used in Europe, this member of the buttercup family may be the most promising herbal treatment for hot flashes.
  • Soy and red clover contain plant-based estrogen, which isn’t as effective and doesn’t work the same way as the estrogen synthesized for hormone treatments. Still, some women say they help.
  • Vitamin E. Again, scientific evidence is scant, but some women say these supplements work for them.

Just because a supplement is “natural” doesn’t mean it’s automatically safe for everyone. Some herbal supplements are quite potent, and others could interact with medication you’re taking or exacerbate a physical precondition you already have. So consult with your doctor or pharmacist before taking botanical remedies.

If you discover a remedy that works for you—please share!

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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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