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Posts Tagged ‘relationships’

Let’s first acknowledge that women—and men, too—come to sex with a host of different backgrounds, value sets, cultural expectations, emotional foundations, and experiences. It’s very difficult, given that variety, to assert that anything is or should be true for every woman.

It is theoretically possible to have a strong physical attraction and enjoy sex with little emotional intimacy involved—whether we are men or women. There are differences between us, though: Research suggests that for women there are six neurotransmitters involved in sexual activity, and that the areas that “light up” in our brains with sex are completely different from men’s responses. Women release oxytocin with sex, a very strong bonding hormone; men don’t.

Cultural stereotypes may exaggerate the differences between men and women when it comes to sex, but the science is there to prove there are differences.

Among the women in my practice and in the rest of life, I observe that women often go into sexual experiences with an expected outcome that includes some emotional connection. Most of the women I see desire emotional intimacy as a cornerstone for their enjoyment of physical intimacy. And the study I recall that went the furthest in qualifying sexual enjoyment (“A Portrait of Great Sex“) implied emotional intimacy as intertwined with physical intimacy.

All of that said, I come back to the fact that women come to sex with enormous variety of experience and expectation. As long as she is caring for her own emotional and physical safety and health, each woman can choose, I hope, the right combination of emotional and physical intimacy.

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That sounds like a bad riddle, right? Like one I heard on NPR last week: What goes up a hill and down a hill but doesn’t move? The answer to that one is a road. And the answer to what subtracts more than it adds is sex.

Here’s the disturbing—but not, when I think about it, surprising—statistic I ran across this week, courtesy of colleague Sheryl A. Kingsberg, a PhD and chief of the Division of Behavioral Medicine at the University Hospitals Case Medical Center: “When sex is good, it adds 15 to 20 percent additional value to a relationship. When sex is bad or nonexistent, it plays in inordinately powerful role draining the relationship of positive value—about 50 to 70 percent!”

I was so struck by that statistical picture, I’m on the trail of the original research to understand more. But in the meantime, what I know from other studies—and my own experience and conversations with women—suggests that’s about right.

Let me first say that good sex doesn’t automatically make a relationship good. And a good, loving relationship doesn’t automatically mean that the sex will be good. But if I think back to a study done a couple of years ago, “The Components of Optimal Sexuality,” I’m reminded of how many of the characteristics of good sex are also characteristics of good relationships.

I won’t revisit the whole list, because you can read the series of detailed blog posts we did on each of the components. But here are just a few that come to mind in this context:

  • Being present. It’s so easy to take our partners (and, of course, others in our lives) for granted. Truly paying attention to one another—today—is a great gift.
  • Connection. When we feel connected to our partners, intimacy comes naturally (especially when we’re overcoming obstacles together). If you’re feeling “together but alone,” there are steps you can take.
  • Authenticity. At this point in our lives, I find that many of us are more willing than ever to own what we think and feel. Whether we’re in longstanding or new relationships, this helps us to be ourselves—and to be open about what we like and need, in the bedroom and the rest of life.
  • Vulnerability. Having sex is perhaps the ultimate act of making yourselves vulnerable to each other. What a reinforcement of the bond that a couple has with each other!

If those parts of your relationship are important to you, too, you’ve got more reason to understand how to stay healthy and be intentional about nurturing this part of your life.

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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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A couple of weeks ago, I talked about an article I’d seen about how sexual intimacy is linked to marital happiness. The research, by Adena M. Galinsky and Linda J. Waite, found that continued healthy sex-lives help couples dealing with physical illness, especially chronic health problems.

Couples who had sex frequently (and sex was defined broadly—it didn’t need to include vaginal intercourse) were more likely to say they had a good relationship.

This is, of course, a chicken and egg: More sex doesn’t automatically make a relationship good. It’s more likely—and perfectly reasonable—that an unsatisfying relationship will include less sex. And the women I meet through my practice as well as the rest of life show me that this is often a time when our relationships get some re-evaluation.

Sometimes it’s the empty nest, and the change in schedules and priorities that comes with it. Sometimes it’s retirement, for one or both partners, which means a lot more together time. Sometimes it’s the stress of caring for aging parents along with everything else. Whatever the prompt, when some of us look at our relationships, we say, “Is this really what I want?”

So it was interesting to me to read the details of the Galinsky Waite study, to see how they measured the quality of relationships. These are the questions they asked:

  • How close do you feel your relationship with your partner is?
  • How often can you open up with your partner if you want to talk about worries?
  • How often can you rely on your partner for help with a problem?
  • How often does your partner make too many demands?
  • How often does your partner criticize you?
  • How happy is your relationship with your partner?
  • Do you like to spend your free time together, separately, or some of both?
  • How emotionally satisfying is your relationship?
  • How often does your partner get on your nerves?

If you’re feeling some vague discontent, those questions might help you with a conversation with your partner—or with a couples therapist if you decide some outside perspective and coaching would be helpful. If you’re feeling angry, or resentful, or isolated in your relationship, it’s no surprise that you’re not feeling sexy.

And you deserve to.

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One of the motivations for my work with women both in my practice and through MiddlesexMD is the difference staying sexy makes for women in their relationships. I’ve heard anecdotes on both sides of the issue: from women who feel the intimacy with their partners drifting away, and from women who’ve reignited their sex lives and feel a burden lifted in their relationships as they and their partners re-engage.

So I was especially interested to see a study announced this month that puts some numbers to those observations. The study was led by Adena M. Galinsky and Linda J. Waite through the University of Chicago’s Center on Demography and Economics of Aging. I’m waiting the full text of the study, but an article in The Washington Post provides some interesting highlights.

A healthy sex life helps couples dealing with physical illness. Illnesses, especially chronic ones, can stress a marriage at any age. The study results showed that couples with more sexual intimacy viewed their marriages more positively in spite of illness.

Assessments of relationship quality are tied to frequency of sex. To put it plainly, couples who had sex more often were more likely to say they had a good relationship. In other studies, good marriages have been shown to prolong life—and certainly quality of life.

At any age, we can “expand [our] idea of what sex is,” according to Amelia Karraker, postdoctoral fellow at the Population Studies Center at the University of Michigan. I look forward to studying this part of the study in detail, because many of us grew up thinking sex equals vaginal intercourse. When that becomes uncomfortable or less pleasurable, too many of us think we’re done with sex.

This study’s data encourage us to keep sex as a part of our lives for just as long as we’d like to. When sex changes for us, we only need to learn about what’s different and how we can compensate (and engage our partners along the way). When we abandon that part of ourselves, we accept an unnecessary loss—to ourselves and our relationships.

“Wellbeing in older age incorporates both psychological and physical wellbeing as well as sexual wellbeing, which can occur at the intersection of those two,” Karraker said. Or, to put it another way: Sex is part of our physical and emotional health. Our whole lives.

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As a menopause care provider, I have lots of conversations with women about sex. I’ve heard confirmation that our motivations to have sex change with our situations. What motivates us when we’re young and single is very different from what motivates us when we’re older and in longstanding relationships, or older and single.

So when we suffer from lack of desire—are we missing the sort of drive we had when we were teenagers? Or is it possible we just haven’t found a new motivation for sex? The more we learn from women, the more it seems that for us sex doesn’t always begin with lust, but instead starts in our hearts and minds. We engage in our heads first, decide to have sex, and then with enough mental and emotional stimulation, our genitals respond. The older we grow, the more this is true. Age and maturity bring a new game into the bedroom.

For us, having sex is less an urge than a decision, one we can make and then act upon. When we decide to say yes instead of no, decide to schedule sex instead of waiting (perhaps for a very long time…) for our body to spontaneously light on fire, decide to engage with media or methods that will put us in the mood rather than wait for romantic moments to happen along, we’re using our heads to keep sex in our relationships.

Deciding to be intimate unlocks the pleasure. And the more sex we decide to have, the more sex we will feel like having. That’s the secret to regular bonding.

Why just decide to do it? This much we know:

  • Sex leads to a longer life.
  • Sex, like all exercise, helps protect us against heart attack and possibly stroke.
  • Hormones released during sex may decrease the risk of breast cancer and prostate cancer.
  • Sex bolsters the immune system.
  • Sex before bed helps us get to sleep.
  • Sex burns calories.
  • Sex can help relieve chronic pain, including migraines.
  • An active sex life is closely correlated with overall quality of life.
  • Good sex can protect us against depression, reduces stress, and increases self-esteem.
  • Sex with your partner stimulates feelings of affection, intimacy, and closeness.

That last point is what I hear most often in my practice: Women want to keep or already miss the intimacy with their partners that mutually satisfying sex communicates. While they also miss the feelings of power and wellbeing that sex gives them, it’s the loss of connection that impels them to take action.

And you can take action, too. We don’t need to wait around for “desire” to lead to thoroughly satisfying sex. We can use our heads.

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First, let me assure you that you’re not alone in feeling a loss of libido: It’s common for women to lose desire, even in great, emotionally supportive relationships.

Low desire is challenging to treat, because we women are complex sexual creatures. I prescribe testosterone for some of the women in my practice; about 60 percent of those who’ve tried it have found that it does boost libido. I wish it were 100 percent, but it’s not! And some physicians are reluctant to prescribe testosterone for women because it’s “off-label.”

Given what we know about women’s sexuality, I advise women to engage “mindfulness” when it comes to sex. Often, we feel desire somewhere in the process of being intimate; we may not be driven to intimacy by desire. We need to choose to be sexual! I encourage women to plan for sex, committing to a frequency that is comfortable for both partners. It might be once a week, once a month, on Friday evening or Sunday morning—whenever you’re least likely to be distracted, stressed, or tired. When we have been sexual, we’ve typically found it pleasurable and we’re glad we did!

Finally, you mention being self-conscious about your breasts, which are no longer like they used to be. We are our own worst enemies when it comes to body image, and we pay the price when we rob ourselves of pleasures! I’ll bet your partner doesn’t look like he used too, either, and that he loves every inch of your body, as you love his. You might reread this blog post on body image and try some of the suggestions to “send your body some luv.”

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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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My last blog post, about thinking about sex as we think about exercise to encourage us to keep our sexuality alive, reminded me of another article I saw a while back.

In “Men Don’t Think about Sex Every Seven Seconds,” Dr. Laura Berman set out to debunk the urban legend alluded to in the headline. She cited a study done at Ohio State University, which concluded that men think about sex, on average, 19 times a day; women think about sex about 10 times a day.

That’s a far cry from every seven seconds, which works out to somewhere over 8,000 times per day, if my math is right and assuming eight hours of sleep.

Now, that research was done with college-age men and women, and I’m willing to cross-reference the National Surveys of Sexual Attitudes and Lifestyles (NATSAL), recently completed in Britain, to guess that by midlife, the rate is reduced by as much as 60 percent. For women like me, that means thinking about sex three or four times a day.

I don’t know how that strikes you—as too much or too little! Laura made another comment in her article that resonates with what I’ve seen in my practice: Researchers “found that incidence of sexual thoughts were most highly governed by one’s own sexual belief system. …People who had anxiety, shame, or guilt around their sexuality were less likely to have sexual thoughts, while people who were comfortable and secure in their sexuality were more likely to have sexual thoughts.”

That’s especially important to us as midlife women. We get lots of messages that conflict with the reality that we are still vital, complete, sensual, sexual creatures. As we watch our bodies change—through childbearing, decades, illness, losing and gaining (and losing and gaining) weight, new wrinkles—we ourselves sometimes question whether we are still sexual, attractive to ourselves as well as to our partners.

Dissatisfaction with our bodies is hardly exclusive to us midlife women, sadly. But when it affects what we decide to do or not to do, it begins to matter more to us. You’ve no doubt seen articles about staying active, because the more active you remain as you grow older, the more active you’re able to remain. You keep muscle tone, bone mass, and balance only as you exert yourself.

The same is true of our sexual selves. Physically, being sexually engaged increases circulation to vaginal tissues, which naturally thin and become more fragile as we lose estrogen. It’s equally important that we’re attuned to the mental part of the equation.

Remember Stuart Smalley on Saturday Night Live? The nerdy guy with the affirmations? “I’m good enough, I’m smart enough, and doggone it, people like me.” What if we midlife women had affirmations for ourselves? Could we use them to both reclaim our bodies and nurture our sexual selves?

I’ll have to give that some thought. Possibly up to ten times a day.

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There are many benefits to being sexually active: It releases estrogen and increases oxytocin, serotonin, endorphins, and immunoglobulin A. This chemical and hormonal stew makes us both feel and be healthier. Having sex makes us feel powerful, giving, and connected, all of which feed our relationships with our partners.

I came across a recent study that affirms another benefit I often talk to women about: Sex is good exercise.

The study was conducted by Antony D. Karelis, who teaches exercise science at the University of Quebec at Montreal. Participants in the study wore armbands while having sex, and also jogged on treadmills to produce comparative data. The results? On the “metabolic equivalent of task” scale, on which sitting still ranks a 1-MET, sex ranked 6-MET for men and 5.6-MET for women. That puts it, according to Gretchen Reynolds, author of “Sex as Exercise: What are the Benefits?” as roughly equivalent to playing doubles tennis or walking uphill. To do your own comparisons, it’s categorized as “moderate exercise.”

Good to know, right? And I think we midlife women can use this knowledge to our advantage. Part of my counsel to women experiencing diminishing libido is to be intentional about remaining sexually active. There are two parts to my rationale: First, as our hormones diminish, we’ve got that “use it or lose it” thing going on that I’ve talked about before. Second, having sex begets having sex. That is, we women will want to have sex more often when we—wait for it—have sex.

There’s a line from the study conclusions that made me smile: “Both men and women reported that sexual activity was… highly enjoyable and more appreciated than the 30-minute exercise session on the treadmill.” I’m so glad to hear that!

So I start to wonder: How can we apply to our sex lives the same thinking that gets us religiously to yoga or Pilates several times a week? Neither we nor our partners want us to be thinking about sex as one more chore on the to-do list or an obligation on our calendars. But can we consider it a gift to ourselves and our health, as we do our morning walk or Zumba class? Will that give us the extra incentive to make the time and the commitment?

I’m hoping so.

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