Archive for January, 2011

Hot flashes. They’re the stereotypical symptom of menopause, the subject of T-shirts and mugs: “It’s not a hot flash, it’s a power surge.” But when you say to yourself or your partner, in an intimate moment, “I’m hot,” you want to feel sexy, not soaked.

Unfortunately, among the things that trigger hot flashes is arousal itself. And as uncomfortable as you may be—both physically and emotionally—this is no time to put your sexuality on hold. Remember our “use it or lose it” discussion?

There’s not a lot we can do to disconnect the arousal trigger for hot flashes. What we can do, though, is look at other triggers to make sure we’re not making ourselves overly susceptible.

  • Quit smoking. As a physician, I list that first because it contributes not only to hot flashes but also to other serious medical problems. I don’t smoke, so I know it’s easy for me to say, but if you’re still smoking at mid-life, it’s time to take that tough road to being smoke-free.
  • Drink less. A glass of wine can be part of a romantic evening, but be aware that alcohol can be a trigger for hot flashes. You can do your own experimentation to see if alcohol’s a trigger for you, at what level and with which kind of alcohol.
  • Eat well. Smaller meals of low-fat, high-fiber food will keep your digestive system from heating up from overwork and acting as a trigger. Spicy food can also sometimes be an aggravating factor.
  • Exercise. Women who exercise regularly have fewer hot flashes than women who don’t. More good news: Sex is exercise!
  • De-stress. Easier said than done, I know, but the more stressed you are, the more hot flashes you’re likely to have. You can’t remove all the stressors from your life—some of them are people you love!—but you can develop mindfulness practices that help you manage them more easily.

On that romantic evening, especially, plan your activities to minimize your triggers. Drink cold beverages. Eat a light meal, not excessively spicy. Wear natural fabrics (like cotton) that will breathe and keep you cool. Make sure that the temperature in your bedroom is cool, or position a fan. Use cotton bedding and layers of light blankets that let you adjust. And remind yourself to keep breathing.

It might help reduce your anxiety (remember stress is a trigger!) to have a conversation with your partner about how to stay in the mood with a hot flash.

For a few of us, none of these strategies contains the damage, and hot flashes really interfere with our lives and sexuality. None of these options is perfect for everyone, but hormones, anti-depressants, and blood pressure medications have each had some positive effect. Your care provider can help you balance treatment of hot flashes with your health history and other medical conditions you may have.

And finally, remember that there is sex after hot flashes. Most of us, a year or two after menopause, are completely hot-flash-free. Staying sexually active through this transition keeps us able to continue to enjoy intimacy. Because, you know, we’re still hot!

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Both Replens and Yes, the vaginal moisturizers we offer at MiddlesexMD, are perfectly safe for oral sex. In fact, all of the products we offer are chosen with safety in mind.

Your partner may have personal reactions to a taste or texture of either product, or to personal lubricants. Feedback through our personal lubricant selection kit proves just how individual those reactions are!

If you or your partner isn’t happy with a moisturizer or lubricant, don’t think you’ve got to give it up! Just check out some other options to find one that works for both of you.

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You say you don’t have issues with vaginal dryness, but you did feel discomfort–difficult to sit comfortably, spasms of pain–for at least a week after intercourse. It does sound as though you experienced some trauma.

It’s likely that though you’re still experiencing your own lubrication when stimulated, you’re experiencing some atrophy, too. I’d suggest that you start using a vaginal moisturizer (like Yes or Replens) or a localized estrogen to maintain moisture all of the time–not just when you’re aroused.

If you and your partner aren’t able to be intimate often (and I’m afraid the definition of “often” varies from woman to woman), you might think about some of the additional options I talked about in a blog post about “Staying Ready for Sex.” It’s easier to maintain your sexuality than to restore it!

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“I just want to want sex again.”

I can’t tell you how many of my patients have expressed — in one way or another — this simple desire for the desire they experienced in their 20s and 30s, when their bodies were flooded with procreative hormones.

Wouldn’t it be great if I could mix up a love potion to send home with them and to share with you here? Some powerful concoction of roots and herbs perhaps, a magic elixir guaranteed to bring it all back?

Well, here’s the next best thing. A recipe you can use to produce your own personal, all-natural love potion. For free.

Oxytocin, a hormone produced by the pituitary gland, has long been recognized for its role in childbirth and lactation and mother/child bonding. Women in labor are sometimes given a synthetic oxytocin to stimulate contractions. And mothers and babies both experience the pleasurable effects — calmness, trust, contentment — of the natural oxytocin that is released into their brains and blood streams during breast-feeding.

Recently though, research has been identifying the significant effects that “the cuddle hormone” have on men as well as women — and on their desire for (and enjoyment of) sex that isn’t about making babies.

Both men and women experience rising oxytocin levels in response to being touched anywhere on their bodies. The effects promote a bond of closeness that increases sexual receptiveness — and the desire for even more touching. Even more touching leads to even more oxytocin which leads to even more arousal and even more desire for even more touching. Isn’t it beautiful how that works?

There’s more: high levels of oxytocin cause nerves in the genitals to fire spontaneously, triggering powerful orgasms. And during orgasm the body releases — you guessed it — more oxytocin. (Which, as it turns out, is good for you in all kinds of ways. Research indicates that oxytocin helps people sleep better, enhances feelings of well being, and counteracts the stress hormone, cortisol.)

The best thing about this amazing hormone for women our age is that — unlike estrogen and other sex hormones — you can make it yourself. Caressing your partner, enjoying a massage, bringing yourself to orgasm are all ways to get more oxytocin into your life. In fact, many women find that self-pleasuring is the best way to boost a sagging libido. More orgasms = more oxytocin = more desire.

Check out our website for information and products that can help you get this wonderful pleasure cycle up and running!

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Absolutely not! As we grow older, it takes more stimulation for us to arouse and lubricate, and that stimulation can come in many forms–physical or mental. If watching an erotic video provided visual stimulation for you… well, you’re not alone!

It’s sometimes a challenge to find the right material–arousing but not offensive–but it sounds like you found it! Don’t feel guilty or embarrassed. Most women need to change things up a bit and adding erotica is a perfectly acceptable option.

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When a patient tells me that she no longer enjoys sex, one of first things I ask her is to tell me about something that she does enjoy.

If she isn’t able to come up with a fairly quick answer, in my experience it’s likely that depression is playing a part in her loss of libido.

Anhedonia — the inability to gain pleasure from normally pleasurable experiences — is a core clinical feature of depression. And because depression affects nearly twice as many women as men, and because recent studies suggest that midlife is a period of increased risk for depression in women, I am always on the alert when a patient mentions that she has stopped enjoying activities — like sex — that used to give her pleasure.

The cause-and-effect relationships between menopause and depression and between depression and loss of libido are complicated — to say the least!

Some studies suggest that changes in hormonal levels, such as those that occur during the transition to menopause, may trigger depression. The production of mood-enhancing neurotransmitters is boosted by estrogen. Lower levels of estrogen that accompany menopause can mess with the brain’s chemical balance, leading to depression. Other biochemical changes that come with age, such as those that result from decreased thyroid function, have also been linked to the onset of depression.

But the pressures and stresses associated with midlife surely play a role as well. The loss of our youthful looks, of our reproductive and mothering roles, and sometimes even of our jobs or life partners — all make us vulnerable to depression as we move into and through our menopausal years.

Whatever the cause — and at whatever age — depression has a significant impact on sexual function and enjoyment. Nearly half of all women — and men — diagnosed with depression report that it interferes with their sexuality.

The good news: If depression is behind your loss of interest in and enjoyment of sex, there is an array of proven treatments to relieve the underlying cause and its symptoms. Your doctor can help identify and treat medical causes, such as thyroid problems. In some cases, hormone replacement therapy that elevates estrogen levels may be effective. Antidepressants that help correct chemical imbalances in the brain help many (although these may have their own sexual side-effects). Regular exercise, improved sleep habits, and dietary changes can help to counteract depression, and counseling and support groups are other options to explore.

Don’t let depression drain the pleasure from your life. Talk to your doctor. See our website for more information on hormonal changes and therapeutic resources. And if you have experienced and overcome anhedonia in your own sex life, we’d love to hear your story!

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“There are many paths to heaven, and sex is one of them.”

–Abraham Maslow

Maslow, the humanist psychologist who invented the term “peak experience,” would know exactly what participants in the “Optimal Sexuality” study mean when they say that “transformation” is an essential part of extraordinary sex.

People interviewed for a groundbreaking study published last year in The Canadian Journal of Human Sexuality used words like “bliss,” “peace,” “awe,” and “ecstasy” to describe this transcendent aspect of peak sexual experiences. Some compared it to the “high” that cam be achieved through meditation. Others used religious language to describe the feeling, calling it “revelatory,” “eternal,” “an epiphany.”

“At this moment,” one participant said, “we were in the presence of God.”

It can seem a little over the top, I know. But while not all of us can say (like one study participant) that we’ve experienced sex that felt like “floating in the universe of light and stars and music and sublime peace,” many of us can relate to what singer Marvin Gaye called “sexual healing.” Physical and emotional intimacy can simply make us feel better, more in harmony with ourselves and our partners.

The transformative power of great sex that “can change you, can make you more than you are,” goes beyond the bedroom, I think. True sexual healing carries over into our everyday lives, makes us calmer, happier, more loving people.

For some of us, hormonal changes or the special stresses of midlife have reduced the power of sexual healing and transformation in our lives. Remember, though, if we understand what’s happening to our bodies, we can find ways to bring that power back. Check out our recipe for enjoying sex after menopause, or our selection of books and CDs on mindfulness and sexual health.

You can find your own little piece of heaven, right here on earth.

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