Archive for August, 2012

Sexual health always follows general health, so it’s hard to enjoy sexual health with other chronic conditions. Obesity is a known risk factor for heart disease, stroke, sleep apnea and other breathing problems, and osteoarthritis, among other things, and is associated with depression. Unfortunately, not sexy things to think about! And even more unfortunate is the fact that weight gain is common among women experiencing perimenopause; some say that a woman in her 40s and 50s typically gains a pound a year.

High blood pressure is commonly associated with obesity. Antihypertensives, which are critical for your cardiac health, can interfere with sexual desire and response.

UnattributedI know it’s hard to hear, but it’s most important to put “first things first,” to get regular exercise, achieve and maintain a healthy weight, develop and honor regular sleep habits, and eat healthily both in amount and type of food. Exercise and activity will benefit you most. Yoga might be a good starting point, since it’s low impact; it’s also been proven to help women sexually, including with pelvic health. If you start there, you can add more aerobic activities as you’re able.

Having a health care provider who can help you untangle the issues associated with obesity and menopause can be extremely helpful. If you’re not confident in your current resource, you might look for someone certified by the North American Menopause Society. NAMS has a provider locator on their website.

There’s no easy single answer for any of us: We’re complicated creatures. Start small and keep moving in the right direction—but, most importantly, start!

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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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Before Sex and the City, before Gloria Steinem, before Jane Fonda, there was Helen Gurley Brown. She was the creator of the iconic Cosmo Girl, wearer of organza and décolletage, and advocate of a woman’s right to a career, sex, and life on her own terms.

It may be hard to remember or to appreciate how radical her approach to a woman’s place in the world was as we look back through the lens of rapid change in women’s rights and cultural expectations.

In the old-school world that Helen Gurley Brown faced in the 1950s and 60s, women had only grudgingly been granted the right to vote. She did not come upon the scene with either pedigree or good looks. (She called herself a “former mouseburger… not beautiful or even pretty… not bosomy or brilliant,” although others said she was “obsessed with boobs,” as the Cosmo covers suggest.) Her achievements came because of hard work and skillful politicking and through the unabashed use of feminine subterfuge and seduction.

In this she differentiated herself from the bra-burning feminists who were to come shortly after. She was the anti-feminist. She challenged the traditional role of women in the workplace (as secretaries) and in the bedroom (as wives) just as vigorously as the ERA women, but from a different perspective. In HGB’s world, a woman had to be smart and confident. But it was also useful to be feminine and to know when to deploy those charms, either to get what you want or for the sheer fun of a sexual romp.

While she predated the feminist movement by almost a decade, her book Sex and the Single Girl was the first crack in the dike, the first shot across the bow, signaling the vast social upheaval that would follow. In her book, “Brown challenged [single women] to take the same liberties as young men: to enjoy a long and lusty sexual prelude to marriage and to use the rest of the time to build a successful career,” writes Gail Sheehy in Cosmo.

Although the feminists who followed disagreed, sometimes vociferously, this was HGB’s homegrown revolution, and she practiced what she preached.

Born into poverty and possessed of no great physical endowment, HGB worked like a draft horse at 17 jobs before reaching the seat of power she’d been striving for at the age of 42—editor-in-chief of Cosmopolitan magazine.

For the next 32 years, until she was forced out of her job at 74, HGB created the icon and the culture of the Cosmo girl. And while on the one hand, the Cosmo girl perpetuates the imperative of feminine beauty and bosom, perhaps at the expense of brains; on the other, it celebrates the power and potential of a woman who knows how to use her femininity.

At the time, the Cosmo Girl was fresh and naughty; then, however, as one pundit commented, “she became familiar. And then she became a cliché.” Maybe, in today’s world of silicone cleavage and über-sexiness, she has become a caricature.

But in her work and in her personal life, HGB was a cheerleader for lots of fun, juicy sex. Clearly, sex continued to be important in her last marriage to David Brown as they both grew older. And it is in this capacity that Helen Gurley Brown has something to say to us—mature women who might be wondering what role sex has in our lives and relationships. While we may not want to emulate her, from that perspective we can learn a thing or two.

In memory of Helen Gurley Brown, who died August 13, 2012, at the age of 90, here are a few choice quotes for the older woman:

  • “It’s just ridiculous for a woman over 50 to assume sex has to be over. You may not be as rambunctious as when you were a teenager, but an orgasm is an orgasm, it doesn’t matter how long it takes to get there.”
  • About keeping the romance in marriage: “It helps if you go on romantic trips together. …When you’re in another city and a glamorous hotel that is conducive to sex, you think, ‘Hey, let’s don’t let this go to waste.’”
  • “What you do have to do is work with the raw material you have, namely you, and never let up.”
  • “Being sexy means that you accept all the parts of your body as worthy and lovable … your reproductive organs, your breasts, your alimentary tract.”
  • “A woman who even occasionally enjoys an orgasm from the roots of her hair to the tips of her toes is sexy.… Remember, frigidity isn’t a physical disability. It’s a curable state of mind.”

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The editor of the MiddlesexMD newsletter, who somehow knows these things, tells me that August is Romance Awareness Month.

Who knew?

According to an online poll by Zoosk, which calls itself a “romantic social network,” couples enjoy more romance than single people. Without getting too fussy about the details, according to the Zoosk survey, 79 percent of people in couples say that their partner is romantic while only 41 percent of single people say the same (presumably of their current interest?).

And even though the vast majority (78 percent) of those polled consider romance important in a relationship, only 20 percent of single people are happy with the romance in their lives compared to 59 percent of the coupled folks.

(Just to be clear, neither single people nor couples considered taking out the garbage romantic—so don’t try to make that count.)

In honor of Romance Awareness Month, maybe it’s time to take stock of the romance in your life. Are you stuck in a rut? A little rusty when it comes to new ways to woo your honey? Or maybe you haven’t thought about romance in a long, long time.

Romance might be considered a nuisance and a bother by some long-term couples. Romance is for newlyweds. What’s the point? He (or she) knows I love him (or her).

Maybe. But we frail human creatures still need reassurance from time to time. And saying the words out loud keeps our own emotional machinery in good working order, too. I’m betting that couples who manage to stay sexy and in love over the years are very good at romance. You know the couples I’m talking about. They hold hands; they enjoy being together; they touch; they make eye contact.

Romance can be as simple as a little squeeze or an “I love you” before bed. In fact, couples in the Zoosk survey actually preferred a hug and a kiss to dinner by candlelight (41 to 39 percent), while the singles prefer the dinner to the kiss (44 to 32 percent).

The tricky thing about romance is that it requires you to really know your partner in order to anticipate the unique things that will please him or her. Roses and chocolate might completely miss the mark while fresh coffee in the morning might be the most sensitive, loving and, yes, romantic, gesture imaginable. There’s no one-size-fits-all when it comes to romance.

Romance is all about acts of thoughtfulness and caring that is uniquely targeted toward the person you love. It’s about going a little out of your way for no reason at all, except that you care.

Done right, romance communicates to your partner that he or she is uniquely loved, and that leads to a sense of intimacy and caring in return. (And maybe to sex.)

This is the stuff that keeps a relationship tender and vital. While romance can be sexy, it isn’t about sex; it’s about expressing your love without ulterior motive or expectation of return in a manner that that only your partner will appreciate.

August may be Romance Awareness Month, but there are eleven more months to practice in.

Let’s get started!



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The Big “O”: For Him

We talk a lot here at MiddlesexMD about female side of sex, how to keep your libido alive and your sexual experience comfortable and pleasurable.

But we often take the male orgasm for granted (or… maybe not, at this stage of the game). For most of us—at least in the beginning, that pump was always primed; the shotgun always loaded. Now, whether our partner is slowing down, in need of a little pharma assistance, or still willing and able at the drop of a pin, we know for certain that his orgasmic experience is different from ours.

For starters, its purpose is different; the plumbing is different; and the “sexual-response cycle” (a term coined by sex researchers Masters and Johnson) has a different timing (say, like a hair-trigger).

On the other hand, male and female orgasms do share basic similarities in that both genders progress through similar stages. And, as with its female counterpart, a lot is still unknown about the male orgasm.

Since a little knowledge is a helpful thing, understanding what happens during a guy’s orgasm might help us appreciate the similarities and differences of our mutual experience. Maybe Mars and Venus can orbit in slightly greater harmony.

The male orgasm is designed to position healthy, active sperm so that it achieves its biological objective—babymaking. The job involves the coordination of brain, nerve, muscle, and blood, and psychological factors, to get those swimmers into our receptive vessel.

Testosterone is the juice that fuels the system in a male. It’s the critical hormone that keeps his libido finely tuned and his sexual apparatus running properly. Testosterone can boost our libido too, but a guy’s daily testosterone output is about 20 times greater than ours.

Testosterone is produced in the testicles, which also makes the sperm and mixes it with a protein-rich fluid bath for nourishment during the arduous trip up the vagina. Sperm and fluid together constitute semen, which is what is ejaculated during orgasm.

Usually (there are some exceptions), a guy has to have an orgasm for the pumping mechanism to work. For us, orgasm is nice to have, but not essential to the job at hand. Our orgasm might help those little sperms along somewhat, and it makes sex feel good, but orgasm or no, we can still get pregnant.

The actual sexual-response cycle unfolds in four stages for both men and women. For a guy, however, orgasm is a more straightforward and less tricky process. Given a normal anatomy and normal testosterone levels, a flash of nicely turned thigh or bosom is enough to trigger the first stage of the male orgasm: arousal.

We experience arousal too, of course, but it generally takes different stimuli and a longer time frame.

During arousal, blood flows into a guy’s penis through enlarged arteries perhaps 50 times faster than normal, and veins that normally drain blood from the penis close off. Muscles tense and the scrotum pulls inward.

Voilà! Erection.

The second stage is the plateau, in which the man’s body prepares for orgasm. Heartrate and blood pressure increase. Muscles tense further. Involuntary pelvic motions begin. A clear pre-ejaculate fluid may change the PH balance in the urethra so the sperm has a better chance of survival.

Orgasm in men occurs in two phases. First, semen collects in the urethral bulb at the top of the penis. This is called “ejaculatory inevitability,” in which the man reaches the point of no return. Then, the rockets fire. Muscles at the base of the anus contract rapidly to pump semen through the urethra, and nerves deliver orgasmically pleasurable messages to the brain. The ejaculation phase is fairly reflexive and is controlled by nerves in the spinal column.

The final stage—resolution— is when our man rolls over and falls asleep and we’re left feeling all warm and fuzzy and yearning for pillow talk—or for more sex. But don’t jump to conclusions—he’s spent, literally. He loses about half his erection immediately; the rest fades shortly.

While we may not be fully satisfied after one orgasm, our man is. It takes a recovery period (called refraction) before he’s ready to go again. When he was 19, refraction may have lasted half an hour. Now, well, it’s a different story. This is when a little sleight of hand or toy action might help you out.

While the male orgasm is less affected by mood and psychological factors than ours, hormonal imbalances, physical issues, medications, and of course, aging can still muck up a man’s ability to become aroused or to have an orgasm.

So, the next time your man starts to snore as soon as the deed is done, you don’t need to take it personally. Blame nature.

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According to a recent New York Times article, women now have available a plethora of products meant to boost “feminine arousal.” And they’re appearing not behind the pharmacist’s counter, but in over-the-counter products in major pharmacies, right beside the Vaporub and Ace wraps.

Yahoo—I think.

Many of these products contain blends of botanicals and oils and “secret-recipe” ingredients designed to boost a woman’s sexual response. I wish some of them would carry more information for the user so that, for example, some oils aren’t unintentionally used internally when they’re best only for external massage. As with many beauty products, some strike me as setting unrealistic expectations (or even sending unfortunate messages), as with “anti-aging creams” for the vagina, clitoris, and inner thighs.

Few of these products have been objectively tested for efficacy or safety, so it’s a “buyer beware”—or, I’d rather say, “buyer be informed” marketplace.  Zestra’s oil is the only arousal product that has been subjected to a randomized clinical trial in which it “significantly” outperformed a placebo. Too many products are promoted with only survey results, which are not the same thing as a clinical trial.

As the Times article noted (and we’ve stated many times), the trouble with female libido is that it’s complicated. Everything from mood to culture and personal beliefs to hormonal imbalances can affect a woman’s ability to “get it on.”

And in fact, a woman’s lack of libido also affects her partner’s sexual pleasure. Dr. Michael Krychman, gynecologist and MiddlesexMD advisor, notes that men often neglect to fill their Viagra prescriptions because their partner’s sexual issues remain unaddressed.

Finding a one-size-fits-all silver sex bullet is like looking for fairy dust. Most of us have to develop a multi-pronged regimen to keep our sex drive functional, especially as we get older. We could abide by the Hippocratic principle to “do no harm,” and given that these products are, by-and-large, indeed harmless, and that they may do some good, why not give them a trial of your own? Use a site like ours to inform yourself about what might be worth looking for or avoiding (we have this advice, for example, about choosing a lubricant), and then make some room for some playfulness.

“Do they work for serious issues? No. But do they work to make your sex life more fun? Maybe. There’s certainly no harm in trying,” says Dr. Bat Sheva Marcus in the Times article.

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Recently, I was interviewed by Dr. Michael Krychman, a gynecologist and MiddlesexMD adviser, about the 50 Shades of Grey series. In case you’ve been, um, visiting another galaxy for the past few months, 50 Shades is a trilogy that follows the romance of Christian Grey, a suave billionaire with some unusual sexual notions, and Ana, the timid virginal woman who has become his obsession.

While the books make no pretence at literature, they have become enormously popular with women. The raw sex, the romance, the twist in the traditional love affair—Christian is into dominance and control to the point of implied threat. Yet, the books have sold 10 million copies and created a genre called “mommy porn.”

“This book is a revival of the Harlequin romances but without the ‘fade to black’ love scenes,” Michael said in an article in the Washington Post, “which is nice because it helps with creativity and imagination, and can give people ideas that help counter sexual boredom.”

Yup. Those love scenes are there all right, in explicit living color.

In our webcast, Michael and I discussed the effect these books are having on our patients. Michael mentioned that patients come into his office with the cover ripped off the book because they’re embarrassed to have anyone see what they’re reading. But “It allows women to start the conversation,” he says. It’s a form of bibliotherapy, which uses books to help people understand and begin to articulate issues they may struggle with.

I think 50 Shades gives women a sexual voice in a similar way that Sex in the City did. The main character is a woman and the books take readers beyond “vanilla sex” by breaking some boundaries and adding some danger, all within a romantic love story.

So—what can the enormous popularity of these books tell us about how men and women relate as sexual creatures? And how it can enhance our own sex lives?

According to an anonymous online survey conducted by More magazine, while many women fantasize about kinky sex with whips and chains, most (69 percent) of women would never act on those fantasies and actually prefer Christian in scruffy jeans “that hang from his hips just so” rather than with his riding crop.

So, most of you are romantics at heart, but prefer a softer side of sex and aren’t really into submission and dominance.

Female readers love the fact that Christian really wants to please Ana, sexually and otherwise, and that he knows how to do it. She doesn’t have to ask, and she doesn’t have to explain. “Ana is adored by Christian Grey. I think women want to be adored and ravaged,” said one reader.

Of course, in my practice, I encourage women to talk to their partners, communication being a cornerstone of good sex. I tell women to ask for what they want and to be explicit about it. But part of the appeal of this book is that Ana doesn’t have to. “Talking can be difficult, and maybe the popularity of 50 Shades is in part a backlash against the admonishment to talk, a sign that sometimes people yearn for someone who just knows,” suggests one talk-show host.

Some couples, however, are making good use of the book to enhance their own sex lives. As one husband commented in an online forum, “I’m reading 50 Shades of Grey along with my wife, and we are really enjoying the book. It has helped us both open up a bit and start to think about some of these darker desires we both have but never truly expressed.”

Sue, an acquaintance who admits to reading the series, also says that they’ve definitely spiced up her sex life and that makes her husband a very happy camper indeed. Another male caller to a talk show suggested that, if women are embarrassed to discuss the book, they print out the pertinent pages for their partners. “Let the book do the talking,” he says.

Fifty Shades is getting a lot of people thinking and talking more openly about sex, sexuality, desire, and interest,” says Debby Herbenick, a research scientist at Indiana University, in an article in the Washington Post. “It’s helping many women to feel comfortable enjoying something about sexual fantasy and arousal…. Not only is it okay to fantasize, not only is it okay to read really explicit info about sex, but right now, it’s the cool thing to do.”

Literary quality aside, if the books help couples to talk about sex, if they break down inhibitions and encourage fantasy, if they increase libido, then for us older gals, they’ve done their work.

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