Archive for December, 2013

I rarely recommend water pills unless a patient is in heart failure and we need to decrease the fluid load on her heart and kidneys.

Bloating is usually related to gastrointestinal issues, and water pills don’t address those issues. When the kidneys are functioning properly, they’re getting rid of excess fluid; water pills put you at risk for depleting needed fluid or becoming dehydrated. Better options are to reduce salt intake and (counter-intuitively) to drink water.

My take on water pills for weight loss is the same: It’s not a safe long-term solution.

What do I recommend? So sorry, but there’s no magic! Eat well, exercise often, and see your health care practitioner to diagnose and find healthy and long-term ways to address symptoms!

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

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

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

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

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

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

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

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

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

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

Rosemary Basson's model of female sexual response

Rosemary Basson’s model of female sexual response

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

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

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

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

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The best option for what you describe is a regular routine of vaginal moisturizer use; use it consistently at least two times a week. Add a lubricant at the time of intercourse to assure your comfort.

Yes is the most popular product at MiddlesexMD for this condition; it’s an organic vaginal moisturizer that can also be used as a lubricant. Emerita is another moisturizer option that works well.

Lubricants come in a number of formulations, so you might want to use our personal selection kit to try out a few and find the one that’s most effective for you and your partner.

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You’re wondering whether your hormone therapy, designed to address your hot flashes, is having an unintended negative effect on your libido. The good news is that adding estrogen is better for sex, in general terms. So you don’t have to take back your hot flashes to get your libido back!

The less good news is that libido is sometimes a puzzle to solve. I’ve found that non-oral estrogen addresses hot flashes with fewer unintended effects on sexual desire. The reason is that oral estrogen enters our systems in ways that affect metabolization in the liver and resulting circulating testosterone levels. And testosterone, though not entirely understood, is as important to women’s sexuality as it is to men’s!

You might start by changing to non-oral or transdermal estrogen; it will likely take up to 12 weeks to see whether there’s an effect. And if that doesn’t make enough difference, there are other options you can explore with your health care provider.

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Had you asked Charles Darwin why people have sex, he would say that it’s all about procreation. You know, survival of the fittest and fastest breeders and all that.

Had you asked 1,500 students at the University of Texas in 2007 why they have sex, you’d have gotten 237 reasons (perhaps unsurprising, given the population) ranging from the blatantly self-centered (good exercise) to the altruistic (to please my partner).

But doesn’t the more relevant question have to do with the effect of those reasons on one’s sex life and relationship than about why a person has sex? After all, if you know that sex for your partner is simply an alternative to going to the gym, I suspect that would color your experience of sex and view of the relationship.

We know that more and better sex is linked to happiness and relationship satisfaction. But some of our motives for sex would seem to make our lives and relationships better and others to make them worse. And are there nuances within this paradigm—are some reasons for sex better than others, and is more sex always good? Finally, are there some practical applications for all this academic falderal?

Recently, in two separate studies, researchers at the University of Toronto quizzed a hundred or so dating and married couples about their reasons for having sex. The couples kept diaries for several weeks, answering questions whenever they had sex about their motivation, levels of desire, and how they felt about the relationship.

What the researchers found was that why we have sex on any given day does indeed affect how we feel about our relationship, our partner, and our level of desire. The effects were the same for both men and women, and they persisted for months after.

Responses were grouped into two main categories: approach, which seeks a positive outcome (I want to be closer to my partner) and avoidance, which seeks to circumvent something negative (I don’t want to feel guilty.) Motives for sex can also focus on oneself (I want to feel good) or one’s partner (I want to make my partner feel good.)

Researchers found that when respondents engaged in sex for partner-focused, approach motives, they felt more satisfied with the sex and better about their partner than those who had sex for self-focused, avoidance reasons.

The surprising element was that, when a person had sex for positive, partner-focused reasons, the partner also felt more positively about sex and the relationship, and that these effects persisted over time.

“If I am having sex more for approach goals, it increases my desire and satisfaction, so my partner probably senses that and it contributes to their outcome. Our satisfaction carries over to them.” says Dr. Amy Muise, lead researcher, in this article.

So it would seem that, while more sex is good, more sex for the right reasons is even better.

Of course, everyone has sex for a variety of reasons, depending on the day. Sometimes they’re positive and partner-focused (to give pleasure) and sometimes they’re negative and self-focused (to avoid guilt or conflict). And of course, we have sex when we aren’t particularly in the mood. But simply understanding the power and cumulative effect of positive, partner-focused motivation might encourage us to work on our attitude the next time our partner gets that look.

We might also work on the kind of communication and mutual respect that will make it easier for both partners to have sex for positive reasons more often.

“Perhaps younger men and women still give in for this (avoidance) reasons,” says Iona Monk, counselor and founder of Vancouver Couples Counseling, in this article, “but I’d like to think it shifts as we mature, and learn to communicate better and know and accept our needs more.”

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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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Great question! Unfortunately, there’s enough controversy about the answer to have warranted a whole blog post on the subject. The short answer, though, is that the G-spot (named for the German gynecologist Ernst Grafenberg, who talked about it in the 1950s) is a sexually sensitive area about a third of the way up the anterior (front) vaginal wall. There seems to be a rich plexus of nerves just beneath the vaginal surface in that area, which, when stimulated, may produce a variety of feelings: discomfort, urge to urinate, or pleasure. Some believe–and experience–that stimulation in that area leads to orgasm; this may be the specific source of vaginal orgasm (as opposed to the more-common orgasm from clitoral stimulation).

Being aware of the discussion of and theories of the G-spot is great; so is experimenting to see what sensations are present for you, in a spirit of creativity. Don’t assume there’s a “should” or an “ought” that you’re missing. Please explore your own body, and embrace your own personal sexuality!

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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