Archive for February, 2016

Letters! We Get Letters!

One of the joys of the work I do is hearing from women about how what I do—through my practice orMiddlesexMD—helps them with their health and intimacy. Often, I hear those stories in conversations, and as good as my intentions are (because I believe in sharing our stories), by the time I get back to my office, I forget to take good notes. But a letter! Remember how lovely it is to get letters? Here’s one I can share with you!

Dear Dr. Barb,

I loved your blog post “Don’t be a Stranger.”

It was timely for me. I thought I was doing this all pretty well. Three years ago when my primary care doctor retired, I chose my new provider carefully. I told her I’d been following MiddlesexMD since the blog launched in 2010, and that I was interested in keeping my sex life healthy. I asked her not to shy away from anything she thought I should know, and that I intended to try to be as proactive as I could be.

It was a good start. I’m relatively healthy, so I have seen her only on an annual basis since. I have vibrators and dilators and use moisturizers. Most important, I have a good partner!

And life went on. My husband travels a lot. My father died. I went on Medicare (which somehow managed to administratively change my primary care provider – requiring 8 phone calls and numerous interruptions). Job changes and financial stresses complicated my life.

At my visit in January (before your blog post), my doctor and I worked to figure out how to make sure my medical care didn’t get disrupted. We reviewed all of my “checkpoints” – mammogram (sister is a breast cancer survivor), pap test (I’ve had cervical “pre-cancer”), bone density, skin check, high cholesterol testing, blood screens, etc., etc.

Only when I thought the exam was about to end, did I blurt out, “I’m unhappy with my sex life.” So much for proactive.

To her credit, she stopped. And she started asking me questions. After a little exploration, she asked, “Have you ever tried topical estrogen?”

Full stop.


I had. But not for years.

After a little examination (serious atrophy) she prescribed a cream.

Three weeks later, my sex life had taken a new (and better) trajectory.

So, I want to echo your advice to keep the conversation going – because I can’t keep it in perspective by myself, no matter how good my intentions are!

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When it comes to sex, friction is bad; lubrication is good. Nicely lubricated surfaces not only protect delicate vaginal tissue, but revitalize the sexual experience.

That’s why we talk a lot about personal lubricants here at MiddlesexMD. Sexual lubricant is part of a regimen of vaginal health that is meant to keep vaginal tissues moist and sex pleasurable. This goes for all ages, not just menopausal women.

So, in the interest of great sex (we’re always looking out for you, sister!), here are six tips to help you choose and use your lube:

1. Use one! This is general good advice for young and old(er). It will revitalize your sex life and help to keep it pain-free.

2. Experiment. What do you like? Thick or slick? Warm or cool? Tasty or—not? Lube choice is as personal as eye color. And there is no shortage to choose from. Sexual lubricants are sold online and over-the-counter in every conceivable permutation of flavor, color, and promise of ecstasy. As we said in this post, it’s hard to even determine a trend among our clients.

Here are the main categories:

Water-based lubes are thick and easy to wash off, but they don’t last as long as silicone-based or hybrid lubes. They are safe for use with silicone vibrators and sex toys.

Silicone-based lubricants are slippery and long-lasting. They don’t dissolve in water, so they’re good for sex play in the hot tub or shower. They do coat the vagina, however, so you may need a good, soapy clean-up. Silicone lubes may also stain clothes and bed linens. And you can’t use a silicone lube with a silicone-surfaced toy or vibrator. This includes the E-string vaginal ring, which delivers hormones to the vagina and is partly made of silicone.

Hybrid lubricants are the newest kid on the lubrication scene. They’re mostly water with a bit of silicone, so the texture is both thick and slick. Hybrids last longer than water-based lubes, tend not to stain, and wash off more easily. You can use them with silicone toys.

A good place to start? Our Personal Lubricant Selection Kit. We’ll send you sachets of 7 different lubricants: water-based, silicone, and hybrid, along with a card to choose your favorite. Return the card, and you get a full-size bottle of that lubricant. So much better than having a collection of leftovers of lubes you don’t like!

3. Vet your lube. Your hardworking vagina deserves nothing but the best. Not only that, vaginal tissue is very absorbent, so those substances end up directly in your bloodstream.

Check the ingredients in any lube you’re about to buy. Avoid products with parabens and any compound ending with –paraben (this is a preservative that acts like estrogen in your system) and polypropylene glycol (a thickener with some unpleasant side-effects). If you’re among the women prone to yeast infections, you may want to avoid glycerin. Check out fragrances; when they’re safe and natural, they can enhance your experience, but they’re not necessary, so not worth a chemical risk.

Bottom line: Your lube should be as natural as possible. In our shop, these water-based lubricants are good options, especially for people with allergies or skin irritations: Good Clean Love Almost Naked or Restore,Sliquid Organics Natural Gel, Yes, and Aloe Cadabra.

4. Keep it healthy. Vaginal tissue becomes more delicate as we age. Plus, it has a specific Ph balance to inhibit yeast and other infections. You can disrupt that balance or introduce harmful bacteria by using saliva, oil, petroleum jelly, body massage oils, or anything not specifically formulated for the vagina.

5. Keep it handy. What good is a lube if it’s stored in the bathroom down the hall? Keep your lube (better yet—a couple varieties, depending on the vibe that night) beside the bed. Carry sachets in your purse because—you never know.

6. Make it sexy. Lubes are all about fun and comfort, so don’t be stingy. Use it on his penis for some slick hand work or in the condom or on the condom, if you use them. (And you do use them under these circumstances, right?) Put some on your nipples or lube your breasts and slide them over his body. Aren’t the options enticing? You’ve got your lube, now get creative.

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ED: Finding a New Groove

Erectile trouble (let’s call it ET) is going to happen (when it happens most of the time, it’s erectile dysfunction [ED]). If your partner is a man, you and he are going to need to understand this probability in your sexual lives. You’ll need to accept and work with it the same way we work with all of the changes that come along as we age—with curiosity, intelligence, creativity, a bit of adventuresome spirit. ET and ED, like a lot of body changes, give a couple a chance to go where couples maybe haven’t gone before.

But before jumping there, let’s back up a bit. I am a doctor and have to make sure you’ve covered your bases. ET happens to every guy, and starting much younger than the endless ED commercials on ESPN would have you believe. But when guys have trouble getting or keeping erections more than half the time, you really should talk to your doctor. (One in five times or less? Not something to worry about. Relax.) We want to make sure the ED isn’t a signal of something something going on with your health. If it is, fixing the underlying health problem could easily fix the ED. Got that? Really important. In 30 percent of men who go to their doc about ED, the ED is the first evidence of cardiovascular disease.


We’ve talked a lot here about our Recipe for Good Sex, and with ET/ED, we need to attend to the whole enchilada. ET/ED is not purely a problem of blood flow, though the pills and paraphernalia made to treat it usually focus just on that. But we here at Middlesex MD know that ET/ED is a head game, too. Pun intended. Treated best, we treat both. Pun definitely intended. We help the guy with ET/ED by sustaining blood flow to his penis and sexy thoughts to his brain.

Once we have that recipe in our heads, it doesn’t take a genius of a woman to figure this out. There are smart positions and smart actions to help your guy out. Smart foreplay and smart sex. Different kinds of sex. Even sex that requires no erection whatsoever. That’s where we go boldly where maybe you never thought of going before, and maybe where he never did either. Bear with us here and use your imagination…

First, his brain and your foreplay…

Your man needs to feel relaxed and playful and as if no matter what happens between you, nothing is at stake in your sexual play. At this point in your lives, just being together and making each other feel good is a very good goal.

Is. The. Only. Goal.

Can we all agree to that?

Can we leave orgasm aside and not worry about it as a goal? Orgasms are very nice, yes we all agree, but they aren’t necessary. And can we all get to that place and that freedom? All kinds of sex feel good. Rubbing skin feels good. Goose pimples and tickling feel good. Caressing hair feels good. Soothing muscles feels good. Stroking limbs feels good. Nipple play and earlobe play and lips and tongues. It all just feels so good. So… you know? Can that be the thing? Good music? Scented candles? Chocolates? Sexy movie? Lovely dinner first? Maybe a wee bit of alcohol, if you like, but not a lot, because it could slow response… (No caffeine at all, no nicotine. These constrict blood vessels and cut off blood flow.) A back rub? Shower? And then?

And then, ah yes, blood flow to the penis! Logic: If he is using his major muscles in his body for blood flow, he is reducing blood flow to his penis. Right? Right. So think about that, and reduce that effort. That means, lady, if he is able to achieve an erection, you climb on top. Or both of you stay on your sides, spooning, or with your legs interlocked. Or both of you remain in a seated position, with his back resting comfortably against a wall. He should not be holding you up. If anything, you hold him up!

No erection? No problem. Plenty of playful options. Here are our favorites:

  • Oral sex. Even without an erection, a man will generally not say no to suction on his penis. So long as he knows you don’t need his penis to be hard. Keep your fingers working at the base of his penis to keep the blood you suck up into place.
  • Toys. Vibrators, dildos, rings and balls, warm and minty lubes, feathers, ticklers, flavored lotions. These are all the things that make playful sex more interesting these days. It’s time to make variety work for us. This is really our time to take the time to explore these things. Why not? A man can come without an erection with a vibrator applied to the glans, but be careful and gentle, and let him be the guide.
  • Rubbing. Climb on top, with his penis facing his chin, lots of lube between your vulva and penis. Find a yummy spot, and glide. Be generous with the lube, and stop if anything gets sore.

Well. We hope this helps keep your play-dates interesting and the love alive and well even with ET/ED in the room. Ours is the generation that ought to make ED no big deal. Easily shrugged off for any guy and certainly any couple.

You both deserve this.

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