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Archive for December, 2016

So Grateful For You!

This is my quiet moment—the pause between the years, the time of taking-stock. One thing I know for sure—I have a lot to be grateful for this year!

Here's to good health and good sex.It’s been more than ten years already since I decided to specialize in the sexual needs of women in midlife—women like you and me. As I mention here, I wanted to provide clinically sound, research-driven information to women who are caught in the throes of the menopausal transition. I wanted to address our sexual issues head-on, without embarrassment or beating around the bush. I also wanted to provide a safe, tasteful environment in which you could actually buy the products I was recommending—vibrators, lubricants, moisturizers, dilators, vaginal weights.

That was the rationale behind MiddlesexMD. I envisioned a space in which to communicate with a lot more of you than I could see in my clinical practice. A place where you can ask questions or start a conversation and where I can discuss whatever’s on my mind—from research on new drugs and therapies to tips on maintaining sexual intimacy. And we did put together a shop, where you can find those safe, tested, high-quality products, and have them mailed to you in discreet packaging.

It’s been a journey, that’s for sure—rewarding, challenging, busy, and sometimes unexpected. In 2013, the North American Menopause Society awarded me the “Certified Menopause Practitioner of the Year.” Late last year, I published my book, Yes, You Can: Dr. Barb’s Recipe for Lifelong Intimacy. The book uses my recipe for sexual health and draws from the accumulated wisdom on MiddlesexMD—your questions, the blog posts, and my own thinking.

Response to the book has been wonderful. It was a banner year for interviews on various media outlets about the book and my work. I’m grateful for these opportunities to communicate to a broader circle of midlife women that they have options, that sex can still be rich and fulfilling, and more importantly, that they are not alone.

When I began this endeavor, I couldn’t have anticipated how gratifying it would be to meet such resilient, independent, inquisitive women who are tackling life’s challenges gracefully and well. I’ve been honored to share this journey with you and to provide some support and information that may make the experience easier and, I hope, more joyful for you.

So, my friends, here’s to good health and good sex. Thank you for sharing your journey with me.

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The Art and Science of Resolutions You Can Keep (Sexually Speaking)

What is it about that first, unblemished day of a new year? The first white page of a journal? The hush that follows merrymaking; the pause before the quotidian rushes in again?

I’ve always loved that moment of held breath after one year ends and before the next begins. For me, it’s a day (or, more realistically, an hour) of reflection when I remember, take stock and my own measure, of what the year has brought, and how I’ve responded to it.

Resolutions, however? Not so good.

Turns out, there’s a bit of art and science to resolution-making—a few principles that increase our odds of success. In the spirit of helping us all out to a solid start, let’s explore ways to make our resolutions stick. (Success is always affirming.)

And secondly, instead of resolutions focused on self-improvement, let’s explore resolutions that focus on relationship-improvement.
Don't give in. Get up and start again.Far be it from me to diminish the value of losing weight (#1 on the list of New Year’s resolutions for 2015) or of “staying fit and healthy” (#5), but I would suggest that, in addition to these worthy goals, you get a lot of bang for the buck when you work on your sex life. According to relationship consultant Dr. Sheryl Kingsberg, a good sexual relationship adds significant value to a relationship (15-20 percent), whereas a poor one actually drains a relationship significantly and negatively (50-70 percent).

Since only 8 percent of the people who make resolutions actually achieve them, let’s look at ways to beat those dismal odds.

  1. Make it fun. The good thing about improving our intimate relationship is that it doesn’t have to be a grinding exercise in self-discipline. In fact, it shouldn’t be. You want to tickle the most primitive pleasure centers in your brain—the part that eons of evolution fine-tuned so that sex is pleasurable and intimacy is deeply satisfying. So, for this resolution at least, a light touch and playful intent is better than acts of will and grim resolve.
  2. Make it specific. Grandiose is good but measurable is better. Dr. Paul Marciano, author of Carrots and Sticks Don’t Work, advocates SMART goals: Specific, Measurable, Achievable, and Time-bound. What this might look like vis-à-vis our sex life is: This month I will improve my pelvic health by using vaginal moisturizer daily and a few reps of kegels four times a day. Or: I will notice at least one thing I like about my partner every day, and I will express appreciation for it. Or: I will suggest one new position for us to try each month. Or: We will reserve two evenings a month for a romantic date.
  3. Be realistic. I had a friend who would periodically go on an extremely rigorous regimen of weight loss and exercise. She’d cut out all sugar and strictly limit caloric intake; she’d walk four miles every day, and she’d do this for month. She’d lose weight and look great. But inevitably, the sheer difficulty of her regimen was its undoing. She couldn’t keep it up. So, she’d crash and burn with the same intensity, putting all the weight back on and then some. It was painful to watch.

Even with something that’s supposed to be light-hearted, like improving your sex life, you should realistically assess what is likely to work for both you and your partner. Maybe planning a romantic evening at home would work better than a night out. If your partner isn’t entirely on board, maybe you’ll work on your own sexual health and subtly introduce changes

  1. Write it down. Or better yet, get your partner’s suggestions and buy-in, so both of you are involved. Resolutions are more likely to be successful when you’ve made a verbal or written commitment.
  2. Persevere. Of course your resolve will wax and wane. Of course you’ll forget about your date night or run out of nice things to notice about your partner. We are all inextricably pulled back toward the dog path. We are all tempted by that niggling voice that whispers, you’ve already missed two months. Just give up.

Don’t give in. Get up and start again. That’s the very essence of discipline—keeping on.

Next January 1, when you reflect on the year just passed, I hope you can derive some quiet pleasure in having moved the intimacy needle a bit and generally banked some points in your sexual wellbeing account.

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I know it can seem like ob/gyn offices are full of pregnant women! And while general practitioners can be extremely helpful, sometimes you want the extra training and focus of a menopause care specialist.

You asked. Dr. Barb answered.I recommend finding a menopause provider in your area by going to the North American Menopause Society (NAMS) website, where you can enter your zip code and specify a mile radius to find a practitioner near you. Note that you can also check the box (NCMP) to limit the search results to NAMS-certified providers, who have completed additional focused training and receive ongoing updates on research and recommendations from the society.

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Continuing with our series of tips for holiday sanity, and even enjoyment, this is the most fun suggestion of all: Schedule a quick, romantic getaway for after the holidays to re-connect with your honey and get some downtime in a sweetly unfamiliar place.

You want to keep the emphasis on the fun and not get carried away with anything elaborate and expensive. A weekend away with minimal planning increases the chance that you’ll actually do it—no good excuses, and it’s easy to find someone to check in on the cat.

A quickie in midwinter can be especially economical and especially delightful. You’ll encounter a laid-back and welcoming atmosphere that’s lacking in the midst of summer tourist season. You’ll also encounter off-season rates.

Give yourself a treat.I fondly recall a midwinter weekend in a tourist town near my West Michigan home. Yes, some places were closed for the season, but the rest of the town was just as scenic and beautiful in winter. We eavesdropped on local chatter in the diner and neighborhood pub that had been crawling with tourists just a few months before.

So, here’s my down-and-dirty guide to a relaxed, relationship-rejuvenating weekend in the middle of the long winter night.

  1. Keep it simple. Vacations can be exhausting, but you’re already exhausted, so don’t engage in deficit energy spending. Don’t plan rounds of museum visits or post-holiday shopping. Don’t plan to do anything, unless both of you really want to. Make that a ground rule.
  2. Keep it local. You don’t want to add an 8-hour drive to both ends of your weekend. Unless you live in the middle of the Badlands, you probably already know about cool places within a few hours—maybe a B&B you always wanted to visit or a quaint town with a couple good restaurants and a sweet vibe.
  3. Make it about the two of you. You don’t have a lot of time, so make it count. One nice meal. A few nice bottles of your favorite beverage. You can always stream a sweet or sexy or even erotic movie in your room. Don’t forget your toys, lubes, and oils.
  4. Get your sexy on. Don’t go overboard. (See #1) But a new camisole can make you feel like a million bucks. A nice lotion or essential oil on your skin. A shave. The little things.
  5. Only pillow talk. Don’t bring up anything more challenging than what movie to watch or whether to go out for dinner or order room service. Lay unpleasantries firmly aside. There’ll be plenty of time for the serious stuff when you get back.
  6. Create memories. Bring a favorite playlist or a wine you both love or a movie that’s significant. Pack a few favorite snacks. You could bring photo albums of Christmases past to browse through.
  7. Just do it. Don’t overthink. Don’t plan. Don’t put it off, or your calendar will fill up. Pick an inviting location nearby; pick a weekend; make a reservation; go!

Keep the emphasis on the fun.You are now approaching the crescendo of holiday preparation. Give yourself a treat to look forward to. A weekend getaway won’t break the bank but will ease both of you out of the post-holiday, wintertime blues. And maybe just knowing you have this special weekend on the calendar will remind you to be more gentle with each other during the holiday frenzy.

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The symptoms you describe–moodiness, depression and anxiety, hot flashes, sleep interruptions, less sensitivity in nipples and clitoris–are all consistent with stopping the hormone therapy (HT). Sensitivity to the effects of hormones varies among women, and you’re definitely in the “responder” category!
You asked. Dr. Barb answered.You mention that you discontinued the HT because of concerns for long-term health. It’s important to consider the form of HT you’re using: The Combipatch that you were using is a transdermal estrogen (and progestin) delivery method, and that method has significantly less risk for stroke or thrombosis. If estrogen is taken orally, it is metabolized through the liver, which increases a blood clotting factor and puts women at a slightly greater risk for stroke and blood clots. Transdermal (through the skin) delivery doesn’t pose the same risk, because it bypasses the liver metabolism and enters the bloodstream directly.

You’re in your 50s, fit, and low risk: You’re a perfect person to consider continuation of HT for all the reasons you mention. It sounds like HT definitely improves your quality of life, which is to me a determinative factor. We don’t really have a clear time frame in which we know that HT starts to pose additional risk.

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Yeah, I know. The last thing you need right now is another list of ways to avoid stress during the holidays. The mere thought of another list is stressful all by itself.

Pay attention to what you're doing this moment.I don’t cotton to holiday de-stress lists, either. That’s why I combed through dozens of tips from experts and ordinary folks to winnow out what I think are the best, most truly helpful holiday reminders. I’m betting that something on this list will truly make your life easier and your spirit more joyous. Most of the suggestions even have some science behind them, which always makes me happy.

For the mind and emotions
  1. Cultivate gratitude. If you develop an attitude of gratitude (as they say), you’ll find yourself in a happier place. This is more substantial than simply counting your blessings (although that works, too). You can be generous; you can be large of spirit. This is necessary soul-work and deserves attention at any time of year, but this season of hyper-consumption is a good time for a reality check. Do a shift in a soup kitchen or a food pantry. Be a Salvation Army bell-ringer. Deliver Christmas baskets to the less fortunate. Giving money is important, too, but it doesn’t pack the life-affirming power of face-to-face contact.
  2. Be non-judgmental. Before Uncle Bob begins his NRA rant or Aunt Millie makes not-so-sotto-voce comments about your grandchildren, prepare your mind. These are the people with whom you share the planet and your DNA. You aren’t going to change them, so you might as well adjust yourself. Practice a benign attitude of acceptance. A glass of wine also helps.
  3. Visualize. What one word describes what you hope for this holiday season? Peace? Serenity? Acceptance? Love? Write it on a card (or several) and tape it to the bathroom mirror. This is your holiday guide and mantra.
  4. Be mindful. We wrote about this in a previous post, but its impact on stress-reduction can’t be overstated. Pay attention to what you’re doing this moment. When you get to a holiday task you enjoy, decorating cookies or the tree, maybe, tackle it with focused attention and just enjoy the heck out of it.
  5. Smell citrus. The lemon-y scent of citrus smells clean, but it also increases norepinephrine—a mood stabilizer and stress-reducing hormone. Rub some lemon or orange essential oil under your nose or carry a hankie dabbed with the scent for a dose of feel-better. Use it as aroma therapy during the holidays.
For the body.
  1. Exercise. Holidays are a black hole for shrugging off daily routines. Who has time to exercise? That’s exactly why it’s so important. Exercise is critical during stressful times because it gooses our system with feel-good endorphins and increases energy levels. Getting outdoors for a walk or jog amplifies the effect.
  2. Go natural. Research shows that patients with a view of the outdoors heal faster. It also reduces stress. So, open the curtains; flood your house with natural light; and bring the outdoors in with pine boughs, holly berries, and essential oils. Go outside and gather your own for a double exposure.
  3. Eat moderately. You can certainly enjoy every morsel of holiday fare—just don’t get carried away. You know how you’ll feel after a night or several of overindulgence—and the morning of January 2 will be very, very bleak indeed. Once again, practice mindfulness. Pay attention to the colors, tastes, and delicious holiday smells. You’ll be less likely to blindly put things in your mouth, and you’ll enjoy what you do put there a lot more.
  4. Sleep. It’s hard to turn off the mental hamster wheel that you’ve been running on all day. But good sleep is essential to good functioning, and bad sleep is a total killjoy, as we all know. There’s a well-developed science of sleep hygiene. Here are a couple of safe natural sleep aids: Chamomile has been used to aid sleep aid for hundreds of years. What is more soothing that a hot mug of chamomile tea before bed? Melatonin is a hormone that helps regulate your sleep/wake cycles. Some people find that 5 mg. of melatonin before bed helps them feel sleepy and fall asleep faster. It’s safe, inexpensive, and easily found in pharmacies.
  5. Touch. What is it about loving touch? Research shows that touch releases dopamine and oxytocin—both soothing, mood-altering hormones. You don’t have to go all the way to home base (but if you do, sex is a great stress-reliever as well); just a gentle hug, shoulder massage; quick kiss helps put the moment in perspective. Don’t neglect the power of touch this season.
For your sanity
  1. Clean house. No, not you. Get your house deep-cleaned early in December. You’ll love knowing that the dust bunnies no longer live under the beds and that you’re ready for drop-in guests and family overnights at any moment.
  2. Simplify. Ditch fussy traditions. Lower your expectations. Spend less. The point is to enjoy the time with family and friends and to savor the sensual beauty of the holiday. The contemporary focus on fancy gifts and decorations and a whirlwind of parties is distracting and exhausting. Just say “no” to the distractions from the true spirit of the holidays.
  3. Watch a Christmas classic. For an enjoyable break, gather whatever family is available and settle in with hot chocolate and popcorn to watch your favorite Christmas movie, whether it’s Charlie Brown or Miracle on 34th Street. You can’t go wrong with an easy and heartwarming evening like this.

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You say you’ve read about oral stimulation in She Comes First. Congratulations on continuing to learn about sexuality and your own body!

You asked. Dr. Barb answered.Oral stimulation is for everyone: all ages, all stages. It’s personal preference, or maybe not. I have a number of patients who only experience orgasm with oral stimulation.

Like so many things sexual, there are many variations, many preferences, and no “one size fits all.”

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