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Lots of attention has focused on the finicky female orgasm in recent years, from Dr. Rosemary Basson’s model of the female sexual response cycle to the helpful finding of just how female anatomy influences the probability of vaginal orgasm.

A new study from Chapman University, Indiana University, and the Kinsey Institute colored in some details of female sexual response, in part by rounding up a wide net of participants. Over 52,000 men and women between the ages of 18 and 65 responded to an online survey, including a more robust sample of those who identify as gay, lesbian, and bisexual.

There's significant misunderstanding between Venus and Mars.The take-away from all this analysis was the jaw-dropping finding (tongue in cheek) that men (95 percent) orgasm dependably, while women, not so much (65 percent). About 44 percent of women said they rarely or never reach orgasm with vaginal intercourse alone, a number that is quite low compared to other studies suggesting that fully 70 percent of women don’t orgasm with vaginal penetration. These numbers point (again) to some very significant differences in sexual response, which in turn, lead to significant misunderstanding between Venus and Mars.

“About 30 percent of men actually think that intercourse is the best way for women to have orgasm, and that is sort of a tragic figure because it couldn’t be more incorrect,” said Dr. Elisabeth Lloyd, a professor of biology at Indiana University and author of The Case of the Female Orgasm in this article.

Additionally, while 41 percent of men think their partner orgasms frequently, far fewer women (33 percent) say they actually do orgasm. The researchers note that this difference could be due to women faking orgasm for several reasons: “to protect their partner’s self-esteem, intoxication, or to bring the sexual encounter to an end.”

The researchers were particularly interested in the disparity between how dependably lesbian women orgasm (89 percent) versus heterosexual women (that 65 percent figure). They theorize that this is due, in part, to women having a better anatomical understanding of each other’s needs.

The headliner result of all those survey is a “Golden Trio” of sexual moves that the researchers say are almost guaranteed to induce the Meg Ryan-style “Yes! Yes! Yes!” in women: clitoral stimulation, deep kissing, and oral sex. Even without vaginal penetration, 80 percent of heterosexual woman and 91 percent of lesbian women were able to orgasm dependably with this magic trio. (Although deep kissing and oral sex seem either mutually exclusive or tremendously acrobatic.)

The research noted that women who orgasm more frequently also have sex more frequently and are more likely to be satisfied with their relationships. Whether satisfying sex is the chicken or the egg—a contributor to a satisfying relationship or an effect of a good relationship, it’s safe to say that the two go hand-in-hand. Good sex and good relationships are both enhanced when partners communicate about what works and include a healthy dollop of fun and flirtation.

“I would like [women] to take that home and think about it, and to think about it with their partners and talk about it with their partners,” said Lloyd. “If they are not fully experiencing their fullest sexual expression to the maximum of their ability, then I think our paper has something to contribute to their wellbeing.”

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“Midlife: when the Universe grabs your shoulders and tells you “I’m not f-ing around, use the gifts you were given.” —Brene Brown

I don’t know about you, but I love seeing old people in love. The way they hold hands toddling down the street. The way they go about their daily tasks having made peace with the past. I think it’s a miracle when love lasts this long and ages this gracefully.

Relationships encounter lots of challenges in the course of a lifetime, but from my own observations, which are supported by the data, the midlife transition, that somewhat fraught passage, is nothing to sneeze at. Menopause aside, the awareness of time passing often arrives unexpectedly and with surprising intensity, leading both men and women to make decisions that belie common sense, compared to which the red Corvette might be among the most benign. For example, the highest divorce rates from 1990 to 2010 occurred among couples over 50, according to this study. Concurrently, co-habitation rates among over-50s tripled from 2000 to 2013.

Whatever the cause—longer lifespan, greater economic freedom for women especially, cultural change—the fact is that something shifts when folks approach that midlife marker, and it’s often the woman who agitates for change.

This isn’t necessarily a bad thing. Periodic reevaluation and readjustment is healthy. So is honestly confronting ingrained habits and responses that ultimately stifle intimacy and deflect communication. Like a vintage car, most lengthy relationships require a major or minor tune-up now and then.

Still, midlife often opens a Pandora’s box of restlessness and dissatisfaction—the perennial is this all there is? What happened to the passion? Am I missing out? Do I really have to endure the quirks and habits of this individual for the rest of my life? What is really important? What dreams have I buried?

Those existential questions herald an important crossroad—the frontier between youth and maturity. With regard to your most intimate relationship, you can:

  1. Invest in what you have. Work on ways to reinvigorate and reignite the flame. This won’t be the passion of your youth, but something burnished by time and familiarity. A golden glow rather than red-hot embers. If your relationship is solid and things have just cooled off with time and neglect, it’s worth investing for the future.
  2. Reinvent it. Sometimes a creative change eases the chronic irritations that can erode a longterm relationship. Some couples successfully stay together but give themselves extra space with separate households, for example, or planned time apart, or splitting the daily finances and decision-making that cause problems. Rejiggering the quotidian foundation might ease the annoyances enough to allow a couple to value and appreciate the familiarity and intimacy that has developed over many years.
  3. Scrap it. This is a very tough judgment call, but some relationships have never worked well; some matches are misses; and sacrificing the years you have left may not be worth it for one or both of you. Dismantling a lifetime is a heartbreaker (or—maybe a release), but you may end up in a better place when the dust settles.

Major life transitions should never be done in haste. They deserve a considerable degree of mature reflection. We all know people who make fast and sometimes rash decisions in the throes of passion or as a desperate attempt to seize a day that appears to be slipping away. Amid the landmines of midlife, the baby is sometimes thrown out with the bathwater.

Here’s a little reality check.

However irresistible the urge, don’t blow up your life. Wait. Reflect. Seek counsel. The demand to create something more authentic, to realize cherished dreams is real and should be honored. But the best path forward probably isn’t over the shattered pieces of your present life.

You still have time. You can still seek your bliss, optimize potential, maybe with more freedom and effectiveness now that the kids are grown and you’re more self-confident. Start a business. Learn Chinese. Travel. The world is your oyster—just in a different shell than when you were younger.

Romantic passion is a landmine. Passion is powerful, blinding, and temporary. You can’t make good decisions in its throes. And even the most incredibly passionate relationship will inevitably fade with the demands of daily life. White-hot passion doesn’t last; it’s not meant to. And when reality checks in, the dirty socks on the floor look the same. Trust me on this one.

Talk to someone if you need to. A therapist. A friend. You can’t see things clearly (even if you think you can). Trust the counsel of someone wise and objective.

Don’t freeze out your partner. However restless and unsettled you may feel, your partner is probably not the enemy. You want to elicit support, not resistance. Anyone would feel threatened when cracks appear in the foundation of a secure life. Anyone would feel uncomprehending and maybe hurt. If, however, you are able to communicate what you’re feeling, even if it’s confused and incoherent, at least there’s a bridge rather than a canyon.

“This too shall pass,” writes blogger Deb Blum in this article. “It will pass more gracefully and completely if everyone is gentle and loving and gives the space necessary to get through this time.”

And that study about over-50 divorce rate also found that the longer a marriage lasts, the less likely it is to end in divorce. So those old folks holding hands in the park? The real deal.

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We blather on regularly at MiddlesexMD about the importance of good health—staying active, eating well, exercising, maintaining a healthy body weight. Given the many exercise fads that come and go (remember Jazzercize?), maybe it’s time to get specific about ways a mature woman can stay in shape.

Yoga is one of the best. Hardly a fad, yoga’s been around for at least 5,000 years; the earliest mention is in sacred Ayervedic texts in northern India. In the US, it’s now a $10 billion-a-year industry with 20 million practitioners.

As you can imagine, many styles of yoga have developed over the millennia, but the main forms you might encounter are:

  • Hatha. The most familiar style that focuses on the breath while holding various poses.
  • Vinyasa. Series of poses that flow smoothly into one another.
  • Bikram. You might have heard of this “hot” yoga style that involves a specific series of challenging poses done in a very hot room.
  • Iyengar. This type uses props, such as foam blocks, straps, or blankets to maintain comfort and good form during poses.

What all these flavors have in common is a focus on the breath as a meditation and on moving at various speeds through a series of poses, which are sometimes very challenging. As such, it combines the calming effect of meditation with bodyweight strength-training of held poses.

The benefits of a regular yoga practice are impressive. Yoga clearly increases flexibility and strength, and improves balance. According to a slew of studies, the mind-body effect of yoga may also relieve stress and depression, lower blood pressure and heart rate, stabilize blood sugar levels, relieve chronic neck and back pain, and even improve brain function.

Referring to a 2015 study published in The European Review of Preventive Cardiology, an article in the Harvard Heart Letter reports, “over all, people who took yoga classes saw improvements in a number of factors that affect heart disease risk. They lost an average of five pounds, shaved five points off their blood pressure, and lowered their levels of harmful LDL cholesterol by 12 points.”

Despite the fact that some of these studies are small and not terribly rigorous, the consistent result is that, while yoga isn’t a cure-all, it helps to relieve some surprising conditions.

One of those small studies published in the Journal of Sexual Medicine reported that yoga can even improve sexual function. In this study, 40 women practiced yoga for an hour every day for 12 weeks. At the end of the study, 75 percent of them reported improvement in sexual satisfaction on several assessment areas, such as lubrication, desire, arousal, and pain. Women over 45 showed the most significant improvement in lubrication, arousal, and pain.

The good thing about yoga is that you can jump in and feel challenged at any fitness level, from couch potato to workout devotee. It’s low-impact, so it’s easy on the joints. It isn’t competitive, so you shouldn’t be looking over your shoulder (or between your legs) at the next person. It doesn’t require any equipment other than a mat, so don’t stress the gym wardrobe.

You can find yoga workouts online or on DVDs, but classes are offered everywhere as well. The glut of choice actually makes teasing out the best choice for you more challenging. It took hours of online searching to find a workout that fits my ability but that also avoids an annoyingly smarmy monologue or off-the-wall comments about hairstyle or the leader’s latest manicure. (Not kidding.)  I ended up sampling the beginner clips from this list.

Taking a bricks-and-mortar class may be the best option for maintaining motivation, but also for feedback and advice on proper form and avoiding injury. Check out the background of the person leading the class. Barriers to entry are low, so anyone can teach yoga with a few hours of training. You’ll want someone with experience and many years of practice in the discipline.

“To my mind, a good teacher always asks, ‘Are there any injuries or conditions I should know about before we get started?’” writes Julie Corliss, editor of the Harvard Health Letter.  She also advises checking out a few different classes to find a good fit.

 

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Sex after menopause can be challenging. This website and my medical practice is dedicated to addressing those challenges, so topics like dry vaginal tissue, pain with intercourse, loss of libido get a lot of press here at MiddlesexMD.

But for once, let’s turn the picture on its head. Let’s look at postmenopausal sex from the sunny side of the street.

Sure, menopause isn’t for the faint of heart. It’s a hormonal roller-coaster with a chaser of unpleasant side-effects. Sex can become collateral damage during all the turmoil.

But the big picture? The view from the top of the hill? Not so bad at all. In fact, depending on your inner resources and resolve, both sex and life after the big M can look pretty darned sweet. Some women even report experiencing a resurgence of desire, sort of golden age of post-menopausal sex.

Several elements tend to coincide during those post-menopausal years that contribute to a more serene, predictable life and the potential, at least, for a renewal of romantic zest. For example:

  • More time; less stress. Retired or not, you’re probably past actively building a career. The kids are independent and maybe out of the house. You aren’t completing financial reports while sitting at basketball practice. You can linger over a pinot grigio and actually listen to the Tchaikovsky Concerto in D Minor without the distracting din of kids fighting.
  • No periods; no pregnancies. A lot to celebrate here. The years of birth control (and worry about the Whoops! factor), the discomfort and nuisance of menses—all in the rearview mirror. You can sleep in and take the triple gatehook locks off the bedroom door. Canoodling can last as long as you want.
  • Financial freedom. Generally speaking, the hamburger years are over. You can afford steak, a night out, a nice bathrobe, or even a romance-inducing cruise. All of which can make you feel relaxed, sexy, and vital—and more connected to your honey.
  • Fewer crazies. As the hormonal ride levels off, you’ll feel more stable, mature, and confident. You know what you want, sexually speaking and otherwise, and you know how to ask for it. You’re coming into your own—no one is the boss of you.
  • Synchronicity. With maturity, the sexual needs of men and women tend to converge. Men slow down and value emotional connection. Women become more assertive. It can be a great time for playful exploration on all levels.

Intimacy at midlifeGranted, aging comes with challenges, and they can be unpredictable. But growing older and staying sexy is more about your attitude, and the resources you bring to bear than what’s happening below your neck. “So here’s the big reveal,” writes Barbara Grufferman in this article. “After 50, we’re at a sexual crossroads, and need to make a choice: We could go through menopause, shut down that part of ourselves, lock the door and throw away the key. Or we could embrace this new life with a sense of freedom and fun…”

So that’s the thing: it’s a choice. There are no wrong answers (unless they hurt your partner); instead, you have lots of options. Barriers to good sex are very fixable, both for men and women.

Here’s a list of simple things you can do to enjoy these golden sexual years to the full:

  • Preheat the oven. You are responsible for your own arousal, so get to know your body and what it likes. Read erotica. Play with toys. Then teach your partner. Don’t wait passively for Prince Charming to ring your chimes.
  • Just do it. Sometimes you have to begin in order to get aroused. Start the kissing and cuddling. It’s quite possible that your brain will catch up. “If you’ve been ignoring, neglecting or denying your sexual self for a while, then you must consciously decide that you want sex in order to even let yourself feel desire,” writes Grufferman.
  • Sex leads to more sex. “Women who have regular sexual activity have less sexual dysfunction [and fewer] complaints,” says Dr. Madeline Castillanos, a psychiatrist and sex therapist in New York City. It’s that “just do it, you’ll like it” thing again.
  • Take your time. You don’t have to hurry, and you don’t even have to please your lover. Turning you on is a big turn on for him, too. So you can relax and let go of the worn and useless sense of duty about getting him and yourself off expeditiously.
  • Engage in outercourse, says Dr. Sheryl Kingsberg, a psychologist with University Hospitals Case Medical Center in Cleveland. Involve all the senses; practice luxurious, languid, voluptuous sex that may or may not actually require penetration. Most of all, have fun doing it.

According to the experts, the most dependable predictor of good sex after menopause is good sex before menopause. And if it wasn’t so great before, time’s a-wasting. You can apply your hard-won life skills and your intimate knowledge of your partner to begin addressing the issues that stand in the way of intimacy and a solid sex life.

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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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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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Many of us are very goal-oriented. We like to make lists and to tick items off those lists. We like order; we don’t like chaos.

Unfortunately, life is messy and sometimes chaotic.

At no time is this truer than during the holidays. All the demands of the holidays—the shopping, cooking, partying and gathering—will simply be heaped on top of our already overflowing schedule. We know that the price we pay will inevitably be snappishness, exhaustion, maybe the scratching of old scabs and regurgitation of old hurt.

In the interest of helping all of us not only to survive, but maybe even to enjoy the holidays, I offer you a mini-tutorial on a practice that has been known to help everyone from cancer patients to Fortune 500 executives. It’s even known to improve our sex lives, which is why we highly recommend the practice of mindfulness on our website.

Mindfulness is a straightforward concept. It’s developing the ability to pay attention to the moment—not to zone out, but to develop a facility of focused attention, without judgment or emotion, on the present. Mindfulness was a Buddhist concept, but in 1979 Jon Kabat-Zinn, a psychiatrist at the University of Massachusetts Medical Center, adapted and developed it into a formal eight-week program for patients “who weren’t being helped” by traditional medicine. His program incorporates meditation, mindfulness exercises, and yoga.

The results were impressive. Patients experienced less pain, and they healed faster. The practice relieved stress and improved the immune response. The concept of mindfulness meditation quickly seeped into the broader zeitgeist.

Now, I know that it’s one thing to read about a spiritual practice, helpful as it may be, and entirely another to actually incorporate it into daily life, especially in the midst of holiday frenzy. The essence of mindfulness, however, is simple and almost intuitive. Best of all, it takes almost no time. You can practice mindfulness while you’re rolling out pie crust or brushing your teeth. It quiets our “monkey mind” and brings us back to the moment, which, after all, is the only moment we really have.

“Life is available in the here and now, and it is our true home,” writes Thich Nhat Hanh, a Buddhist monk and globally famous spokesperson for mindfulness meditation.

Mindfulness practice doesn’t take effort, and it doesn’t take time. It just requires a focusing of thought and awareness. The basic meditation is to focus on your breath: Just paying attention to breathing in and breathing out. Your breath doesn’t have to be long or short. You just have to follow your in-breath and your out-breath.

You can think, Breathing in, I’m aware of my body; breathing out, I release tension in my body. You mentally pay attention to any parts of your body that are tensed—your lips, your neck, your back—and consciously relax that part. When you wait in line or stop for a light, you have a bit of time to practice this focus and release. And then smile, says Thich Nhat Hanh.

I can't get enough of gratitude and gracefulness.This principle can be applied to whatever you’re doing: cooking, cleaning, taking a shower, taking a walk. You bring your attention lightly but completely to the activity you’re engaged in. You don’t think about the next thing you have to do or the fight you had with your spouse this morning. Those thoughts are like the clouds crossing a bright, blue sky. You observe them without emotion or judgment and let them go, returning to your focus on your breath or your walk or the pie crust.

As you practice mindfulness, you may become conscious of the moment before you react to something.   When you are aware of that moment, the moment before you react, then you have a choice about how you will react, whether in anger or kindness, fear or trust, passion or forbearance. If you’re aware, then you have a choice.

“Between stimulus and response there’s a space, in that space lies our power to choose our response, in our response lies our growth and our freedom,” writes Victor Frankl, Holocaust survivor and author of Man’s Search for Meaning.

I’m thinking that if ever there was a good tool for avoiding those uncomfortable confrontations during the holidays, this might be it. If you’re aware of the moment of stimulus, when your brother makes a snarky remark about your son’s tattoos, for example, then you are given a moment of choice about how you’ll respond. And a moment to breathe in, breathe out without tension or judgment.

Even though it’s effortless, developing this practice isn’t easy. I guess that’s why it’s called a “practice.” I do know that improvement, however incremental, helps me to live with gratitude and gracefulness.

And during the holidays, I simply can’t get enough of either.

As Thich Nhat Hanh writes: “The real miracle is not to fly or walk on fire. The real miracle is to walk on the Earth, and you can perform that miracle at any time. Just bring your mind home to your body, become alive, and perform the miracle of walking on Earth.”

Amen to that!

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