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Posts Tagged ‘mindfulness’

I wish there were a “secret sauce” that worked for all of us to restore libido. Not surprisingly, it’s more complicated than that.

It’s somewhat unusual to have an abrupt change to libido; for most women, it’s a “slow drift.” The first thing to consider with a dramatic change is any new or different medications. There are quite a few that have effects on desire: blood pressure, pain, and mood medications (antidepressants) to name a few. If you have had a change, you can work with your doctor to experiment with dosage or medications; let him or her know of this unintended side effect.

You ask about Cialis and similar products. They can help with orgasm (as they do for men), by arousing blood supply to the genitals, but they don’t have an effect on libido or desire.

One option to consider is testosterone. While it’s thought of as a male hormone, it’s also present in women and is linked to libido. Some physicians aren’t willing to prescribe it for women because it’s an “off-label” use, but 60 percent of women report significant improvement in libido with testosterone replacement, and 20 percent of U.S. prescriptions for testosterone are now for women.

The other factor important to consider is mindfulness–which we might also call intentionality. While you may not feel desire that motivates you to be sexual right now, you know your long-time partner does. You can make the decision (together) that you will continue this activity together, including foreplay. (And I note a recent study that linked frequency of sexual activity with the quality of relationships, which confirmed my intuition.) When you make that decision, sex is a “mindful” activity: You anticipate and plan it and prepare physically and emotionally for an optimal experience with your partner.

Many women grieve the loss of a part of their lives that was once so important and fulfilling. It’s most often an unnecessary loss, and staying sexually active has many health benefits as well as giving us feelings of both individual wholeness and connection to our partners.

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I once knew a crusty old farmer who refused to acknowledge the existence of daylight savings time. Ask him the time during spring or summer, and he’d respond, “Do you want the real time?” To Robert, daylight savings time was just some misguided newfangled invention.

This weekend, we return to “real” time.

While we gain an hour of sleep early on Sunday morning, we give up an hour of evening sunlight for a whole season. There’s something primeval about these fall and winter twilights. Something that makes you want to draw near the fire. Huddle together for warmth and protection. Share tall tales and drink something bracing.

We can ignore this ancient urge. We can fill the evening hours with activity. We can turn on lights, and stay up late.

But we may be ignoring something important in this seasonal cycle. Perhaps the shortening days and waning light are also reminders. I know they are for me. Our own time is becoming short as well. It’s a bittersweet truth that can’t be altered no matter how busy we keep ourselves.

Rather than avoiding this natural cycle, wouldn’t it be better to savor these twilit evenings, this waning light, with awareness and gratitude—in the same way we ought to experience this season of our lives? Wouldn’t this time be the richer for living it with greater compassion and attention? And doesn’t it make sense to begin with those closest to us?

This year, why not celebrate the return of real time? Why not set aside that hour or two of fading light to reaffirm love and life with the person you share it with now? This can be a quiet thing—the spirit of this season isn’t bombastic or overblown. Its colors are muted—ochre rather than fuchsia; the tone is subdued—Bach rather than Wagner.

Maybe walk together as evening falls. Crunch the leaves; smell the musty crispness. Hold hands.

Maybe sit together in the twilight. Drink mulled wine. Light candles.

Watch a special movie that moves you both. Read aloud—poetry or a book you love.

Mostly, experience this transition with your spiritual senses. Life is moving on. You are acknowledging the passing of time with someone you love. That’s something to be done with care and attention.

When he was 81, my friend Robert moved out of the farmhouse he had shared for his entire life with his bachelor-farmer brother. He moved out to marry Paula, who had outlived three husbands. This was his first marriage. I was the “flower girl” for the marriage of two octogenarians.

Robert wept as he said his vows. When he kissed the bride, it may have been for the first time. You can bet he rejoices in every moment of real time he has with his love.

We should do no less.

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“I cannot give you another regimen that has as many good health benefits as exercise. Hands down. Exercise improves life energy and sexual energy; your body image will improve. I can’t give you a better, free intervention.” So said psychologist Helen Coons in a recent speech to breast cancer survivors.

Any gentle exercise regimen during recovery is good. It helps ease many of the distressing symptoms of cancer treatment: insomnia, fatigue, weight gain, depression, poor body image, sexual dysfunction.

Yet, one of the best forms of exercise, according to several recent studies, is yoga.

Yoga combines gentle stretching and holding of various positions, which helps with balance, flexibility, and muscle tone. But it also involves a meditative component. The breath work in yoga “stimulates the parasympathetic nervous system and causes the body to relax and the blood pressure to drop,” says Maureen Ryan, sex therapist and nurse practitioner.

Yoga also encourages a sense of mindfulness—being aware of the moment and present to it. When the recent past is full of pain and the future is full of fear, “mindfulness brings people back to the present moment,” says Ms. Ryan. In one study of women with gynecological cancers who were experiencing difficulty with sex, the most helpful component of the experimental program was the practice of mindfulness.

Yoga is so effective because it exercises the body and calms the mind.

A small but significant study found that several weeks of Restorative Yoga, which involves gentle poses, usually with support from pillows and other props, reduced depression by 50 percent in women with cancer. (All had breast cancer; about one-third were still in treatment.)

Another larger study focused on the effect of two types of yoga—Hatha Yoga and Restorative Yoga—on cancer survivors who were having difficulty sleeping, a common problem for survivors and one that isn’t easily alleviated with medication.

Half the group attended 75-minute yoga classes twice a week and also practiced yoga at home. At the end of a month, this group was sleeping better with less medication than the control group. The group also reported less fatigue during the day.

In yet another study, breast cancer survivors reported better body image and less self-consciousness. After doing yoga for two months both at home and in group sessions, these women also had less pain, better muscle tone, more flexibility, and greater weight loss than a control group that had just exercised minimally for 30 minutes a week.

In fact, yoga is seen to be so effective in recovery that several top cancer centers, such as Memorial Sloan-Kettering and Stanford Cancer Center, provide their own yoga classes to patients.

Any form of exercise is helpful, but evidence suggests that the kind of mind-body regimen that yoga offers is particularly effective. Yoga classes are also easy to find—most communities offer them, and they are affordable.

Besides, anything that reduces depression, increases energy, improves body image, and reduces pain has to be good for sex, too.

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“Your most powerful sex organ doesn’t lie between your legs,” the famous sex researcher Alfred Kinsey is reported to have said. “It lies between your ears.” (Or, of course, as Dumbledore said to Harry Potter, “Of course it is happening inside your head, Harry, but why on earth should that mean that it is not real?”)

This has some interesting implications for sex—and for everything else in life.

Your brain is your personal Grand Central Station with gazillions of nerve impulses arriving and departing, docking, disconnecting, and releasing armies of little chemical messengers, like dopamine, oxytocin, and serotonin, into your system. In fact, these neurochemicals are what makes sex—or drugs or food—so irresistible.Stop saying I wish and start saying I will...

Yet, you are more than your neurochemical impulses. You make choices; you can direct the course of your thoughts and actions. And therein lies the potential for harnessing that big brain power to improve not only the quality of sex you have, but also the quality of your life.

Begin with thoughts. “As you think, so you shall become,” goes the adage, so begin training your mind to think positively. Happy thoughts, sexy thoughts, visualizing yourself as a powerful, confident, attractive woman, actually recreate the circuitry in your brain. You can become happier and more powerful and confident, simply by rewiring your brain with a different kind of thinking. On the other hand, “when you’re immersed in swarms of negative inner dialogue about yourself and how you think and feel about sex, you’re grinding your sensory responses down to nubs,” writes Natalie Geld in her blog. So the first mental exercise—and it isn’t easy—is to harness the power of your thoughts.

Practice mindfulness. We’ve written about this a lot because it’s so important. We all experience the nonstop nattering of our chatty left brain; we’re all familiar with the distractions of tomorrow’s deadline or yesterday’s meeting that intrude on sex, sleep, and quiet evenings at home. Distraction is built into our fast-paced, multi-tasking, fragmented culture.

MiddlesexMD_DickinsonMindfulness, on the other hand, is the mental practice of being fully present in the present moment, of installing an off switch in your left brain. It’s a discipline rooted in Eastern spirituality that immerses you in the present without distraction or judgment. You can practice mindfulness anywhere, but what better place to begin than when you’re making love? For one thing, nothing is sexier than someone who is completely focused on you; for another, it encourages your partner to respond in kind.

In one study conducted by researchers Lori Brotto and Julie Heiman with the Kinsey Institute, women who had been treated for gynecological cancer were given a “phychoeducational intervention” to help them reestablish sexual desire and arousal. One component of the intervention included mindfulness training. “In particular, the women reported the mindfulness component to be most helpful,” write the researchers in their report.

Paying attention to the present moment engages all the senses: the smell of your partner’s breath, the flecks of color in his eyes, how his skin feels against yours. Relaxed attention allows to you to release stress, which in itself can make sex more pleasurable. “Distracting thoughts, stress and worry are enemies of orgasm,” writes Debby Herbenick, a researcher with the Kinsey Institute.

Some ways to develop a more attentive, mindful approach to life:

  • Do yoga. Besides developing strength and balance, yoga is all about clearing the mind of distractions.
  • Practice meditation. Whether a religious exercise or simply a way to relax and relieve stress, the purpose of meditation is to develop the ability to focus on the moment.
  • Pay attention to everyday activities. Next time you walk, wash dishes, eat a meal or perform any simple, repetitive task, don’t turn on the iPod or television. Don’t multi-task. Simply pay attention. Focus on the taste, sights, and sounds around you.

While sexual problems often have physical origins, don’t discount the power of the mind in contributing to their resolution. Positive thoughts and mindful activity can make sex better, and they can make life better.

“Our ability to achieve an erection or ability to attain orgasm is far less important than our thoughts about those abilities,” writes psychotherapist Elisha Goldstein, PhD. “More often than not, unsatisfying sex is caused by the mind.”

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We’ve talked before about mindfulness – making a conscious effort to become more fully aware of something and thinking more deeply about it – and how being more mindful of sex can help increase your desire for it.

Because like many things in our busy lives, it’s easy to put sex on the back burner, along with items like haircuts and ironing. And if that burner’s not turned on, things can cool down pretty quickly.

And let’s face it, as we get older, our sex drive can diminish as hormone levels drop after entering menopause. So unlike when we were young and our hormones were raging, sex isn’t always “on the brain,” as it used to be. And unless you’re pro-active about putting it there, it might go away. Which would not be a good thing because sex and intimacy are such important parts of a well-balanced, healthy relationship.

But once you make the decision to become more mindful about sex, you’ll find many opportunities to incorporate sexual thoughts into your life. And it starts in places other than the bedroom.

Like the kitchen, for example. There’s always been a great relationship between food and sensuality (remember the movie Tom Jones?). You might want to check out The New InterCourses: An Aphrodisiac Cookbook on our website. It explores the history of aphrodisiacs and offers a guide for pairing dishes with relationship stages and different times of year. It also includes easy recipes for massage and bath oils. Why not give it a try? It might just lead to a romantic encounter.

Speaking of baths, next time you’re in the tub, put out some candles and invite your mate to come in and chat while you soak. It’s a peaceful and relaxing setting (no phones allowed) that’s ideal for conversations about intimate topics like… your sex life!

Remember, too, that we women are much more responsive when we’ve received sexual stimuli — thoughts, sights, smells, and sounds — than we are to just diving into sex spontaneously. Getting in the mood might just be a matter of giving some thought to what turns you on – and telling your mate about it.

As the old saying goes, “Sex starts between the ears,” and that means in your head. So if you want to keep your sex life active – or get it cooking again – start thinking about it more. And watch what happens.

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Orgasm. Such a complicated topic; so many questions, so few answers. But let’s focus on the most important point, which is, that for women, the biggest obstacle to experiencing orgasm is anxiety. How can anyone relax while having sex if she’s thinking, “Will it happen this time or won’t it?”

As you can imagine, research on this topic is somewhat limited. But the renowned sex researchers William Masters and Virginia Johnson, who were the first to describe the four-step process of experiencing orgasm (during intercourse) many decades ago, said there are four steps involved:

1) Excitement. During foreplay, blood begins to engorge the clitoris, vagina, and nipples, and creates a full body sexual blush. Heart rate and blood pressure increase.

2) Plateau. Sexual tension builds as a precursor to orgasm. The outer one-third of the vagina becomes particularly engorged with blood, creating what’s called “the orgasmic platform.”  Heart rate, blood pressure, and respiration continue to increase.

3) Orgasm. A series of rhythmic contractions occur in the uterus, vagina, and the pelvic floor muscles. Sexual tension releases, and muscles throughout the body may contract. A feeling of warmth usually emanates from the pelvis and spreads throughout the entire body.

4) Resolution. The body relaxes, with blood flowing away from the engorged sexual organs. Heart rate, blood pressure, and respiration return to normal.

(For another model of sexual arousal, remember Rosemary Basson‘s, which takes into account women’s more complicated reality.)

Another good thing to know is that experiencing orgasm during intercourse takes time. In one study of 1,000 women, the “mean duration” was about 13 minutes. So trying to hurry it along or time it to coincide with your partner’s is probably not going to help.

It all gets back to the whole idea of relaxing—of letting go and focusing on the moment, enjoying the closeness and intimacy itself without worrying about what the outcome will be every time you have sex.

And, too, most women—two thirds of us—never experience orgasm at all during intercourse; some say the only way they ever get there it is through hand stimulation (their own or their partner’s) or with a vibrator, which often is the quickest route.

If you’re having trouble experiencing orgasm, try some things on your own to see what works and what doesn’t, not just physically, but mentally. Some women, for example, find that fantasizing puts them in a “zone” where they can escape the distractions of life. (Imagine yourself on a desert island with the one you love!)

This is one of those things that can only get better with honest, open communication. Talk with your partner about your feelings, your reactions—everything—so that you both have a good understanding of what’s going on and why.

Let us know your questions about experiencing orgasm; we’ll do our best to answer them (if you’d rather not post them here, use the “Ask Dr. Barb” button on our site). And in the meantime, relax and enjoy the journey.

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What’s the difference between “connection” (number two of the “eight components of optimal sexuality”) and “deep sexual and erotic intimacy” (number three)? That stumped me for a bit while I was digesting the study published last year in The Canadian Journal of Human Sexuality.

Then I read this quote from one of the study’s participants, describing a type of intimacy that goes beyond intense connection in the moment: “It’s part of the way you act with each other long before you’re actually engaged in any kind of, you know, technical sex.”

I like that. I think that “the way you act with each other” before, after, and during “technical sex” is essential to deep erotic and emotional intimacy. Trust, respect, and real admiration and acceptance build the foundation for a truly intimate relationship. These are things that take time, that come with knowing each other in a profound way.

And, in my experience, you can tell if a couple has this kind of intimacy just by observing the way they interact at the grocery store or a dinner party. Do they laugh at each other’s jokes? Do they exchange quick touches and knowing glances? Do they refrain from criticizing each others’ tastes in breakfast cereal?

According to study participants, a deep sense of caring for one’s partner is a key characteristic of sexual intimacy. One woman mentioned that her need to feel solicitude and concern had become more important to her with age: “I don’t know that I’m capable of having great sex anymore without really caring about a partner.”

The study’s authors noted that “almost every participant identified a deep and penetrating sense of trust as characteristic of the intimacy that was part of great sex for them.” They needed to trust that their partners cared for them and that the relationship was secure.

This kind of trust and intimacy doesn’t just happen. It takes time and openness and communication. Especially at midlife, when our bodies and needs are changing, it’s important for partners to talk with each other, to stay up-to-date on feelings and desires. Honest and caring talk about sex can be erotic in itself, and can go a long way toward creating and maintaining the deep intimacy that makes for sex that is “better than good.”

More on this next week, when we look at component number four: Extraordinary Communication!

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