I know people hate it when this is the answer, but genuinely: It depends. The best lubricant for you may not be the best lubricant for someone else and vice versa, and you should feel absolutely no pressure to like something that you’re just not warming up to.
I talk to women in my practice, and I watch the sales through the shop here at MiddlesexMD. I know how many variables there are for women, and that some of them are unexpected. The first thing women in my office do is feel the lubricant between their fingers. Next, they take a sniff. We may talk about whether they have sensitivities or allergies to any ingredients or whether they prefer all-natural products. The things they can’t test—easily—in my office are how long-lasting a lubricant might be or how it might taste, which may be important to you or your partner.
Given all the variations, though, both in products and preferences, I’ve seen women gravitate toward silicone lubricants as best in midlife, because those tend to last longer. That’s important if you’re producing less lubrication yourself. At the other end of the ingredient spectrum are water-based lubricants, which may need to be reapplied during intimacy—and it’s a matter of personal preference as to whether that’s a feature or a bug. Water-based lubricants tend to come in a wider range of viscosity, which can change the application experience (and mess potential). Some are quite liquid, and others range into cream- or gel-like consistencies.
Hybrid lubricants, for the record, have the benefits of water-based with a touch of silicone for staying power. Our research team has found fewer products in this category recently, but we’re quite fond of the one brand we carry; it’s been a customer favorite for a number of years.
Regardless of the type you use, your best lubricant will be the one that matches your sensitivities (which is why we list SkinSAFE ratings, when they’re available, for each product) and then your very own personal preferences. If you’re tempted to say, “I tried a lubricant, and I didn’t like it,” I’d like to encourage you to try a different type or a different brand. Because the very best lubricant for a midlife woman is the one they’ll reach for and use!
P.S. If you'd like to try a few lubricants without making a commitment to a full-sized bottle, you might like the Personal Lubricant Selection Kit. Experiment with the samples, tell us which you like, and we'll send you a full-size bottle or tube.
An article last month in Time magazine is headlined “This CEO is Pushing a Pill for Female Sex Drive. But Does the Science Hold Up?” The story is about Cindy Eckert and her long-time advocacy for a prescription drug named Addyi, which I’ve been watching for years as it made its way through FDA approval and into the market.
What was disappointing to me about the article is that it doesn’t follow through in answering the question its headline posed. Yes, it shares opinions about hypoactive sexual desire disorder (HSDD). But it doesn’t include information like I saw presented at this fall’s annual meeting of the North American Menopause Society (NAMS). And it pokes holes in the notion that desire is only in the brain, which I don’t hear claimed in venues like NAMS. In fact, I hear the opposite: that women’s desire is complex, including but not limited to activity in the brain. Let me break it down.
The first question is whether there’s brain activity associated with desire, and whether there’s a difference between a “typical” woman (who among us will claim that title?) and a woman who is distressed by a lack of desire. Dr. Irwin Goldstein is the director of San Diego Sexual Medicine, Director of Sexual Medicine at Alvarado Hospital, and Clinical Professor of Surgery at University of California at San Diego. He presented data at the NAMS meeting in the form of magnetic resonance imaging (MRI) of women diagnosed with HSDD compared with other women. There’s a clear and observable difference, and his explanations of the underlying details went beyond what I can make clear in a brief blog post.
Irwin also talked about the “plasticity” of the brain, which is its ability to change and adapt. The research that he presented showed, essentially, that with treatment over time, the brain of a woman with HSDD can change so that it is no longer a contributor to a lack of desire.
But his presentation did not assert that the brain is the only ingredient for sexual desire for women, which is what I understand to be the second question. He introduced psychosocial themes that were then expanded upon by Sheryl Kingsberg, a clinical psychologist and associate professor in the Departments of Reproductive Biology and Psychiatry at Case Western Reserve; she’s also the staff psychologist of the Department of Obstetrics and Gynecology at University Hospitals of Cleveland.
What both Irwin and Sheryl presented was desire resulting from a balance of excitation and inhibition, which are affected by brain chemistry, on the biological level, and also by psychosocial cues. Given her background and specialties, Sheryl emphasized the psychological and interpersonal contributions to an increase in inhibition (and a loss of desire), which can include depression, shame, lack of trust, childhood trauma, “ghosts of past relationships,” fear, and more.
Add changing hormones to the mix (the subject of yet other presenters at NAMS), and you begin to understand how complex is the sexual response of women, as we began describing with Rosemary Basson’s model when MiddlesexMD first launched.
So back to Time magazine: Yes, the science backs up the role of the brain in sex, and the role of Addyi for women who genuinely have HSDD. I’ve seen the data and the studies, and I’ve met the women in my own practice. Yes, for some women a glass of wine, a hot bath, a romantic movie, or a piece of dark chocolate is all it takes to get in the mood. If you’re among them, be grateful. No, Addyi isn’t the answer for every woman with sexual health issues--even for every woman with HSDD. But for those for whom it works, it’s life-changing. Who would deny them that experience?
And, by the way? Cindy Eckert looks great in pink. (And I’ll be keeping an eye out for similar commentary on male entrepreneur wardrobe choices.)
How often does your mind wander during sex? You might wonder whether you’re “doing it right” or whether the light is flattering. You might be thinking about tomorrow’s plans or rehashing an event from today. You might wonder whether that noise is the furnace coming on or something to worry about. You might be musing about a topic you know you should have raised with your partner before you went to bed. This kind of mental multitasking is more common that you might think. And as if experiencing orgasm weren’t sometimes difficult enough, the last thing you need is your brain working on overload.
Mindfulness and meditation come up often in my conversations with patients. Practicing mindfulness has been one of the “recommended actions” women can take since the initial launch of MiddlesexMD. I’ve talked about it since on several occasions, including in an article reviewing research on “great sex.” The number one component? “Being there.”
Dr. Lori A. Brotto, clinical psychologist and sex researcher, has spent more than 15 years researching how to make meditation and mindfulness work in the bedroom. In an article entitled, “Want to *Actually* Improve Your Sex Life? Try Mindfulness. Seriously,” Brotto talks about the need to practice mindfulness in everything you do—every day.
We are programmed to think we need to multitask to be successful, when, in fact, we should be doing just the opposite. Brotto explains, “If you’re constantly multitasking throughout your life and never fully present, it’s going to be really hard to just do that during sexual activity. The brain has been hard-wired and it’s going to find it very difficult to do that.” Makes perfect sense.
When we multitask, we think we’re getting so much done because we are “successfully” getting several things done at once. But, is that actually good for our brains? Not according to Brotto: “Research has shown that rapid multitasking is really bad for our brains in general. We might feel like we’re accomplishing a lot by switching between tasks very quickly, but with each switch it’s actually more taxing on our brains.”
The same holds true for our sexual responses. If we’re constantly thinking of everything else that is on our minds during sex (e.g., everything we should be doing instead of having sex), we can’t really enjoy the “task” at hand. Even worse, if we’re having negative thoughts (“Will I reach orgasm this time?” or “Is he satisfied?”) when we’re being intimate with our partner, we put a lot of pressure on ourselves—and in a particularly counter-productive way.
When we are under all this pressure, the part of the brain known as the amygdala is stimulated, releasing cortisol, also known as the stress hormone. Our body goes into fight-or-flight mode, causing our emotions to get totally out of control. Brotto talks about fight or flight and how it can take away from the sexual experience: “That system is actually the opposite to the sexual arousal system. So the sexual arousal system is parasympathetic and when we go to that judgmental, stressful, worrisome place, the sympathetic nervous system is activated.”
When we are able to rid ourselves of all the negative thoughts going around in our brain, we open ourselves up for other feelings—feelings we might even know we had. If you can stop worrying about your own performance or if your partner is satisfied (or whether you remembered to turn off the oven), you can be more present and able to feel sensations. This is where mindfulness can make a difference—it helps us be totally present in the moment and really enjoy what is happening to our bodies.
One of the best ways to stimulate mindfulness is yoga. We all know yoga helps improve our flexibility and balance, but it also involves a meditative component. The breathwork 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 exercises the body and calms the mind—exactly what we need if we want to be fully involved when being intimate with our partner.
Meditation in general has several benefits, including giving you energy, keeping you centered, and decreasing stress. It’s difficult to have sex if you’re too tired or stressed from a long day at work.
We know mindfulness and meditation have numerous benefits in daily life and in the bedroom, so why not give it a try? You really have nothing to lose and everything to gain.
Start by reading the discussions here at MiddlesexMD on mindfulness and meditation. And if you’d like a resource you can curl up with, we highly recommend Thich Nhat Hanh’s book, The Miracle of Mindfulness.
This is your life—you deserve to get what you need from your doctor. If you aren’t getting your questions answered when you go for an appointment, what’s the point of being there? Right? Your physical and emotional well-being are important, and if both of those needs are not being met at your doctor’s office, you may need to speak up or make some drastic changes—maybe even both.
Think of it this way: If your car needed repair, you wouldn’t take it to just any random mechanic to be fixed: You’d ask your friends for referrals, you’d check online reviews, and you’d have a conversation with the mechanic to be sure he or she can communicate with you about what repairs are required and why.
You should expect at least as much from your health care provider as you do your mechanic. When you leave your appointment, you should honestly feel that you were able to discuss your concerns openly and get your questions answered. If not, you can empower yourself to get what you need from your current provider or find a new one.
So, here are eight signs that you may not be getting what you need from your current health care provider and might need to start shopping around:
Going to your doctor may never be “fun,” but it doesn’t need to cause you added stress and anxiety. If you don’t feel like you’re getting the care you need—including for symptoms of menopause— from your health care provider, ask yourself if you need to make a change. It may be the best thing you could do for yourself—and you do deserve care!
You say that penetration is becoming increasingly difficult, although you’re using lubricants. This is normal progression: In the absence of estrogen due to menopause, our genitals atrophy. The vulva and vagina get smaller, the vagina narrows, there’s a significant loss of volume of the genital tissues, including the clitoris. There are fewer folds in the vagina (I’ve talked about a transition from a pleated skirt to a pencil skirt to give an idea of the change in elasticity). The tissues become thin, pale, dry, and fragile, and the pH level changes.
These changes are what we in medicine consider to be “chronic and progressive,” so without treatment, there’s no question that the changes will continue. The most basic “treatment” is regular sex or external and internal use of a vibrator (if you don’t have an available and willing partner), which improves blood supply to the area and restores some comfort and tissue health. Using a vaginal moisturizer daily or at least twice a week can also help somewhat to keep tissues healthy.
There are also prescription therapies that are designed to really reverse the atrophy. They are all very effective. They include localized estrogens, the oral non-estrogen Osphena, and now, the newest, the non-estrogen daily vaginal insert Intrarosa. A discussion with your health care provider would be very helpful to determine next steps.
Sometimes the use of dilators can be helpful to stretch the vaginal tissues to maintain capacity. But without prescription treatments like those listed above or, possibly, systemic hormone therapy, the tissues are not very elastic, which limits the degree of stretch you can obtain.
With some investigation and follow-through, you can “keep the shop open”!
While reflecting on our anniversary a few years back, we were reminded of how many women have come before us, paving the way for straightforward conversations about women’s sexuality. We don’t see any reason not to keep adding to the series (read the first, second and third) meant to express our gratitude to them!
Patricia Schiller’s parents wanted her to be a teacher. And while she eschewed a degree in education for degrees in law and, later, psychology, she did end up teaching an entire generation, becoming “a leading voice in sex education and counseling.”
As a lawyer in the 1950s, it occurred to her that couples needed counseling more than the legal advice she was offering them. She returned to school and earned a masters degree in clinical psychology from American University in 1960.
In 1963, a time when pregnant teenagers were expected to drop out of school and did, she helped launch the Webster School, which gave pregnant girls the opportunity and support needed to finish their educations.
She also was a founder of the American Association of Sex Educators and Counselors, helping to establish standards for the profession. At the same time, she was changing the conversation about sex education. One of her goals was to make it acceptable to talk about sex, which she saw as being about more than just the act of sex. To her it was “a function of being human” and something that could lead to people becoming “warmer, more caring.”
Sex education should reflect that idea, she felt. In her book Sex Questions Kids Ask—and How to Answer, which she published in 2009, she wrote “sex education can teach children what it is that makes a mother or father sympathetic, understanding and respected.” She wrote two other books (Creative Approach to Sex Education and Counseling and The Sex Profession: What Sex Therapy Can Do), as well as many articles for professional journals.
People often joked about Schiller’s profession, saying things like “there’s the sex maniac.” “But I don’t mind,” she once told The Washington Post. “I enjoy it.” She died on June 29, 2018, an educator to the end.
Walk into any drug store and confront the aisles of skincare products: cosmetics, conditioners, lubricants, lotions, potions, and creams. If you’re looking for the safest, least allergenic product for your particular skin—good luck.
You walk up to a counter and how do you begin? How do you interpret the labels; how do you cross-reference which products might have been the irritant? It’s an impossible task to do as an individual.
You could read the teensy print on dozens of bottles and attempt to identify which unpronounceable ingredient might be causing your itchy rash. You could try to find products without parabens or Methyldibromo Glutaronitrile (yeah, that’s a thing). You could buy something expensive because the label says it’s “dermatologist tested” or “hypoallergenic.”
Or, you could go to the SkinSAFE website where that analysis has already been done on tens of thousands of products that touch your skin, from shampoo to cosmetics to sexual lubricants. There you can find products with the “TOP Allergen Free” designation, meaning that they contain none of the ingredients that have been identified as highly allergenic. You could also scan your favorite product into the SkinSAFE app on your smartphone to find out how that product ranks on the TOP Free scale and what allergens it might contain. Both the app and the website are intuitive, easy to use, and give you information that was impossible to find before.
EmpowHER, a website dedicated to providing credible health information for women. (Michelle describes her journey in my podcast series, Fullness of Midlife.)
According to its clinicians, the number one complaint that brings patients to Mayo Clinic is skin conditions. Research also suggests that up to 45 percent of contact skin allergies could be avoided by using allergen-free products like those with the TOP Free designation on the SkinSAFE website. This kind of scientifically sound, third-party ranking of everyday products according to their allergenic properties is a huge public service, not to mention one that could avoid many trips to the dermatologist.
SkinSAFE is a significant tool empowering consumers to make informed buying choices in an industry that’s been confusing at best and misleading at worst. It creates a meaningful designation—Top Allergen Free— based on science rather than marketing hype; it eliminates price from the equation. Neither price nor labels like “organic” or “hypoallergenic” are indicators of a product’s allergenic properties. Maybelline products, for example, are just as likely to receive the TOP Free designation as more exclusive brands. (And Uberlube is among the TOP Free products you'll find in our shop.)
“There are a lot of myths about skin-care products,” says Dr. James Yiannias, a dermatologist at Mayo Clinic and co-developer of SkinSAFE, “so if you choose a product that says ‘hypoallergenic’ or ‘dermatologist-tested’, unfortunately, it doesn’t really mean a whole lot.”
For example, we often think of botanical ingredients as “natural” and thus harmless. We’d rather put something natural on our skin than a product laced with unpronounceable chemicals, right? But botanicals can be just as allergenic as synthetic ingredients. One of the major allergy-causing ingredients in skin-care products is fragrance. And “fragrance” can include natural botanicals, such as balsam of Peru, which is highly allergenic.
For most of us, this information just helps us make better choices in skincare products. But for those of us who truly suffer from skin sensitivities or allergies (which often only become more severe with age), it’s critically important information. The SkinSAFE website has a special section for those with very sensitive skin that allows you, presumably along with your doctor, to create a “personal allergy code” (PAC) that filters out products with your specific allergens and only shows you products that are safe for you to use based on your individual profile.
The SkinSAFE app and website are a tremendous resource intended to empower consumers and clinicians alike with current, credible, and badly needed information. And we’re adding SkinSAFE ratings to our product pages and submitting not-yet-rated products for SkinSAFE review. Because as Michelle Robson says, “You just need to know. Information is power.”
Everyone likes nicely defined muscles, the kind that hint at strength and endurance and a healthy lifestyle. Some of us even work hard to build them. But what if I told you that exercising a certain set of muscles could not only help with the kind of bladder control that eludes many of us older women, but also lead to stronger orgasms and better sex in general? And that those exercises were fairly effortless and could be done anywhere?
You’ve probably already guessed that I’m referring to Kegels.
We’ve talked about these helpful pelvic floor exercises before:
Let me just say that however you do Kegels (as long as you’re exercising the right muscles) is just fine. Sit, stand, lie. Make dinner or watch TV. Drive. Got the picture? Kegels are invisible to everyone but you. That’s the beauty of it. However, as with any exercise, Kegels aren’t a magic pill or quick fix. You may not notice improvement for weeks. The important thing is just do it! Regularly.
Let me also say that some women find using Kegel weights (also called yoni balls, ben-wa balls, vaginal cones) helpful in identifying and isolating their pelvic floor muscles. Weights may also help develop those muscles more intensively—like using weights to build your biceps.
With a dearth of solid research on the topic, you will find wild, and wildly diverse, opinions about using vaginal weights. The Kegel Queen swears that doing Kegels can cure everything from organ prolapse to bad sex. She would never consider using vaginal weights to augment them. On the other hand, Kim Anami, the Kung Fu Queen of vaginal weightlifting, says that most women aren’t helped by Kegels because they don’t do them properly. She, however, will teach you to move furniture, shoot ping pong balls, and lift weights with your vagina. Or control your partner’s ejaculation. This might terrify most men. Or not.
I’m thinking that the truth probably lies somewhere in between.
While they’re not for every woman, vaginal weights add a level of gravitas to your commitment to Kegel. They come in a rainbow of sizes, shapes, and materials, from jade to silicone, balls to barbells. We’ve culled the selection to a manageable assortment in our shop. You can choose from a simple, inexpensive “starter” kit with two silicone balls to a programmable Elvie trainer that syncs with a phone or tablet app to customize your Kegel workout and give you biofeedback to make sure you’re doing them correctly. Then there are the classic Luna Beads, which are beautifully designed and easy to use.
To use Kegel balls:
Kegels of any sort, weighted or not, are an important part of your downtown health regimen. They can help with bladder and bowel control; they can help keep your organs where they belong. Kegels improve muscle tone and blood flow to the pelvic floor, which makes sex more pleasurable for you and your partner. And if you decide to practice a little vaginal weightlifting, you can go here for inspiration.
One of the benefits of my work with MiddlesexMD is the networking that makes it more likely that I’ll run into medical information, over-the-counter products, articles and books that could be helpful to my patients, and, of course, the interesting conversations that turned into our podcast, The Fullness of Life.
I received an advance copy of Love Worth Making: How to Have Ridiculously Great Sex in a Long-Lasting Relationship, by Stephen Snyder, MD, a month or so ago. Steve is a couples therapist, psychiatrist, and writer, as well as associate clinical professor of Psychiatry at the Icahn School of Medicine at Mt. Sinai in New York City. While I’ve met him—so far—only via email and his written words, I know we share some perspectives: that intimacy remains important to us no matter what our age, that men and women do have some differences in their approaches to love-making, and that there’s nothing wrong—and lots that’s right—about seeking tools that help us!
I think it’s useful to hear men’s perspective on sexuality, too, so when Steve offered to contribute to this blog, I accepted! Read on for more from Stephen Snyder, “sex therapist in the ‘hood.”
Several years ago, a merchant in my neighborhood learned that I was both an MD and a sex therapist. The next time I was in his shop, he asked me if I could get him some Viagra.
“How long have you had erection problems?” I asked.
“I don’t,” he answered. “But my wife and I have been married for 30 years. To tell you the truth, sometimes I’m too tired or preoccupied to get hard without the Viagra.”
What was this man’s problem, exactly? He wanted to have sex with his wife, even though he wasn’t feeling that strongly turned on. Evidently there were other reasons he wanted to do it.
Sound familiar? Of course: He wanted to make love like a woman.
Women can have sex with their partners any time they want. They don’t have to be very excited. Sure, some lubricant might be required, especially over 50. But the absence of peak excitement isn’t necessarily a deal-breaker.
A woman can make love for other reasons besides strong desire. To feel close or emotionally connected to her partner. To promote loving feelings. Or just for the simple pleasure of the experience. Even occasionally to keep a partner happy, even though she might be too tired or preoccupied to be really into it. A useful book on the subject calls it “good-enough sex.”
One wouldn’t want all one’s sex experiences to be like this. But once in a while it’s okay. Especially if the alternative is not to make love at all. If there’s one thing that sex research repeatedly shows about successful long-term couples, it’s that they keep having sex even when if the sex isn’t always earth-shaking. The ritual itself is important.
Men traditionally haven’t been able to do sex very easily under conditions of lower arousal. Especially over 50, when it ordinarily takes more stimulation to stay hard than it did at 20. If a man, for whatever reason, hasn’t been strongly turned on, conventional sex hasn’t usually been an option for him.
Viagra changed all that. Since the blue pill came on the market in 1998, a man can take Viagra and have sex even if he’s tired or preoccupied and just wants some loving and affirmation but isn’t feeling peak excitement. In fact, just having a good erection can help a man feel more in the mood.
There is often strong partner resistance to a man’s boosting his erection through chemistry, though. Women especially are used to the affirmation that occurs when a man gets hard (as Mae West famously put it) simply because he’s “happy to see her.” It’s worth it for a man to communicate that he needs sex for closeness and affirmation and pleasure as well. Just like she does. And that worrying about his erection just gets in the way.
Some couples worry whether taking Viagra under such conditions is a wholesome or natural thing to do. If it just takes more sexual stimulation now to keep him hard, wouldn’t it be more natural to simply intensify the excitement?
Maybe, but not necessarily. Intensifying excitement sounds like a great idea. But in practice, having to do things to get the man hard enough can be a bit of a burden. And it can take time, sometimes so much time that the moment is lost.
Sound familiar? Of course. It’s the same predicament that women find themselves in when they can’t get lubricated or can’t climax. Deliberate efforts to manufacture excitement often backfire. They usually aren’t very erotic.
My advice? It depends on the couple and the situation. But sometimes Eros is best served by taking the Viagra. Then a man can stop worrying about his erection, and get back to making love.
Sometimes it’s best for a man once in awhile to make love like a woman.
What you describe—pain during intercourse and tissues that your doctor says are thinning and pale—sounds like vulvovaginal atrophy, also called genitourinary syndrome of menopause (GSM). Since your hysterectomy (if it included your ovaries) or whenever your ovaries stopped producing estrogen, your vaginal tissues have become more fragile and can actually tear. GSM is what we call chronic and progressive, meaning it will continue to get worse over time as a natural consequence of the loss of hormones. If you want to have comfortable intercourse, you’ll need to maintain a treatment plan.
The most likely effective treatment is localized estrogen (in creams, ring, or tablet) or Osphena, a non-estrogen oral medication, or Intrarosa, a non-estrogen vaginal insert. Those are all prescription therapies. If you don’t have access to prescription medications, or in addition to them, vaginal moisturizers can be of some benefit; I’d recommend PrevaLeaf Oasis.
You say that your partner is sometimes away from home for weeks or months at a time for military service. That can also pose some challenges for you. At this point in our lives, we face a “use it or lose it” challenge with our vaginal tissues, circulation, and muscle tone. That means treating your GSM can’t be an off-and-on pattern; you need continuous maintenance. I published an article shortly after MiddlesexMD launched called “Vaginal Patency for Single Women.” While you’re not single, you might follow some of its advice, including the use of a vibrator during those “dry spells” when you’re home alone.
Best of luck in regaining not only comfort but pleasure! Intimacy is an important part of our relationships and our lives.