Keep on Learning

Remember in middle school (we called it junior high in those days) when the boys and the girls were shepherded into separate rooms for those awkward films? It might have been presented by the gym teacher or the guidance counselor; maybe your school was large enough to have a health teacher who presided as we were introduced to the signs and effects of puberty—and the dangers of acting on urges.

My conversations with women lately have reminded me that while we take great pains to introduce our younger selves to their biology, we don’t quite follow through. In the sex ed I’m familiar with, the story stops with the fertile years. We don’t introduce the full cycle we can all expect to experience if we only live long enough.

Yes, breasts bud and menstrual cycles begin. We have children, or we don’t; we may have illnesses or surgeries. At some point, the cocktail of hormones shifts, and the parts of our bodies once prepared for reproduction begin to change once more. Our periods become unpredictable and eventually stop (a year without defines menopause). Our tissues become dryer, more fragile, less elastic. Without care and attention—and often in spite of them—our vulvovaginal tissues atrophy, which means they actually shrink.

And where do we learn this? Not in a gym or a cafeteria with a hundred of our same-sex classmates! For too many of us, we learn it only through our own experience, at a point in life when there aren’t many people we’re talking to about sex. We’re tempted to think this is an odd thing that’s happening only to us. We’re a little embarrassed, maybe a little ashamed.

There’s so much more common about our experience than most women think! If only there were a middle school for midlife, so we could all get together and learn about this next phase of physical transitions. As we thought (or it was hoped we were thinking) back in the original sex ed, knowing what’s ahead is the first step in making good decisions and taking charge of our own sexual health.

I haven’t yet figured out where to offer my midlife sex ed classes, or how to get busy women to attend! So I’ll keep having conversations with women one on one in my practice and through the MiddlesexMD website. I hope you’ll be having conversations, too, because even without the awkward films, we’re all in this together.

For All the Right Reasons

Had you asked Charles Darwin why people have sex, he would say that it’s all about procreation. You know, survival of the fittest and fastest breeders and all that.

Had you asked 1,500 students at the University of Texas in 2007 why they have sex, you’d have gotten 237 reasons (perhaps unsurprising, given the population) ranging from the blatantly self-centered (good exercise) to the altruistic (to please my partner).

But doesn’t the more relevant question have to do with the effect of those reasons on one’s sex life and relationship than about why a person has sex? After all, if you know that sex for your partner is simply an alternative to going to the gym, I suspect that would color your experience of sex and view of the relationship.

We know that more and better sex is linked to happiness and relationship satisfaction. But some of our motives for sex would seem to make our lives and relationships better and others to make them worse. And are there nuances within this paradigm—are some reasons for sex better than others, and is more sex always good? Finally, are there some practical applications for all this academic falderal?

Recently, in two separate studies, researchers at the University of Toronto quizzed a hundred or so dating and married couples about their reasons for having sex. The couples kept diaries for several weeks, answering questions whenever they had sex about their motivation, levels of desire, and how they felt about the relationship.

What the researchers found was that why we have sex on any given day does indeed affect how we feel about our relationship, our partner, and our level of desire. The effects were the same for both men and women, and they persisted for months after.

Responses were grouped into two main categories: approach, which seeks a positive outcome (I want to be closer to my partner) and avoidance, which seeks to circumvent something negative (I don’t want to feel guilty.) Motives for sex can also focus on oneself (I want to feel good) or one’s partner (I want to make my partner feel good.)

Researchers found that when respondents engaged in sex for partner-focused, approach motives, they felt more satisfied with the sex and better about their partner than those who had sex for self-focused, avoidance reasons.

The surprising element was that, when a person had sex for positive, partner-focused reasons, the partner also felt more positively about sex and the relationship, and that these effects persisted over time.

“If I am having sex more for approach goals, it increases my desire and satisfaction, so my partner probably senses that and it contributes to their outcome. Our satisfaction carries over to them.” says Dr. Amy Muise, lead researcher, in this article.

So it would seem that, while more sex is good, more sex for the right reasons is even better.

Of course, everyone has sex for a variety of reasons, depending on the day. Sometimes they’re positive and partner-focused (to give pleasure) and sometimes they’re negative and self-focused (to avoid guilt or conflict). And of course, we have sex when we aren’t particularly in the mood. But simply understanding the power and cumulative effect of positive, partner-focused motivation might encourage us to work on our attitude the next time our partner gets that look.

We might also work on the kind of communication and mutual respect that will make it easier for both partners to have sex for positive reasons more often. “Perhaps younger men and women still give in for this (avoidance) reasons,” says Iona Monk, counselor and founder of Vancouver Couples Counseling, in this article, “but I’d like to think it shifts as we mature, and learn to communicate better and know and accept our needs more.”

Tickle Your Sexy Bone

You already know (you do know, don’t you) that the skin is your largest sex organ. We’ve talked about that, also about how important foreplay is now that we need a little more stimulation to get in the mood.

So let’s get specific about this whole skin thing.

Not all our parts are created equal: Some are ticklish; some are sensitive; and some are very willing to play along with our pre-sex games. We call these our erogenous zones. Since we have many of them, why not spend some time exploring this secret garden with our partner? I’m betting you’ll discover new ways to tantalize your mate as well as to become aroused yourself.

We are each unique. What turns you on may not excite your partner. A ho-hum move for you may electrify him. Men and women each have special turn-on zones that are unique to the gender. Cut lines for men; nipples for women, for example. Gentle touch may be more pleasurable in one place while another may require a firm hand or even a smack. Variations in touch and texture can also be exciting, so don’t overlook fur and feathers or heat and cold.

Women often wish their partner just knew what they like without having to be told (or shown), but let’s get over it. That may work for Christian in 50 Shades, but our real-world guys need a hint. Heck, you may not even know all your own sexy spots.

You and your partner could map out places on your bodies you’d like to touch and explore. Tell each other where you fantasize being touched just so. Make cards with the names of various erogenous zones and draw one or two randomly. Focus on those in your next love fest. Finally, and most importantly, let each other know when a particular touch feels good—or when it misses the mark.

In my next post I'll list some top erogenous zones, according to several sources I’ve run across.

Together but Alone

I hear from a number of women that although they’re in long-term relationships, they’re feeling alone. Sometimes this becomes apparent as part of adjusting to other changes—like sending the last kid off to college, welcoming a parent into the household, or adapting when one or both partners retire from a career. I asked MiddlesexMD advisor Mary Jo Rapini, a psychotherapist who specializes in intimacy and relationships, what women can do when they find themselves unsatisfied.

The loneliest feeling doesn’t come from being single. It’s being married or living with someone, but feeling alone. This happens when one of the partners checks out emotionally but eats there, does their laundry there, and sleeps there. For all other purposes, though, there is no partnership. This happens to couples who live together as well as couples who date and marry. Many times some type of crisis precipitates a partner’s emotional distance, but sometimes it just happens. You may sense your partner no longer values your judgment. You may notice your partner no longer listens to you, talks to you, or wants to engage with you.

When a woman first begins to feel lonely in her relationship, she doesn’t automatically get help. She’ll usually try to understand what is going on in her partner’s life. She may ask, “You okay?” or “What’s the matter?” Those questions are usually answered by, “Oh, just work,” or, “I’m just tired.”

Sometimes the partner will come back with, “Nothing I say is good enough, and you fight me on everything.” When this happens, the partner who asked the question begins feeling even more alone and more stuck in her loneliness. They may reach out to friends or family, or begin reading self-help books. Her friends may validate that her partner is cruel, insecure, having an affair, or all of the other things friends try to do to make one feel better. The bottom line is, she’s in a bad position. She is committed to someone and very much alone.

The amount of distance in a relationship is determined by the couple and the style they develop. Many of us like more distance between ourselves and others, and this is reflected in how we relate. Just as some people are very private and others extremely open; some couples cannot go to the grocery store without the other, and some travel across the world without each other. It’s a personal preference; neither is right or wrong.

Feeling alone is much different than actually being alone. Feeling alone means the communication is broken. Your partner may be in Africa and you in Texas, but if you are talking on the phone and sending silly texts or emails, you’re together. If he is at your side, but no longer engaging with you, talking to you, wanting to be with you, he might as well be in Africa.

As with most things, this emotional distance is easier to prevent than to fix once the damage is done. But here are three steps to take to feel less isolated in your relationship:

  1. Ask yourself if you really want this relationship. Sometimes we become lonely when we long for someone or something else. Your partner may sense that you’re not communicating that you feel stagnant or want out. Your partner may be withdrawing as a way of limiting—or pre-empting—the hurt.
  2. Talk to your partner about how you feel. Does your partner know you feel unloved or distant? No one can read your mind. It’s possible that your partner is feeling the same distance and will welcome you raising the issue.
  3. Are your beliefs about money, sex, or faith getting in the way of your need to be connected with one another? Couples who are fighting may project the anger from the disagreement onto the relationship. The distance created is actually about disagreeing over a topic. If you talk about this, it will help bridge the distance you feel.

Our relationships are a way to receive—and to give—the love, acceptance, and security we need to grow and evolve. To be physically and emotionally alone in a committed relationship is unbearable because the hope of connection is lost. Study after study has shown what happens to babies who are isolated from human love, acceptance, and security. We never outgrow that need.

If you still feel stuck, get help. Couples therapy has helped thousands of people reconnect. And if your partner isn’t interested, a trained, objective counselor can help you to evaluate where you really are and what your options might be.

Talking Sex with Your Health Care Provider

Dr. Sheryl Kingsberg is a MiddlesexMD advisor and a psychologist specializing in women’s sexual health. She talks to physicians a lot about why it’s important to at least ask about a patient’s sexual health and maybe take her sexual health history. So she’s very familiar with the view from the physician’s side of the desk when it comes to talking about sex with patients. Generally, she says, health care providers have little training in women’s sexual health, even though they deal with those organs all the time. So—“they’re not going to ask about a topic they don’t know much about because they feel like they’re walking into something blind,” Sheryl says. Plus, they’re probably embarrassed, and they’re afraid the discussion will take too much time. “All health care providers struggle with this issue,” she says. Patients are often embarrassed to bring up the S-word, too, even though they may have questions or problems. Or—they may think (studies prove this is true) that nothing can be done about the problem anyway. This is because, in general, women’s sexuality is complex and can be affected by everything from physical changes to cultural morés. There are treatments for women’s sexual problems, but they’re just not as simple as a pill, because, well, our sexuality isn’t that simple. As a result, sex is the elephant in the examination room. It’s the health care version of don’t ask, don’t tell. What Sheryl tells physicians is that not only is it important to give a woman permission to talk about sex and to be prepared either to treat her problem or to refer her to a specialist, it’s also their responsibility as a practitioner. Here’s how she puts it:
  • Sexual issues are very common. About half of women will have some sexual difficulty at some point in their lives.
  • Sexual health is a basic human right, according to the World Health Organization. It is the health care provider’s responsibility to be concerned about and to manage the patient’s sexual health.
  • Sexuality is important to a woman’s overall health and quality of life.
  • Patients are uncomfortable bringing up the topic. They don’t know if it’s appropriate, and they don’t think anything can be done to help them.
  • Patients won’t be offended if the provider asks about their sex life.
  • Asking about a woman’s sexual health doesn’t have to take a long time. At the very least, the health care provider should communicate that it’s okay to talk about sexual problems, and be prepared to refer the woman to a specialist.
That’s it. That’s the manifesto. It’s your right to have your sexual health questions and problems addressed, and if your physician can’t or won’t do that, Sheryl says: “Find a new provider.” The medical landscape is changing, she says. Rather than the old “doctor knows best” mentality whereby you, the patient, comply with the treatment regimen your doctor prescribes, now the approach is to work together with your provider to develop a regimen you can adhere to rather than passively comply with. Sexuality is important, and if your health care provider hasn’t asked you about this quality of life issue, bring it up. Then, if he or she doesn’t respond, well, there are lot of other providers in the pond.

When to Say Goodbye—to Your Health Care Provider

The provider-patient relationship is delicate and fraught with opportunity for misunderstanding. On one hand, you have a busy professional in a somewhat risky, stressful profession who is pressed for time and is trained to speak a foreign language—medical mumbo-jumbo.

On the other, you have ordinary people who may or may not be good at communication and who are paying a lot of money to entrust to this person their most precious possession—their health.

On one hand, it takes time to become familiar with someone’s personality and communication style. And it takes time to develop trust, which is a critical ingredient in any relationship that will last a long time, including this one.

But on the other hand, the stakes are too high to overlook for very long a bad attitude, questionable treatments, or ongoing discomfort on your part.

So how do you know when to finally pull the plug and find another health care provider? And how do you go about that process, anyway?  We’ll answer the first question in this post and the second in a later post.

The top reasons to look for another health care provider:

  • Your health care provider interrupts or doesn’t listen. Your questions are prepared and succinct. You aren’t rambling on or complaining about your job, yet your provider is glancing at the clock, seems preoccupied, or keeps checking his or her Blackberry. Or—you’ve barely begun to ask your questions, and your health care provider interrupts. (Some studies indicate that providers interrupt their patients within 23 seconds after a conversation begins.)
  • Your health care provider is arrogant, argumentative, or unapproachable. Your health care provider must be able to listen to challenging questions and to answer them thoughtfully and without defensiveness. A health care provider who doesn’t welcome questions from his patients, who blames the patient, or who becomes hostile, defensive, or argumentative either has a personal problem or doesn’t understand the first thing about a professional relationship. If you like being bullied, stick around; otherwise, head for the hills.
  • You can’t get in for an appointment. You may have to schedule a routine physical several weeks in advance, but you want to be able to see your health care provider when you’re ill. At that point, even a few days are too long. If you can’t see your health care provider when you need to, that’s a problem.
  • Your health care provider’s staff is unfriendly, unhelpful, or incompetent. Unreturned calls, lost paperwork, billing errors, curt or snippy responses to questions, and long stretches on hold—these annoyances seriously impede your relationship with your health care provider. You owe it to your provider to let him or her know about your experience with the staff, but if nothing changes over time, you’ll have to assess whether the relationship is worth the aggravation.
  • And finally—your health care provider is unwilling or uncomfortable addressing your sexual health. Sexuality is a big part of your identity and a major contributor to your quality of life. Yet, as we’ve discussed before (and will again), most providers don’t bring it up. And they should. Dr. Sheryl Kingsberg, sex therapist and MiddlesexMD advisor, takes no prisoners on the issue. (More on this later, too.) “If your health care provider is that uncomfortable or indifferent to your quality of life, then I’d consider getting a new provider.”

New Study: Docs Don’t Talk about Sex

When was the last time your doctor asked you how your sex life was going?

I thought so.

In a new study, a team from the University of Chicago surveyed over a thousand OB/GYNs about whether they talk with their patients about sex. The results may not surprise you, but they won’t reassure you, either.

  • 63 percent routinely ask whether their patient is sexually active. (Good, but fairly superficial.)
  • 40 percent routinely ask if the patient is having any problems regarding sex. (Which means that 60 percent don’t ask about sexual problems.)
  • 28.5 percent ask about sexual satisfaction. (Which means that two out of three doctors don’t ask.)
  • 28 percent ask about sexual orientation or identity. (Yikes! Two out of three don’t even know if their patient is gay or bisexual.)
  • 13.8 percent ask about sexual pleasure. (Which means that 86 percent don’t ask whether the patient enjoys having sex.)

Even more distressing was that 25 percent of OB/GYNs reported expressing disapproval of a patient’s sexual practices. Foreign doctors, older doctors, and very religious doctors were more likely either not to address the issue of sex or to express disapproval. Female doctors and those whose practice focuses on gynecology rather than on delivering babies were more likely to do some sexual assessment, although it was often insufficient.

Dr. Stacy Tessler Lindau, a practicing OB/GYN and lead researcher in the study, points out that OB/GYNs are the most appropriate health care provider to be asking these questions, and if they aren’t, it’s unlikely that anyone else is. Which means, as we have found repeatedly, that women tend not to mention sexual problems, to assume that a doctor can’t help anyway, and to suffer with or adapt to sexual problems on their own.

Doctors should be talking about sex with their patients because

  • Sex is an intimately linked to overall quality of life and the quality of one’s relationship.
  • One-third of younger women and one-half of older women report having some sexual issues, from lack of desire to painful intercourse
  • A change in sexual patterns can indicate an underlying health problem, such as depression or thyroid problems.
  • Women with ongoing sexual issues are more likely to feel self-conscious, isolated, embarrassed, ashamed, or guilty.
  • Assuming that a patient has a heterosexual orientation is alienating to patients who are lesbian or bisexual and can result in miscommunication and misdiagnosis.
  • Common medications, such as those for depression and breast cancer, for example, can cause sexual problems, such as low libido. Women are often not told about sexual side effects of medications and are therefore unprepared to cope with them.

The researchers hypothesize that doctors don’t talk about sex because, like everyone else, they’re embarrassed or they may worry about embarrassing their patients. Talking about sex isn’t part of their medical training, and although they may treat a woman’s sexual organs, they aren’t equipped to assess and treat her sexual problems. So what’s a frustrated patient to do?

Take the initiative, counsels Dr. Lindau. If you trust your doctor, but he or she hasn’t asked about your sex life, you can, and should, begin the conversation.

  • Formulate your questions ahead of time. What, exactly, do you want to ask your doctor about sex? Do you have specific issues, such as painful intercourse or low libido? Are you anxious about entering menopause and need information about what to expect? Write down your questions and be as specific as possible.
  • Acknowledge your discomfort, advises Dr. Michelle Curtis. It clears the air. “I know this is a little embarrassing, but I have some questions about sex I’d like to discuss.” Don’t worry about embarrassing the doctor, says Dr. Curtis. It’s his or her job to answer your questions.
  • Empower yourself. The medical profession will change as women take responsibility for their own sexual health and begin asking questions and expecting thoughtful answers. You can ground yourself in basic information with websites like this one or others backed by solid medical organizations, such as the Cleveland Clinic or Mayo Clinic. Then you can approach your doctor with good, informed questions.
And if your doctor doesn’t respond in kind, avoids your questions, or seems uninformed, you can consider finding another doctor. We’ll discuss that process in a future post.

An Open Letter Part Two: Down and Dirty

Dear beloved partner of mine:

If you read my last letter (you did, right?), then maybe you understand how I feel—and how to make me feel better—sexually speaking.

So let’s stop beating about the bush. (Music to your ears, I know.) I’m going to get very specific about how to turn me on. But I’m hoping that if I take this step, you’ll reciprocate, and maybe we can begin talking about sex more openly, about what we each like, and about how to make it good for both of us.

Prime the pump. Always remember that, for a woman, sex begins in the mind and imagination. Use that to your advantage. Begin early. Make the coffee and bring it to me in bed. Leave me a provocative note in the morning. Send me a sexy text. Bring home lovely wine and chocolate. Help me get my head in the game.

Finesse the foreplay. I recently read that it takes a woman an average of 20 minutes to reach orgasm—and it takes a man four! Those numbers may be optimistic for both of us these days, but they illustrate one important difference between Venus and Mars: I need time! Besides, we’re sitting on Golden Pond now. What’s the rush?

Try starting in a different room. (Variety is always spicy.) Whisper sweet nothings. Tell me I’m beautiful. Show me that you desire me.

So once we get down to business, don’t just go for the goal posts: tease me. Use light touch. Use your tongue. Use your imagination. Experiment. Try running your hands over my inner thighs, tickle my neck. Try stimulating my perineum. (That’s the spot between my vagina and my anal opening.) Once I begin to steam up, hone in on the erogenous zones—my breasts and vulva. Lightly touch, lick, or kiss. Back off and do it again. Ask me to show you how I like to be touched.

Many ways to score. Despite all you’ve heard about how hard it is for women to reach orgasm, we’re actually equipped with several ways to do it. In fact, according to an article in Everyday Health, “researchers have even found a nerve pathway outside of the spinal cord, through the sensory vagus nerve, that will lead a woman to orgasm through sensations transmitted directly to the brain.”

Pretty fancy, huh?

But the surest way to orgasm for most women is through the clitoris—it’s the tail that wags the dog. And while it may take some practice to get it right, that little number isn’t choosy about the medium. Both oral and manual stimulation work just fine.

I know you’re not completely clueless, but let’s run over some technique. First, remember the tease. Don’t dive right in and go for gold. Kiss my abdomen and thighs, then move to the vulva and its inner lips. Gently lick or kiss. Explore with your tongue. Lick my clitoris lightly, then move away. Then come back. Don’t lick one spot too intensely or too long, because it just becomes numb. Let me know you like this. Pay attention to how I’m responding. Do I seem to be getting turned on? You can ask, you know.

When I’m good and ready, you can focus on the clitoris. At this point, a firm, repetitive licking should do the trick. You can also place your finger in my vagina at the same time. Maybe you can find the elusive G-spot. I’ll let you know. Or, you can caress my breasts as I’m coming into full-blown orgasm. You can also try to stimulate my perineum and see if I like that.

Another move (only slightly acrobatic) would be to move up to missionary when I begin orgasming clitorally and get your own orgasm started. (You should be pretty turned on by now—it’s been more than four minutes.) It’ll feel pretty good to me.

If this is a little overwhelming, or if you need more detail, I’ll buy you the book She Comes First: A Thinking Man’s Guide to Pleasuring a Woman by Ian Kerner.

Good positioning. Finally, let’s not neglect positions that might work better for me than our standard missionary. We could try what the kids call the “reverse cowboy,” or the doggy-style, rear-entry position. Or maybe I could sit on your lap? That might hit some different nerve endings, plus we can get real cozy.

We could also try some of those fancy pillows to help us get into all kinds of positions. (And to support our less-than-agile parts.)

And remember, if you’ve come and gone, and I’m still unsatisfied, we can always go back to the good old dependable clitoral orgasm. I just know how good you’re going to get at it.

But really, honey, the point isn’t to learn a bunch of new tricks, but to learn to accommodate our changing bodies and to have a more deeply satisfying time together.

And that’s going to take some good communication and a lot of practice.

So, let’s get started. I’ll bring the lube; you get the wine and chocolate.

An Open Letter: How to Really Turn Me On

Dear beloved partner of mine:

We’ve been together for a long time. We’ve weathered some storms; we’ve had our ups and downs. The kids are raised; the house is ours again. These should be our golden years, right?

That’s why we need to talk. (I saw you cringe.)

You don’t like to admit it, but things are changing for me. Yes, it’s the change. The hot-flash and mood-swing change. The big M.

Maybe you’ve noticed that I don’t lubricate as well during sex and that it takes me longer to become aroused. In fact, maybe you’ve noticed that I’m not “in the mood” much, or rather, I’m in a lot of moods, not all of them pleasant. That’s because my emotions are on a trapeze, my body’s changing, and so is the way I feel about sex and the way it feels to me.

And because I want our sex life to be fabulous in our golden years (I’ve read that after menopause, sex is often better than ever), I want to share some of the stuff I’ve learned. This may require some adjustment on your part, but in the interest of a happy, satisfied, sexy wife, it’s worth it. Right?

Let’s start with a little quote from a friend, influenced, I think, by Shakespeare:  “Tup my mind and you can tup me.”

There’s a deep truth in that colorful nugget. Sex begins in our minds long before our bodies kick in. If you want good sex, here are some ways to get my mind in the game:

  • Make me feel valued, desirable, beautiful. Maybe I’ve gained a few pounds; maybe I’m drenched in sweat at night; maybe I’m feeling old. But yours is the only opinion that matters to me. Look at me the way you used to. Bring me flowers. Tell me I’m beautiful—and mean it.
  • Listen to me. Turn off the TV. Don’t offer solutions. Don’t try to fix things. Validate what I’m going through. Don’t patronize me or belittle my experience. And don’t even begin to think that it’s “all in my mind.” This is just a rough patch, and frankly, how sexy I’ll feel toward you on the other end will have a lot to do with how attentive you are now.
  • So—be attentive, just to be supportive, not for sex. Make dinner or clean up afterward. Leave a love note on the dresser or a sexy text on my cell. Do small things that let me know you’re thinking of me. And not once or twice. Make this the new normal.
  • Work out with me. I’m not happy with the way my body’s changing. I don’t feel sexy, and I don’t feel confident. You can help by not only encouraging me to exercise and eat healthfully, but also by doing it with me. If we both diet and get in shape, think how much better sex will be—and maybe how much longer we’ll have to enjoy it!
  • Touch me. Just loving, compassionate touch without a hint of horniness. You know I’m a sucker for a good snuggle. You don’t? Well, it’s time you learned. A quick hug; a little shoulder massage after work; a nighttime cuddle—just to let me know you care.
  • Be patient. You may be a magnet for my moods, and not the mood you’re hoping for. Try to understand that my hormones have run amuck and that my body’s playing tricks on me, and that you (certainly not my boss or my mother) are the safest target. I don’t like it, either. Give me some space. Don’t take it personally. If I was once a nice person, she’ll be back, and she’ll be very grateful for such a thoughtful, supportive partner.
  • Be playful. Lighten up. Make me laugh. You don’t have to be seriously funny, just be a little goofy. Laughter releases all kinds of soothing juju, and it reminds us that life is good.
  • Educate yourself. Read this blog and the MiddlesexMD website so you have some idea about what’s going on with my sexual apparatus. Then you can be on board when I suggest trying lubricants or sex toys.

With your support, I’m going to come out of this stronger, sexier, and more sure of myself than ever. We’re in this together, Honey, whether you like it or not.

As one gynecologist said, “The key to a woman successfully going through menopause is the quality of the support she gets from her husband, or the man in her life. The major mistake a woman makes is to think it’s her problem, because she doesn’t want to stress [her partner] out. There is no such thing as an uninvolved partner.”

Q: How can I feel intimate with an emotionally remote partner?

I posed this question to Mary Jo Rapini, an advisor to MiddlesexMD and a therapist, writer, and speaker. Here’s her advice:

You’re not alone in your feelings of being married to a man who cannot express his love. I am happy that you are healthy enough to advocate for yourself and your own sexual and emotional needs. There are several things I can suggest that may really help you feel more connected to your husband—and will help you feel better as well.

The SmartMarriages website has good information that can help you and your husband. They are very pro marriage, but more than that, they are pro relationship. Anyone who wants to improve her relationship could benefit from their resources.

Buy a book called The Five Love Languages, by Gary Chapman. Many couples have found it helpful; men like it, too, and reading it together will lead to better understanding of each other and how you each feel most loved. The author also offers weekend classes throughout the U.S.; you might find him in your area.

You and your husband would benefit from attending a marital retreat. If he doesn’t like groups, or if you don’t, I would suggest a private therapist. I think your husband would feel less threatened if you sought out a male therapist.

One of the most beneficial experiences to help couples become more emotional in their loving and more connected is attending Tantric classes, offered in many cities. They are a bit unusual, and some guys (especially older) are reluctant to attend, but if you can persuade him to go to just one, he will enjoy it.

Remember that men are raised to be competitive. They usually open up to their wives, but fear being “too vulnerable.” This may generalize to their sexuality. Try more touching with him and less talking or trying to “process emotions.”

Make sure you’re taking care of yourself, including having someone you can talk to! You need emotional support so you can regain your strength and confidence.