Six (or More) Ways to Please Your (Menopausal) Lover

Getting old ain’t for sissies, and neither is menopause. For all you guys out there with menopausal partners, maybe you’ve noticed her, um, lack of patience. Maybe you’ve been caught in the crosshairs of her mood swings. Maybe you’ve been awoken at night to her tossing and night-sweat-induced turning.

And maybe she just isn’t interested in sex anymore.

With some work, you'll weather the storm and emerge stronger than before.In my practice, I usually hear the woman’s side, but I know you’re an uncomfortably intimate co-pilot on this journey. You may be feeling confused, hurt, rejected, and helpless. This person you thought you knew is changing before your eyes. You don’t know how to help; you don’t know what this means—and it seems to be going on forever.

You miss the sex, the intimacy, the person you used to know. You miss the way things used to be, and you don’t know if or when any of these things will ever come back.  

You aren’t alone. Says 70-year-old Larry in this article: “When she got to about 65 it started to change. Intercourse became painful for her and she developed an allergy to semen. Now intercourse is out of the question and she has no desire for anything other than hugs.”

Life—and sex—does change during menopause, but that doesn’t mean you’re doomed to a relationship without intimacy forever. Shifting ground is treacherous, but with some work on both your parts, you’ll weather the storm, and emerge stronger than before.

Here’s what you can do:

Walk a mile in her shoes. Depending on the intensity of her symptoms, your partner is going through moods that may swing wildly without rhyme or reason, and over which she has no control. She may experience uncomfortable and embarrassing hot flashes frequently and unpredictably. She may toss and turn at night, waking soaked with sweat.

    She may gain weight, lose her hair, and generally grow old before her own eyes. This can be particularly galling in a culture that is completely besotted with youth and beauty. “A woman’s self-esteem influences her sexuality, and low self-esteem is associated with sexual dysfunction,” according to this article.  

    What you can do: Educate yourself on menopause. Understand the trajectory and the tortuous path it takes. Read this blog. Learn about comfort measures and possible treatment options. There are many. She may be too embarrassed or miserable to do her own research or even to bring it up.

    Armed with understanding, you can reassure and support. You can say, “You seem pretty down [or angry, or forgetful]. Are you okay? What can I do to help?” That alone may make an intimate connection, but this isn’t about sex right now. This is about reaching out to your lover who’s going through one of the most significant transitions in her life.

    Now that you’ve asked, listen. And keep listening. Be an ally and a partner in this journey. Check in frequently to see how she’s feeling. Don’t advise unless you’re asked. Just listen. If she talks with her girlfriends, fine. But let her know you’re in her court. Most important—reassure her that she’s still beautiful to you. Girlfriends can’t do that.

    Nothing says love like taking out the garbage.Follow up with actions. Don’t sit on the couch while your partner makes dinner and then watch the game while she cleans up. Nothing says love like taking out the garbage or doing the dishes so she can take a bath. Once in a while, go out of your way. Cook a special, romantic meal. (You can order from one of those home-delivered meal plans, like Blue Apron or HelloFresh.) Send her flowers or plan a surprise getaway weekend. No expectations; no pressure—just an expression of your love and caring.

    Get healthy. I harp on this all the time, but both you and she will feel a whole lot better (and feel more like sex) if you’re eating healthfully, maintaining a good weight, and exercising. You can gently encourage walks together, healthy eating, and good sleep habits. Don’t be a drill sergeant, but your good example and attempt to make it a couple’s thing can’t hurt.

    Shake things up. Boredom is a slow leak in the sex balloon. I’m not talking about having sex on the kitchen table. But just exploring the array of tools and props that can add sizzle and simple comfort to the routine. Since your partner is probably experiencing the common menopausal complaints of dry vaginal tissue, painful sex, loss of libido, you’ll have to shake up the routine anyway.

    You’ll need lots of foreplay, lots of lube, and some toys. Try reading an erotic story or watching a sexy movie together to get your heads in the game. Don’t downplay the effect of a romantic ambiance—candles, incense, music. Use pillows to cushion joints and prop up the bits that matter. Try positions that might relieve pressure, offer a different kind of contact, or just be more comfortable.

    Take your time and maybe forgo the literal act if the timing’s off. You can kiss, cuddle, spoon. You can use your tongue and mouth. You can masturbate together. Take the pressure off the performance and focus on trust and intimacy.

    Don’t take it personally if she just doesn’t respond the way she used to. It isn’t about you, and it isn’t personal.

    Once in a while, go out of your way.Find a counselor, if necessary. Generally, celibacy isn’t a healthy state in a marriage. If you’ve reached an impasse, and there’s no way out, you may have to get some help. This isn’t an admission of defeat; it’s a sign of maturity and wisdom to look for help when you need it. If your wife won’t go, you need to find a therapist for yourself to acquire the emotional tools to navigate your relationship.

    I’ll leave you with the beautiful and encouraging counsel from the perspective of a 40-year marriage: “…we have found ways to enjoy sex with each other that do not need penetration. Mutual masturbation and oral and always with some nice foreplay, we still enjoy each other.

    “I miss intercourse…but we make it work, and it’s usually fun! I hope some men will read this and decide there’s a way to stay happy with the woman of your youth.”

    April 17, 2017

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    couples ›   menopause ›   relationships ›  


    Midlife Love: Navigating the Landmines

    “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.

    Q: Can I satisfy my wife in spite of my size?

    You’re concerned that your penis is short, and that since it sometimes slips out during intercourse, you may not be satisfying your wife. The good news for you is that most women--about 70 percent--can’t achieve orgasm only with intercourse. That means it’s unlikely that your size is at fault or you’re doing something “wrong.”

    Penetration is not required stimulation for most women; instead, what they need is direct clitoral touch and stimulation, whether by hand, tongue, or vibrator. I’d recommend that you ask your wife what she prefers to feel pleasure and experience orgasm.  

    You asked. Dr. Barb answered.She may very well already know! The sooner you talk about it, the sooner you’ll both be more satisfied. If she’s not sure herself, she can do some exploration herself--or you can explore as a couple. And you can participate fully, knowing that your size doesn’t need to be an issue for either of you.

     

     

    March 16, 2017

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    couples ›   intimacy ›   orgasm ›   sexual health ›  


    Q: What can help my male partner orgasm?

    You say that you and your partner use manual and oral stimulation, since you’re no longer able to have intercourse. Your partner requires extended stimulation, and you’re wondering what might help.


    Stronvivo is a nutritional supplement developed for men’s cardiovascular health; it’s been found to significantly improve sexual health--because circulation is integral to arousal and orgasm. It is used for both male and female sexual health, improving both desire and function (ability to arouse and orgasm). I’ve had many women report improved ability to orgasm, and the clinical trials report the same for men.

    The other factor to consider is medications that may be interfering with orgasm, or hormonal factors, like low testosterone. I’d strongly recommend a conversation with his physician, if he hasn’t already had one, to see whether there are health factors to consider.

    Good luck!

     

     

    Sex after Menopause: The Golden Years?

    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.

     

     

    February 13, 2017

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    couples ›   intimacy ›   relationships ›  


    What to Do When Your Partner Is Addicted to Porn

    Not much is known about addiction to pornography, not the numbers of people affected; even the definition is hazy. There just isn’t a body of research surrounding the issue.

    "There is a real dearth of good, evidence-based therapeutic literature," says Dr. Valerie Voon, a neuropsychiatrist at the University of Cambridge in this article.

    The relatively recent advent of the Internet has revolutionized the world of porn, serving up  raw, unfiltered, hard-core, and nonstop stimulation. The result is a cohort of (mostly) men who have become addicted and desensitized to the dopamine rush of a constant barrage of online porn. Occasional porn consumption is common, but therapists and doctors are seeing more relationship and sexual performance difficulties among heavy porn users—behavior that looks a lot like addiction.

    Discovering that your partner uses porn addictively is a crushing, confusing experience. Women compare it to the betrayal of discovering an affair, except that the “other woman” is a computer screen that is available 24/7 and that doesn’t look or act like a normal woman.

    A partner’s initial response is often denial: Is it really so bad? Doesn’t everyone view porn sometimes? Is this normal?

    The morality or “normalcy” of porn use is a different conversation, but when a partner becomes secretive and withdrawn, when he can’t stop the behavior even at work or, as one woman discovered, during a weekend visit to her parents; when porn use creates difficulty in real-life sexual performance; when it causes pain and conflict, then it’s an addiction and it isn’t normal.

    Porn addiction is socially anathema—people don’t talk about it or easily admit to having a problem with it. Support groups for partners of porn addicts are rare. And research-driven treatment for porn users themselves is also rare. The most common treatment is called a “reboot” in which porn users are counseled to stop masturbating to online porn until their brain chemistry and ability to engage in real-life sex is regained, which may take months.

    The behavior of porn addicts is similar to other addictions. They minimize their porn consumption or outright lie about it. They may accuse the partner of causing the problem. They withdraw and hide what they’re doing. They may gaslight—a newly vogue term that refers to undermining the partner’s grasp on reality by lying, evading, bullying, and blaming.

    This dynamic is devastating and toxic. Partners of porn addicts are often recognized as having symptoms of PTSD-like trauma.

    The non-porn-using partner may try to control “the addict’s access to porn through anger, snooping, crying, guilt tactics, threatening, shaming and blaming the addict. This destructive behavior was once considered co-dependent, but those of us who work with partners of porn addicts now view these actions as symptoms of trauma,” writes Mari A Lee, sex addiction therapist and co-author of Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts.

    As with any addiction, the path to recovery is difficult and riddled with relapse. The harrowing challenge to a partner of a porn addict is to maintain her own integrity and emotional health while offering her partner forgiveness and the space and support to manage his recovery, if he so chooses.

    Women who’ve been there say:

    • This isn’t about you. Your partner’s behavior has nothing to do with how you look, how much you weigh, or your performance in bed. Don’t take the blame. “[P]orn addiction is not about [the non-addicted partner’s] worth or value, it is not even about sex; instead, porn addiction is about soothing pain,” writes Lee.
    • “You did not cause it. You cannot change it, and you cannot control it.”
    • Try not to let your partner’s addiction take over your life or consume your thoughts. Set goals. Stay active. Stay healthy.
    • Try to find support—a therapist, a group, a trusted friend.
    • Respond to your partner with as much compassion and forgiveness as you can muster without becoming sucked into the addiction.

    A partner’s addiction may be one of the most painful and difficult knuckle sandwiches that life can smack you with. It attacks the very foundation of trust, security, and intimacy that a relationship is built on.

    However, there is hope, both for your own healing and the recovery of your partner. “When each person makes the choice to end the destructive dance of addiction, blame, shame and hurt, and instead chooses to move toward healing and recovery – miracles can happen and relationships can heal,” writes Lee. 

    February 09, 2017

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    couples ›   intimacy ›   relationships ›  


    Porn Addiction: A Source of Sexual Problems

    A patient came to see me a few days ago. She had been in a sexless marriage for years—and she had recently discovered at least part of the reason. Her husband was addicted to pornography.

    This is more common than you think. It’s also not a simple problem.

    Lots of people—men and women—consume porn at least occasionally. Estimates range from 50 to 99 percent of men and 30 to 86 percent of women—numbers that are so broad and vague as to only suggest “a lot.” Women tend to watch porn with their partner and to consume softer types—erotica might be a better term. Women usually report feeling greater intimacy with their partner after viewing porn.

    Men tend to consume porn alone, and it portrays sometimes aggressive and sometimes deviant forms of sex. A heavy diet of this can cause them to withdraw from intimacy and to feel "increased secrecy, less intimacy and also more depression," says Dr. Ana Bridges, a psychologist at the University of Arkansas in this article.

    Porn has been around since time immemorial. What’s changed is the amount and type of porn that’s available online all the time. We aren’t talking about the Playboy or Hustler magazines from a previous generation. This is hard-core, porn-on-steroids content served up in any flavor to satisfy the wildest imagination. These aren’t normal bodies, it’s not real sex, and it’s available any time, day or night.

    Although the scientific community has been hesitant to label such consumption as an addiction, and although many people, perhaps most, view porn occasionally without guilt or moral quandary, plenty of anecdotal evidence suggests that a problem is brewing.

    Whatever you call it—addiction or compulsion—when an activity becomes uncontrollable and consumes many hours; when it affects performance at work, compromises intimate relationships, and physical or emotional health, then it’s a problem.

    Therapists and doctors are increasingly seeing patients who report less interest in sex and sometimes an inability to have sex in real life. Erectile dysfunction is showing up in greater numbers, especially in young men who began viewing porn while still in their teens.

    Or, like me, healthcare practitioners are hearing from confused, distraught partners who don’t understand what’s happening to their partner and to their relationship.

    The mechanism that creates the problem is only beginning to be studied and understood. Consuming porn many times a week over a period of months (or years) is a solitary, alienating, guilt-inducing pastime.  It frequently changes the way a person interacts sexually with a partner in real life—the person is often more impersonal, distant, and sometimes rough or demanding. Sometimes the person withdraws from the partner altogether.

    Heavy porn viewing actually changes brain chemistry. In a small but carefully conducted study, a group of German researchers determined that high levels of porn consumption results in a shrinkage of gray matter in a specific region of the brain. Researchers were unsure whether this reduction was caused by the “wearing and downregulation of the underlying brain structure” due to hours of porn consumption or whether the subjects consumed porn because they had less gray matter in this area to begin with and needed more stimulation to experience pleasure.

    Generally, however, the hypothesis is that heavy porn consumption desensitizes the viewer, so that more intense levels of consumption are required to reach the same level of satisfaction. “You need more and more stimulation as you build up this tolerance, and then comes your reality with a wife or partner, and you may not be able to perform,” said Dr. David Samadi, chairman of urology at Lenox Hill Hospital in this article. “It’s a problem in the brain, not the penis.” As such, drugs for erectile dysfunction, such as Viagra, aren’t effective. The penis may engorge, but orgasm doesn’t follow.

    Obviously, ongoing porn consumption is problematic for a relationship. It can persist for years, with trust and sexual intimacy almost inevitably becoming collateral damage. The situation is confusing, hurtful, and debilitating to a partner, in part because the issue is so socially unsavory and so rarely discussed.  

    I’m thinking it’s time to crack open the door and begin talking about porn addiction, how to recognize it, and what a partner can do about it.

     

     

    Don’t Settle for a Sexless Marriage

    Sexual partnerships are as variable as snowflakes. Each couple dances to a unique harmony. For some, sex remains a vibrant and fundamental part of the love and intimacy between them. But for many others, sex fades into a boring and infrequent routine or it just doesn’t happen at all. And that’s not a happy place to be.

    Each couple dances to a unique harmony.For many couples, sex—or the lack of it—becomes the white elephant in the room. They ignore; they avoid; they work around it. But generally, it’s an underlying irritation and cause of increasing anger, frustration, and dissatisfaction. Whether lack of sex is the cause of these emotions or is collateral damage caused by other problems becomes hard to tease out. Just the fact that the darned elephant is sitting there on the couch takes a lot of energy to ignore.

    Relationships without sex are common—it’s estimated that from 20 to 30 percent of marriages are sexless, which is roughly defined as having sex 10 times per year or less. Even though women tend to struggle more with libido during menopause, “women don’t have a corner on low libido,” says Michele Weiner-Davis, therapist and author of The Sex-Starved Marriage in this very worthwhile Ted talk.

    The number of times couples “do it” per year isn’t the point. Really, who’s counting? It’s the level of contentment and connection between them that counts.

    “If a couple is OK with their pattern, whether it's infrequent or not at all, there isn't a problem," says clinical sexologist Judith Steinhart in this article. “It's not a lack of sex that's the issue, it's a discordant level of desire.”

    And that discordant level of desire—when one partner wants sex and the other doesn’t--can cause deep, relationship-destroying pain.

    We’re hard-wired for connection. We crave intimacy and emotional safety within our committed relationships. And sex is a powerful intimacy-builder.

    But when it becomes the sole task of one partner to ask for sex, and when he or she is frequently rejected, a hurtful dynamic is set in motion. More is at stake than a roll in the hay. One’s self-worth and sense of being attractive to, connected to, and cared for by a lover is on the line. In research studies, that kind of rejection activates the same parts of the brain as physical pain.

    Over time, repeated rejection morphs into anger, frustration, and contempt—or withdraws into boredom. Communication and connection on other levels shut down. Intimacy flattens like stale beer. We all know couples who don’t touch or make eye contact, or share a joke.

    With discordant levels of desire, the person with less need for intimacy controls the relationship, says Weiner-Davis in this article. The bargain goes like this: “I am not into sex. You are. But I don't have to care about your sexual needs. Furthermore, I expect you to be monogamous.”

    Besides being unfair, the fatal flaw of this unspoken agreement is that relationships are built on mutual caretaking, and when that falters, the essential contract begins to crumble. Sex in a loving relationship is a reaffirmation of that mutual caring—a giving and receiving of pleasure, intimacy, and trust. That’s what we all deeply long for, and if it goes away, we deeply grieve its loss.

    So, whether you’re the withholder or the seeker in your relationship, there’s good news. Even couples in long-term relationships can reignite the flame. “It’s never too late to have a passion-filled marriage,” say Weiner-Davis. That doesn’t necessarily mean shades of gray, sex on the kitchen table kind of passion, but it does mean a renaissance of sexy touch, playfulness, cuddling, and general “canoodling,” says Foley.

    For starters:

    • Explain how you feel. Often, the partner with a lower libido doesn’t understand the hurt caused by rejection and lack of physical intimacy. Explain how much you miss the physical expression of love in your relationship. That it’s painful to feel he or she isn’t interested in being close to you. That you don’t want to settle for parallel, unconnected lives. That sex is important.
    • Just do it. If you’re the low-libido partner, sometimes, you just have to get started in order to feel desire. If your partner clearly needs a little cuddle time, seize the opportunity to please and affirm your partner, whether you feel like it or not. If you can’t get into the mood, you can touch, kiss, and pleasure your partner in other ways—masturbation or oral sex, for example.
    • Get creative. Familiarity and routine can be a serious buzz kill in a long-term relationship. Sometimes, mixing it up a little reignites the spark. Maybe recall the moves that used to turn you on or maybe take a midwinter break for a rejuvenation weekend. Be new lovers for each other.
    • Get a physical. We all slow down with age. This isn’t problematic in itself, but if the slowing is one-sided or if either or both of you want more action between the sheets, then a complete physical workup should be one of your first steps—for men and women. Sexual functioning is linked to so many physical and emotional variables—medication, stress, depression, illness—that teasing out the possible intersections is a job for the professionals. Once they’re diagnosed, sexual issues can usually be treated or improved.
    • Get counseling. Maybe you need a few sessions to jump-start communication. Maybe you need a deeper dive to unearth ingrained bad habits. Counseling, group therapy, a marriage retreat or some other reset might help address blind spots and self-defeating behavior. If your partner doesn’t want to go, you should go alone. "Counseling can help you figure out strategies to help yourself," says Sallie Foley, director of the Center for Sexual Health at the University of Michigan in this article.

    Tackling a sexless marriage isn’t easy. Even if the status quo is unsatisfactory, changing it is risky and uncomfortable. If you’re continually gnawing on irritation; if you feel rejected and unattractive to your partner; if you’ve shut down and settled for boredom, it’s time to rattle that cage, express your feelings in a loving way, and actively seek out help.

     

    Films to Fuel the Fire

    When I read the results of a new study showing that couples who watch and then discuss movies about relationships could reduce the likelihood they would divorce, it occurred to me that watching movies that include sex scenes might have a similarly positive effect on one’s sex life.

    Friend, it does, and the reason is simple. Sitting down and watching a movie together on any topic—be it global warming, relationships, or sex—creates mindshare for that topic. And when it comes to sex, once you’ve created mindshare, the rest often takes care of itself.

    We’ve talked about movies before, and our difficulty in finding them. I’ve been pressed for time the last month or so, so I asked a friend for some recommendations to pass along. She did some research—and a lot of movie-watching—on our behalf and recommends these three movies—movies with real storylines, acting, cinematography, and sex scenes that spring organically from the plot—guaranteed to remind you and your significant other that each of you are not only a spouse, parent, child, employee, or committee chair, but also a lover. (The comments are hers, but she also helpfully included links to New York Times reviews if you’d like confirmation!)

    Y Tu Mamá También (NR, subtitles, New York Times review)

    Julio and Tenoch, teenage boys in Mexico, can’t believe their luck when Luisa, a (slightly) older woman, agrees on a whim to go on a road trip with them to find a beach. Carnal relations ensue, some more surprising than others, but so does self-awareness. If, at the outset, the movie feels like a Mexican American Pie (the first sex scene occurs 20 seconds in, and the boys have a manifesto that includes “do whatever you feel like” and “don’t marry a virgin”), don’t be discouraged. It gets better. Luisa eventually tires of their immaturity and makes the rules, which the boys agree to follow. Her own manifesto includes “I pick the music,” “You cook,” and “You’re not allowed to contradict me.” Now that’s sexy! And there is a secondary storyline that hints at Mexico’s political and economic landscape seen from the car windows as the threesome cross the country. Sexy, funny, sad, and smart.
    Sex and Lucía (NR, subtitles New York Times review)
    This movie had me at the premise: Lorenzo is a writer; Lucía is an avid fan. She tracks him down, says she loves him and his novel, and moves in with him that same night. “I always liked people who tell good stories,” she says. “I trust them.” But should she? Lorenzo has a complicated past, and he’s also writing another novel; in the movie, you can’t always tell whether a scene is real or one he’s writing for his novel. No matter. Just enjoy the ride, particularly during the sweet and explicit (yes, both!) photo shoot L&L do together at 28 minutes, and a sexy (Lucía’s) and funny (Lorenzo’s) strip tease a few minutes later. A person might pause the movie there and get down to business with the one you’re with. Later you can resume the film, which gets a good deal darker, and try to untangle fact from fiction over a nice glass of wine.
    The Lover (NR, New York Times review)
    French Indochina, 1929, is the setting for this story about forbidden love between a French teenager from a dysfunctional family and a wealthy Chinese man who is besotted with her—but betrothed to another. The plot unfolds in a leisurely fashion, giving the story time to build. Looks are exchanged and fingers are tentatively touched, before they give in, but oh, when they do (38 minutes in for about 10 minutes), it’s a beautiful, aesthetically pleasing thing. The lovers are doomed, of course, but until the day of reckoning, they escape their own pain and inflict (primarily emotional) pain on each other. As with Sex and Lucía, to avoid having the plot spoil the mood, pursue your own agenda whenever you’re ready (if not by the 54-minute mark, then certainly after).

    In fact, that’s good advice for watching any of these movies. Act now (and now, and ohhh, now); discuss later. According to research, both are good for your relationship.

    And we’re always happy to hear from you about movies that stoke your flames!

    Sex Therapy: How It Works

    This is the second part of our interview with sex therapist Sarah Young, who works with individuals and couples to help them rediscover--or perhaps discover for the first time--the joys of sex.

    Q: At what point does the woman’s partner usually get involved?

    A: Usually, I work with a woman for about a month before bringing in her partner. At that point, I try to get a feel for where he’s coming from, whether he wants to meet individually. If he does, we might move ahead where every other session is with the couple--so it’s couple, individual, couple, individual, through the duration of the therapy.

    Q: What are some of the therapy techniques you use with couples?

    A: We have many techniques, but if we need to talk about the basics, such as specific sexual positions and so on, I have these two little pipe cleaner people. The little blue person with the erection represents the man, and the pink one, with little boobs, is the woman. It’s delightful because some people have a problem even looking at pictures, so it’s a very neutral way to teach people positions.

    I’ll also suggest readings, and we use a lot of sensate focus, too, which is kind of the default “go-to” for sex therapy in terms of reintroducing touch to couples. They rediscover the joy of just looking at each other, or sitting together, or holding each other. That also gives the therapist some control to say, okay, I’m going to take over your sex lives for awhile. You don’t have to worry about whether you should be doing this or doing that. You just have to do this one exercise, and it’s not even going to involve your genitals.

    Because sex is not just about orgasms; it’s not just about his erect penis and your lubricated vagina. If that’s how it’s framed for couples, they’re doomed for failure. But if they can broaden their definition of the sexual experience, it’s huge for them in terms of being allies in the bedroom, on the same team, saying, this stage of life can be fabulous, how can we really embrace it?

    Q: Can you give an example of a successful case involving a husband and wife?

    A: There was a woman who came to see me because she wasn’t enjoying sex; for her entire married life it had been, “Okay, let’s just get this over with…” Come to find out, when she was a little girl, she was experimenting with masturbation, as kids often do. Her mother, who was very uptight about sex, discovered her and flipped out, making her filled with shame and guilt over it.

    First we had to deal with her wounds, dissolving some of the lies she believed and getting her to see her sexuality from an adult perspective, rather than through the eyes of a seven-year-old.  We talked about how a person’s sexuality is not just limited to the bedroom; it’s part of who you are every day. I gave her some exercises to increase her confidence. For instance, a lot of women will look in the mirror and just see sagging boobs and cellulite. But I had her stand in front of the mirror and take joy in her hands, the hands that had held her children and made food for her family. And instead of keeping her sex drive on a low boil, I told her to go get some red underwear to remind herself that she’s a beautiful, sexual woman who has a right to enjoy and to be enjoyed by her husband. So it was getting her to see things in a new way, as an adult.

    Over a period of time, she began to gain confidence, becoming more mentally present with him in the bedroom. And it just kind of took off from there. She’s still working on not feeling uptight, but she’s doing really great.

    Q: Your work must be very satisfying. Do you enjoy it?

    A: I absolutely love it; to see the hope in a woman’s eyes when she finds out she’s not crazy or abnormal or to see a husband who feels like he’s got his wife back, it’s just the best thing.