May 23, 2011

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Sex Goes Mainstream!

I’m very happy to tell you about an article that appeared recently in the Wall Street Journal about... sex! It’s encouraging to me to see that a traditional business publication like the WSJ is actually broaching the subject; the more we see sex talked about in mainstream media, the better for us all.

Because as I’ve said before, I don't think sex should be a taboo subject; it’s a big part of our lives. The more informed we are about it, the better.

In the past, it’s pretty much been the domain of women’s magazines, but the articles on sex have often been of the “How to please your husband in bed!” variety, rather than more serious discussions, like how it affects or interacts with your overall health.

I’m seeing evidence that it’s changing. Psychology Today, too, now often reports on sex in a very open way, as do many highly respected websites, including MayoClinic.com and WebMD.com.

I’ve even been invited to appear on local television—and before 9 p.m.!—to talk about the role of sexuality in our lives as mid-life women and how to keep the spark alive in long-term relationships. (I don’t often toot my own horn, but if you’re curious, you can see the video online.)

As for the Wall Street Journal article, called “The Joy of Researching the Health Benefits of Sex,” it covers some of the same topics we’ve discussed here on the blog, like how sex increases oxytocin (the author referred to it as “the cuddle hormone”) which promotes bonding and stimulates endorphins.

I’ll talk more about other medical findings they mentioned in another post; my point here is that I’m just so thrilled to see mainstream media joining in the discussion!  Who knows how many dinner table (or wine and cheese) conversations that story prompted between friends or spouses and partners. The more comfortable we all become talking about sex, the easier it will be for women to feel free to discuss sexual problems with their doctors. And that’s huge.

The discouraging part about the article was what a scientist said about getting funds for sexual research. “If ‘sex’ is in your grant proposal, it’s very hard to get it approved,” said Dr. Irwin Goldstein, director of sexual medicine at Alvarado Hospital in San Diego and editor in chief of the Journal of Sexual Medicine. Bummer: No money, no research, no new information to enlighten us.

But I really do believe that’s changing, and you have the power to help. So I encourage you all to contribute to the discussion. If the Wall Street Journal can talk about how many calories sex burns (about five a minute), so can you!

The Third Component of Great Sex: Deep Sexual and Erotic Intimacy

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

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

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

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

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

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

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

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

Warming Up to Foreplay

I’m a recreational runner, and before a run, I always spend a few minutes warming up. I’ll run in place and do some stretches, especially of my calves and ankles. Experts no longer say this is a must, but I do it anyway because I know that as I’ve grown older, I have tighter muscles and less range of motion in my joints. And I’ve learned that if I exercise and end up hurting, I’ll be more likely to postpone my next outing.

This cycle can also be true of sex. If you rush past the warm-up—foreplay—you may not have enough lubrication to make penetration comfortable. If sex hurts, you’re less likely to initiate it or to respond to your partner. The more time that passes without having sex, the more difficult it is.

Many couples have a long habit of foreplay, but If the women I talk to are representative of the larger population (and I believe they are), men don’t always get the connection. They are happy to skip the foreplay and sprint to the finish line. Early in the relationship, that might work even for women, who are more sexually complex than men, because excitement is high all the way around and it’s easier to get aroused. It might even fly during the “thirsty thirties,” when women’s sexuality peaks.

But during menopause and after, hormones work against us. Estrogen declines, vaginal tissues become thinner and more fragile, and circulation to those tissues decreases. The less stimulation your vagina receives—from sex with a partner or your own self-care—the faster those changes happen.We’re not kidding when we say, “use it or lose it!”

So after menopause, we need more to warm up. More real intimacy, more talk, more titillation. In short, more time.  The stakes are higher now. If we don’t warm up, it hurts. If it hurts, we don’t want it. If we avoid it for too long, it’s more and more difficult to have it. If any of this sounds familiar, it’s probably time to talk about it.

Because a little foreplay has gone a long way in the past, your partner might be puzzled when you suggest your lovemaking include more foreplay. He might worry he’s losing his sexual prowess. This is a great opportunity to explain how changing hormones affect your response to sex. If there’s something you’ve secretly been longing to suggest to him lo these many years, you can slip that into the discussion, too. It’s never too late for your partner to learn, and telling him what you need and why is a great first step.

How about you? Have you been able to change the patterns of sex with your partner? How did you approach it? How did your partner respond? We’d love to hear!

Q: How can I increase sensation and more readily orgasm?

There is no doubt that the ability to achieve an orgasm becomes more difficult as we age, and the orgasm itself is often briefer and less intense. As we age, we need more time for every step of the process, starting with foreplay. Sometimes our partners need to hear a clear message about what's changing for us! We hope our website can make it easier to have those discussions with a partner.

Using a warming lube, like Oceanus G Stimulating or Sliquid Organics Stimulating O Gel, can improve sensation for some women. Warming lubes include a minty or peppery ingredient, which increases circulation and sensation in genital tissues.

You mention occasional orgasm success with a vibrator. Not all vibrators are alike: Some don't provide the intensity of vibration that our tissues need in midlife. We offer vibrators by Emotional Bliss that are more powerful than average, designed for those who specifically need more stimulation, more intensity. I’ve seen some amazing results with these in women who previously were unable to have an orgasm because of neurologic diseases or medications that are known to interfere with orgasm.

You might also talk to your health care provider to see whether vaginal (or localized) estrogen is a good option for you. Lack of estrogen to vaginal tissues results in a decrease in circulation, which leads to less sensation, which is why you may not sense penetration as you did before.

Do talk to your partner and explore your options. Sexual satisfaction comes in many forms, but if you're missing orgasms, there's no reason to leave them behind.

Can We Talk? I’m Not Sure.

Maybe I was naïve. We ran into some issues with the launch of MiddlesexMD.com earlier this year: We couldn’t advertise on a popular social networking site. An article we submitted was rejected because of subject matter. We were “ineligible” for a medical site designation.

And I took all that in stride, with some disappointment, as an entrepreneur, and some concern, as a physician trying to get the word out to women that sex is good for you and still possible and pleasurable, well beyond menopause. But I’m a parent, too, and I understand that there’s adult content that can’t just go everywhere.

But in the last week I saw a couple of articles (one in the New York Times) about Zestra and the walls its makers were hitting in trying to advertise. If you’ve missed the story, a commercial for Zestra Essential Arousal Oils was turned down by TV networks, cable stations, radio stations, and web sites. When it was accepted at all, it was slated to run in the middle of the night. Rachel Braun Scherl, the president of the company that makes Zestra, says, “When it comes to talking about the realities of women’s lives, you always have some woman running in the field…. There’s a double standard when it comes to society’s comfort level with female sexual health and enjoyment.”

As evidence, Rachel points to the advertising for Viagra and Cialis. And that’s when I start to think I may have been naïve. I remember the first time Bob Dole came on my television, during prime time, when my daughters were in middle school and still watching TV with me. It was a little awkward, maybe, to explain to them what “erectile dysfunction” was, exactly. Now they’re old enough to snicker with me (in a compassionate way—I am a doctor) when we hear “in the event of an erection lasting more than four hours, seek medical attention.”

So this gets me thinking. Why can we be so public about an aid to a man’s sexual satisfaction, but not aids to a woman’s? Is it because Viagra and Cialis are prescription products for a condition that’s been named a medical problem? In the case of erectile dysfunction, have we successfully separated the erection from sexuality? Because women’s arousal and satisfaction are more complex (remember why we love Rosemary?), is it too difficult to make that same separation? Or is there really still a double standard, with men’s sexual satisfaction ranking higher then women’s?

I’ll keep thinking. And, I’m sure, gathering anecdotal evidence on both sides of my questions. I’d love for you to join the conversation.

In Search of Hot Lit

We’ve written before about our efforts to find erotica to recommend to our growing MiddlesexMD community (Hi there, community!). Our efforts are are purely pragmatic, you understand. By subjecting ourselves to hours of film, reams of erotica, searing our eyeballs with the online offerings — all off this sacrifice, all for YOU, we are looking to find the good stuff, the stuff that really does, in fact, heat up a grown woman. (Real life experience has a way of turning an awful lot of porn and romance into comedy, we have found.)

If you haven’t been following the posts here, let me explain briefly: In menopause, our circulating sex hormones dimish. That can sometimes, not always, lead to a drop in libido. Even when the libido is willing, becoming aroused enough for sex can take a little time and effort. We need to step in, do the work our hormones did for us when we were young.

An easy and inexpensive way to adjust to this new reality is to give ourselves more opportunities to have sexual thoughts -- i.e., watching sexy movies, reading sexy literature, masturbating, wearing/doing sexy things.

Sexy literature… That's my subject. I've been poking around just a bit, looking at collections of erotica, some of it good fun, much of it yawningly dopey. While I’ve been looking, I’ve been thinking about the guideline we established during our silly, foiled movie night: We much prefer a Great Story That is Sexy to a sex story.

Enter Jacqueline Carey. When I think of great stories that are sexy, she springs immediately to mind. Her New York Times bestselling Kushiel’s Legacy Series encompass great epic tales full of romance, politics, turmoil, grief, tragic loss, breathtaking triumphs, and plenty of sex. Most of the sex is great, some of it is frightening, but all of it is integral to the storyline. I love that. Her novels are fat and involving enough to keep me diving into them night after night. Sexy enough to keep me on the edge of my libido for hundreds of pages.

So, why not ask the author herself about “Great Stories that are Sexy”?

I put the question to her, and waited. At first, coming up with a list stumped Carey too, which made me feel a little better about coming up with so few recommendations of my own. She's trolling for answers among her friends, too, but did come up with a starter set. Ms. Carey says:

*Try Diana Gabaldon's "Outlander" series.
*For fun, sexy fluff, Janet Evanovich's "Stephanie Plum" series.
*I don't know how well it stands the test of time, but I thought Colleen McCullough's The Thorn Birds was hella sexy and a good read back in the day.
*And check out Smart Bitches, Trashy Books for romance reviews. The genre's come a long way in the past decades.
I feel as if we've finally got a foothold on Hot Lit. The birth of a canon. But it's not really very big, is it? We need to feed this list. And for that, we need to hear from you. What do you think? Have you found writers whose work does it for you? Please share. We will keep adding to the list and will republish it as it grows. Those of us who read constantly need a steady supply…!

“Exactly What I Need at This Point in My Life”

It’s been great to hear from a number of you after the opening of our shop. You’ve validated my suspicion that, for lots of women, there just weren’t good sources for information and products they felt comfortable perusing. These are two of the comments that have made me smile in the month since we’ve opened:

"…Thank you so much! I happened upon your site and it is exactly what I need to see at this point in my life. I'm so happy! I'm finding all kinds of info that I haven't seen anywhere else and just in the nick of time. What a relief to find that I'm not alone, that someone understands, and what a wealth of useful information. Thank you, thank you, thank you! I'll be back often."

"…My entire experience was perfect. I was a little self-conscious reading and browsing at first, but soon I was so absorbed in the information/sexual aids that I had my Gigi vibrator and other items selected and bought before I knew it! When I opened the box and saw the card and tissue paper and all the care that went into making my first intimacy purchase special, I knew that I would not be disappointed. And I wasn't! And neither was my husband. I have no words to describe how much we've been enjoying each other! It's like we're on our honeymoon!!"

Like these women, many of you are exploring sexual aids for the first time. One of our most popular products has been a lubricant selection kit. Women who buy it get seven samples of different kinds of lubes—water-based, silicone, and hybrid. After they’ve experimented, they can tell us which they like best and receive a full-sized bottle of their favorite. If you have suggestions for other ways we can make it easier for you to figure out what works, let us know!

We’ve certainly been hearing from people who want to “Ask Dr. Barb,” as we invite you to do on our website. I’ve been answering the questions directly via e-mail, but I’m sure others of you are wondering about similar issues.

To expand the discussion, we’ll start posting the answers to common questions sent to “Ask Dr. Barb” here on our blog—of course, we’ll protect the privacy of the people who asked! And remember, there’s no substitute for talking to your own physician for specific advice for you. But we hope our exchanges here will help you feel comfortable knowing what questions to ask—and inspire you to sustain your sexuality just as long as you’d like.

Talking about sex.

I live and practice in the Midwest, where open discussion about sex is just not part of the culture. Even among close-knit groups of girlfriends, it’s a rare discussion, at least not past a certain age. I’m trying to remember when I stopped talking about sex openly with my friends...

I remember it was a subject of great interest and fascination when I was very young. Whispers, conjectures, a lot of mis-information and tall tales. By high school, we knew more, the better informed among us bringing along the uninformed.  In college, we received a great deal more detail as data from actual, rather than fictional, experimentation became more commonplace.

I suppose it is marriage that closes our mouths. We may have been willing to share exploits or guess at sex before we chose our mates, but once we do, the walls of privacy go up, and silence rules our sexual lives.

And that’s okay, so long as we have opportunities to continue to learn and explore, and provided we have some source of information and aid when things aren’t working. Because, let’s face it, we aren’t trained in sexual techniques. There is no sexual master class. No black belt to earn. And sex isn’t always smooth sailing. Our anatomy isn’t flawless or consistent in its function. We need information as we grow and change sexually, and most particularly when we enter the menopause.

In some cultures discussion about sexual technique among same-sex family members and social sets is nearly endless. But in our Puritan-influenced culture, silence is golden. So what are we to do? It isn’t likely that we’ll change a whole culture any time soon.

Well, online, we have a real opportunity. Here, we can talk to and learn from each other without sacrificing the privacy and propriety we hold dear. The online environment we want to build is one where we can share reliable, well-researched information that will help us understand and share not just matters of sexual health, but of sexual technique, too.  A good, safe, monitored discussion place to learn from each other and from the research and writings of sexual health practitioners.

We are busy gathering a good collection of information, but we’ll want to hear from you, too. What has changed for you with the menopause? What questions do you have? What has worked for you? What have you learned from others? What experiences are daunting? What Aha!s can you share?  Post under your own name, or under another name you choose -- either way, we'd love to hear from you.