Connection: The Second Component of Great Sex

We’ve talked about how crucial mindfulness--being mentally and emotionally present in the moment--is to enjoying great sex, sex that is “better than good,” as reported in a study recently published in The Canadian Journal of Human Sexuality.

I like to think of “connection,“ the study’s second ingredient of optimal sex, as “mindfulness times two.” Connection is what happens when both partners are present together: in bed, in the moment, in each other. As one study participant describes it: “Inside my body I’m the other person’s body and we’re just all one together at that moment.”

This sense of merging, of “two becoming one,” was regularly cited as part of the experience of great sex, which has to involve “at least one moment,” as one woman said, “where I can’t tell where I stop and they start.”

I believe that this kind of intense sexual alignment is something that becomes more accessible to us as we get older. Part of our maturity is greater acceptance of self and others, which leaves us more open to making a deep physical and spiritual connection with another person. To experience the joy of merging, of temporarily letting go of the sense of any boundary between the self and the other, a person has to know herself well--and feel safe and respected by her partner.

Which brings me to two great impediments to sexual connection: unsafe relationships and sexual trauma. If you have reasons for not feeling completely safe with a particular partner, or if you have a history that leads you to feel unsafe whenever you are in a sexual situation, you’ll need to address these issues before you can experience intense connections in intimate relationships. There are resources that can help.

But for two self-aware people who respect and desire each other and who are capable of being completely present with each other in the moment, a deeply satisfying sexual connection can happen even without penetration or orgasm. The study’s authors report that great sex is often more about the level of energy between partners than about the actual physical act itself. (Check out our website’s alternatives to intercourse for imaginative techniques for increasing sexual energy and connection.)

Have you experienced these moments of sexual oneness? What were the circumstances? We’d love to hear your stories!

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!

Being There: The Number One Component of Great Sex

In an earlier blog post we reported on a study published last year in The Canadian Journal of Human Sexuality called “The Components of Optimal Sexuality: A Portrait of ‘Great Sex.’” Analyzing interviews with 20 sex therapists and 44 people who reported having experienced “great sex,” the researchers identified eight major components of “optimal sexuality”sex that is “beyond functional, beyond positive and satisfactory, beyond good.”

It didn’t surprise me at all to read that the number-one component, the one that was brought up most frequently by both experts and “practitioners,” was “being present.”

We’re not talking, of course, about being literally, physically present (although that’s fairly essential), but about being mentally and emotionally there in your body, in the moment. Here’s how one woman who was interviewed for the study put it:

“The difference is when I can really just let go and completely focus and be in the moment and not have that, you know, running commentary going through my head about anything else.”

For women our age, that running commentary is likely to include not only the long to-do lists of our everyday lives (what am I going to fix for dinner? how can I convince Mom that she really does need that hearing aid? I hope Sally’s midterms aren’t stressing her out too much), but the new and nagging concerns that come with middle-age sex (does my face look more wrinkly when I’m on top? is he going to be able to keep his erection this time? I’ve really got to get back into a regular routine at the gym).

There’s plenty of evidence that the practice of mindfulnessnon-judgmental, present-moment awarenesshelps people manage things like stress and depression. It only makes sense that intensely focused attention, the ability to be fully aware of sensations experienced moment by moment, would be a central feature of sex at its best.

If you feel sometimes that you are not totally “there” during sex, that you’re distracted or just going through the motions, consider learning more about meditation and mindfulness. Being more present in all aspects of your life will help you more fully experience the pleasures and sensations your body is designed to feel.

Watch for more “components of great sex” in future posts, and let us know what you think. We’d love to hear what makes it “better than good” for you!

Sagging Libido? Tone It Up with Yoga

There are many “natural” reasons women our age begin to lose interest in sex. Hormonal changes, diminished energy, lowered self-esteem as we mourn the loss of our youthful bodies -- a complicated mix of physical, psychological, and social influences conspire to make us feel less sexy and less sexual.

When patients ask me about “natural” ways to increase levels of arousal and desire, my prescription almost always includes a combination of mindfulness and exercise. Awareness techniques like meditation help us focus on the moment and block out the stress and distractions of our everyday lives. Exercise increases blood flow, releases endorphins, tones our muscles and our perceptions of ourselves as strong and attractive.

I wasn’t surprised then, to read in a recent issue of the Journal of Sexual Medicine that yoga, a practice that combines both of these libido-enhancing elements, “improves several aspects of sexual functioning, including desire, arousal, orgasm, and overall satisfaction” -- particularly among women over age 45.

This study, which surveyed healthy, sexually active women before and after a 12-week program of daily yoga practice, found significant improvements in all of the areas measured: desire, arousal, lubrication, orgasm, pain, and overall satisfaction. Nearly 75 percent of the women who participated in the study “said that they were more satisfied with their sexual life following the yoga training.”

Other research has found that yoga increases body awareness and can be used to direct blood flow to the pelvis to enhance arousal and lubrication. The mindfulness that yoga teaches and requires helps a woman be more aware of her body and its needs. “When you’re present, you know what you need to feel fulfilled by your partner,” explains one expert. “You can then translate and communicate this deeper understanding to your partner during sex.“

And of course the increased flexibility and improved muscle tone that come with regular yoga practice help a woman feel more confident and attractive -- in bed and out.

If you’re looking for a natural way to tone up your libido, find a yoga class. And let us know how it works for you!

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.

Q: I'm not interested in sex at all. Is it all in my head, as my husband says?

A declining interest in sex as we age is typical for women, but many face a couple of additional factors that are really big: 1) It is painful; and 2) the event itself may not be particularly engaging. Is it any wonder that there isn’t much motivation to participate?

If you have pain, you need to find a practitioner who can help solve that issue. There is almost always a solution for pain with intercourse. NAMS (The North American Menopause Society) is a good resource for finding a certified menopause practitioner if you feel your provider isn’t able to find a solution--or you're not comfortable discussing the issue with him or her.

The other issue is more difficult to address. After years, maybe decades, of a less-than-fulfilling sexual relationship, it is hard to reinvent, but most women would agree it is worth trying. For some menopausal women a great sexual relationship doesn’t even need to include vaginal penetration, but that takes a caring, nurturing partner.

Your partner needs to understand that romance and emotion are key to improving your libido--and you need to feel confident that you deserve that... because you do. For some women testosterone, in addition to that intimacy and foreplay, can make a remarkable difference in libido. Again, finding the right provider to investigate that option would be beneficial for you.

Some women have told me that visiting our site with their partners has been helpful. You might review the bonding behaviors together to start a conversation about what kind of foreplay and attention you need for a better opportunity for comfortable--even satisfying!--sex.

Your lack of interest is not in your head! I have yet to see a woman with pain with intercourse for which I couldn't find some cause and some solution options. Things to explore with a menopause care provider are atrophic vaginitis, vulvodynia, or vaginismus. Sometimes localized estrogen is required in addition to HRT to fully estrogenize the vagina.

There are solutions out there! Please explore them fully. Good luck, and don’t give up!

Q: Any suggestions for overcoming lack of desire and pain during sex?

The first thing I try to do with women who have both of these issues is to make sex comfortable. It is pretty hard to be interested in intercourse when you know it is going to lead to pain.

You might consider vaginal estrogen--estrogen that is 'localized' rather than 'systemic' and is delivered only to the vagina. This would require a prescription product. Or you need to commit to using a vaginal moisturizer consistently; this reintroduces moisture to the vagina on an ongoing basis.

Once sex is comfortable, then approach the issue of desire, which admittedly, is difficult. Yours might be a situation in which to consider using testosterone or buproprion, an antidepressant that can have the side effect of increasing desire. Engaging mindfulness and choosing sex is important to the sexual relationship. I review Basson’s research with patients, and remind them that desire does not play as big a role in women’s sexuality at this stage of life, so being intentional and choosing to engage is often necessary.

Find a provider you trust to talk through some of these issues and begin to explore options.

Make Time Stand Still -- the Body Scan

I’m busy exploring the boundaries of a new phase of my life, brought on by an illness I’m managing. As illnesses will, it’s grabbed me by the collar, given me a big shake, and forced me to order my priorities. Also, it’s made me take a good look at Time.

Not in the Time-is-Limited sort of way, but in the nature of time. How fast it goes when we’re not paying attention, or when we are multitasking, when we’re playing our To Do lists in an endless loop in our minds. And how it’s actually possible to slow it down when we are paying careful attention to what we are doing.

I first noticed this in a not-so-pleasant way, as a young girl, in bed with horrible headaches. These headaches made me seek out darkness and quiet, and there was very little that medications could do to reduce the pain. I would lie for hours in bed in an eyemask, and the hours felt like days. I could think of very little else besides the pain, and time stood still.

It wasn’t until I tried meditation for the first time that I had the experience again -- meditation made time stand still. This was in the 70s, and through the PBS television series, Lilas Yoga and You. Remember lovely Lilas? She ended most classes with Savasana. It was through her suggestions during savasana that I first learned to do a “body scan,” a way of getting in touch with my body through guided meditation.

In Body Scan meditation, you begin in a relaxed state, then use your mind to ‘visit’ every part of your body, noting how it feels, acknowledging pain or stiffness or itchiness, lightness or heaviness. It’s a way of checking in with your body, to connect with it. It sounds simple, but it does take practice. You can use body scan to help you relax. You can use it to help manage pain.

That work, inadvertently, taught me to manage the pain of my headaches from a very early age. I learned to separate the pain I experienced in my head from the rest of my body. I learned to relax into the pain, and keep it sequestered from the rest of my body. I thought I'd discovered some secret power, until I came upon the work of Jon Kabat-Zinn. What I’d stumbled upon through Yoga, he’d been teaching for years through his Stress Reduction Clinic at the University of Massachusetts Medical Center.

By now you must be asking yourself how any of this ties into midlife sex. Well, my secret power, savasana and body scan meditations, also taught me to relax and enjoy sex. I’ve always been a woman who wished for a body different from the one I had, so early experiments with sex were always fraught with efforts to conceal from my lover the parts of my body I didn’t like. That kind of distraction is a real barrier to intimacy.

Later, mindfulness techniques helped me to turn off the chattering brain brought on by an overstuffed life, at least during lovemaking.

Now, meditation helps me to stop the clock during lovemaking. It helps me keep the pain in my body contained so that it can’t overwhelm the experience of lovemaking. And it helps me to fully appreciate my one and only body. The only one I'll ever have. Might as well love it.

If meditation can make time stand still, can stop the clock, might as well try it, right? If you've never tried meditation, you should know it's not that hard to learn, and not that easy to master. It's one of those things that just gets better with practice. And I know of no better or less intimidating guide than Kabat-Zinn, especially through his Mindfulness for Beginners program.

Our Secret Recipe for Sex after Menopause

The post title is just tongue-in-cheek, folks. A little health writing humor, poking a stick at the whole idea of health “secrets.”

We don’t believe in keeping information about attaining good health secret.

So here, today, long before going live with our website, we are happy to divulge our recipe for sex after menopause. The ingredients are:

Tada!  Whooot!!! We have balloons falling and confetti rising over here at MsMD headquarters!! How about you?! No?

Wait, No?

Maybe you don’t realize how hard it is to distill good-sex-after-menopause down to an easy-to-remember system? So let me explain: Months ago, we began our work with a hard look at the American Psychiatric Association's DSM-IV description of disorders contributing to Women’s Sexual Dysfunction (There’s a phrase we won’t use a lot around here, because it worries us. If we don’t yet understand Women’s Sexual Function, how can we comfortably describe its dysfunction?).

We embraced (and strive to remain mindful of) the point of view of women’s sexual problems developed by the New View Campaign, and their concerns about the medicalization of human sexuality. We reduced by our focus on peri-menopausal and menopausal women. Filtered all of these concerns through recent research and publications by members of the North American Menopause Society (NAMS) and the International Society for the Study of Women’s Sexual Health (ISSWSH).

We surveyed current literature on female sexuality. We added recent work by sex researchers and therapists and coaches, relationship coaches and mindfulness gurus.

That was the first step.

The next step was sorting all of the helpful advice, tips, skills, and learning into clear descriptions of conditions and pragmatic actions so that women in menopause can understand exactly what is going on with their bodies and what they can do about it if they want things to be different.

We didn’t go looking for the recipe. It surfaced from the work, organically. We began to see how all of the latest and best advice of medical, psychiatric, and sex researchers and coaches, seeking to help older women enjoy their sexuality, clustered into just a few central goals. What does a woman need to do to enjoy sex after menopause? (Assuming, of course, that she wants to enjoy sex after menopause at all. Because that is still her choice.)

1. Knowledge

She needs to know the physiology of menopause, so she understands what is happening when it happens, and especially that though her experiences are unique to her, she's not alone. And she needs to know some new sexual techniques that will keep sex enjoyable as she ages.

2. Vaginal Comfort

She needs to learn how to take care of her vulvo-vaginal tissues so that sex remains comfortable.

3. Pelvic Tone

She needs to learn how and why to strengthen and maintain her pelvic girdle to encourage circulation and maintain or strengthen her orgasms.

4. Genital Sensation

She needs to compensate for less blood flow and less sensitivity in her genital tissues by providing herself with more stimulation, more sexual sensation.

5. Emotional Intimacy

She needs what every woman needs at every age for sex to be good. Sex needs to be intimate. It needs to mindfully create and reinforce a real connection. There it is. No secrets. When we take our site live in April, you’ll get all the rest, descriptions of conditions that get in the way of achieving these five goals, actions you can discuss with your doctor or take on your own to enjoy sexuality for life, and products we have selected to help you on your way.

A Little Conversation About Mindfulness

Since launching MiddlesexMD, I have to say, my dinners have gotten a lot more spicy.

You know how it is when dining with buddies. It’s polite—required—for them to ask what you’ve been up to lately.

When I tell them about MiddlesexMD, you would think it might stop the conversation cold, but I’ve found just the opposite is true.

My friends do want to talk about this. It’s not surprising when men are there that they are a bit more quiet, but they are engaged, too. We all appreciate our partners’ attention to these discussions—because we’re not always alone with these changes. They affect our sexual partners, of course.

I had dinner the other night with an old friend. The subject of our conversation turned to the idea of how important it is, especially for long-partnered people, to keep their sexuality top-of-mind if they want to keep their sex life going. I talked about how older women, particularly, need extra stimuli (both physical and emotional) as they get older.

We need more opportunities to think about sex, consider it, fantasize about it, and more emotional intimacy throughout the day to find or sustain the mood.  Sex is like any pursuit, if you want to get better at it, it requires your attention. Some call this "work" Awareness or Mindfulness. And I think this dimension of a relationship is valuable enough to “do the work.” (Smile.)

It was a simple conversation. I didn’t think it had any sort of profound effect at the time. But I ran into that friend a few weeks later. She pulled me aside, and whispered, “Hey Barb! Thinking about sex more? It WORKS.”

I wasn’t surprised, if it works for me, it should for you too!

Gee, I love my job.

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