Extraordinary Communication: The Fourth Component of Great Sex

When they listed “communication” as an essential component of “optimal sexuality,” participants in the groundbreaking study published last year in The Canadian Journal of Human Sexuality were talking about a lot more than talking.

Their descriptions of “extraordinary communication” often suggest a state of “heightened empathy” in which partners share themselves with each other completely, using touch and other senses as well as words. Nonverbal communication, the ability to convey and understand feelings and desires purely through physical contact, was considered essentialbefore, during, and after a sexual encounter.

In fact, the kind of communication the study participants refer to seems to have little connection to the conversations about sex that therapists and doctors like me recommend to couples experiencing problems with their sexual relationships. That kind of talkI like when you touch me here, how does it feel when I do this, would you like to try something new?may be important, even necessary, to achieve the “extraordinary communication” that makes for great sex. But the actual experience of it takes place in the moment, in the acute and continual awareness of how partner and self interact and respond.

As one study participant puts it, extraordinary communication is the ability to recognize “even if you’re not told, that one kind of touch elicits a certain response in your partner and another does not.”

It occurs to me that this deep empathy is what my patients are expecting, looking for, hoping for when they protest that talking about sex diminishes or even ruins the act itself. We all wish our partners could know exactly what we want and how we feel without being told.

But in my experience, this kind of extraordinary communication doesn’t happen unless couples first invest time and effort in a lot of pretty ordinary communicationhonest and explicit talk about sex and feelings and desires.

What’s your experience?

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!

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…!

Q: Why are orgasms different and more elusive?



If you’ve missed periods, you are perimenopausal. It’s likely that you are experiencing symptoms of less circulating estrogen. Hot flashes are the most common symptom from that, but the way we experience sex changes too.  Medications taken for other conditions can compound the issue.

It is not unusual to for orgasms to differ in sensation as a reflection of differing stimulation. Using a warming lubricant may help with arousal, or considering localized (vaginal) estrogen could also help. To help with arousal with a partner, you can introduce new techniques or bonding behaviors. With a partner or on your own, you might experiment with erotica—either books or DVDs.  You may want to use a vibrator, or if you've been using one and it doesn't seem to be helping any more, consider one that offers more stimulation.  

Welcome to this new phase of sexual life!

Seeking Worthy Erotica

As a general rule, women over 40 need more stimulation to become aroused enough for good sex. When we were young, just thinking about making love with our partners may have been enough to arouse us physically, but as we grow older, as sex hormones decrease and distractions build, it takes more. But not too much more. For some of us, reading a steamy novel will do it. For others, visual stimulation works better. A hot movie, for instance.

Ever since I first conceived of MiddlesexMD, one of my goals has been to gather a tasteful collection of erotica, visual and verbal art that will stimulate arousal in older women. All we had to do is find it, right? How hard could that be?

None of us at MiddlesexMD had really explored the world of erotic art. So we set our product buyer to work, buying up a sampling of the “state of the art,” beginning with films. She studied and chose a good selection, from how-to films to soft-boiled, story-centered erotic movies. We chose films targeted at women. And films targeted at older women. As the DVDs piled up in our product room, we decided to take an analytical approach to our selection.

Sort of analytical. We each invited a few girlfriends over for glass of wine, a viewing and a discussion.

Our goal was to review these films to gather criteria and characteristics of films that most appealed to our friends — some way to inform our buying choices for the store.  Which would they use? Which would they recommend to their friends or watch with their partners? How would they rate them? What, specifically did they like about each? We had our notepads and our pens poised. We had poured the wine, curled up in front of the TV…

And then, showtime!

One film after another… fell flat on its face. We couldn’t watch more than a minute or two of any of them without reaching for the eject button. There was no analysis, no rating, no pulling apart criteria. We all… hated everything about all of them.

And we were disappointed. Really? Does it all really have to be so awful? We began again, discussing scenes in mainstream movies that we love, that work for us.  We could easily name dozens of scenes that made us blush just recalling them. Scenes from the English Patient, Room with a View, Breathless, Nine and a Half Weeks, Body Heat, The Piano, Atonement, Shakespeare in Love, The Unbearable Lightness of Being, Looking for Mr. Goodbar, The Godfather, Sweetland, The Graduate, Under the Tuscan Sun, Thief of Hearts, Vicky Christina Barcelona, Moonstruck, anything with Daniel Craig in it. We exausted ourselves thinking of the scenes.

And what characteristics did these movies and scenes have that mattered to us? The story is important, the emotions feel real. There is a buildup of passion, tension, and release. The woman’s seduction receives detailed attention. In short, there is romance.

What we didn’t like? Explicit sex. Mechanics. We really enjoy using our imaginations to fill in, and are perfectly happy with closeups of rapt faces.

We learned a lot from each other that night. We learned, too, that among our friends, at least, we’d all rather read a good sex scene than watch one. So now we’re looking for really good erotica to offer in our store.

How about you? Have you found tried-and-true erotica that works for you? What do you like about it? Have you failed to find anything? What is it about the works you’ve tried that doesn’t work for you?

Let's Get Aroused

Hi everybody. My name is Julie. I’m a writer here at MiddlesexMD. My credentials for writing about sex at midlife are… Well… I have reached midlife. And I enjoy sex.

Still.

Despite almost 30 years of togetherness with the same guy. Despite aches and pains, stress and too little time, and all the physical surprises of menopause. Despite all of that, we are nowhere near ready to hang up our sheets.

So when my own friend (we served undergraduate years together) and doctor (my own menopause doctor, because I’m lucky), Dr. Barb, asked me to help her develop her website, I jumped at the chance. I needed to learn about this myself. What better way?

I’ve been writing for years and years, and for many years researching and writing on health  topics. But I have never written about sexual health. Barb is teaching me—you would not believe the size and density of these textbooks.

So, day one, lesson one, Basson’s Model. I had no idea that there is a difference between Sexual Desire and Sexual Arousal. I really always thought they were the same thing, or flip sides of the same impulse, or something. Because that’s the way I’d experienced it for most of my life. Arousal and Desire arrived on my doorstep, it seemed, instantaneously.

But they are considered distinct aspects of the sexual experience. And now that menopause has slowed me down a bit, I understand better.

We can achieve arousal with or without desire. We can have comfortable, enjoyable, emotionally satisfying sex with or without desire. That is, we need arousal for sex. But we don’t need desire. We like it. We want it. We enjoy it. But we don’t need it to engage in sex or get a lot out of our sexual experiences.

The easiest way for me to tease these ideas apart is this way: Desire happens in your head. It’s an idea. Arousal happens all over. It’s physical. Certainly the idea can spark a physical response. But it works the other way more often for women. Sexual stimuli—physical sensations, emotional feelings, sights, sounds, smells—arouse us physically. Our arousal readies our bodies for sex and can breed desire.

So, when we start talking about the kinds of sexual problems women may experience with menopause, the distinction becomes very important. Are we having difficulty with arousal or with desire? Or both?

What used to follow automatically from sexual stimuli—the arousal part—may now take more time and more stimulation. We may have to ask for and give ourselves more help and support to become aroused. This isn’t a lack of desire, but a greater need for stimulation.

We may be receiving all the same sexual stimuli that we always have, that always worked before, but we don’t respond to it as readily. We love our partners just as much or more. But our bodies just don't respond as quickly now. Or we may now have physical or emotional limitations or illness or medications that muffle the effect of sexual stimulation.

This was lesson one for me. A real eye opener. I used to worry that I didn't feel the same desire as I did when I was in my 20s and 30s. Worry isn't the word. It upset me. I am much more relaxed about it now. I'm learning to tune in to stimulation, to appreciate and notice my body's response more. And that helps a lot. Well, I suppose writing about sex every day doesn't hurt either...

There have been and will be many more lessons. Some embarrassingly basic. Some I wish I’d known 30 years ago. I will always be willing to show my ignorance in these matters, followed by Dr. Barb’s patient teachings.

Meantime, I’m gathering up all my favorite stimulants: I’m with Reka, a visitor from the last post, on the potency of Dr. Gregory House. And Dr. Andrew Weil too (his relaxation tapes have an opposite, unadvertised effect on me). I have a thing for David Strathairn. Indian food. Tango/dance movies. And I have this special drawer in my bedroom….  And you? Care to share?

(Anonymous sharing is always welcome. Or make up a name, if you like!)