The loss of estrogen that comes with menopause results in thinning of urogenital tissues, which include the vagina, vulva, and urethra. Because those tissues are thinner, they can be more fragile and susceptible to "trauma." We don't think of sex as "traumatic," but the activity can cause minor tissue damage.
Sex can also introduce bacteria to the bladder via the urethra, which can lead to bladder infections. And either an infection or the inflammation of damaged tissue can lead to the symptom of urinary urgency.
Using a lubricant during intimacy will minimize the "trauma" to tissues. Emptying the bladder soon after sex may flush out bacteria before they can proliferate and become an infection. (Women with frequent urinary tract infections linked to sex sometimes find it helpful to take a dose of oral antibiotic with sexual activity.) And a therapy like localized estrogen or Osphena may help by restoring proper pH and increasing cell layers.
There are many benefits to being sexually active: It releases estrogen and increases oxytocin, serotonin, endorphins, and immunoglobulin A. This chemical and hormonal stew makes us both feel and be healthier. Having sex makes us feel powerful, giving, and connected, all of which feed our relationships with our partners.
I came across a recent study that affirms another benefit I often talk to women about: Sex is good exercise.
The study was conducted by Antony D. Karelis, who teaches exercise science at the University of Quebec at Montreal. Participants in the study wore armbands while having sex, and also jogged on treadmills to produce comparative data. The results? On the “metabolic equivalent of task” scale, on which sitting still ranks a 1-MET, sex ranked 6-MET for men and 5.6-MET for women. That puts it, according to Gretchen Reynolds, author of “Sex as Exercise: What are the Benefits?” as roughly equivalent to playing doubles tennis or walking uphill. To do your own comparisons, it’s categorized as “moderate exercise.”
Good to know, right? And I think we midlife women can use this knowledge to our advantage. Part of my counsel to women experiencing diminishing libido is to be intentional about remaining sexually active. There are two parts to my rationale: First, as our hormones diminish, we’ve got that “use it or lose it” thing going on that I’ve talked about before. Second, having sex begets having sex. That is, we women will want to have sex more often when we—wait for it—have sex.
There’s a line from the study conclusions that made me smile: “Both men and women reported that sexual activity was… highly enjoyable and more appreciated than the 30-minute exercise session on the treadmill.” I’m so glad to hear that!
So I start to wonder: How can we apply to our sex lives the same thinking that gets us religiously to yoga or Pilates several times a week? Neither we nor our partners want us to be thinking about sex as one more chore on the to-do list or an obligation on our calendars. But can we consider it a gift to ourselves and our health, as we do our morning walk or Zumba class? Will that give us the extra incentive to make the time and the commitment?
I’m hoping so.
You say that you're both excited and anxious about being with your partner, but that you're tense with him and haven't experienced this before. Let me first say that there's no magic pill that will solve this problem.
For women, sharing sexual intimacy requires the ultimate in trusting, giving, and sharing. This emotional component is just one part of a complex whole for women, but it's the place I'd start. I'm curious about whether you're tense with this partner in situations outside the bedroom, and whether you've been able to express your concern. It would be helpful it it's a problem you're looking to solve together rather than a "performance anxiety" issue for you alone. Being anxious about being able to experience orgasm only makes it more difficult!
You might consider seeing a therapist with a focus in sexuality to be sure that you're clear on the emotions and feelings you're experiencing.
If there is no emotional barrier to address, I've recommended Viagra or a very low dose of testosterone for women who have lost orgasm or intensity; both of these drugs are rescribed "off label," which means they're FDA-approved for another use.
I wonder whether you're able to experience orgasm with self-stimulation; if you haven't tried, I encourage you to. A vibrator used either alone or with your partner may provide the increased sensation you need. And if you're able to orgasm alone, you may learn some things about your response that you could share with your partner.
Sex is often complicated, with multiple interdependent components; it doesn't help that our bodies change as we gain years! Please do look to a therapist for any emotional considerations; if physical considerations remain, a health care provider knowledgeable about menopause can help you evaluate options. Most women in my practice are able to reclaim this part of their pleasure!
Few things affect quality of life like lack of sleep. Nothing kills the jazz or even dulls the everyday ho-hum routine like that head-in-a-fog, feet-in-the-mud feeling of too little sleep.
And sex? Romance? That delicate dance we do to stay connected with our life partner? Fuggedaboudit. We’re having enough trouble keeping our heads up and off the desk at work. All we want is a good night’s sleep, and that’s the very thing that’s as elusive as a four-leaf clover in an alfalfa field.
If you haven’t discovered already, insomnia is the dark shadow of the menopausal years. (And insomnia can begin years before other menopausal symptoms and can last long after other symptoms subside.) In fact, almost half of women age 40-64 report having sleep problems, according to a 2007 National Sleep Foundation survey. Compared to premenopausal women, those in peri-and post-menopause report sleeping less, sleeping badly, and are twice as likely to use prescription sleep aids.
Yuck. That’s a lot of cranky, sleep-deprived women.
As you might expect, menopausal insomnia can be caused by a lot of things—hormonal changes, for one. "With impending menopause, most women experience a reduction in progesterone and estrogen," says David Slamowitz, MD, medical director of the SleepWell Center in Denver, in an for More magazine. "These hormones help regulate sleep, so declining levels can cause sleeping difficulties."
Better sleep may be another reason to consider hormone therapy.
But these years are often associated with change in our careers, health, children, parents, and partners. Change is stressful, and stress is the archenemy of sleep. If you’re anxious about your health (or your parents’ or your partner’s), if your children are adjusting to adult life, if you’re having difficulty covering the demands of your job, it’s hard (or impossible) to drop these worries at the bedroom door.
Other causes of sleeplessness can be the physical insults of getting older—arthritis, frequent nighttime urination, sleep apnea, restless leg syndrome. Not to mention the misery of hot flashes and night sweats, which can awaken us several times a night. The only mercy here is that if we can make it to blessedly sound REM sleep, hot flashes tend to lose their power to wake us up.
So, what is a foggy-brained, sleep-deprived, menopausal woman to do?
Well, first, if you snore, feel depressed, or find insomnia to be seriously affecting your ability to function, talk to your doctor. You may need to tease out how other factors may be influencing your sleep. Review the medications you’re taking, which can also interfere with sleep (and sex). Ask him or her to check your thyroid for an endocrine disorder that can disturb sleep.
But you have some control over your sleep (or lack thereof) as well. You can be proactive about getting a good night’s sleep. Plus, good sleep hygiene often ends up being good for your overall health as well. (You knew we were going there.)
Here’s a regimen that may have you sleeping, if not like a baby, perhaps almost like a normal human being.
With any luck, you’ll gradually move beyond this tough transition and slowly reestablish more normal sleep patterns as your hormones settle down. But as with many issues during menopause, we may need to adjust to a new normal as well. Some women say they’ve been able to make their peace with and adapt to different sleep patterns.
And whether we’re talking about sex or sleep, adaptation is what it’s all about right now.
Maybe you gathered from last week's post that the clitoris is command central of the female orgasm. Perched atop the labia minora, its sole purpose and function is sexual pleasure. It has more nerve endings than the penis, and—although affected by conditions that reduce blood supply—it can retain sensitivity as you age.
Most of the clitoris is out of sight, extending deep within and around your vagina and labia. “The most recent anatomical research suggests that the clitoris is perhaps better described as the 'clitoral complex,' where the vagina, urethra, and clitoris all function as a unit rather than as individual parts," says Dr. Debby Herbenick, in this article for Men’s Health.
Unlike the penis, the clitoris can orgasm repeatedly without a refactory (rest) period. Clitoral orgasms also last from between 10 to 30 seconds and involve from 3 to 15 contractions, which can reach from the abdomen to the vagina.
So, rather than creating artificial divisions and hierarchies between whether an orgasm is vaginal or clitoral, why not view the whole area as one big erogenous zone? Clitoral orgasms involve the vagina and vice versa, so neither is “better” or more desirable. Every orgasm is right on the money. Use what works, rather than focusing on the vagina, which as you know, can get a little cranky right about now.
And if you can coach your partner on some clitoral finesse, lovemaking could take on a whole new dimension.
Let’s return to the fact that the clitoris, as we mentioned before, is “homologous” to a penis—it has the same biological features. Thus, it has to be treated gently. Too much or too rough and it’ll either hurt or go numb. So start slow and gentle.
To begin, use lube on your fingers. (Your partner’s tongue is great.) Start a vibrator on low. The glans (head) is usually too sensitive to touch directly, so stroke the hood over the top of the glans, stroke around the labia minora and the vaginal vestibule. Stroke inner thighs, breasts, nipples. Use round and round and over the top motion on the clitoris.
For the partner: Tongue action on and around the clitoris is very erotic. Done well, it can make her “come” all by itself. Don’t jump into action. Get things warmed up with your best foreplay action.
Then, with lubed fingers begin a gentle, playful massage downtown—gently stroke her inner labia, across, over and around her clitoris. As your partner becomes aroused, slide between her legs and begin using your tongue, licking firmly up the tiny shaft of the clitoris, using separate strokes at first. Vary the action with quick darting motions on the exposed glans or by flicking her clitoris with your tongue. Begin using a firmer, continual stroke without breaking contact until she begins to orgasm.
You can then quickly move to penis-in-vagina action until you orgasm, or you can cup her “mound” with the palm of your hand, applying gentle pressure to her clitoris, which feels very comforting.
You don’t have to go crazy with the tongue action (how exhausting that would be!). Set the scene well with foreplay; keep the action gentle and varied, increasing both the frequency and firmness as she becomes aroused. Some handwork on her breast and nipples helps. And remember, practice makes perfect!
Good positions to increase clitoral contact during sex include the faithful missionary but with the partner pressing down to engage the clit. Either partner can reach the clitoris if she’s on top or in the rear entry position. “There's no need to be overly fancy during sex—the very best positions are the ones that focus on the clitoris,” says author and sexologist Dr. Logan Levkoff.
Finally, the clitoris needs good blood flow to be its best orgasmic self—and orgasms boost the immune system, support a healthy sleep cycle, and help keep your hormones balanced. You can keep clitoral blood flow through:
I had never thought of bringing together these two very personal and powerful actions until I read this post by psychotherapist and MiddlesexMD advisor Mary Jo Rapini. She writes, “One method not as well studied but also valid in bringing a couple closer together and improving sex lives is prayer.”
Well, that got my attention! Prayer, however you express it, has always seemed like something you do alone and in private, although we pray with others in certain contexts, such as liturgies and church rituals.
Sex, on the other hand, is an intimate and private act between two people, who may sometimes struggle with the vulnerability such intimacy demands.
But bringing the two together? Doesn’t that seem, um, odd if not downright sacrilegious? After all, one is sacred and one is, um, fairly creaturely.
Actually, prayer and sex are the most natural intertwining of intimate acts in the world.
If you believe in any sort of Higher Power, bringing that Being consciously (through prayer) into your sex life could open a new level of intimacy between you and your partner. It could also sweep away those musty, Victorian notions that sex is somehow “of the flesh” and therefore opposed to things of the spirit. Which may be where that stubborn scent of guilt that clings to sex originates.
Nothing could be further from the truth. There is no such dichotomy, even though we tend to create one. Male and female become “one flesh”—that’s how we were made, to be sexed creatures. We were made this way by the God whom we would prefer to exclude from the bedroom.
“See, sex in not an afterthought, a way to make more babies. Rather, it is an indispensable quality woven in the fabric of each life on this planet. Sex is not first something we do; it is primarily who we are,” writes Dan Hayes in this post about sex and prayer.
Why not invite God in? Consciously. By praying together. You don’t even have to belong to the same religion—you just have to believe. (God is there anyway; it’s just helpful for us to acknowledge it.)
Sex is a sacred act. That concept is the foundation of many Eastern practices, such as the Tantra. Sex is sacramental—the most intimate physical joining that human creatures can attain. Prayer acknowledges this, and it introduces a different kind of intimacy and perspective between partners.
A few of the effects of bringing prayer into sex, according to Mary Jo, are that by acknowledging a higher power, our own ego and self-righteousness dissolve, unspoken barriers between partners are broken down, and the bond between them is strengthened.
Praying together begets acceptance and forgiveness. It softens the sharp edges that creep into a relationship over time.
So, in the midst of using all the other tips and tricks we’ve discussed so much on this site, why not also pray together? You can do it in any way that’s comfortable for you. You don’t have to use words, but it might be helpful for each of you to hear the prayer of the other.
Join hands. Be still. Quiet yourselves.
Then pray. Together. With or without words.
If you don’t know what to say, here’s a starter:
Father, send your Holy Spirit into our hearts. Place within us love that truly gives, tenderness that truly unites, self-offering that tells the truth and does not deceive, forgiveness that truly receives, loving physical union that welcomes.
Open our hearts to you, to each other and to the goodness of your will. Cover our poverty in the richness of your mercy and forgiveness. Clothe us in our true dignity and take to yourself our shared aspirations, for your glory, forever and ever.(“A Prayer Before Sex” from Patheos.com)
Ladies, sometimes we are just too full of ourselves.
Yeah, it’s tough growing older in a society that adulates youth. It’s especially distracting in bed: Does he see the cellulite on my thighs? When I’m on top, my belly sags like a pregnant dog, so let’s stick to the missionary position. While we’re at it, nothing stronger than a candle. One candle.
Of course, our secret vulnerability is that we yearn, in the secret recesses of our still-adolescent souls, to be desired. To have the person we love (or maybe someone who looks like George Clooney) think we are the most beautiful creature he’s ever seen. In such a way that we know it’s true.
And, of course, as we discussed before, everything in our culture, in our psyche, and maybe even from our family of origin rewards youth, beauty, and thinness. And we are not those things any more.
But what about men?
Aren’t they unscathed by cultural expectations about sex and intimacy? They created them, didn’t they? And they don’t have to be in the mood. They don’t have the same, um, unpredictabilities when it comes to getting it off in bed. Things are just more straightforward for guys.
I’ve been doing some reading lately, and it’s given me a different perspective on Mars. The cultural messages and expectations they absorb almost from the cradle are equally potent and can be equally unrealistic and even damaging. And part of the message is that they aren’t supposed to talk about it. No whining, no complaints, just be a man. Get it up and get her on.
Consider this observation from a researcher who has interviewed men (and even more women) for many years: “… From the time boys are from eight to ten years old, they learn that initiating sex is their responsibility, and that sexual rejection soon becomes the hallmark of masculine shame." She heard this from a man she interviewed:
"Even in my own life, when my wife isn’t interested, I still have to battle feelings of shame. It doesn’t matter if I intellectually understand why she’s not in the mood. I’m vulnerable, and it’s very difficult.” (From Daring Greatly by Brené Brown).
I encounter this sentiment repeatedly. Men are vulnerable too. Because they usually initiate, they can be rejected. And they’re “responsible,” not only for their own orgasm, but in some way for ours. After all, if they were slower or faster or lasted longer or were more skilled….
There’s a reason for performance anxiety in men. A lot is riding on that “performance.” They don’t articulate it, not even to themselves, but their self-worth is connected to “performing” well. And if we don’t get off, or, God forbid, if they don’t, the result is shame.
“A guy can’t get through the day without seeing an ad for an erectile stimulant, getting spam about some sort of penis enlargement pill, or hearing sexual tall tales from the guys in the locker-room,” says Ian Kerner, author of She Comes First. “We live in an age where a lot of guys feel like they have to make love like porn stars, and with all the cultural reinforcement, it’s hard to believe otherwise.”
When you think about it, ladies, who are the male role models put before our men and boys? Wouldn’t the Disney Princess counterpart for boys look something like GI Joe or the Terminator? And for men, according this Esquire list, it’s George Clooney (who “eats class for breakfast”) and Liam Neeson. (Actually, the list is incredibly thoughtful and diverse. Check it out.)
But the point is that social pressure on boys to be “men,” and how we define “manly” is every bit as intense and constricting as is the pressure on us to be young, beautiful, and thin. And performance in bed is absolutely integral to the definition of being manly.
“Sexual prowess is the Holy Grail of manhood,” writes Scott Alden. “More than success, more than athleticism, more than witty banter—if we’re not a killer in the sack, we’ve failed as men.”
But what is really sweet, actually, and vulnerable and heartbreaking is that the thing your man wants most—even if it’s buried deep inside under years of habitual behavior in bed and out—the thing your man want most, is to turn you on and to know that he did it.
Truth. Nothing is sexier to a man than to turn on the woman he loves.
“For men, there’s nothing sexier in a woman than awakened desire,” writes Alden. “We also have a deep-seated need to keep our mate committed to us, and pleasing her better than anyone else in the history of sex has ever pleased anyone would be a good way for us to do that.”
All of us—men and women—are stereotyped in unhelpful ways by our time and culture. We’d probably have a lot more fun if we understood the forces that form us and viewed each other with a little more compassion.
Let’s face it. When you get to this stage of the game, and especially if you’ve been with the same partner for years, you may be wondering whether sex is really worth all the bother. Is it really worth the time, the mess, the mental energy? Why not just let it go the way of your vanishing waistline? Well, you might consider that many couples in their mature years have discovered a
kinder, gentler sex life that enriches their relationship and keeps their finger on this essential juiciness of life. You might think twice about closing the door to this most lovely of intimacies with a person you love. You might reconsider losing this thing that keeps you in touch with sensuality in the broadest sense. As Dr. Christine Northrup said in an interview, “Menopause is the fork in the road where one side says ‘Grow,’ and the other says, ‘Die.’ Menopause… like the fall of the year, is an open window.”
Libido is a fragile flame at this stage of life. We can snuff it out, or we can coax that flicker into a cozy fire. And like other parts of our life, with some nurturing, some honesty, and some practice, sex can become one of the delights of our mature years.
So, maybe it’s time to rethink attitudes and values you’ve carried with your throughout your adult life. Your body, your libido, and your responses—and maybe your partner’s vim and vigor—are changing anyway, so maybe it’s time to bring some open-mindedness, more compassion and patience (and maybe some new moves) to the bedroom.
First, you have to discover what pleases you sexually. You might have a hard time articulating or even knowing what turns you on. Maybe you haven’t thought about it, or you’ve focused on your partner’s pleasure, or you’ve never enjoyed sex all that much, or you’ve been too self-conscious for that kind of exploration.
Have you ever considered that the biggest turn-on for your partner is when you’re turned on? And that it doesn’t even take penis-in-vagina sex to turn you on? “The good news is, men do not need a penis to pleasure a woman,” says Dr. Northrup, “and it’s very important to a man’s self-esteem that he know how to pleasure a woman.”
So, the first order of business is to find out what pleases you and then to communicate that to your partner.
So—explore your sexual parts! Get to know yourself and what feels good and where. Practice. Masturbate. You’ll probably discover that, rather than a full-on attack, a gentle tease, a buildup of tension, then backing off is both effective and pleasurable. Consider using a vibrator if you need more stimulation.
Now, have a little tutorial with your partner. How is he supposed to know this stuff if you don’t show him? Maybe he can show you what pleases him as well.
Next, broaden your definition of sex. According to sex therapist JoAnn Loulan, sex should begin with willingness and end with pleasure, with or without orgasm in between. Lots of intimacies count as sex—cuddling, kissing, touching. As long as it’s emotionally pleasurable and fulfilling and keeps the spark alive, it all counts.
Your mind can be the pink Viagra that everyone’s looking for. Harness your creativity and imagination. Fantasize. Read or watch erotica. Many women are gathering ideas from the latest 50 Shades of Gray series. (More on that later.) Or read this for our own list of movies that turn us on.
Finally, a few wrap-up thoughts:
What makes sex feel so good? What ignites passion and sustains attachment? What is it that makes your heart flutter? And how can you keep those feelings alive, especially in the bedroom, after 10—or 40—years?
Turns out passion and attraction—all the stuff of poetry, song, and story—are the product of your most ancient brain—the limbic system—which you have in common with lots of other animals and which regulates a chemical stew of neurotransmitters. Emotions, drives, impulses, and desires originate in the limbic system. This part of the brain is wired for pleasure and passion, and it operates independently of our conscious choice or will.
Now, just for the record, I refuse to believe that our primitive mammalian brain and a bunch of electrochemical impulses is all there is to love and romance, but a good part of what maintains a relationship and makes sex feel good is indeed all about the chemicals.
The neurochemicals in the brain have two evolutionary goals: to encourage reproduction and then to help maintain a sufficiently nurturing environment for offspring.
Sex is supposed to feel good so that you have lots of it and fulfill your evolutionary mandate to multiply. We wouldn’t last long as a species if sex felt bad. But lots of casual sex and many partners is counterproductive for the long and challenging process of raising children. So your neurochemical circuitry is finely tuned to make sex pleasurable, but also to reinforce the bonds with your mate.
And even though your children may be grown and gone, you still operate within that chemical framework. So you might as well understand it and use it to your advantage.
If you find something pleasurable, sex for example, or chocolate—or sex and chocolate—it’s because your limbic system releases a rush of dopamine when you indulge in what you crave. Dopamine drives people to fulfill their cravings. In one well-known study a rat receives a spurt of dopamine every time it presses a lever. Soon, the rat is obsessively pressing the lever, no longer eating, copulating, or tending to its pups.
Orgasm releases a big surge of dopamine.
Like the rat, you can’t exist on that tingly dopamine high, however good it feels. When there’s too much dopamine in the circuit, the brain begins to reduce the levels it produces and to shut down dopamine nerve receptors. That’s why addicts need an ever-increasing “fix”—more of the drug, sex, porn, or gambling—to reach the same high.
So, immediately after orgasm, dopamine levels drop and prolactin is released to calm things down, especially in males. Prolactin is the dopamine antidote. This is what regulates the “recharge” time in younger men (remember when?); it produces a feeling of sexual satisfaction—and sleepiness, which is why men tend to roll over and fall asleep.
So, don’t take it personally; it’s just the prolactin talking.
Endorphins are also released during sex. These are opioid-like neurochemicals, like morphine and heroin, that block pain and induce feelings of euphoria. They’re also released when you laugh or exercise. (That’s what’s responsible for the “runner’s high.”)
Vasopressin, another neurochemical released during sex, encourages bonding behavior. When vasopressin is suppressed in male prairie voles, a mammal that forms monogamous pairs, they tend to lose their sense of connectedness and become disinterested in their mate.
But the most important chemical that balances the irresistible dopamine “high” is oxytocin. This is the “cuddle hormone”; it makes you feel close and loving. It calms you and relieves stress. And unlike dopamine, you can never get enough of it.
Oxytocin is released during sex, but it’s also released during labor and lactation to create that instinctive bond between mother and baby. During sex, it reinforces your connection with your mate. It offsets the opioid-like cravings of dopamine and endorphins while making the two of you feel close and receptive to sex.
Evidence even suggests that when you have more oxytocin in your system, more nerve receptors are created just to accommodate them. So be sure to laugh, exercise, make love, and cuddle before and after (if your mate can stay awake) to create lots of receptors for your increased oxytocin levels.
And in order to increase your sensitivity to the dopamine and endorphin “high,” cuddle without the sex occasionally. Take a little sex break so that when you come together, your pleasure circuitry is primed and ready.
Your body is hard-wired for sex in the most primitive levels of the brain. When you make love, you’re producing the most potent chemicals your system is capable of. You are a sexual animal. Celebrate!
A male reader wrote to me recently. He’s “turned on” at the thought of his wife using a vibrator and wants to incorporate it into their sex life. The problem is that his wife is “creeped out” at the thought and won’t consider it.
This dilemma presents several issues that I think can be instructive to explore.
The first issue has to do with respect. We’re all at different points with regard to what turns us on and our openness to new approaches. Trying something new takes a willingness to explore and be vulnerable—and that can’t be forced, especially in intimate relationships. Otherwise, rather than feeling close and connected, your lovemaking will feel tense and coerced. Respecting boundaries is fundamental to a loving relationship.
That said, it’s also important to keep an open mind about what pleases your partner. Grownups do all kinds of things in bed, and as long as it’s safe, consensual, and pleasurable for both partners, there’s no right or wrong. The willingness to try something new, especially if it’s a “turn on” to your partner, is a loving act. And, who knows, you might like it, too.
When you encounter resistance from your partner to an idea or suggestion, you need to take a step back. Maybe discuss exactly what turns her off about, say, using a vibrator. Maybe she’d be more receptive to something smaller and less intrusive. Maybe she needs to try it alone first.
On the other hand, you could also talk about what your partner finds arousing. What has she always wanted to try? What are her fantasies? Try a trade-off. You do something for your partner, then switch roles.
There are some very good reasons to use a vibrator. They help us maintain vaginal health and boost blood circulation. They give us the strong, consistent stimulation we may need to reach orgasm. Using a vibrator, either alone or as a couple, isn’t “creepy” by most standards, and it isn’t particularly unusual. In fact, studies consistently show that introducing new things to your sexual routine in the form of toys, sex aids, or places and positions is helpful in maintaining a healthy sexual relationship.
If you’re at an impasse, you might consider continuing the discussion with a sex therapist, who can provide perspective and suggestions for moving forward in a loving way. But the bottom line is that you need to respect your partner’s boundaries, communicate about your desires and fantasy as well as your fears, keep an open mind, and be willing to incorporate new things into your sex regimen.