July 26, 2010

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The Good Stuff ›  


The Components of Great Sex

Last year researchers published their study defining "The Components of Optimal Sexuality: A Portrait of 'Great Sex.'" View full article →
July 22, 2010

2 comments

desire ›   libido ›  


Movies to Turn You On

Not long before launch time, we wrote about our movie night with girlfriends, exploring erotica, and talking about what sort of flicks worked to turn us on... The premise being that as we grow older, using movies and literature and images to "get in the mood" can really help us overcome our skimpy sex hormones to fire up libidos.

In that post, we shared our list of movies that we found hot or naughty or disturbingly sexy, and a friend wrote asking for details on the movies we chose. Here's a bit about each of them:

A Room With a View: Romance literature depends upon eras when a lot of clothes, social restrictions and sexual oppression offer the perfect fuel to set off explosive passion. Helena Bonham-Carter and Julian Sands’ longing is by turns sweet and frustrating, and always titilating.

Breathless: If you have a tendency to fall for bad boys, Jean-Paul Belmondo is your type. A liar and a thief and a persistant seducer. The film is set in Paris, a classic and masterpiece of the influential director, Jean-Luc Godard and writer Francois Truffaut.

9 1/2 Weeks: Mickey Rourke and Kim Basinger are just bad for each other, and it’s so good. Lots of erotic play. Lots of sex. A terrible relationship. Not so much a feel-good movie here. You don’t hope they end up together in the end. New uses for the jars of stuff in your fridge.

Body Heat: William Hurt and Kathleen Turner in a steamy southern summer film noir. She seduces him, talks him into murdering her rich, oppressive husband so they can live happily ever after. The seduction and heat and sweat between these characters is more than memorable.

The Piano: A movie pairing Holly Hunter and Harvey Keitel made our list of sexiest films? Oh, my, yes. A haunting story of passion and the bargains women make to survive, and to thrive.

Atonement: The lovely, epic novel about class, love, jealousy, malice, and regret is made alive with performances by Keira Knightley and James McAvoy, whose passions are doomed from the start. But they do get off to a good start…

Shakespeare in Love: Find just about anything with a Fiennes in it — Joseph or Ralph — and you’ll likely find a hot film. These boys embody sexuality. Here Joseph is the young Shakespeare, and he’s in love. Gwyneth Paltrow is Viola, a woman mismatched and thwarted. A funny movie with a Shakespearean plot and much of his dialogue. The heat between Fiennes and Paltrow is luscious.

The Unbearable Lightness of Being: Daniel Day-Lewis, Lena Olin, Juliette Binoche. The cast should be enough to recommend the film. The sexy and disturbing triangle of Milan Kundera's novel, gorgeous Prague, the Soviet invasion. This is one beautiful, erotic, memorable film.

Looking for Mr. Goodbar: Diane Keaton and Richard Gere are hot for each other, and the movie made our list of turn-ons for that reason. But their obsessions get the best of them, to say the least. Amazing performances by great actors.

Sweet Land: Elizabeth Reaser and Patrick Heusinger are awkward and beautiful as they work his rural Minnesotan farm. A gorgeous movie whose sensuousness bubbles up from nowhere and nothing. There are so many barriers to this romance, it just has to bloom. And it does. And it’s breathtaking.

The Graduate: Dustin Hoffman loves Katharine Ross and lusts for her mother, Anne Bancroft. Sick? Well, yes, okay. Yes. And really, really sexy too. 60s angst. Remember 60s angst? We do.

Under the Tuscan Sun: The title gives it away: Tuscany. Heat. This film is about escape and discovery. A grown woman’s fantasy come true.

Thief of Hearts: Sexy Steven Bauer has stolen Barbara Williams’ diary. Her dull and predictable life breeds a rich fantasy life in those pages, and now he knows every detail of it. Careful what you wish for, girlfriends…

Vicky Cristina Barcelona: Javier Bardem could stand in the middle of the room and read our grocery list, and that would be enough for us. But put him in a movie with a lot of sexy women and supremely sensuous surroundings, and… why aren’t there more movies like this?

Moonstruck: Ah, Moonstruck. How many times have we seen it? A dozen times? How many media have we owned it in? VHS, Disc, DVD, Digital… and counting… This campy romantic comedy just never gets old. An aging Italian Cinderella in Manhattan gets another chance at love. And she takes it. Cher and Nicolas Cage. Mama Olympia Dukakis nearly steals this movie.

Daniel Craig films: Oh Sigh. His Bond flicks are so yummy. But really, we’ll take him in anything, in or out of a tuxedo. Out is good.

Q: What do I do about pain during intercourse?

If you have pain during intercourse, you need a good, thorough physical exam to start, to make sure there is no obvious cause for the pain with penetration (for example, vulvodynia/vestibulodynia). If the exam doesn't identify any apparent physical cause, you might spend some time on MiddlesexMD's recipe for sexual health, walking through each component to see what makes a difference:
  • Understand the physiology of menopause so you understand what you're compensating for.
  • Learn to care for your vulvo-vaginal tissues, including considering moisturizers or lubricants.
  • Compensate for less sensitivity in genital tissues with more stimulation -- and more patience!
  • Maintain pelvic floor muscles to encourage circulation and maintain orgasms.
  • Attend to emotional intimacy -- because the brain is a vital part of arousal for women.
Our website is structured to help you learn about and address each of these topics; just follow the tabs across the top. You'll need patience to figure out what combination of strategies will work for you, but continued use of the vagina is recommended for continued sexual activity. Avoidance because of pain only makes matters worse. Be in touch if you have questions as you explore possible approaches to get past this pain. It's worth the time you spend!

Q: How do I treat dryness and vulvodynia while taking Tamoxifen?

The most important thing is usually to re-estrogenize the vagina—with localized, not systemic estrogen. I haven’t seen a single oncologist not agree to allow breast cancer patients to use this. There are a couple of really low-dose estrogen products to use in the vagina; the estrogen is not absorbed outside of that area. Vulvodynia occasionally benefits from the localized estrogen too, or there are some topical options.

A thorough and detailed pelvic exam could help to determine where the pain is arising (vulva, introitus, vagina, pelvic floor muscles, and/or vaginal cuff). Each of these has a different solution, or maybe a combination of options.

A lubricant will help somewhat with sex, but a moisturizer (like Yes) is more important for prevention and long-term preservation (vaginal estrogen can accomplish this, too). Some of my patients use a topical anesthetic in the area. If you have lost some caliber of the vagina—some narrowing, dilators can help restore that. Some women with longstanding pain with intercourse develop vaginismus, in which the involuntary muscles of the vagina go into spasm.

Don’t stop trying! Usually we can restore comfort!

Q: Am I stuck with an unfulfilling sex life?

No!  It’s great that you recognize the value of remaining sexually active, despite your decreasing libido.

As we get older, we have to learn some new techniques to continue to enjoy sex. You can use the MiddlesexMD website to have a discussion with your husband:  Take him to the site.  It will help him understand what you're experiencing, and that it's not "about him."  Review together the bonding behaviors and alternatives to intercourse.

You may find a role for erotica, like DVDs or books. Just this week a woman told me that she keeps a book of erotica nearby. It works really well for her to read from it in anticipation of sex (although her husband isn’t aware she has it for this purpose).

If you're comfortable with the idea, incorporating a vibrator may help; after menopause we do require more stimulation for arousal and orgasm. Healthy relationships require intimacy -- it's worth the effort.

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!

Q: Incontinence with stimulation? What’s up with that?

Urinary incontinence for women is usually classified as "stress incontinence" or "urge incontinence." Losing bladder control during sexual stimulation is most likely urge incontinence: The stimulation of the area nerves causes the urge to urinate and then contraction of bladder muscles (for some women it's just a strong urge, for others it's actual leaking).


While it poses no risk to you or your partner, it is definitely undesirable! Make sure to empty your bladder just before sexual activity. See your doctor to rule out a bladder infection. Performing regular Kegel exercises may be of benefit. The type, duration, and location of stimulation may influence the urge; more practice may help you better understand cause and effect. Certain positions may decrease leakage (for example, woman on top or side-lying position).

There are medications for urge incontinence that could be trialed just before having sex. Taken 10-60 minutes before sex play, the medication can decrease the urgency sensation and actual loss of urine.

This issue can really interfere with sexual expression, so addressing it sooner than later is important. See your gynecologist or urologist to further discuss which of these options are best suited to you based on your medical history.

Need Help with Kegels? There's an App for That

Weights in hand, what I need is time and focus and coaching. And ladies, there is an App for that. That is, if you use an iPhone or iTouch, you can download Kegel coaching applications for anywhere from free to about $5. I’ve found three. They’re very different, and all helpful. View full article →
July 01, 2010

0 comments

estrogen ›   hormones ›   maintenance ›  


Chicks Without Ovaries—a Maintenance Plan

I surely don't miss the troublesome little egg sacs. The havoc they played with my system when they were there made my life miserable, to say the least. The new freedoms I have without them are well worth the maintenance work of not having them. View full article →

Do you use herbal remedies for menopause support?

While we are on the subject of finding medications and supplements that can help us… a quick note about using herbal remedies to help alleviate the symptoms of menopause and/or to boost your flagging libido and support your vaginal tissues...

Herbal supplements, for the most part, are developed and marketed in the U.S. as food stuffs. For this reason they do not require clinical studies to test their efficacy or to measure their side effects. They are also not subject to manufacturing rigor that would guarantee their potency. So I can't promise or deny their effectiveness or safety.

At the same time, there is no doubt some of my patients have experienced some relief of their symptoms by using various supplements. Very few of the herbal products designed for menopause support are known to be harmful, and trying them yourself may be the best way to learn of any benefit. It's your body. How these supplements work for you is really the question.

A good way to test their efficacy and safety for you is to keep a symptom journal for a week or so before starting a new supplement, and then for 12 weeks after starting it, tracking the type and severity of your symptoms, and how they change over time. The accepted wisdom for herbal supplements is that 12 weeks is an adequate time to determine whether a supplement will help your symptoms or not.

There are so many supplements out there thought to support us as our hormones are changing. What has been your experience of supportive supplements? Any that have helped you? Any cautionary tales?