Q: My libido is higher than ever! Will it last? Should I be concerned?

When you're in perimenopause, we say that your hormone levels are, in general, declining. While they are declining "in general," it's likely that your levels of estrogen and progesterone are fluctuating erratically from day to day. Testosterone is usually more steady, not particularly fluctuating day to day or month to month. As a result, the mix of hormones changes, and for some women testosterone seems to play a more dominant role; one effect of testosterone is enhanced libido (it's sometimes considered as part of therapy to restore sexual function).

This may explain what you are experiencing. You asked whether you should be tested for hormone levels. While it's possible to measure hormone levels, and those measurements are accurate, the levels are accurate only for that hour or day and are not particularly helpful to predict what to plan on in the upcoming days or months.

I would say, enjoy the current state! I hope this is your ‘new norm.’

Q: Why did I have pain and tightness during intercourse?

In menopause, in the absence of estrogen, the vagina narrows and becomes more thin and fragile. Even when you are lubricated enough, the tissues have likely lost elasticity and can’t comfortably stretch with intercourse. Some light bleeding represents the "trauma" to those tissues and usually comes from near the opening of the vagina or the vaginal tissues themselves.

Using a vaginal moisturizer (like Yes, Replens, or KY Luiqibeads) would almost certainly help. It may also beneficial to use dilators to try to get back more caliber or capacity (dilators literally stretch the tissues gradually). You might also talk to your health care provider about vaginal estrogen, also known as localized estrogen, which may be of benefit to you in restoring elasticity.

Don't give up! You can be comfortable again.

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.

Q: I've had a hysterectomy; does my vagina still clean itself?

Fortunately, the vagina is self-cleansing; it requires very little attention. The cells on the surface of the vagina naturally regenerate or ‘turn over’ on an ongoing basis. After intercourse, semen deposited in the vagina coagulates and then slowly liquefies again and is slowly secreted.

The top of the vagina is called the vaginal cuff when the cervix has been removed as a part of a hysterectomy. Not having a cervix doesn’t change that cleansing mechanism. Douching is disruptive to this natural cleansing process, disrupting the natural, healthy environment created by ‘good bacteria’ that belong there. In this case, less is best!

If you've had your ovaries removed or are naturally menopausal, the absence of estrogen means your vagina can benefit from a moisturizer placed inside the vagina. We offer several great choices.

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.

Q: Are mental fog and PMS-on-steroids related to perimenopause?

Oh, where do I begin? Perimenopause can be a pretty tough transition for many women. It is not only possible but probable that those symptoms are related. Patients with these complaints get a one-hour appointment in my practice to review the signs and symptoms that accompany this transition.

Riding it out is one option. Above all, make sure you optimize lifestyle, with exercise being probably the most important factor. Aerobic exercise of 45 minutes 5 days a week along with 60 minutes each week of strength training is a great goal to set.

I often recommend a book to patients: Dr. Robert Greene's Perfect Balance. It covers this transition quite well and reviews options in treatment including diet, exercise, and hormone alternatives. It was originally published in 2005, but is still one of the best I have seen.

Good luck! Things will get better!

Dean Martin. Found.

My libido woke up.

This week we shoveled out a room to make room for a new hobby. In the unearthing, my husband found my long-lost, autographed picture of Dean Martin:

Autographed photo of Dean Martin

Oh, be still, foolish heart!

My grandmother snagged two of these, one for my sister, and one for me, in Rome, when Martin was shooting there on location. She sent them to us when we were still too young to really understand what Dean could do for us.

But at the time, we were living on a naval base in the tropics, where it was hot, hot, hot. We spent most of our time in the base movie theatre, which had a sound track that ran the same songs over and over and over again between films. That track included “Everybody Loves Somebody, Some Time.” That voice could tease desire out of even a 10 year old. It turns out.

We fell a little in love then, but a lot in love later when we returned to the States and snuck around to watch Dean Martin on his television shows, and Dean Martin movies and listened even more to Dean Martin records. We have loved him ever since.

A quick quiz among a gathering of girlfriends suggests we are not alone. Dean still does it for a remarkably wide age demographic, doesn’t he? I know it included my mother, who would be in her late 70s now. And it extends to friends in their 40s…. I wonder if he could have ever known what lust he could inspire?

Anyway. Dean’s there for you on YouTube, whenever you want him. Here’s hoping he still works for you the way he does for me:

Especially for my sister:

That’s Amore:

Innamorata, sizzle

That’s just a sampling, friends. Happy memories…

July 26, 2010


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


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!
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