May 29, 2015

The Romance of Travel

With a long hard winter that took far too long to end, it’s been easy to forget there’s a big world out there. Help is on its way, via a new book: Frommer’s/AARP Places for Passion: The 75 Most Romantic Destinations in the World—and Why Every Couple Needs to Get Away.

The subtitle says it all. The co-authors, Pepper Schwartz and Janet Lever, are PhDs and sex experts. They’ve put a huge amount of thought and research into a book crammed with irresistible ways to foster romance.

They list getaways to suit every taste—cities, natural beauty, beaches, and adventure; on every continent—well, maybe not Antarctica. A random sampling: the Great Barrier Reef, the Loire Valley, the Amalfi Coast, Marrakech, Bali, the Cotswolds. Detailed listings for each destination make planning that much easier.

The hardest part might be deciding where to go. Schwartz and Lever suggest having both partners list the three places they most long to see. With luck, the two lists will share at least one destination.

The authors acknowledge, “Keeping romance—and passion—alive over the long term isn’t impossible, but it isn’t easy, either. It’s complicated: We crave the security that comes with our committed relationship, but we also desire adventure and fresh discovery.” Traveling, including the planning and anticipation beforehand and the shared memories afterward, restores the excitement a relationship had when it was new.

Couples who share a long history are inevitably liable to “hedonic adaption”: getting so used to good things that they don’t feel good anymore. When traveling, couples encounter one surprise after another. Novelty makes the two more interesting to themselves and to each other. The authors write, “Research shows that the very best way for couples to refresh their love for one another is to do something, anything, novel together.”

Uninterrupted time away from day-to-day obligations means a chance to get to know a partner more deeply. Learning new skills, like kayaking or navigating an unfamiliar transit system, enhances mutual respect. According to the authors, a magnificent natural view “can ignite all four of the so-called love hormones: dopamine, which fosters feelings of love; oxytocin, which helps create trust and bonding, serotonin, which increases feelings of pleasure and well being; and norepinephrine, which gives us energy and is part of our sexual arousal.”

Inspired to start dreaming? Some promising websites are Travel.AARP.org,Frommers.com, PeterGreenberg.com, and SmarterTravel.com. AARP membership includes discounts for those 50 and older. Road Scholar(formerly Elderhostel), a nonprofit, offers educational adventures all over (including Antarctica). The Golden Age Passport, for those 62 and up, gives lifetime free admission to all U.S. national parks for only $10. For those 50 and older who would like to try swapping housing with other travelers, there’s also SeniorsHomeExchange.com.

But you don’t have to look across the world for new experiences to share. A day trip or a weekend trip can get you there—or even a trip to your bedroom!

April 15, 2015

Q: Which of my medications is inhibiting my orgasm?

You say you’re taking daily doses of Wellbutrin and Effexor. Effexor is the likely culprit, since Wellbutrin is actually “pro-sexual.”  Wellbutrin increases dopamine, a neurotransmitter beneficial for sex; Effexor increases serotonin, a neurotransmitter that is negative for sex—in that it can decrease libido or ability to experience orgasm.

If you can decrease the dose of Effexor without an increase in other symptoms, that may help. Decreasing the dosage may mean other symptoms comes back, or that orgasm is still out of reach or diminished. In those cases, I offer Viagra, used off-label for women. A number of clinical trials have shown Viagra to be helpful when SSRIs (selective serotonin reuptake inhibitors, a class of treatments for depression and other disorders) lead to an inability to experience orgasm.

A newer SSRI, Pristiq, is reported to have fewer negative sexual side effects. I’ve seen that to be true, but also have worked with patients who found that health insurance was not supportive, since newer drugs are often more expensive. It may be worth exploring!

Another alternative that works for some women is to take a ‘drug holiday': skip the daily dosage of the SSRI on a weekend day when they are more likely to be sexual. This doesn’t work for everyone. Some people have withdrawal symptoms or other unintended side effects with the ‘holiday approach.’

I encourage women in my practice to consider using a vibrator, which can increase sensation and sometimes lead to orgasm. At midlife, it’s important to stay sexually active (that ‘use it or lose it’ thing), so it’s worth the effort to experiment.

I see how frustrating this dilemma is for women to manage through! I wish you patience and perseverance to find the right balance of overall health and intimacy for you.