The Female Brain and Your Level of Sexual Desire

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Sexual desire is funny mystery. You want to be relaxed enough so that you can then enjoy a build up of tension. It seems like two different directions at the same time, yet that is how sex works. The following current medical research looks at these two directions:

MRIs were taken of the brains of women who have low desire. Their brain activity was compared to the activity in women without low desire. In the women with low desire, the area of the cortex that is involved in self-monitoring and has ‘inhibitory executive control’ showed hyper activation. This meant her YES for sex was dampened down, and she had built-in inhibition. This is not what most women want.

In medicine, low desire through one frame is seen as the result of an imbalance in the excitatory and inhibitory processes inside of us. These are biochemical processes. The imbalance is caused by too little excitement or too much inhibition or a combination of those two phenomena.

Neurotransmitters are one focus of what may be involved. For example, Serotonin is a neurotransmitter that stabilizes our moods, is calming, and promotes good sleep. It is also a key inhibitory factor in sexual desire. It weakens the ability of the excitatory systems in our bodies to be activated by sexual cues. Sexual cues are what trigger our arousal and get us activated sexually. You want to be activated to have a good time.

Medicine is currently looking at ways to intervene in this process by modulating these excitatory and inhibitory pathways through targeting of neurotransmitters. Bupropion (Wellbutrin), bremelanotide (possible brand name is Rekynda) buspirone (Buspar), and flibanserin (Addyi) are examples of the drugs being explored to activate. At this time only flibanserin (Addyi) has been approved by the FDA to treat low desire.   Of note, there are combination products under study now. A combination product of testosterone and buspirone has been designed and is not yet available in the US, and a combination of trazodone and bupropion is in development here.

There are non-pharmacological ways to influence neurotransmitter levels too!   Cuddling with your mate and spending time with girlfriends are two that are well known to increase your activating neurotransmitter levels.

In my blog post titled: “Women and Sexual Arousal” I talk about Addyi, click here to read it.

More coming on this topic in future newsletters.

Sex Doesn’t Have to be Painful

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“Treat Your Vaginal Dryness Early” are the words I would put on large billboards along I-5 and along other major highways in the US. I want to get the word out to women sooner about this common problem. Many women I see have waited months or years to seek treatment, and I cringe at the number of nights they have been in pain. Or the number of nights they are ambivalent about having sex as they face the no win choice of either “sex with pain” or “no sex”.

 

 

Treating women’s dryness early would reduce that personal pain and burning during and after sex, and it would do so much to maintain the closeness in marriages — the closeness that can wobble when this happens. So don’t wait. There is no reason to wait. Vaginal dryness, particularly menopausal vaginal dryness, is progressive. The earlier you treat it the better.

Treating dryness early would not only reduce sexual pain for women, it would also improve the capacity for arousal and the quality of the orgasms of millions of American women. On top of that it would add quality to the sexual experience of the women’s partners. As far as what it would do for relationships, well that is a lot. When a partner isn’t available for sex there is confusion, distress and sometimes a misinterpretation of the source of the problem. Treating dryness early would make this relationship chaos less.

Vaginal dryness occurs in more than 50% of women experiencing menopause. It also occurs in young women. Usually these young women are on hormonal contraceptives like the birth control pill, hormonal IUDs, and implants, or they have a hormone condition called PCOS (Polycystic Ovarian Syndrome). Significant sexual pain occurs in 10% of young women who go on the pill because of vaginal changes that occur from taking the pill. This intimate pain is quite a negative introduction to the new world of sexuality for these young women.

Whether vaginal dryness is due to the pill or menopause or other conditions, it is quickly and easily treated. Don’t wait. The symptoms of pain with intercourse or the feeling like you have a rug burn after sex, will resolve in six to eight weeks. And the treatment is safe. It doesn’t increase your risk of getting breast or endometrial cancer (links to the research on safety are included later in article).

There are multiple treatments for dryness, and there are a few new ones. Intra-vaginal DHEA is one that I reviewed in the last newsletter. More new treatments, including laser therapy, are gathering data now. Low dose minimally absorbed estradiol is still the go-to treatment for dryness. Below is the handout I give to women when prescribing this medication.


USING LOW DOSE MINIMALLY ABSORBED VAGINAL ESTRADIOL

You have been prescribed a vaginal estrogen preparation to use topically.

This prescription is to treat vaginal dryness related to loss of estrogen, or for some women it is to replace estrogen when “crowded out” by naturally higher levels of testosterone.

This is a prescription that you pick up at the pharmacy.

This medication is a low dose hormone prescription. It is different than a lubricant, and different than a vaginal moisturizer. You can think of it like a conditioner.

You do not use it before sexual activity.

The hormonal changes that occur to the vagina also affect the tissue around the opening of the vagina and the urethra (the tube that creates the passage where urine leaves your body). When a topical estrogen cream is prescribed, often the instructions are to take ½ the dose and apply around the opening of the vagina and the labia (lips) including the clitoris and clitoral hood. The other half of the medication goes into the vagina using the applicator from the pharmacy. You also can use your fingers to insert the cream internally.

If you are beginning the prescription, you will often be advised to use it daily for a week, then reducing to twice a week. It takes six to eight weeks for the tissue to get back to the thickness it had been before the hormonal change. When your symptoms are gone, you can reduce the prescription to once a week. If symptoms reoccur you can then increase again to twice a week. If you have been using it for 8 weeks and you still have dryness or pain, come back in — something else may be going on besides vaginal dryness.

Prescriptions for inside the vagina are also written for rings (Estring: this is a ring that is placed inside the vagina and releases low dose estrogen for three months) or suppositories (Vagifem or custom compounded suppositories). These methods deliver estrogen to the vagina internally. Often when a woman uses rings or suppositories internally she will still benefit from some estrogen cream applied externally around the opening of the vagina where more pressure occurs particularly with thrusting.

Compounded vaginal estrogens can be made in creams without parabens and propylene glycol and other chemicals that irritate when cracks or fissures are present, or when there is skin sensitivity. There are bio-identical options for both compounded and non-compounded prescriptions.

Vaginal Estrogens have not been shown to cause an increased risk of breast or endometrial cancer, or any other cancer. See the 2016 American College Of Gynecology guidelines here for women who have had Breast Cancer, and their use of estrogen, click here to visit.

The use of low dose vaginal estrogen and risk of stroke continues to be under study, and so far the Estring, and low dose topical creams show no increase in blood clots, click here to visit.


THE BOTTOM LINE: Don’t put up with dryness or sexual pain from dryness. Find out the cause and treat it until it is gone. There are many resources to help you be successful with this safe treatment, so if your provider doesn’t ask you, then you ask them for treatment.

Click here to read my article about why there is no better time in history to be a post-menopausal woman who wants to have a great sex life.

 

New Treatment for Menopause and Vaginal Dryness

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On July 24, 2017 the Vaginal DHEA suppository we have been hearing about for five years became commercially available. Called Prasterone, with the brand name Intraosa, it is available by prescription. It is for the treatment of sexual pain during intercourse due to menopausal changes. Prasterone (DHEA) is converted locally in the vagina into androgens and estrogens which are the hormones that restore the vaginal tissue.

According to AMAG Pharmaceuticals, there is Copay Savings Program, which lets most insured patients receive their first prescription for a $0 copay and will then pay no more than a $25 copay for each refill for the duration of the program.

The unique research news was that the hormonal effects happened locally in the vagina and did not appear to raise blood levels of estrogen or testosterone throughout the body. Even though hormone levels did not increase, this treatment is not currently approved for women who have had breast cancer, or women who have unexplained postmenopausal bleeding. You can get the prescription from your provider. The vaginal suppository is inserted daily.

Click here to read my blog post about why there is no better time in history to be a post-menopausal woman who wants to have a great sex life.

Women and Sexual Arousal

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When women get in bed with their mates and start touch that leads to sex, they are often starting at a zero Female Arousallevel of sexual arousal—maybe a one or two out of ten. The arousal level exciting enough to lead to orgasm would be a nine or a ten. That is a big jump, and it is a jump you want to know how to make. Finding out how to do this is a process of discovery. Most women I talk to who have low levels of arousal have not spent the time needed to explore what brings them pleasure. They have not discovered what actually works for them. Or, in some cases, they used to know, but their bodies have changed, and they have not re-explored.

Talk about sexual arousal reminds me of what a 33-year old woman said in an evening class I taught. She introduced herself saying that she was there to find out if she could have sex that was something in-between the sex she was currently having with her husband, and the sex in the erotic novel, 50 Shades of Grey. Peals of laughter emerged from all corners of the room as the women in the class could relate.

The remarkable thing about the sex in 50 Shades of Grey, in my view, is not its S and M components; it is that the book displays the benefits of having sex with someone who is well trained in sexual arousal. This level of training is the standout element in this book. The sex in 50 Shades of Grey did not just happen. It was sex with someone who had spent hours paying attention to what is sexually arousing to another person. Christian Grey had invested time, attention, and thousands of dollars on his sexual education and hours spent in practice and experimenting in how to move a woman from a zero to a ten. He learned to identify increases in heart rate, to figure out which pressure of touch got his partner to create faster, which moans indicated she was near her edge.

If the arousal level in your sex life does not match 50 Shades of Grey, don’t be down on yourself or your partner. Don’t think you should already know. If you’re like most of the people who come to see me, neither you nor your partner has had a single class in sexual arousal. You have not had the hours of one-on-one mentoring with uninterrupted focus and no expense spared that the fictitious Christian Grey had.

Most women piece together their education in sexual arousal with the bits and pieces they have stumbled upon from direct experience, or as interpreted through girlfriends, the movies, TV, Cosmopolitan Magazine, and maybe a sister. They hope their partner has had a better education, but this is unlikely.

As interested as men are in getting their women excited and pleasing them, and they are interested in doing that, few are well informed about how to do it. Most likely your partner has had little useful education about sexual pleasure. High school sex education classes cover anatomy and physiology, pregnancy, and sexually transmitted diseases. These classes focus on real problems and risks involved with sexual activity, but they do not educate at all on how to create a good experience or peak of pleasure. His information about your pleasure, most likely, is collected from bits too; e.g. his friends, TV pornography, or other things he as read on the internet, as well as what he has found to work in the past.

Your arousal is at the heart of enjoying sex and central to both you and your partner’s satisfaction. Your arousal is a very good thing. The more you are aroused, the more excited you will feel, and the more likely you are to orgasm. Finding out what kind of stimulation gets you going is essential. What works for you sexually is not something you get to choose, it is something you get to discover. You can’t decide to be aroused by something — you get to try it and see if it does actually work. If you don’t know what works for you it does not mean there is anything wrong with you. Most likely you are sexually “normal”. Don’t think you should already know, and don’t blame yourself. The action for you to take is to experiment! Experimenting is the doorway to finding out.

The first thing to know as you explore what takes you from a zero to a ten is that no two women are alike. You have your own personal arousal triggers. The ideas you see in the movies, or hear from a girlfriend may or may not work for you. How do you find out what works for you?  You experiment. You find out what makes you tingly or hot and what makes you wet.

Be yourself, relax your mind, and feel your reactions. Perhaps a light touch to the side of your ribs is deliciously arousing to you. Or maybe you prefer being lifted strongly into the bed by your partner and aggressively mounted. Or a tender personal, erotic dialogue in your ear during intercourse may be what works to get you going. Is it roses? It is his sexual advances? Is it when he does something on the edge? What gets you sexually excited?

Maybe romance arouses you? If so, don’t judge it; work with it. Read romance novels. Watch movies with swashbuckling heroes or heroines that are swept away by love. Ask your partner to up his romantic moves. Ask to be surprised with flowers, or to have your bed littered with rose petals and an enormous number of candles lit around the room, or dine first by candlelight as a prelude. Perhaps you’d like to role-play with him. He gets to be the Texas Ranger, and you are the irresistible damsel in distress, or vice versa. As you experiment you may be surprised what excites you. Make note of it. You may not choose to do every thing that excites you, but you may want to do some of them.

Watch erotic movies, or read erotic literature. There is a whole genre of material out there that is designed to turn you on – see if it does. In bed try a variety of touches and pressures, different positions, unique places and see how you respond.

When something works don’t keep it to yourself. With your words or your moans, let your partner know you are turned on. You can say: “More there,” “Yes!” “That’s it.”
When things are not working, let him know too. If his hand is slightly off the right spot, move it. If the pressure is too strong, adjust your body or his.   Don’t do it as a frustrated woman, or a stern teacher, do it as a sexy female who is aroused and wanting to be more aroused. You are on the same team, working together to make sex exciting for both of you.

If you don’t know what touch or position you want, but you know what he or she is doing isn’t working, communicate your desire to experiment, “Let’s try here” or “Touch me here.” Take his hand and place it where you can explore. Move it in the rhythm that feels good to you. Small immediate sexy communications that disclose to your partner what is happening inside your body work to keep arousal building.

If squeezing your nipples is more arousing than kissing them, tell him to squeeze them. If you know the kind of passion in the kiss you want, show him. Kiss him the way you want to be kissed. Tell him in your aroused passionate (not angry or critical) voice that this is how you love to kiss.

For examples of women who have claimed their sexual selves enough to share the specifics of their own orgasms go to www.OMGyes.com.  The open talk on this site may reframe things

Don’t take it personally if you have to tell him again the next time. Persist. When he sees what awakens when you get fully excited his memory will improve.

Be direct and positive. A man’s macho self can take it. They can take your honesty. They want you to be excited, so they are more open to change than you think. They don’t know what to do to get you excited, so tell them. If your partner is female, communicate with her in the language that would work for you, whether you are using the language of touch or words. Watch and listen to her responses closely, and adjust what you do. There are two arousal speeds in the room, and you want both of you to get to 9 or 10.

Remember, if you don’t know what works for you it does not mean there is anything wrong with you. Most likely you are sexually “normal”. Don’t think you should already know, and don’t blame yourself. The action for you now is to find out.

For more in depth writings on this subject, click here to buy Fanning the Female Flame-How to Increase Your Sexual Desire.