A delightful woman, perhaps 36 years old, came to one of my bedroom classes about four years ago. At the beginning of the first class, when the participants went around the room to introduce themselves, she said she was in this class because she wanted to have sex somewhere in-between the sex she was having with her husband and the sex that happened in Fifty Shades of Grey. Peals of laughter filled the room. All the women related to that wish to have more erotic sex.

Erotic sex is desirable. In my office I most often hear a woman saying she wants to have that kind of sex with her current partner — the same one she lives with and may have kids with. I take her desire to have better sex personally. Even though I see women professionally, my desire to support women’s quests for great experiences is not only linked to my identity as a nurse practitioner; it is deep and elemental to me. There is a wild and instinctual side to women, sometimes mercurial and often wondrous. I am 100% for that aspect. And the bedroom is a place to express that.

So what needs to happen to increase wonder and sensuality? There are many avenues to explore, and in this newsletter I am starting with the very basics, the female physical body and the sexual anatomy involved in her arousal and orgasm.

The reason I am starting with the basics is that they are not taught to us, and we have gaps in our know-how.

Three months ago I taught an OLLI class at Southern Oregon University titled ‘Fanning the Female Flame After Menopause’. It was my first post Covid class. The students were women all over the age of 50 and the class was full. When I reviewed the actual anatomy of female genitalia with images via power point, more than a quarter of the women were surprised. They never knew the clitoris had legs and that the legs extended down behind the labia. It was brand new info to them. It was new to me 22 years ago as part of my training in Sexual Medicine. I had never had that anatomy in my nurse practitioner education, even in my practicums that included women’s health. Now, 22 years later, female genital anatomy is still not mainstream knowledge.

This lack of basic info makes a difference and is relevant to the Fifty Shades of Grey trilogy. There is a reason that the sex in that series was hot and yours may not be.

And it isn’t because their sex involved S and M. And it isn’t because their chemistry as a couple was hotter, or that they were younger, or their connection started off stronger. The great sex in Fifty Shades of Grey did not just happen. It was great because this fictitious Christian had hours and hours of one-on-one training on how to notice the subtle changes of increased arousal in a female and how to increase it further. He was educated. He knew what he was doing. He paid attention. He had been trained for years to pay attention. Not for months — for years. He was more thoroughly educated in arousal than probably 99% of people you know. He was trained in S and M — a practice that many would decline to partake in – and yet it was that attention to detail that worked. He noticed subtle changes in his partner’s breath, and in her heart rate, and he followed those changes to see if what he was doing excited her. If it didn’t work, he would try something else. He was willing to experiment and he did experiment. His education and experience were key to the erotic charge they had as a couple. The erotic charge that many women and men want to experience.

Sex is a profound activity. Usually there is some preparation for profound activities: Reading, studying, talking with wiser more experienced persons, or being mentored along the way. But the bedroom has not been included in this avenue of education. Not at home, not at school, not at church. Education in health class about sex has focused on preventing pregnancy and avoiding STDs. It rarely includes anything about sexual function or satisfaction let alone peak experiences.

Most often you have pieced together your education in sex with bits from your girlfriends, movies, tv, podcasts, porn, reddit, cosmopolitan magazine, and maybe a sister. Or maybe an experienced sexual partner? For some this has taken you to a very happy place and for others you are still waiting.

Hours of lesson are available in many communities and families on how to learn to ski, horseback ride, get a black belt, or watercolor. But hours are not spent learning how to touch or communicate with your partner, finding out which of their body parts are most sensitive, exploring what is meant by a peak of ecstasy, exploring how to move differently in bed, or even a small thing like how often you are going to talk during sex. Experienced people are not personally sharing with the inexperienced what they have found that works. Mothers are not sharing with daughters tips on what to do when your arousal is going down instead of up.

So don’t be down on yourself if you have been sleeping together a long time and can’t count on having high states of excitement and pleasure. You have never been taught how. Don’t be down on your partner either. Most likely he or she has learned about sex in bits as you have. The people I see, both men and women, genuinely desire to please their partner but they don’t know how to do it. This lack of education often leads to a woman being bored or frustrated and then not wanting to be available in the bedroom. Potentially great lovers don’t become the great lovers they could be as no one has showed them how.

You can change things. I have seen it with my own eyes. You start by knowing that there are things to learn and on that list is your own body and the places on it and in it that are designed to get you highly aroused. As you begin to initiate a change — reframe your stance from disappointed or frustrated to curious. Get highly curious! And then you can explore. Yes, you can start by talking to a person who enjoys sex. It can be a friend or family member. You start with general questions and then lead onto specifics. It is breaking a social standard to even ask — so approach respectfully.

​You can also go online. Below there are three terrific online resources with candid views that can add to women’s sexual experiences. And before you jump down to those links I want to say this very important thing:

If sex is painful or if you have ongoing vaginal dryness (at any age) or if you are terribly uncomfortable with sex, do go see a professional with your concern. Dryness can be resolved in weeks. And pain is resolvable. It isn’t just menopausal women who have dryness and pain — 10%of young women on birth control pills will have dryness as a side effect, that dryness causes muscles to contract and intercourse to become unbearable and can result in years of heartbreaking problems in those beginning relationships. If you have pain don’t wait — this pain rarely goes away on its own. There is a reason for it and it can be solved.

The Links:

A straightforward friendly seven-minute video from Laura Berman, Phd about the anatomy of the clitoris.
Laura Berman – Clitoral Anatomy

A six-minute aesthetically done video about the anatomy of female arousal and orgasm.
Arousal and Orgasm anatomy

A potentially multi-hour explicit educational experience that can be viewed in small bits. It is a nonprofit joint venture initially between Indiana University and the Kinsey Institute which breaks through many barriers of the silence around sexual information for women. Watch the many explicit videos, animations and how-to’s –alone and with your partner.
It will cost you around $100 total to get into both of the two main sections. It is a onetime fee for those two sections and it is well worth those dollars.

The magic and power of the bedroom is often right in front of us waiting to be awakened. Yet we can miss it, miss the fantastic rewards and the many wonderful states of being that sex offers. This can happen even when we are with a partner that we treasure. Start here with the above basics and you may learn a key piece you didn’t know you were missing.

Feel free to share this newsletter with your friends

Valentine’s Day is a holiday that celebrates romantic love. It is a day for lovers. So this Valentine’s give yourself a treat and start early to remind yourself that you are a sensual creature. One of the most powerful things you can do to do this is to bring your attention home to yourself and to your own bodily senses. This can be counterintuitive in this busy world of ours, where our attention is pulled to the next crazy headline, or the next problem to be solved. Yet moving our attention is a power we have, and when you move it to your own body and to what you are physically or energetically sensing you can create valentine magic. 

In our world of seeing faces over Zoom, or across café tables, we forget about our own power center, or the place where ‘chi’ abides, as martial arts call it. We put our attention elsewhere. That does not help us when we go into the bedroom and somehow can’t get our attention on ourselves and our genitals.

 Who reminds you that you are a sensual being? Who lets you know that your body is not just a tool to get tasks accomplished, but is a source of pleasure? Your partner may remind you, with touches or words, what this holiday celebrates. That can happen in an instant with the right contact. That right touch can instantly rally your awareness to your skin or your vagina. Yet if our attention isn’t where the touch is, or if the touch isn’t compelling enough to get us there, we won’t succeed in getting turned on. Disappointment or frustration sets in. It doesn’t have to be all on your partner to get you there. You can independently get yourself cued up to remember this lovely capacity to feel pleasure. 

Who reminds you that you are a sensual being? Who lets you know that your body is not just a tool to get tasks accomplished, but is a source of pleasure?

To do this tune into what you feel, not what you think, or what you are planning. Feeling can feel like a letting go and a dropping in and down. Your circling thoughts quiet down. You may feel less ‘smart’ but you will feel more ‘you’. You then register your skin sensations, register your breathe going in and out, and for this holiday in particular I would drop your attention into your pelvis and register what it is feeling.  

The female pelvis is so central to the world that it should have its own holiday, probably named after a female, rather than St.Valentine. Until then I personally celebrate the female pelvis on Valentine’s Day. So let’s get ready for an erotic time on Valentine’s Day, a day where touch can take you to new states of being, ones that can feel delicious. Here are three steps to get your awareness more in your pelvis. Between now and next Monday the 14th, try these three things every day:

1.Greet your pelvis during the day by doing a subtle pelvic tilt. This can be done so subtly that no one around you notices. A pelvic tilt is when your pubic bone tilts up as if it wants to go towards your nose. Your lower back will move back when this happens. Repeat it five or six times each time you do it, and do it five to ten times per day. When you scoop the pubic bone up you activate your abs, and your body awareness drops down. There is a link to a video that shows a pelvic tilt when lying down, click on ‘pelvic tilt’ above. You can adapt that motion to standing or sitting. If you move half as much as the video shows you will still get your awareness to drop. 

2.Right before you enter a room or a new Zoom meeting let your awareness settle into your pelvis. To do this move your awareness down from your thoughts or down from the level of your head into your pelvis. You can do a few pelvic tilts to help descend. When you feel it drop down – then enter the room. In your mind’s eye let your pelvis walk into the room first before your thoughts and mind enter.  

3. During the day, when you go out to eat or prepare a meal, ask your pelvis what she wants to order or make. Listen for the answer. Even if you don’t get an answer, be curious. It isn’t the answer that is important, it is the placing of our awareness there that is the key. 

Your body center is also a place where unfelt feelings get layered in. When your awareness moves in to feel sexual pleasure it can also feel the other things stored there. It can be hard to feel pleasure if you have to first feel how pissed off you are, or feel the disappointment of not being seen or heard by the one you love. Naming the feelings and feeling them fully is a ticket to them being released.

In my experience working in the energetics of relationships, particularly my training in Sente Energetics, unexpressed feelings in body center get in the way of being available to what the moment is offering. One doesn’t have to necessarily fix a problem around the feelings for the past feeling to be felt and released. Name the feeling and give yourself space to feel it fully. Is it resentment? Feel it, even if it is toward your partner, the one you will spend Valentine’s with. Feel it fully. Don’t be afraid to go into it.  

If you do have a cringe about inhabiting your pelvis with your awareness, proceed gently and be tender with yourself as you explore. If you have had physical or sexual trauma, and the feelings that come up are too big or overwhelming, then inhabiting your pelvis can be a bigger project and one you may want a therapist to be with you as you explore. For many women keeping attention up with our thoughts is a habit, robustly supported by our culture. You will find you can change this habit with practice. Not only will you feel more personally aligned, you will have more fun, and have the potential for more profound states of being during sex.   

PS: And on Valentine’s Day as you move into whatever sexual or sensual encounter you may have, let go of your identities that get in the way of pleasure. You want to let go of the capable you. The one that get things done quickly. Let go of the mother you. Let go of the do-er you, no matter how effective that do-er is. Let go of the responsible you. Let yourself enter a space where time does not exist. Relate to the lover in you. The one who loves to touch skin and feel warmth. The one who is excited to be turned on. 

We arrived in bed, arms around each other and legs entangled. I was thinking about sex and thinking we would make love. My husband then said something, in an almost lamenting voice, asking why he was the one that always initiated sex. His voice wasn’t a total whine, and maybe not even a whine, but it was definitely a lament.

I was taken aback by it. He had never voiced that before, ever once in 20 years, and it startled me. I knew this to be an almost universal complaint of men, at least stereotypically, and it had never applied to me. And on top of that I thought it just wasn’t true. I could remember the last two weeks and the three times we had had sex; I had been the one that initiated things each time. I had given him an inviting wink, or an extra-long suggestive kiss. In that moment I was truly confident that it had been me that started things the last few times, and indignant that he was saying he always did.

I started to protest. To point out why this was untrue. I began to recount the details that would counter his conclusion. He wasn’t always the one that initiated it – ‘let’s set the record straight.’ 

As my mouth started the protest, my mind skimmed forward to what would or could unfold in the next ten minutes. There would be a back-and-forth discussion of what each of us thought had happened. I would listen to him, and he would listen to me. Chances are we would actually hear each other. There was a small chance we would be triggered and emotions flare, but probably not. It wasn’t a horrible way to spend ten minutes, but it wasn’t what I wanted. At the end it looked like we had understanding, but there wasn’t much juice in that view. We certainly weren’t having sex. Going that route looked flat to me in comparison to where I’d wanted to go. 

The aha came to me in a flash… We could go in a different direction.

The aha came to me in a flash. Underneath his lament was his desire to have sex. He liked sex. The invitation to debate the truth and set the record straight was not the direction I actually wanted to go and in that flash I knew it wasn’t his either. We could go in a different direction. 

I stopped talking and reached for him. I kissed his lips with passion and made a sound that indicated pleasure. We skipped the conversation and went toward what we wanted more. In that moment I made a choice to go in the direction of sex. I did not go in the direction of deciding who was right. I also didn’t go in the direction of understanding more about the psyche of my husband. I chose sexual union with my partner. I jumped tracks – from being on a train running in one direction I leapt onto a line that was obviously going to a different destination.  

It has been 5 to 6 years since that experience and the aha of going towards what I want stays with me. I share it with you so that if you are in a moment that is going in a direction that feels automatic and natural to you, and yet it is not taking you any closer to what you actually want, you can jump. Jump off that line and onto a line that takes you to what the core part of you desires.  

What women truly desire has yet to be taken seriously in this world – let’s make sure we, ourselves, take what we want seriously.

Michelle was a 43-year-old woman in my last bedroom class series before Covid began.  She stood out as she was open with her thinking and she shared her inner experience more than the other women in the class.  She also got my attention as her obstacle to having a good time in the bedroom was her thoughts, the ones in her head about herself. 

She said sex wasn’t happening that often in her house, and she said it was mostly due to her. She said no to sex a lot – mostly because she didn’t want to be seen naked.  She said that her husband reassured her that she was sexy, and that he desired her, and she just couldn’t buy it.  She had gained 20 lbs since they had married 18 years earlier, and she didn’t like the way she looked. She couldn’t see how her husband could find her attractive, because she didn’t see herself that way. And she didn’t feel attractive.  

I looked at her and thought I was probably seeing what her husband saw.  Long dark hair, dark eyes, expressive voice. There was a luscious appeal about her and she brought a wash of the feminine into the room with her. She wasn’t lean, and her hips looked as if they had taken on those extra pounds. She was attractive. 

I didn’t know Michelle’s husband, but I could imagine him watching her as he walked behind her, watching her hips undulate in front of him.  She had the feminine mystique going on.  It wasn’t about her shape or her weight. Maybe a bit about her shape in that there were curves, but more it was how she inhabited her hips and her body. She was in her hips, there was motion and aliveness there, and I imagined he wanted to get in there with her.  

Michelle did not recognize her own beauty nor the power that her feminine nature had in attracting her husband. She was locked onto what she thought she should look like. You could say the twenty extra pounds were probably irrelevant to how attractive she was to her husband, yet her thinking about it created an obstacle for them getting closer.  

I have heard hundreds of women’s stories, and I know that how attractive you actually are by society standards is not a determinant of how excited or pleased you are in the bedroom. Nor does your own value judgment of your looks necessarily limit your pleasure. 

And I also know that many women feel more beautiful after a good romp in the hay than before, even if they felt down or PMS-y before they had sex.  

Why would any woman not move towards pleasure and intimacy, or at least go in that direction, rather than stay with her negative thoughts about herself and not connect? In the big view of what would please a woman It doesn’t add up.  

In that moment I decided to challenge her thoughts. I gave her another view to consider. It was more like her husband’s view. I let her know my honest, gut-level experience of her presence. I told her that she most definitely is an attractive woman with a strong feminine nature, her femininity was obvious.  The extra twenty pounds did not take her attractiveness away. she would draw people with male energy like a magnet.  Her own thoughts were inhibiting her, and they were not telling her the truth about herself.  On top of misrepresenting her, they were keeping her from the closeness and pleasure that sex had to offer her. Perhaps she should listen to others on this one, and not listen to her own critical thoughts. 

And if she were going to use her thoughts at all in her desire to have more sexual desire, she could put them to work for her and think sex-friendly and erotic thoughts. She could remember the last time she felt highly turned on and replay her physical sensations of that moment. Or she could recall the feeling of her partner’s skin on hers. 

She took that in, and the class moved on to other disclosures and discussions of low desire and what to do about it. 

Two weeks later we met for the third and final class. Michelle said that she and her husband had begun to flirt, and to tease back and forth.  It was fun for her. It was enlivening. Their energy was like when they were first dating. To me this was a big motion – bigger than it looks. Flirting is an announcement that you are a sexually awake person, who is willing to engage with your own sexuality and your partner’s. It signals you are available to connect.  And flirting has promise in it, promise that something sexual is going to happen at some future time. 

In an ongoing relationship, flirting is especially poignant and necessary. Flirting reminds you to see your mate as a romantic possibility, a lover, not as the mother, the nurse, or the plumber, or any other identity he/she happens to be in that day. 

That class ended and I haven’t seen Michelle again. I don’t know if she still doesn’t want to be seen naked.  I suspect that she moved past her inhibiting thoughts as she had been moving in the direction of getting sexually closer to her mate through flirting.  Michelle was going in the right direction for a woman that wants to increase her desire for sex.

There can be many obstacles that a woman may have to navigate through to feel and own her desire for sex. Many. And there are many resources to help you get around those obstacles. Each woman is uniquely herself, so there are many, many paths of activation, and they can be personal to you. 

In general, the question to ask yourself is, “Are you moving in the right direction?” And how do you know? Here are the three questions I suggest you ask yourself to check that out:

1. Are you doing what brings YOU pleasure? Are you liking what you are doing? Does it feel really good? Is it fun for you? Is your whole being engaged?

2. Is what you are choosing to do moving you closer to your partner or further away? (You want closer.)

3. And finally, are you going in the direction of what is erotic?  

Once you get started going in the direction of YES to SEX, one choice builds on another, which gives something back to you, which encourages you to keep going in that direction. 

The erotic is what turns you on, delights your senses, in a way that makes you exquistely glad you are alive. You don’t choose what the is erotic for you, you discover it by feeling it activate your right buttons. You discover the erotic by happy accident or by experimenting. If you are tired of waiting for a happy accident, try experimenting. For a fresh and fabulous cut at what the erotic is click here to read Esther Perel’s article on the topic.

If you’re looking for more on how to create a marvelous sex life, check out Fanning the Female Flame for a more in depth exploration.

The short answer: More than I thought. 

Many of the women I see in my office tell me about their therapeutic use of marijuana. They take it to lessen their body pain, to get to sleep and to feel less anxious. We list it in their chart on their list of medications.  When doing this I never thought to ask them about what it did for their sex lives. Not once. Not having used pot since we used to sneak it into the dorms, I didn’t know it did anything specific for sex. Sitting here compiling what I have learned this year I feel like a girl late to the party. There is more promise here than I ever expected.

The biggest piece to me is that THC, in some doses, can be a vasodilator. In the world of sexual medicine that is big news. The category of vasodilator includes Viagra, and Levitra.  It also includes the ‘scream creams’, which are topical arousal aids.   Getting more blood in the genitals is what those of us in sexual medicine want to see happen for women.  We want woman to have enough blood flow that she feels turned on and excited (and we want her to be turned on and excited enough that it triggers good blood flow).  The vascular areas around the clitoris, that encircle the urethra, and are adjacent to the legs of the clitoris are designed to engorge with blood. Dilating blood vessels is a very good thing for women and sex.

This vasodilation effect could explain why research shows that female orgasms can be more intense or prolonged with marijuana use. The most recent study, published in Journal of Sexual Medicine last year, was a survey done at an OB/GYN practice.  It was voluntarily completed by 373 women.  127 of those women reported having used cannabis before having sex.  Women who reported using marijuana regularly before sex had a 2.1 times higher odds of reporting satisfactory orgasms than those who didn’t use it regularly. That is big news from this botanical. 

There are multiple other studies on cannabis with reports of prolonged orgasm or more intense orgasm.  There are also reports of heightened skin sensations, increases in sexual desire, and reports of a slowing of the perception of time so that pleasure feels prolonged. Reduced desire is reported too, mostly linked with higher doses and heavier use. 

Each of our bodies has cannabinoid receptor sites spread throughout it. This was ‘discovered’ in the 1990’s when the first receptors CB1 and CB2 were identified.  Historically it has been very difficult to get a license to legally research our innate cannabinoid system or our body’s reaction to the cannabis that we ingest. This has made data limited. All the survey results noted above are based on individuals self-reporting.  This is valuable info, and it is not the same as giving a woman a certain amount of THC and/or CBD and documenting her experience and measuring her actual hormone or neurotransmitter levels. 

Animal studies have been done with precise amounts of drugs, and changes in behavior and the physiology has been recorded. In these studies scientists have discovered what many humans have personally experienced for years — that the cannabis we smoke or ingest, interacts with our hormones and our neurotransmitters. 

One sex positive finding from the animal studies is that intermittent or light use of cannabis can cause the release of dopamine, the feel good neurotransmitter, aka the neurotransmitter of pleasure.  This finding, like the vasodilation finding, hits at the heart of drugs currently used in sexual medicine to optimize sexual experiences.  Wellbutrin, an antidepressant which increases dopamine, has been prescribed for years to augment sexual satisfaction.  This drug is used either alone or is prescribed to counterbalance the unfriendly sexual side effects that can come with raised serotonin levels from SSRI anti-depressants. And ADDYI, the first ever libido drug for women approved in 2015 works in part because it raises dopamine levels.  

The endocannabinoids (cannabinoids we naturally produce in our body) also interact with our hormones (testosterone, estrogen and progesterone), as well as our neurotransmitters. Receptor sites for this innate ECS (Endocannabinoid system) are widespread and include our central nervous system.

Of the 80 different compounds in the cannabis plant THC and CBD are the two well-known ones and they are the most researched overall.  In terms of sexual effects THC is more researched than CBD.  Other cannabinoids, CBDA, THCA, CBN, CBDV… are mysteries yet to be investigated. 

Cannabinodiol, the compound in cannabis called CBD, has promise for the anxious woman, or the woman with too many things on her plate. Women I see often have too much going on in their lives and no true down time.  They juggle roles and tasks from sunup until they hit the bed– where their pillow often looks better than their partner.  Small daily deadlines have been shown to be as detrimental to a woman’s arousal and orgasm capacities as major stresses such as a death or divorce. For many females it is go go go day after day. CBD products may be one of many answers to help her let go of her day and yield to receiving pleasure in the bedroom. 

Not getting turned on in bed for many women is a disappointing and frustrating experience. 

We need many diverse approaches to changing that fact. I could go on and on about why I think it is vital that we do that for her health and the health of the world. And we want to be intelligent about how we do change it. There are a lot of interesting positives here about cannabis and sex and they do not wipe out the potential negatives. 

Marijuana use has known sinkholes. Concerns about its use are real. The serious concerns come mostly with its overuse.  You probably know these already: Marijuana is dangerous to the forming brain of the teenager and young adult.  There can be brain changes and loss of IQ points that do not reverse.  It can be harmful to the pregnant and breastfeeding woman and baby. You want to keep cannabis away from these groups.  

 Heavy use can affect you sexually in ways you won’t like, for instance it can lower your dopamine levels, decrease your sexual desire, and mute your overall personal motivation. Being constantly stoned can decrease your emotional connection with everyone including your partner. It can slow down your physical movements and coordination, creating accidents.  Marijuana is substantially less dangerous than alcohol and it is still dangerous to be high and drive.  

My friend calls the last two paragraphs my CYA section, and in a sense she is right. I don’t want you to get in any trouble when you experiment.  I want you to talk to those who have experience using, and to remember that there is more THC in the strains out there than there was in the 80’s. Three wise friends of mine have separately ended up in our local ER after using. 

Their stories are funny now, my husband and I roared with them in the retelling. Yet when it was happening our friends were highly uncomfortable and frightened and one felt terribly embarrassed. 

So far our FDA has approved four drugs made from the cannabis plant. Three are synthetically made drugs for the nausea related to chemotherapy, and for neuropathic pain, and in 2018 they approved one RX from naturally extracted cannabis for seizures.  More approved drugs are on the way, and I expect later in the pipeline some will be specific for female sexuality.

Right now, available for use, there are prepackaged OTC products, like AROUSE. These specify the amount of THC and CBD. These are vaping products designed for sexual pleasure.  They are not FDA approved. Your neighborhood dispensary may have a wide variety of other similar products.  

I find it wryly amusing that this botanical we snuck around smoking actually matches up with a system we already had in our body.  And the purpose of this innate system is thought to promote homeostasis, i.e. internal balance.  How wrong can that be? It brings up the question of what else we don’t know about the internal workings of our bodies and what we don’t know yet about the cannabis plant.

I want you to be safe, and I also want you to have the best time possible.  

So be smart and have fun exploring your erotic options. There is a lot of treasure (and pleasure) to be found in doing so.  


For those of you interested in more detail re research here are two links. 

This link is to a review article from the Journal of Sexual Medicine listing all the qualified research on marijuana use and female sexual health.  There are 12 human studies and 8 animal studies, with a summary of each study.  Link:

This link is to an FDA teleconference.  Our FDA is, and I quote, “actively exploring potential regulatory pathways for the lawful marketing of appropriate cannabis products.” On November 19, 2020 the FDA convened experts to discuss effects of marijuana use on women as differentiated from the effects on men.  The Conference title: “CBD and other Cannabinoids:  Sex and Gender differences in Use and Responses”.  This link gives you an overview of what the FDA botanical review team is up to. It includes national and international experts and the FDA’s Directors.  The keynote speaker is on from minute 11 to minute 27.  After that there are multiple experts speaking that include research on pain, anxiety, pregnancy, breast feeding and more. The entire conference is five hours long. I was impressed by their commitment to cannabis research. 

Living with a mate who wants more sex than you do can become a high-pressure situation with no apparent right answer. You don’t want to say no again; you are tired of saying no. You are tired of that defensive role, of feeling like a stingy female metering out the goodies. Yet you don’t want to have sex when you’re not into it. So either you are the stingy woman who won’t have sex or you are the woman having sex who is not into it. Neither choice is an empowering one for you. 

Let’s visit the story of Sofia and Nathan. Nathan wanted sex once a day or more. Sofia did not. Sofia was trying to figure out the level of her own desire, without Nathan’s influence. The greatest help for Sofia in finding her desire, she said, was acquiring the skill to say no to sex clearly and with confidence. Once she was able to tell Nathan no without feeling guilty or yielding to pressure, it helped her find her yes. Sofia learned that men could accept a no. She found she was able to say no and it did not end their relationship. 

“He could take it,” she said. His yearning for her did not go away, and he did not go away. Sofia saying ‘no’ clearly was relaxing for them both. Neither one had to wallow in the indecisiveness of a wavering, fuzzy choice. Before, she had feared that if she said no, he would think she was not interested in him, or think that she was not a sexual person. She had figured that saying no would be awkward or difficult. Turned out It wasn’t. Sofia says it has been the opposite. Saying no directly instead of skirting around the issue is “way more positive” for her. 

Saying no, Sofia found, added to her ability to say yes. When she felt a clear yes, she could give herself over to the moment completely. She and Nathan then had sexual experiences that she treasured. Finding her yes grew when she learned to say no with confidence. 

How to Say No

Be direct and clear. And when you say no keep your sexiness alive. Just because sex is a no for you in one moment, there’s no need to dial down your sexuality. You are an alive and vibrant being. It is you, a dynamic woman who is saying not now. You do not have to take on the persona of a matronly, uptight, or apologetic female because you are saying no. You can say no, not now, with your eyes sparkling. You also don’t need to undress in the closet hoping to avoid turning your partner on. If it is not the moment to be sexual, communicate that. 

Saying ‘no’ is a sensitive declaration. It can be destructive if your partner has resentment about your lack of availability for sex. Couples with different levels of desire for sex are in the opposite of a win-win situation; it is extremely painful and disempowering for both. Be respectful of your partner and their feelings of frustration or powerlessness. If resentment is pervasive get professional help in sorting this out. Often there are other dynamics in play behind a partners lack of interest that don’t have to do with sex itself.

If you are the partner with lower desire, and you are saying no, there are ways to stay closer as you say no. One of the ways is this: when you do say no to sex, you can add a promise of a future yes at that same time, and mean it. For example: 

I have to go work. Come shower with me now and we can play tonight. 

No sex now, but looking forward to Saturday morning. 

Alert: Be sure if you actually make a promise to have sex, that you keep that promise. Sex is so centrally important for some men and women it is not a promise you want to break. 

Empower your communication around YES and NO

In June 2016 there was a headline in The Wall Street Journal, “Women May Be More Interested in Sex Than You Think.” Curious, I read on. It was a discussion of research that had just been published on how difficult it is to perceive accurately whether your partner wants to have sex. The study subjects were all couples in long-term heterosexual relationships. Women predicted accurately their partners’ interest in sex, and men missed women’s interest one third of the time. Multiple theories were put forward to account for this misperception, all interesting and intelligent. Some of the discussion was that the women’s indication that she was a yes for sex was communicated so indirectly that it was not interpreted as a yes by their partner. What I took away from this research is the importance of sending sexual signals to your partner that he or she won’t miss and also won’t misinterpret. If you have a yes for sex, are you sure your signal was received as a yes?

There are times when a woman would actually like to have sex yet she is too tired or distracted to say yes. Her perception is that she is so tired or distracted that she wouldn’t get into the sex — so rather than have a frustrating sexual experience she says no. If you would like to have a wonderful romp with your partner, yet you are afraid that wouldn’t happen, I would encourage you to do one thing differently. I would encourage you to be honest and disclose the whole story. Saying your whole truth could be something like “Yes–I would love to have fun with you in the bedroom, but I am so tired (or worried, or wound up) it doesn’t seem in the realm of possibility that I could have a good time.” I have seen partners successfully meet this challenge. They see where you are at, often sympathize, and surprisingly move you to a better place. You don’t need to fake enthusiasm that you don’t have, or pretend like the worry you carry doesn’t exist. You can bring all of you into the moment and potentially be met by a caring, loving and respectful partner. Admitting you are afraid that you won’t get aroused can add to your arousal. Great sex can come out of moments like this. Sex with tenderness and vulnerability has power. Underneath your worry can be a heck of a lot of vitality and sexual appetite.

When I work with a woman to find her libido, I take it for granted that she has a ‘sexual self’. By sexual self I mean the part of her that desires to feel sensual erotic touch. She has a part that wants to be taken to an exciting edge and takes pleasure in falling off that edge into a good feeling. I assume she has an aspect that wants to powerfully engage with her partner, to melt and merge, and enjoy letting her boundaries go. Even if her sexuality isn’t active at the moment, I assume that she is hungry for these experiences and that in some way her desire for this is part of what propels her into my office wanting more from sex than what she is getting.

This is an assumption I hold, and like other beliefs I have it is not true for every woman I see. This belief about women gets bumped down and knocked out of place, and I feel the bump. It comes when she says “I came here for my husband” or “I am here for my marriage”. “ I, myself, don’t actually care if I have sex again, ever”.When I hear those lines, and I do, I think she can’t truly mean what she is saying. That can’t really be true. 

Her sexual self must have gotten lost in the woods. She must have an over-abundance of roles and responsibilities and she somehow can’t make time for pleasure. Or maybe sex is so frustrating of an experience and she is so tired of feeling frustrated that she is finished with sex. Maybe sex hurts. She couldn’t mean that she is actually tired of feeling sensual erotic touch. She couldn’t mean that she doesn’t want to be taken to an exciting edge and fall off into an exquisite feeling. She must have forgotten. Or she doesn’t know yet what is possible. Maybe there has never been an exciting edge for her, or an exquisite feeling.

And so, the search for her desire begins. It is like a stakeout where the surveillance is agreed upon. Was she ever excited for sex? If so, when was that? When did it disappear? Did it leave quickly, following surgery, or so gradually she didn’t notice it was missing. Was she with someone when it left, or was she alone? Has she looked for it before? If so, where?

Occasionally this mission ends on the first day, usually it lasts longer. Women can be complicated. They are multi-layered beings with many aspects, some quite deep and awe-inspiring. Female sexuality is not a one-hormone show. It can be intruded upon by hormone cycles, medications, relationship issues, illnesses, fatigue, unhealed sexual trauma, and lack of understanding. Any woman I see can be home schooling two kids, volunteering at church, and may be helping her parents in assisted living. She can be working 60+ hours/week as an attorney, have significant PMS and hormonal issues, and be on anti-depressants. She may be angry with her spouse for his business that failed, but trying not to be angry, and keeping her smile on for the family around the dinner table. 

When I look at a woman, I am looking at a complex being with many competing elements. Her sex life is “just” one thing that wants her attention and there are so, so many other things.  I cannot look at her sex life without seeing all the other things that compete with it.

And she, she has to find her sexual self, amidst all her others selves. Find it and give that aspect enough oxygen that it has a pulse of its own. A pulse that reminds her of the excitement and deliciousness of feeling sensually alive.
Too often the mother in her, or the nurse, or the problem solver, or the gardener outweighs the lover. These other aspects dominate her day, and define who she is to herself and to her family and friends. The lover in her may only get twenty minutes of floor time a few times a week. Hard to keep a handle on the part of yourself that you pull up so infrequently.

My personal preference is to keep the lover identity activated in all your roles — as mother, a nurse, teacher and even when you are gardening. You are an alive sexual, feminine being, why are you ever turning that off? Bring your lover with you to work. Bring her to the dentist. You aren’t going to sleep with your co-worker because you are an awake, vibrant, sensual being. You won’t lose your discretion when you claim your sexual self. In your every day world you can keep the aspects of you that you value alive. 

And absolutely don’t let your partner forget who you are. Remind him or her every day, in many ways. And, it’s important to know, there is a difference between what you show the world and what you show your partner, an important difference.

When you are an alive, vibrant, sensual being – you are not promising to have sex with someone, you are being yourself. When you flirt, lift your skirt to show some leg, wink suggestively, or wiggle your hips you are communicating the promise of something more. If you are doing this with a safe, healthy, available partner you can have a great deal of fun engaging these aspects of yourselves. If you are doing this at your workplace or by a construction site, it isn’t appropriate. It can be unsafe too, as your action can be interpreted as a promise for more, a promise that you don’t mean or intend to fulfill. So keep your sensual aspects alive during your day. You can do it cleanly, and transmit to the world and most importantly, to your partner that you are a female that enjoys her sexuality.  

Bottom line:   I am sticking to my assumption that women have sexual selves — aspects of themselves that enjoy sex and sexuality. These selves can be recovered if missing, and they can be enhanced if they need more oxygen. I am currently in the retrieval business, I’m your advocate. 

Look at this list and count how many you have:

Insomnia/restless sleep ~ heavy periods ~ menstrual cramps ~ irregular periods ~ vaginal dryness or burning ~ hot flashes ~ night sweats or unexplained sweating during the day ~ decreased vaginal or clitoral sensations ~ no interest or a decreased interest in sex ~ anxiety ~ irritability about little things ~ short fuse ~ anger ~ rage ~ mood swings – up and/or down ~ PMS ~ poor concentration ~ decrease in memory ~ depression ~ lower optimism ~ fatigue ~ dry skin or decreased skin tone ~ migraine headaches ~ urinary frequency ~ discomfort and/or incontinence ~ weight gain or unexplainable weight loss ~ and presence of uterine fibroids

More than three?  See your medical provider and ask for the tests at the bottom of this page.  If your provider is not familiar with these tests, find one that is.

There is help available for these symptoms. 

Heavy periods, PMS for the week before your period, or irritability that lasts all month long, vaginal dryness, hot flashes, menstrual cramps are all common complaints and for that reason you could call them normal, but they aren’t desirable.  They indicate an imbalance. There are simple and effective and safe answers to counterbalance these symptoms. 

Blood Tests that are often included in the first evaluation for hormonal issues:

  • Serum Estradiol (Estradiol and Progesterone are often drawn in the luteal phase of menstrual cycle if your are still menstruating.  If you are post-menopausal or on hormonal contraceptives labs can be drawn anytime of the month.  If you have a 28 or 30 day cycle, draw on day 20 or 21 of cycle. The first day of your period is counted as day one.)
  • Serum Progesterone
  • Free Testosterone
  • Total Testosterone
  • SHBG (sex hormone binding globulin)
  • DHEA-S
  • TSH Thyroid stimulating Hormone
  • Free T4
  • Free T3
  • Vitamin D (25-Hydroxy Vitamin D) Of note, Vitamin D would be classified as a hormone if discovered today due to its hormonal like actions in the body)
  • Ferritin (Iron stores)

If you’re a capable woman accustomed to getting things done it can be frustrating when things work differently in the bedroom. Many women with high levels of responsibility struggle to shut down their internal dialogue. They don’t become absorbed in the sex that they are having because their attention is busy elsewhere.

It’s wonderful to be a goal oriented, successful woman, and yet when you approach sex that way you are missing the point and the pleasure. Sex is not about getting the job done or doing things ‘right’ — so forget about getting somewhere. It’s not about you DOING anything (for once), but rather an opportunity for you to feel, not to do. Turn off your thinking mind and feel. Receive pleasure, feel pleasure, and let it take you to new places.

In the middle of having sex, if your thoughts are too busy, you can pause them. It is possible. You can take your attention away from those non-sexual thoughts and focus your attention on what you are physically feeling in your body. If you do this you will have a far more exciting and captivating experience. It may not be easy at first to keep your attention on your sensations or in the current moment, yet it is so worth your effort. It makes a huge difference. In your mind you may be wondering if you are going to have an orgasm, or you may be fretting about your body being seen… the list of what you could be thinking can go on and on. When your body is joined with your partner’s, yet your mental focus is miles away from the action, the sensations of heightened arousal and of merging and timelessness don’t happen for you. Magical moments don’t occur when you yourself are split apart like that, they occur when both your body and mind are present and in the same space with your partner.

You want to be activated with exciting thoughts that override the inhibiting ones.

Erotic thoughts can be helpful in getting you turned on — it is the mundane and distracting ones that don’t support a good time. When you’re having trouble leaving the mundane or even negative thoughts behind you there is one thing on your to-do list and that is: take your attention away from your mind and put it in your body. Think of your own attention as a thing that you can move around, and then move it around. Take your attention away from your thoughts and put it where the action is. Put it inside your vagina and on your clitoris. Put it on your skin and on your breasts. Register what you feel. Register the skin sensations, the smells, the visuals. If you find your attention wandering away from the action, invite or pull it back to your body again. You will immediately feel more arousal or sexual tension when you do this. It is surprising how quickly your arousal will increase when your attention is on the sensations you are feeling and not with your circling thoughts.

If you want support to keep your attention on your body’s sensations, download my audio exercise and use that to help change your attention habit. It is available here: click here.

Two arousal speeds exist in your bedroom, yours and your partner’s. Most of the time you both want to end up highly turned on. In my practice 90% of the time it is the woman’s arousal that is lagging behind the man’s. He gets aroused faster and he and she are trying to get her to catch up. If you want to be aroused more fully, keep your focus on your own body and your physical feelings of pleasure. Even if you are doing actions that increase your partner’s arousal — keep your attention registering your own body’s sensations of pleasure.

This mind-body connection is crucial to have bedroom experiences that rock your world.

Many of the women I see in my office want a “natural” treatment for their sex life. They don’t want a prescribed medication if they can get their libido back in some other way. Many experiment with trying over-the-counter herbs fully aware that there may be more hype about love potions than actual fact, and hopeful that there is some truth to the marketing.

In this blog post I point to the medical research that has been done on the over-the-counter products that are out there now; these products are available to everyone, and yet they are not safe for everyone to use. The comments below outline for you what is known about these products from medical research.

The info comes from a 2015 review presented in Journal of Sexual Medicine. The review was done to answer the same question: Was there was any evidence to support all the claims of sexual wonder?  It turns out that fenugreek, Korean red ginseng, maca, L-arginine and tribulus terrestris are plant products that did show supporting evidence, even if the evidence was limited in scope. I have included a few details from this review of research below.

Fenugreek: Fenugreek is an herb, often used in Ayurvedic medicine, which contains building blocks used to create estrogen and testosterone. A 2015 study showed that fenugreek improved arousal, lubrication, and satisfaction in premenopausal women. There were minor intestinal side effects. The dose used in the study was 300 mg twice a day. Fenugreek should not be used by people taking blood-thinning medication (anticoagulants), or by women with hormonally active cancers.

Maca: Maca is a root vegetable from Peru and has long been used for fertility in the Andean culture. Three out of four of the random clinical trials mentioned in this review did show positive effects on sexuality. Study doses ranged from 1.5 to 3 grams of maca a day. Its mechanism of action is not fully understood. It is known to not alter estrogen and testosterone levels as fenugreek does. It does contain phytoestrogens, plant-based compounds that can inhabit the estrogen receptors in your body. This can be a good thing or a bad thing depending on who you are, your hormonal status, whether you have cancer, the medications you are on, and many other factors that researchers are currently trying to decipher. Maca is well tolerated. We do not yet have data on what doses are optimal or safe for women to take.

Ginseng: Korean red ginseng is an herb that has been shown in one double-blind study to heighten arousal in menopausal women. It works by encouraging the release of nitric oxide, which improves blood flow in the clitoris and vaginal walls. (This is the same biochemical pathway that is augmented by Viagra, Cialis and similar medications.) Ginseng has been shown to be estrogenic, so it should be avoided by women with hormonally active cancers, and by women who have bleeding disorders or are on anticoagulant medications.

Tribulus Terrestris: This herb contains a compound which converts to DHEA. DHEA is a building block for your testosterone. This review found two randomized placebo-controlled studies that demonstrated improvement in female sexual function using this herb. The herb was well tolerated and sometimes caused minor intestinal side effects.

Horny Goat Weed (Traditional Chinese Medicine herb), Potency Wood (Brazilian herb), Damiana Leaf (extract from a Mexican shrub), and Gingko (tree used in Traditional Chinese Medicine) have promise, yet lack research. Yohimbine (parts from an African plant) is a strong aphrodisiac and its side effects can be life threatening, so it is not recommended for any over-the-counter use.

L-arginine, a common amino acid, is taken by many men and some women for a Viagra-like effect. It is a precursor to nitric oxide and nitric oxide causes blood vessels to dilate and fill with blood all over your body, including the clitoral and vaginal areas. There is significant evidence that L-arginine is helpful in producing firmer erections in men. Research on L-arginine by itself in women is lacking. There is a small double-blind study of 108 women that showed an increase in sexual desire and sexual satisfaction after taking the supplement ArginMax. This is a multi-ingredient supplement which has L-arginine in it, along with a variety of vitamins and herbs, some of which we have just mentioned: Korean Ginseng, Ginkgo, and Damiana Leaf.

Medicine, to date, hasn’t generated enough evidence-based data to establish guidelines for safe use of herbs over time, so we are left somewhat on our own. I say somewhat as there are naturopaths, herbalists, and nutritionists who are well educated in the potential of these plant products and have used them clinically for decades. Be careful in experimenting! Herbs are powerful products, and as you can see above, they can increase hormones in your body that can contribute to cancers and blood clots.