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Increasing your Arousal

When women get in bed with their partners and start the touch that leads to sex, they are often not yet physically turned on. They may be starting at a zero level of sexual arousal — or maybe a two or three — out of ten. Their partner may already be at 7 or 8. This is a big gap. The arousal that would be exciting and lead them to an interesting experience and an orgasm would be a nine or a ten. That is a big jump, and it is a jump that can stall out. Most of the women I talk to who aren’t getting turned on don’t know what works for them. Neither do their partners.  

A few years ago, a 33-year-old woman introduced herself in an evening class I taught by saying 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. Women want to be highly aroused, and yet they often don’t know what to do to get there. They keep hoping…sometimes for years. 

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

In my view the sex in 50 Shades of Grey is remarkable not for its S and M components but because it displays the benefits of having sex with someone who is well trained in sexual arousal. The level of training in and attention to arousal 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. He had practiced and experimented for hundreds of hours the best way to move a woman from a zero to a ten. He learned to identify increases in her heart rate, to know which pressure of touch got her there faster, to hear 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. 

In the bedroom your arousal is a very good thing. The more you are turned on, the more excited you feel, the more blood engorges your genitalia and the more fully you orgasm. Finding out what kind of stimulation gets you turned on can be the missing information.  

The first thing to know:   

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 try something new and then you notice what happens….  

No two women are just 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. Experiment. Find out what makes you tingly or hot and what makes you wet. In bed try a variety of touches and pressures, different positions, unique places and see how you respond. 

Be yourself, relax your mind, and feel your reactions. Feel them, don’t think about them, feel them. 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? Is it his sexual advances? Is it when he does something on the edge? What gets you sexually excited? Do you want touch on the sides of your clitoris, sweeping in and out, barely touching, or do you want pressure from the top down? 

Does romance arouse 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 their 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. One gets to be the Texas Ranger, and one the irresistible damsel in distress, or vice versa. As you experiment you may be surprised by what excites you. Make note of it. You may not choose to do everything that you find excites you. Some things may not be safe or desirable. You may want to do some of them. 

You can 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.  

For explicit well-done healthy education re how women get aroused go to www.OMGyes.com. The open talk and visuals on this site will expand your options. It also may give you the language needed to express what you want with your partner.  It will cost you to get in, but your sex life will benefit.  

Remember, if you don’t know yet what turns you on, it does not mean there is anything wrong with you!  You have not had the hours of education that Christian Grey had. 

PS And don’t take it personally if you have to tell your partner more than once.  Persist. When they see what awakens in you when you get fully excited, their memory (and enthusiasm) will improve. 

PPS I have been impressed with how many women say it is a “scary conversation” to talk to their partner about changing up what happens in the bedroom.  Yet if you keep doing the same motions and the same touches that haven’t worked before, you will keep having the same experience.  So being honest is part of having success…for more info on how to communicate with your partner about sex click here. 

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A Body Designed for Sexual Pleasure and Female Orgasm

There is quite a lot to celebrate about the female body and how it responds to and is geared for pleasure and female orgasm. It is quite marvelous. When arousal is triggered, cascades of events occur. Neurotransmitters release from a woman’s brain and she gets a nice tingly feeling in her genital tissue. Her nipples become firm, and the clitoris gets erect. Her vulva swells and the labia change from flesh or pink color to a dusky rose or purple. She feels sexually excited. The vaginal walls get suddenly wet. Her clitoris and the surrounding vascular tissue engorges with blood. Some muscles contract and her heart rate increases. Breathing is fast. There is a sense of tension.

On the outside of the vulva, women and their partners can see the glans of the clitoris, that external bump of tissue. This glans has the most nerve endings of any place on her body. This is similar to the head of a man’s penis which is thought to be the most sensitive part of the penis with the highest concentration of nerve endings. Both these glans are very sensitive to touch and they can be extremely so. Yet they are not the whole story of arousal and orgasm. Obvious on the male, yet hidden on the female are the shaft and the two internal legs. The legs of the clitoris are 5 to 7 centimeters in length. The shaft and the legs are what cause both the penis and the clitoris to swell when arousal happens. They become erect. Internal swelling in a female can be felt through the upper vaginal wall in the area we know as the G spot. When swelling is significant enough with stimulation there — orgasms occur.

There is also an area of the vaginal wall that is deeper inside, referred to as the A spot or the Deep spot. This spot, on the upper vaginal wall in front of the cervix, can feel wonderfully arousing. This deep spot is mediated by a different nerve and women report that it feels different than both an external clitoral or G-spot orgasm. Women report they like it being touched directly, with thrusting motion, and they also like it when touch moves across the surface of that area, like skimming the surface of a lake.

The only function of the clitoris and its 8,000 nerve endings is for a woman to experience pleasure, sexual pleasure. The clitoris does not secrete substances or hormones, it does not contribute directly to reproduction or urination, it does not support other processes in her body. It exists for your pleasure.

On top of this awesome genitalia there are the many other erogenous zones in your female body. Your lips, your breasts, your nipples and the skin at the nape of your neck or inner thigh are territories of sensual delight to be explored. Skin can be wonderfully erotic and is packed with nerve endings. Light feathery touch can be scintillating, exploration can be done with your lips, tongue, fingers. There are 2,500 nerve endings per square centimeter in your fingertips, for example, and a lot can be communicated with touch, especially touch that is intended to excite and arouse.

Look at the marvelous features of your  female body, and you can appreciate that the physical groundwork for exquisite pleasure has been pre­-established. Having this sensitive equipment does not mean women get easily aroused. Many don’t. One has to have arousal triggered for this cascade of events to  occur. What triggers arousal and leads to female orgasm is the million dollar question.  Arousal can start long before you get in the bedroom, or it can start in the bedroom. It can start with a look, a touch, a smell. If a woman’s arousal is heightened and sustained on enough of her multiple channels, she will have a great experience.  The equipment for her pleasure is there, and one needs to know how to use it to.

PS: What works to get you aroused is not something you choose — it is something you discover.

See my other posts about arousal and female orgasm:

To read more explicit things about female orgasm and pleasure, click here and visit OMGYes.

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New Treatment for Menopause and Vaginal Dryness

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.

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Treat your vaginal dryness early…..don’t wait at all

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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. The word needs to get out to women sooner about this common problem. Many women I see in the office, and many of my friends, 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”.

 

sex doesn't have to be painfulTreating women’s dryness early would eliminate that personal pain and the rug burn feeling one can have during and after sex.  There is no reason to wait. Vaginal dryness, particularly menopausal vaginal dryness, is progressive. The earlier you treat it the better.

And dryness is not just for menopausal females; dryness occurs in young menstruating women too.  We see it commonly in three different situations:

use of hormonal contraceptives 10% of young women on the pill experience dryness due to the vaginal changes when their estrogen and testosterone levels are lower when on the pill.  Having the intimate pain that can result from dryness is quite a negative introduction to their new world of sexuality.

Changing hormone levels after giving birth can create dryness     particularly when a woman is breast feeding.

women with PCOS (Polycystic Ovarian SYNDROME) often have vaginal dryness.  Their higher levels of androgens (DHEA-S and testosterone) and their lower estrogen levels (if they are not ovulating)  create a demand for supplemental estrogen in their vaginal tissue.

These hormonal changes can affect the inside of the vagina and the tissue around the opening of the vagina. It also affects the urethra. The urethra is the tubal passage where urine leaves the body – its opening is right above the vaginal opening. The drop in hormone thin the tissue of the urethra and increase your risk for UTIs.

The medical name for this condition is Genitourinary Syndrome of Menopause (GSM) or if breastfeeding it is Genitourinary Syndrome of Lactation.

There are multiple ways to treat this dryness.  Below is a handout with the instructions for the most frequently used Rx, topical estradiol cream .01%.  It is a bioidentical hormone.

HOW TO USE VAGINAL ESTRADIOL Cream .01%

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 a bioidentical hormone. 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. Massage in gently. The other half of the medication goes into the vagina using an applicator or 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 or two, 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. If you have been using it consistently for 8 weeks and you still have dryness or pain, see your provider — 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 penetration.

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 a skin sensitivity. There are bio-identical options for both compounded and non-compounded prescriptions.

This cream is low dose and minimally absorbed. Vaginal estrogens used as prescribed have not been shown to cause an increased risk of breast or endometrial cancer, or any other cancer. If you have had breast cancer or other hormone related cancer your oncologist is included in the decision making. 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.

See the most recent Menopause Society Statement on treating GSM (2020)

          https://menopause.org/wp-content/uploads/default-document-library/2020-gsm-ps.pdf                                                         

THE BOTTOM LINE: Don’t put up with dryness or the 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 about dryness, do ask them.

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.

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Women and Sexual Desire: Adding clarity into this mystery

The women I see in my office express a yearning for a deep connection and a big love affair, for a mate that treasures them more than anyone else. They want this passion and excitement in their everyday lives. Preferably they want to have this with their current husband, or partner. They do not want to change husbands to get this, though they may if it seems impossible otherwise.

At the same time that they express this yearning for a deeper and more exciting connection, they speak very highly of their mate. Nine out of ten women who come to my office give high marks to their partners. They deeply love and respect the male or female partner in their lives. They comment on his/her patience, understanding, and willingness to try anything. They talk about kindness and support and goodness. They are attracted to their mate.

And then we come to SEX, the reason she made the appointment in the first place. She says, “Is there something wrong with me, or wrong with my hormones, that I am not interested anymore? Is there a reason I am not into it? Can I change anything? Do I have to accept this as my new normal? Can I get back to the way it used to feel?” Or if she has never been turned on, “Can I ever feel what I hear is possible? It is not him, it is me. I am just not that into it.”

Low desire is the number one complaint women have worldwide. Four out of ten women say they have low libido, and one of those four is distressed about it.

One way to talk about women’s sexual desire is to break it down and talk about the different types of desire. Spontaneous desire is the name we give to desire when a woman herself wants sex. She is interested, she is on the prowl, she is excited. She is not responding to her partner’s advances; instead she is the one initiating the contact, making that first wink. There is also receptive or responsive desire. This is when a woman responds with interest to her partner’s or husband’s approaches. Sex is not her idea. The idea is originating with her partner. He or she does the thing that gets her interested, whispers the personal sweet thighs into her ear, or draws her a bath and lights candles.

Spontaneous desire in women can happen for a variety of reasons. One pattern that gets a lot of floor time in my office is cyclical or biological desire. This is the most common description I hear from women of what desire means to them. If you are still menstruating this occurs mid-cycle for a few days when hormones peak at ovulation time, about day 14 of your cycle. Some women also report an increase in desire right before their period begins or a day into their periods. At this point in your menstrual cycle, the PMS time, estrogen and progesterone are actually at their lowest levels. Testosterone is the only hormone left standing. It gets to dominate the action for a day or two, or longer. This type of desire is hormonally driven by the hormones that drive your menstrual cycles. This cycling drives the acne and irritability before your period too.

The cyclical spontaneous desire that can occur mid-cycle, and maybe at the end of the cycle, is not there after menopause. It is also not there when you block ovulation with hormonal birth control. As you can see women are not simple around sex, and in their beauty and complexity there are many places to look for desire. Occasionally low desire is caused by one thing, like an interfering medication. Sometimes it is hormones, vaginal dryness or sexual pain. Most often it is a variety of obstacles, physical and non-physical.

An important thing to remember: A woman does not have to have a surge of hormonal desire to make something interesting happen in the bedroom. She can create something interesting any day just because she can. 

Click here to read my blog post about women and sexual arousal.

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A Body Designed for Sexual Pleasure

There is quite a lot to celebrate about the fame body and how it responds to and is geared for sexual pleasure. It is quite marvelous. When arousal is triggered, cascades of events occur. Neurotransmitters release from a woman’s brain and she gets a nice tingly feeling in her genital tissue. Her nipples become firm, and the clitoris gets erect. Her vulva swells and the labia change from flesh or pink color to a dusky rose or purple. She feels sexually excited. The vaginal walls get suddenly wet. Her clitoris and its two 5 to 7cm long internal legs and surrounding significant vascular tissue engorge with blood. Some muscles contract and heart rate increases. Breathing is fast. There is a sense of tension.

On the outside of a woman’s vulva, women and their partners can see the glans of the clitoris, that external bump of tissue. This glans has the most nerve endings of any place on her body. This is similar to the head of a man’s penis which is thought to be the most sensitive part of the penis with the highest concentration of nerve endings. Both these glans are very sensitive to touch and they can be extremely so. Yet they are not the whole story of arousal and orgasm. Obvious on the male, yet hidden on the female are the shaft and the two internal legs. The shaft and the legs, are what cause the organs, both the penis and the clitoris, to swell when arousal happens. They become erect. That internal swelling can be felt through the upper vaginal Wallin the area we know as the G-spot. When swelling is significant enough and those clitoral legs are impacted by the swelling that surrounds the urethra, an internal orgasm occurs, a vaginal orgasm. There is also an area of the vaginal wall that is deeper inside, referred to as the A-spot or the Deep spot. This spot is in front of the cervix, and when stimulated can lead to orgasm. This is mediated by a different nerve and women report that it feels different than an external orgasm.

The only function of the clitoris and its 8,000 nerve endings is for a woman to experience pleasure, sexual pleasure. The clitoris does not secrete substances or hormones, it does not contribute directly to reproduction or urination, it does not support other processes in her body. It is there for her pleasure.

On top of this awesome genitalia there are the many other erogenous zones in the female body. Her lips, her breasts, her nipples and the skin at the nape of her neck or inner thigh are territories of sensual delight to be explored. Skin can be wonderfully erotic and is packed with nerve endings. Light feathery touch can be scintillating, exploration can be done with your lips, tongue, fingers. There are 2,500 nerve endings per square centimeter in female fingertips, for example, and a lot can be communicated with touch intended to excite and arouse.

Look at the female body and you can appreciate that the physical groundwork for exquisite pleasure has been pre-established. Having this sensitive equipment does not mean women get easily aroused. Many don’t. One has to have one’s arousal triggered for this cascade of events to occur. What triggers arousal is the million dollar question. Arousal is not something you choose – it is something you discover. Arousal can start long before you get in the bedroom, or it can start in the bedroom. It can start with a look, a touch, a smell. If a woman’s arousal is heightened and sustained on enough of her multiple channels, her orgasm happens.

Click here to read my blog post about women and sexual arousal.

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