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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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Over-the-Counter Aphrodisiacs with Possibility

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.

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There is no better time in history to be a post-menopausal woman who wants to have a great sex life

Hundreds of women have told me, “I love my husband, but I am no longer interested in having sex.” Hundreds! Millions more are out there. More than 500 million women in the world are post-menopausal.  Many of these women still want to be interested in sex, they just aren’t.

Trisha was 62 years old when I first spoke to her about her sex life. Her drop in libido came with menopause, twelve years before. The change happened gradually, and sex with her husband became non-spontaneous and predictable—a once-a-week event, always at the same time in the same way—something like scratching a mutual itch, she said, “If we’re lucky enough to have the itch.” Although they’d had wonderful, compatible sex with each other for decades, it had become “Boring,” she said, “and we don’t do boring.”

Trisha had noticed this happening for a lot of her girlfriends— they were having less and less sex. “What I’ve seen with my friends is that because they’ve lost interest, due to menopause, they don’t feel motivated. They can’t see the point of revamping sexuality because from where they are, they don’t want to. What’s the point? They don’t feel sexy, they don’t feel horny, they don’t need sex anymore, so what the hell is the point of exploring it?”

Trisha was looking for options. Sex had been such an important and a strong part of her relationship with Ted, and they both wanted the spice back. She had high regard for Ted. ey had felt chemically attracted to each other from the time they’d first met in their twenties, and she wanted that back.

Part of the boring part for Trisha was that she used to orgasm during intercourse when she was on top, but she had not been able to do that for the past several years. Thee only way she could make it (have an orgasm) was through oral sex. In the past, she had been resistant to receiving oral sex. Once she began to experiment with it, she discovered how pleasurable it is, and she began to enjoy it. Still, she missed the variety of sexual options she’d previously had. Trisha signed up for my In the Bedroom class with the hope that it might help her figure out how to rekindle the spark she and Ted used to have.

When she told Ted she was going to take the class and why, it opened what she termed a scary conversation between the two about their current sex life. It was difficult and painful, but each of them found the courage and the honesty to say the hard stuff. They both admitted being bored with their whole pattern around sex. They agreed that sexuality was important to them, and that they were at a turning point. They were in their early sixties, and they both wanted to remain sexually active for another twenty or twenty- five years. Something needed to shift.

Trisha said that part of having the courage to broach this topic with Ted was she knew that they were supportive of each other. Neither was out to criticize the other. They both knew they wanted the same outcome: an exciting sex life. “It takes a lot of trust. Trust and knowing that you have faith in your partner, that you both want the same thing. It’s a huge, huge part of it,”Trisha said.

Whether your cyclical desire is gone due to surgery, menopause, or medication, there is a similar landscape to navigate. It is confusing, and can feel like a huge loss, sometimes devastating. One client, amidst tears and angry shouts, expressed how furious she was that no one had told her she would lose her mid-cycle interest in sex. She said she would have appreciated it more when she had it if she had known some day it was going to be gone. For women in a lesbian relationship at menopause, when ovulation stops, it can be doubly confounding, it is especially true if both women stop ovulating at or around the same time. With neither partner having that spontaneous cyclical interest, sexual initiation can drop sharply.

This lowering of libido is a common obstacle of menopause and the other one is the vaginal dryness which is often followed by sexual pain.   Trisha had the drop in libido obstacle, and she did not have the vaginal dryness. She got her libido back. Her story is below.

Highlighting her own femininity was central to Trisha sparking the change in her sex life. Her sex life had become boring, and so she came to my In the Bedroom series for help. At the end of the first class, I showed slides with pictures of ten low- or no-cost things a woman could do to spark an immediate sexual charge with her partner.

Ten Low to No Cost Things You Can Do to Spark an Immediate Sexual Charge

  • Stage your bedroom for a romantic event.
  • Make a sexual promise and keep it.
  • Interrupt your partner with one agenda only.
  • Give a sensual massage.
  • Break the rules.
  • Dress for sex.
  • Deliver a message written in lipstick.
  • Flash a body part, accidentally or with emphasis. Role play with characters you enjoy.
  • Send suggestive voice mails or texts – both ways.

Right after class, Trisha came up to me and asked if she could have a different assignment. “You need to understand, I don’t have any libido. I can’t do these things. I don’t have any desire for sex,” she said.

“Do them anyway,” I said. I wasn’t being unkind. I knew that the best way for her to find her libido was to take action. The following week Trisha was the first to raise her hand. She reported that she had done the assignment and picked something from the list, and she was shocked. She had dressed up in a sexy way, put on lipstick and eye makeup, and gone on a date with her husband. She flirted and they had fun. She already felt juicy again. “I was so surprised. I didn’t believe I could. I did all those things thinking nothing would happen. Now I am looking forward to sex with my husband!” Three months later, I followed up with her. She referred to her sex life as “hot.” “I did not know that I could control feeling horny through my mind, through thinking about sex, and through dressing up like I used to when I was sixteen or twenty-six and feeling beautiful. I think the key for me is really attention. Like you said, I can create that same feeling of hormonal need now, after menopause, by giving my attention to sex and feeling sexy. Part of all that is getting dressed up a little bit and going out somewhere in the evening, which we know isn’t the sexual part but we do it anyway. I like getting dressed up, knowing full well what’s coming later, and flirting, and making an event of the whole process so that I am feeling quite juicy by the time we even hit the bedroom. All of those things have rekindled my desire. I actually feel horny again!

Sounds kind of trivial and superficial to remember to dress sexily again. Luckily we have great bodies, so why not use them and dress sexily and not worry about the fact that I’m sixty-two years old, or believe that I should dress like sixty-two. No, I should not! To be the seductress in the bedroom, it’s the whole process—the way I dress and look, to the way the bedroom is decorated, to creating events, to having dates. Maybe going out for a six course meal, maybe going out for a martini, or something, but somewhere a little elegant.”

Overall, Trisha said her sex life has gone from boring to hot; in fact, her word now is “uninhibited.” She gives herself over to the experience of sex. Her mind quits and she allows her body to take over. ere is no control, and she can get lost in the experience. It feels like freedom and openness to her. It feels like coming home. She gets that luscious experience of oneness, the feeling that there is no separation between her and her husband. “I did a lap dance for him, which was great. I got dressed up and he chose the music, he arranged soft lighting in the room so it wasn’t too bright. The whole series (In the Bedroom) gave me permission to be erotic to do all that. It was wonderful. We went out together to get the stockings and the garter belt. He loves such things. And it’s just fun. It is about bringing the fun back in.” Connecting sexually has brought in more tenderness and respect. “We are both far more loving in the little ways throughout the day. It is just sweet. It really has improved in small ways which is lovely. There’s a wonderful sense of gratitude for each other. Our little secret of what we’ve done here together in the bedroom, which was a big step in intimacy, spills over to appreciation in all the other ways as well.” Trisha found that if she and her husband got into “work mode” for days at a time, they would schedule a date, and the good sexual tension returned. If Trisha missed sex first, she asked her husband to create a date. She liked it when he asked her to go on a date. His expression of desire for her added more romance, and she found romance arousing. There was another physical piece that added to Trisha’s pleasure. Ted’s erection had been getting softer in the past few years.  This is normal, though not desirable. They went together to see his primary care physician and got a Cialis prescription. Since using it, Trisha can orgasm again from being on top during intercourse. She had enjoyed this a lot in the past, and though she had added in oral sex successfully, having more variety of sexual positions was a positive.

Great Post-menopausal Sex is possible – the built in obstacles are navigable.  In part this is due to many different and safe treatments for the vaginal changes (Click here to read my other blog article on Vaginal Dryness), and the availability of Viagra like drugs and other products that are treatments for arousal problems.  It is also due to keeping your sexual vibrancy alive, which is not a drug. For Trisha, and many of my clients, it is doing the actions that keep the sparks flying.

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How PCOS Can Affect Your Sex Life

Having PCOS is like being dealt a hand of genetic cards. You can play those cards so that you feel your best, sexually and in terms of your energy and mood. Your lifestyle, your diet, and hormonal management are all important pieces to manage the hand you have been dealt.

First thing to know is that you are not alone: one in ten women has a similar set of playing cards. PCOS (Polycystic Ovarian Syndrome) is a common genetic hormonal pattern in which your DHEA (an adrenal hormone) and your testosterone are robustly influential in relation to your ‘female’ hormones (estrogen and progesterone). Even though testosterone is widely accepted as the hormone of desire, if you have too much, you will not necessarily have a high libido. You may still have similar desire problems, or arousal and orgasm problems, as women without PCOS, though not for the same reasons. 

Twenty percent of the women I see in my practice have this hormonal pattern and I have found multiple things that work to balance you emotionally and physically, as well as improve your sexual experience. Let’s start with the basics, your period, and then go on to hear how PCOS interacts with your sex life, and what you can do about it.

With this hormone pattern women often experience problems with their periods—skipped periods, frequent periods, heavy bleeding, extra long periods, severe cramps, or no periods at all. Sometimes providers prescribe oral contraceptives to manage the pain and the bleeding, and to make the cycles regular. Women who have heavy and/or long periods can bleed so much that they become anemic. If you have anemia you can become so tired from an iron deficiency that you don’t have the oomph to be interested in sex. On top of that, it can seem to your partner that you are always on your period, and never available for sex. Misunderstanding around this can lead to distance and resentment in your relationship.

Even if periods are regular, with the extra androgen influence, women with PCOS are more likely to have cycles without releasing an egg. Without that mid-cycle hormone spike, you are less likely to experience the surges of desire, the ‘horniness’, mid cycle. Also, when you don’t ovulate you don’t produce much progesterone. Progesterone is the relaxing hormone in your chemical mix. You have estrogen and testosterone in that mix and those are both activating; progesterone balances that activation with relaxation. You have receptor sites in your brain for progesterone and when it lands there, you can feel mild sedation and calmness. When your progesterone level is low your sleep can be restless, you toss and turn, you can get sweaty, and you don’t wake up feeling restored.

Women with this hormonal pattern of PCOS report to me having night sweats, itchy or hypersensitive skin, and greater anxiety and irritability—sometimes too irritable to want to be touched. They also are, according to research, more likely to be depressed.

Also, If you have PCOS you are more likely to struggle with weight, and be at a higher risk of diabetes. The increase in testosterone increases the size of your muscles. Sometimes this works for you, and sometimes your muscles bulk up more than you want. This bulking up increases your weight and excess body weight can contribute to a lack of desire for sex. Many women who gain weight become self-conscious about their weight. It inhibits them from wanting to be seen naked, and so they refrain from initiating sexual contact.

Not all women with PCOS have or are going to have all of these symptoms. Many women with PCOS have no sexual problems, none at all. There is a large variation in how women with PCOS are affected. One third of women with PCOS will struggle with decreased fertility, and having sex will be linked with using ovulatory kits, and jumping in bed when the timing is ‘right’. Some women will have extensive medical workups for this and be on medications that influence their mood and desire. PCOS is not one thing — the underlying hormonal pattern of PCOS is there, but the expression is different. With genetic studies, we are still learning why this expression is so varied and how we can intervene.

Besides low sexual arousal and desire, women with excess androgen hormones can complain of vaginal symptoms including burning, dryness, or irritation. Some women report their own lubrication does not last long enough for them to finish sex without needing to add a lubricant. Sometimes there is ongoing itching and burning of the vagina that gets worse at certain times of the month.

Ann had this PCOS hormonal pattern. It was her anxiety and irritability that brought her in for a hormone evaluation. Specifically, it was the flush of embarrassment on her twelve-year-old daughter’s face when she, Ann, angrily demanded that the man in the ice cream truck turn down his annoying music. She recognized that her reaction was over the top and she was tired of being on the edge. On her intake form, Ann marked her symptoms— anxiety, irritability, vaginal dryness, specifically vaginal burning after intercourse, low libido, restless sleep, and worsening PMS. She had felt on edge for a few years and the number of days she felt moody was on the increase. Her sexual desire had been low for years. Vaginal dryness had started after the birth of her second child and was getting worse. Lubricants helped intercourse feel comfortable, but she was not that excited about having intercourse at all. She had sex because she knew it was important to her marriage, and she did like the closeness she and her husband shared after sex.

The vaginal dryness and burning that is sometimes found in women with PCOS is easily treated. Ann found this to be true. Eight weeks after she began treatment, her vagina felt back to the way it was before she had her second child. She no longer had dryness, and she no longer burned for a few days after being sexual. These vaginal symptoms responded quickly to the same estrogen treatment used for menopausal vaginal dryness : a topical low dose estradiol cream, or suppository used once a week.

Ann received a prescription of micronized progesterone, and with it she felt more relaxed and was able to sleep longer and deeper. She no longer experienced on the edge, moody feelings. She still felt anxious at times, but the feeling was slight in comparison. Her husband could approach her without her snapping at him. His touch, which had become annoying, felt good again. Intercourse was distress free, and she felt stronger levels of arousal than she had in years.

Ann did not have the anemia, but if she did she would have been given an over the counter iron pill to take daily and advised to increase the iron rich foods in her diet. About one third of women with PCOS have heavy periods. Heavy bleeding is defined, in medicine, as a need to change your pad or tampon every one to two hours. Long periods are defined as ones that last longer than seven days. Treat the low iron until your hemoglobin and hematocrit are in the normal ranges. Sometimes prescription iron is recommended. Also, if your provider doesn’t test your ferritin level (a measurement of stored iron), ask for it. Clinically, I notice women with ferritin levels greater than 50 report a stronger sense of wellbeing and are more likely to have some energy left for sex when they get into bed at night, than women with ferritin levels below 50.

Also, your health care provider can help you look at several treatment options to help you modify the heavy bleeding. Some of your options are friendlier to your arousal and libido than others. When your hormones are managed well, you will have more regular cycles, and probably lighter periods. You will discover you have more choices around which days to be sexual, and more energy with which to have it.

Remember, there is nothing ‘wrong’ with you and you are not alone. One in ten women are managing this too, and more genetic studies are underway to increase understanding and optimize health.

Symptoms of Too Much Testosterone in Females

  • Acne
  • Restless sleep/Insomnia
  • Irritability
  • Anxiety
  • Short fuse/Anger/Rage
  • Worse PMS
  • Menstrual Cramps
  • Weight gain/Bulking up
  • Irregular periods/No periods/Heavy periods 
  • Increase in chin and lip hair and hair elsewhere on body and a thinning of hair on top of the head
  • Vaginal irritation and/or dryness

This is an edited excerpt from Fanning the Female Flame-How to Increase Sexual Desire (without Changing Parters).

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How to Keep the Bedroom Alive and Interesting for Both of You

These tips for increasing pleasure are from a handout given out at a recent couples workshop. Read through the list together as it can start an intimate conversation or even a more interesting engagement.

1. Experiment together with different touches, different times and new places to have sex and observe how excited you are. Track what positions, what touches, or what words arouse you. You can write them down. These things make up your arousal pattern, and you want to know what these things are and do them. Ask your partner for them. Don’t stop experimenting until you know what works to get you excited. Having you be aroused in the bedroom is at the heart of having it be special.

2. Sexual arousal is unique in that it takes simultaneous relaxing and excitement. The psyche wants to be relaxed so the body will allow excitement/tension to build. That tension and excitement is a good thing. Arousal is a YES to PLEASURE. Let yourself FEEL pleasure.

3. You have “gates” that arousal triggers have to get past to start the cascade of arousal. Stimulating multiple sensory channels at once increases the chance the gates will open. Physically stimulating the body in two or three places, and using your voice in intimate erotic talk at the same time does this. Adding music and aromatherapy uses even two more channels. In the most delightful sense you want to overwhelm those gates.

4. Be curious about your partner and what makes his/her pulse faster. You are in bed with someone who is different than you. His/her likes, body and attention patterns are different than yours. So is his/her arousal pattern. You can figure it out if you pay attention to what works. Track what works.

5. For women: Own your femininity and make it more real and visible to yourself and your partner. Appreciate that this is what you are sharing, it is not just your body, it is your aesthetic, your motion, your essence.

6. For men: If your woman has a busy mind and is distracted it is OK for you to say to her: “I want all of you here with me. What do I have to do to get all of you here with me?” Then listen closely to her answer and don’t try to add more pressure to the moment. Don’t problem solve. Listen as attentively as you can. If she gets emotional, you stay steady.

7. For men: Use your attention as the powerful agent it is. Get skilled in your use of it and then let your woman bask in it. Your daily attention feeds her as a vital nutrient to her well-being, as well as it can be an erotic additive to sexual moments.

8. For men: When you have positive thoughts about your partner, e.g. the way she looks, the way she feels when she is close to you, how you enjoy watching her move…Say those thoughts OUTLOUD. Verbalize those thoughts. Multiple times per day is not too much.

9. For women: When you dress up, or put on lipstick, or show some cleavage, or wiggle in front of him: LET HIM KNOW YOU ARE DOING IT TO GET HIS ATTENTION. OWN THAT YOU WANT HIS ATTENTION. Keep your dynamic as a couple alive and interesting.

10. For women: Make something happen sexually because you can. Do it because you have that power and can celebrate that power. You don’t have to wait till your body tells you to have sex, and you don’t have to wait for him to start something. You can make something happen anytime.

11. Break the “every time” bedroom habits that you have around sex even if they “work”. Doing new things increases your pleasure and raises the excitement and neurotransmitter levels.

12. Make the bedroom furnishings align with HER (your) sensuality. The colors and fabrics used should be the ones that make you feel the most sensuality and sexually alive. The bedroom creates a physical space that represents how you value your sexual connection. Make yours great.

Click here to read my blog post about how to add femininity into your sexual chemistry.

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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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Create an environment for an “EVENT”

Women want to have an interesting and compelling time in the bedroom. They want experiences where they melt and merge with their partners, have exquisite sensations, and have feelings that are too big and beautiful to be described in words. If you want to invest in having this kind of a sex life, one practical and physical place to start is to “set the stage.” Believe it or not your bedroom furnishings can support your sex-life being great. Getting started doesn’t have to be difficult. Let’s start first by asking yourself these three questions:

  • Is your bedroom a place that looks like it is ready for a romantic and sexual encounter?
  • Does it inspire you to feel sensually alive?
  • Does the decor support your beauty?

The idea is to make the bedroom a place that turns-you-on…a room that reminds you of your own vibrant femininity and sexuality. You can achieve this by simply changing the feeling of the room through the use of textures, colors, lighting and accessories. Overall the décor should draw your eye to the bed and to the mind of sex and rest. Nothing else. It’s not a home office, Landry-sorting station, or TV room. The bedroom is a place for sex, tenderness, intimacy and sleep. Everything else that is not linked with either intimacy or rest has to go. BE RUTHLESS! Declare this room to be only about the sensual wonder and magic that is possible between you and your partner. Even if you’re not there yet, make the room feel and appear as if you are. Imagine a room decorated to match the most exciting sex life that you want to have.

Start by selecting a theme that makes you feel tender, open and excitable. If exotic places take you there, put in exotic elements. If a romantic style is what revs you up, create that. Maybe clean lines and simple surroundings make you feel most open for love, then keep the room understated. A quick Google search of “exotic,” “romantic,” or “contemporary” bedrooms will give you endless decorating ideas that you can use to radiate romance. I am not an interior decorator by nature, so I either need to see pictures of what others have created, or ask my more visually oriented decorating friends to come over for help. Recognize what works for you, decide on a theme then put your plan into action. By shopping at designer discount stores such as TV Maxx, Ross, and Tuesday Mornings, even second hand shops, each offer great selections and styles while helping to keep costs within an affordable range.

Textures- Use fabrics that invite you to touch them. Create a “want to stay awhile” kind of atmosphere by adding layers of silk, faux furs, mohair, cashmere, linen, and other soft, velvety cottons. May eat delicious for you.

Color- The colors of the sheets, bedspreads, walls, and pillows should be colors that are tens for your eyes, hair, and skin. You are the beauty that those colors are supporting. In this scenario the man’s favorites should not be the focus as we are wanting to showcase you at your sensuous best!

Lighting- Most “women” agree that bright light will kill a sultry mood in a heartbeat. Replace harsh white light bulbs with soft pink ones, even add a dimmer. Candles-it’s a no-brainer! The flickering of candlelight can add to the feel of romance in the room and a gorgeous forgiving glow to your skin. Worried about burning down the house? There are many electronic candles out on the market now that can mimic the same effect! Want to shake things up occasionally? Introduce strobe lights and/or black lights to the mix.

Accessorize- Frame romantic or erotic pictures of yourself with your mate and/or mirror and place them in featured positions. Adding accents of curved vases, sculptures, or anything that suggests a sensuous body will elicit a steamy mood.

If you like music, collect songs or albums on your iPod or player that make you feel sexy. Most of the women I talk to don’t have a list of songs that ‘get them in the mood.’ If that’s you…start listening to music with the question in mind: “What song(s) make me feel sensually alive and excited?” Then create a way in which you can quickly access and play them in your room. If you use oils, lubricants, contraceptives or other devices, find a workable and aesthetic way to store them close at hand. Also, benches, stools, and cushions are handy for different activities and positions and should be included int he furnishings.

Maybe after reading all this you are saying: “But, we’re parents of young children.” Even if part of their bedtime involves a regular visit to your bed, don’t make the room a Kids Zone! Kids stuff, including family pictures do not belong in this adult space. This is your play area. The bedroom needs to reflect an intimate, safe place where you can temporarily remove the “mom” mindset and block out the outside world.

Overall, what’s arousing to you is central to having a great sex life. Your arousal, the feminine person’s, is what we are more often looking to increase. You’re not decorating the most intimate space in your home for anyone else- so have fun, experiment, and try something new!

Click here to read my 12 low or no cost tips on how to keep the bedroom alive and interesting for both of you.

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