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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.

The Female Brain and Your Level of Sexual Desire

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

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

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

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

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

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

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

More coming on this topic in future newsletters.

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.

New Treatment for Menopause and Vaginal Dryness

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

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

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

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

Women and Sexual 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.

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.