“Just Say Yes”
Few things in life are fun and free. Sex is one. As Henry Miller said, “Sex is one of the nine reasons for reincarnation...the other eight are unimportant”. Just as lack of sex begets even less sex, reinstitution of sexual relations begets more sex. Like with potato chips: “...bet you can’t eat just one...” (no pun intended).
SEXUALITY AT MIDLIFE:
The Masters and Johnson model of sexuality (desire leading to arousal leading to intimacy, plateau and orgasm) is a male model. Women are different, as described in the more accurate Basson model of female sexuality. In Dr. Rosemary Basson’s model, intimacy comes first (the opposite of the male model). An understanding of these principles is important if sexual intimacy is to be reestablished.
Men and women are different. Desire is the initiating factor for men (no desire/no erection); it is not necessarily so for women. Nothing wrong with that. As you will see, delightful sexual intimacy can evolve outside of the genesis of “desire”. Unless low testosterone is a factor, most midlife men walk around in a more or less continual state of desire. If something occurs—such as an erotic image, the curve of a breast, imprint of nipple, flash of eye or thigh—that man gets aroused, and he desires...intimacy!
It is just the opposite with women. Most women don’t
get turned on if their husband walks around in his skivvies. Women's sexuality
is "circular." A woman's sexual response begins with availability;
in order to be "available," there must first be trust and intimacy.
Then, if there is some physical intimacy (touching 'n cuddling...)there
just may be arousal... and desire for sex. Men are linear: desire?arousal?
sexual intimacy. Women, circular: availability/intimacy?arousal?desire.
(And, if sex is satisfying, this leads 'round again to availability.)
HERE IS WHAT YOU CAN DO
There is a second and separate issue, however. Penises don’t shrink to accommodate the thinning, mild atrophy and dryness of approaching menopause (welll...sometimes they do...), and a woman’s introitus and perineum frequently become traumatized. Since your Bartholins aren't doing their thing to make you slippery, you may now have to supply your own lubrication, but there is nothing wrong with that, and it can even be fun!
There are lots of sexual lubricants on the market, and they come in names like “Silky”, “Astroglide”, “personal lubricant”. All of these products are water-based and use glycerol and propylene glycol for their active ingredients, which means that they are cool and eventually become tacky and dry out. They are usually used on an as-needed basis to, well, help things “slide in”. Not terribly sensuous.
My suggestion is to use either a mousse (like "Intimate Options"), a silicone-based lubricant, or a light oil. Unless you are using a condom, or plagued by recurrent vaginal infections, I recommend a light oil--massage oil, light olive oil, mineral oil...baby oil is great. Have a little bottle at the bedside (or wherever...). Each of you can put a little on your palms, rub them together to warm the oil, and...Play! I am sure neither of you would mind much if the other sensuously applies some oil to all of those parts you like stroked. You can talk and fantasize as well. This leaves a thin coat of oil (which will not dry up) on the various parts that will benefit from lubrication and it becomes much more than just applying lubrication at the last minute so that...”it goes in easier”.
Other great ideas: Besides the vaginal rebellion that occurs in women when their estrogen goes south, the combination of insomnia, mood swings, hot flashes and other disturbances resulting from low estrogen levels couples with the direct effect of diminished estrogens to impact women’s sexuality. Testosterone levels frequently have been going down also (one-half of a woman’s testosterone is secreted from her ovaries—the other half converted from the adrenal glands). This combination can be a 1-2 punch which can be a particularly heavy knock out for those women who experience surgical or chemotherapeutic menopause. Estrogen supplementation can be a lifesaver here.
Have your testosterone checked also and supplemented if your bioavailable testosterone is low. A serum (blood) testosterone alone is worthless here. Only 1% at best of the testosterone circulating in a man or woman is utilizable by the body—the rest is bound to the blood proteins sex hormone binding globulin (SHBG) and, to a much lesser extent, albumin. A woman (or man) can have a low-normal or normal testosterone, but a normal or upper normal SHBG and a healthy albumin and have very little bioavailable testosterone. Salivary testing may also be of benefit here, since in order to get into the saliva, the testosterone must be available to the salivary gland to be incorporated into its secretions. Signs of possible diminished testosterone in women are low sexual desire, more difficult arousal, loss of energy and a general decreased joie d’vivre.
Men can be in the same boat here. Although a man’s testosterone levels are maintained longer than a woman’s, the same thing (lowered testosterone coupled with not lowered SHBG and albumin) lead to only a fraction of 1% of his total testosterone being available, leading to decreased sexual desire, “oomph” and energy and also leading to poor response to erectile agents (if testosterone is low).
Again, a simple blood testosterone is worthless. Testing must include total testosterone, SHBG, albumen (+/-) and free or bioavailable testosterone. Salivary testosterone as well is nice, to see if it is concordant with blood values and is also good to easily follow results of therapy.
Most readers still with me to this point know the uses of erectile agents (Viagra, etc.) in men. What you may not know is occasionally they find usage in women as well—specifically in women with peri/postmenopausal arousal or orgasmic difficulties, who had no such difficulties when they were younger. These agents do nothing for “desire”, however, in women.
But, you know, you can have great sex without desire. Don't beat yourself up if you feel your desire waning. Read on, read on!
“DATES”: Remember when you used to go out on dates? How maybe you would look forward to a little nookie at the end of the evening? Well...resurrect that concept! Here is a great way to resuscitate your barely existent sex life, and put matters “on your turf”.
If you are like so many of my patients, your answer to the question of when you last had sex is an embarrassed “...sometime last month...” Remember: “Use it or lose it.” Remember that (once dryness and lubrication is corrected) it is sorta nice...once you get into it. Remember the bind your husband or lover is in. “...To ask or not to ask...” Remember the discrepancy in the “...Desire/intimacy equation.”
You can put matters on your turf! Schedule Intimacy First.
Take the pressure off and have fun. Here is how:
Anticipation...preparation...intimacy...promise,(and remember, foreplay can begin at the beginning of the day, taking extra care to...be nice to each other).
The pressure is off both you and your partner. He does not have to worry about being rejected. You don’t have to worry about lack of desire as, in this scenario, desire is not the initiating factor. It is on your turf. It puts intimacy first and of course does not preclude other (non-scheduled) interludes.
Also--it is never too late for “new tricks” and explorations. There are many websites specializing in sex toys and erotica. Go to the erotica section of your local bookstore and browse. Anything written or edited by Lonnie Barbach, PhD, is good. (Re-)explore “The Joy of Sex” and “More Joy”, both written by Alex Comfort. Many books, including “Getting the Sex You Want: A Woman’s Guide to Becoming Proud, Passionate, and Pleased In Bed” by Sandra Leiblum, PhD, “How to Have Magnificent Sex: The Seven Dimensions of a Vital Sexual Connection”, by Dr. Lanna Holstein, “I Am Not In the Mood: What Every Woman Should Know About Improving Her Libido”, by Dr. Judy Reichman and many others are wonderful starters.
...Again: Don’t get hung up on desire. If you choose hormone therapy, especially if supplemented with testosterone, this aspect of your sexuality will improve, but not necessarily dramatically. Remember, desire and frequency of sex is not as strictly dependent upon age, but on length of relationship. An “old married couple” of 29-year-olds who have been together 10-11 years will have sex less often than a couple of 55-60 who are new lovers. It is okay not to have rampant desire. So what if it takes longer (“the further from the branch, the sweeter the fruit...”) It takes him longer too...and gives the Viagra time to work!
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