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All About Libido

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Dear Sex Educator,

I hear the word “libido” used a lot. What is it, exactly? If my libido isn’t as frisky as I want it to be, what can I do?

We talk about libido a lot:  “He has a high libido;” “I don’t have any libido.”  We’re usually referring to someone’s “sex drive” or level of sexual desire.  But what does that mean, exactly?

Technically, libido can be defined as psychic energy: urges and impulses that come from the psyche, or mind.  But what does that have to do with sex?

Libido is the “mind” part of sex;  it’s the “desire” part of the process that leads you into further sexual play.  Without the psychic energy that our conscious mind interprets as desire, sex doesn’t happen.  Libido responds to a lot of different stimuli.  Sometimes it’s a rush of sensation in your genitals that starts you thinking, “hey, a little more of that would feel good.”  Other times it’s an arousing image, memory or smell that leads you to say, “I’d like to pursue something sexual right now.”  It can also be the awareness of the rush of blood to your cheeks when you’re aroused by someone or something.  Sometimes it’s a gesture or touch from a loved one that triggers a desire for more.

Why does it come and go?

Libido is pretty fragile.  If you are distracted, tired, stressed or sick, your mind tends to send this form of psychic energy away.  Your mind will say, “Don’t think about sex; you have more important things to attend to,” even when you don’t want it to.  This can become a problem when your mind is focusing on other things and your partner’s mind is saying, “Hey, I feel sexy…let’s romp!”

Libido is usually very strong at the beginning of a relationship—it’s the glue that bonds you together, but it tends to settle down to a lower level about six months to two years later.  Although this change concerns some people, it’s actually very normal.  Anyway, how would you find time to eat, sleep, work and socialize if you were having sex as often as you did when you first fell in love?

Libido can also be affected by physical changes to your body, such as those that occur during and after pregnancy and menopause, and when taking hormonal contraceptives or certain medications, such as anti-depressants.  If you suspect that your libido has changed due to one of these factors, consult your health care provider.  Even if there is a medical reason for a change to your libido, you can still nurture your desire on your own.

Why is my libido at a different level than my partner’s?

Some people have a very active libido—their minds lead them to think about and want sex often.  Others have a very mild libido—they may never really think about or want sex without some outside prompt, or they really aren’t interested in sex at all.  Our level of libido depends on our level of stress, our health, how many distractions are in our environment, how successful and pleasurable our most recent sexual experiences have been, and what we have been taught about how to feel about sex.  A recent study even suggests that libido is genetic.

It is very common for people to have different levels of libido than their partners.  This may only happen from time to time, or it may be constant—either way is normal.  Although there is nothing you can do to change your partner’s libido, there are ways both of you can work together to get your needs met.

Your particular level of libido is individual, variable, and completely normal.  It is only a problem if it causes you distress and you feel strongly that you want to do something to change it.  But if you are fine with how you are and it works for you, then you are normal, regardless of what anyone else thinks.

Do arousal creams or supplements like Spanish Fly help increase libido?

Most supplements will not do anything to you, physically, to help you feel more desire.  The original Spanish Fly is actually toxic, and even in small quantities causes an intense urinary tract irritation that will lead to an infection in most people.  That irritation is perceived as arousal, which is how it got that reputation.  But the things you see available that are labeled “Spanish Fly” are not actually that at all.

The way that some supplements work is to stimulate your whole nervous system, which will allow you to feel more quickly aroused, but you still need something that triggers your arousal.  Some supplements, especially those that you rub on the genitals, produce either mild irritation (like those with menthol or cayenne pepper) or they arouse you because you are rubbing them on your genitals and bringing blood into your genitals.  A nice sexual lubricant like Liquid Silk will do the exact same thing.  But no supplement or cream can increase the thought part of libido.

Okay, so what can I do to increase my libido?

It depends on whether or not you’ve always had a mild libido.  If you have, then it is harder to change. Studies show that people with a “low” libido that has stayed the same for their whole adult lives have a very difficult time changing that level.  In that situation, it may be better to learn to adapt to how you are, rather than struggle to change it.  If you want to try to change your libido and it has always been low or non-existent, we recommend getting help from a sex therapist.

Fortunately, libido is an elastic state of being that can be invited back into your life.  It’s also true that you can enjoy pleasurable sex without having a strong libido.  As Rosie King, MD writes: “Desire and arousal are two separate components, and are run by different parts of the brain … it is much easier to be turned on if you start with a high level of desire.  But even if initially you feel sexually uninterested, if your partner helps to warm you up … you can enjoy a very pleasurable sexual experience … [including] high levels of arousal and orgasm.” (Rosie King, MD, “The Right Conditions for Lovemaking” from Sex Tips and Tales from Women Who Dare, edited by Jo-Anne Baker).
If you have had a higher libido at different times in your life and you’d like to get it to be livelier again, here are some things you can do:

Start with your body.

Check in with your body.  Do you feel attractive?  Do you feel healthy?  Feeling good about your body is important to your libido.  Spend a little time helping yourself feel good in your skin, so you can feel sexy to yourself and someone else.  A little exercise, a relaxing bath, a massage or some stretching can help you feel more alive and connected to your physical self.  For some people, it also helps to wear some slinky, sexy lingerie under your clothes—something that feels good to wear and makes you feel sexy.  And remember, you are beautiful regardless of what shape or size you are.

Get your mind in on it.

Start thinking about the good sex you’ve enjoyed.  Reflect on your favorite past encounters and fantasies.  Allow your mind to wander and your body to become aroused.  Pay attention to the feeling of blood flowing to your genitals.  If you are an older woman, you may not produce lubrication the same way you used to, and that’s perfectly normal.  If you are an older man, you may not become erect as easily or consistently as you use to, and that’s normal, too.  Try to recognize different signs of arousal:  a flush on your chest, tension in your nipples, or an increase in your breathing.  If you have a partner, he or she may notice that your eyes are dilating.  For women who experience dryness of the vulva and vagina, we recommend massaging a moisturizing lubricant (Liquid Silk is a good choice) into the skin of your genitals twice a day.  This increases the skin’s elasticity and encourages blood flow so you become aroused more comfortably.  See our Vaginal Renewal brochure for more information.

Don’t stop now!

Allow yourself to think positive sexual thoughts throughout the day, including fantasies, remembering past sexual experiences, and envisioning the wonderful sex that you’d like to enjoy.  Think about the variety of sexual activities that would be pleasurable, such as genital massage, oral sex or comfortable penetration (if you’re ready for that, and enjoy it).

Then, try something a little frisky…

Invite yourself on a sex date.  If you did not masturbate before now, you are encouraged to begin.  Make self-pleasure a part of your self-care routine.  Learn how your body responds to erotic thoughts, stories, pictures or movies.  A lot of quality erotica is available to help you expand your fantasies and nurture your arousal during both self-pleasuring and partner sex.

Pleasuring yourself will help you know how your body feels when you become aroused, and what kinds of touch and sensation feel best to you.  If you enjoy penetration, include that in your self-pleasuring, exploring how deeply you like to be penetrated and what width is most comfortable.  Then, when or if you choose to have sex with a partner, you can teach your partner what you’ve learned about what works best for you.  For more information about self-pleasuring, see our Masturbation for Women and/or our Masturbation for Men brochures.

But what do I do with my partner if I’m not yet ready for sex with him or her?

Work on your sensual connection.  Take time for giving and receiving massages and enjoying touch and sensation without pressure to have sex.  The goal is to get more emotionally connected with your partner. Encourage your partner to masturbate, adding an erotic toy and/or movie if desired.  When you’re ready, start with genital massage using a personal lubricant as your massage lotion (oil can be irritating to the genitals, so avoid oil or Vaseline).  Focus on giving and receiving pleasure.  Experiment with non-penetrative activities:  kissing, making out, whole body touch, oral sex, mutual masturbation, or any other intimate activities you want to explore.  Eventually, plan to massage each other to orgasm, focusing on the sensations of arousal and orgasm.  When and if you become interested in penetrative sex, have your partner massage you first until you are quite aroused and ready for penetration.

Keep sex going.

It helps to create some uninterrupted space for your sex life.  Make a date with yourself and/or your partner to enjoy one or two hours of pleasure without answering the phone, dealing with the kids, or thinking about work pressures.  We recommend scheduling time for sex, and choosing a time when you are relaxed and comfortable.  Try not to get too hung up on the idea that you lose spontaneity when you schedule sex.  Remember, what you do sexually can still be spontaneous, even if the timing isn’t.  Plus, knowing you will be having sex at a certain time creates anticipation, which heightens your arousal.

If orgasms are important to you, make sure you get the stimulation you need to have at least one orgasm during sex play.  Let yourself fantasize before and during sex.  It’s harmless, and a it’s good way to increase your arousal.  Don’t concentrate on making your fantasies come true, instead, enjoy the wild sexual field trips your mind can take.  Many people find that their fantasies can lose their charge once they are acted out, so focus on enjoying the arousal you get from them now.

Keep in mind that variety is important to keep sex interesting and exciting.  You can try new positions and locations, and it’s great to explore different types of sexual activities (oral sex, mutual masturbation).  The Kama Sutra, an ancient marriage manual, recommends incorporating taste, smell, sound and different sensations to make sex even more rewarding.

Having good sex makes you want more sex.  Building your own history of pleasurable, comfortable sexual experiences will encourage your libido to grow.  Making time for sex and keeping yourself healthy and relaxed also makes space for your libido to come out and play more often.  As one woman said to us “You know, the more I have sex, the more I want to have sex.”

Suggested Resources:

If you’d like some books to help on your journey, we recommend:

Reclaiming Desire, by Andrew Goldstein, M.D., and Marianne Brandon, Ph.D — A great book to help you understand how many areas of your life come together to influence your mood and romantic willingness, and what you can do to de-stress enough to revive a slowed-down sex drive.

Reclaiming Your Sexual Self, by Kathryn Hall, PhD. — Disusses the reasons people experience low libido and gives helpful suggestions for creating the right conditions in your life for more desire and libido.

The Return of Desire, by Gina Ogden, PhD — An excellent book for women who want to bring desire back into their lives.  Inclusive of women of all ages and orientations.  Explores the spiritual side of sexuality as well.

The Sex Starved Wife: What to do When He’s Lost Desire, by Michele Weiner Davis — Gives advice for women in heterosexual marriages whose husbands want less sex than they do, or none at all.  Offers good tools to help couples gain understanding and revive their marriage.

Mating in Captivity, by Esther Perel — A refreshing, original look at the way sexual relationships change over time, the choices we make that create those changes, and what we can do to rekindle the flames.

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Cervical Self-Examination

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Benefits of Cervical Self-examination

There are many benefits to examining your own vulva and cervix. By examining yourself regularly, you can gain a sense of what your body normally looks like. You can understand how your body is put together, what your discharges look like, and how your cervix and cervical mucus change throughout your menstrual cycle, or after menopause. For some women, doing a self-exam allows them to see a part of their bodies that they have learned to ignore or even fear. Other women like the sense of control they get from using a medical tool to see for themselves what others see. This helps to decrease their need to rely on what other people tell them about their bodies.

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Eager Ejaculation

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Dear Dr. Myrtle,

Try as I might, I can’t seem to last as long as I’d like to. How can I prolong sexual penetration without coming?

In books and movies, our culture glorifies the mad, passionate rush to intercourse as the ultimate sexual experience.  Unfortunately, frenzied sexual experiences can sometimes be unsatisfying and difficult to control.  If ejaculation occurs before either partner wishes, it is often called “premature ejaculation.”

This makes it sound like a medical disorder, but it’s not.  Even the fastest ejaculation isn’t a problem if both partners prefer it that way.  Partners who are not particularly fond of intercourse, for instance, may prefer orgasm through oral sex or a vibrator, and may look forward to the fastest draw in the West.

The key is satisfaction, not endurance.  That said, you can learn to work with your arousal and gain more control  over when and how often you ejaculate, so that you can have prolonged, slow-to-climax interludes, “quickies,” or anything in between!  It’s a great opportunity to expand your sexual repertoire.

Things NOT to try.

Some folk remedies that don’t work very well:

Men sometimes drink alcohol to slow themselves down.  Alcohol can slow responses, but it may also make it difficult to get or keep an erection.

Some men’s partners take a hands-off approach, hoping that a lack of caressing and touching will allow their mates to last longer.  But if touching is not allowed, what’s the point of having sex?

Some men try to dissociate themselves by reciting baseball statistics or all 50 states in their heads.  This “focus-on-something-else” approach doesn’t take into account that arousal is an involuntary response.  Involuntary responses are nearly impossible to consciously control.  Think of what happens when someone asks you to stop focusing on your nose: if someone makes you think of your nose, it’s tough to focus on anything else!

All of these solutions can take you away from what you are doing and feeling, and are very unlikely to lengthen your sexual experience or heighten your pleasure.

In some cases, your doctor might prescribe an SSRI (Selective Serotonin Reuptake Inhibitor; commonly used as an antidepressant) to delay ejaculation.  Studies show that some SSRIs can delay ejaculation by about a minute, which gives you enough time to begin using the techniques explained here.  A word of caution: when you stop taking the SSRI, you may experience a quicker ejaculation than you did while you were taking it.  Be patient, and stay with it; the practice you gained while taking the medication can help you continue to work with and learn about your arousal levels.

What exactly happens in arousal?

Arousal is actually a part of our every moment.  Arousal keeps us breathing, increases when we need to concentrate on something important, and calms down to let us sleep.  The arousal system even has its own neurological pathway (the autonomic nervous system), separate from the nerves that make your fingers move.  But arousal cannot be controlled directly.  For instance, your heart beats without you deciding to make it beat.  Although you can slow your heart rate a little bit by thinking about it, it’s impossible to control your heart rate entirely with conscious thought.

Likewise, during sexual arousal, any person has room to tinker, particularly in the early stages.  However, one may reach the “point of no return”–the brink of the orgasmic threshold when it is no longer possible to slow down and delay orgasm.  Learning how to finesse your personal arousal is the key to choosing the satisfying sexual experiences you desire.

In men, it’s often assumed that orgasm and ejaculation are one and the same.  That’s not quite the case.  There are two stages of a man’s orgasm: the cognitive awareness of pleasure, and ejaculation.  These events happen two or three seconds apart.  During the contractions of the prostate gland, the arousal system sends pleasure feedback to the brain, which is experienced as an orgasm.  Men may experience the prostatic contractions as a pleasant fluttering or throbbing sensation.  The second stage, ejaculation, occurs as stronger muscle contractions propel semen down the urethra and out the tip of the penis.  The “point of no return” actually happens after the first part–the pleasure–and before the second part–the ejaculation. 

Path One: Come and Come Again!

One strategy is to have a whole bunch of orgasms, rather than just one.  Who wrote that “only one” rule, anyway?  This is your sexual pleasure we’re talking about, and no one else decides when the curtain goes down on your party.  It’s okay to accept what is and have fun the way you are.  Does it have to mean the end of everything because someone ejaculates?  Nope!  Sometimes, it’s helpful to give yourself permission to have a big, long sexual session. 

The multiple orgasms and multiple ejaculations technique is probably the easiest to learn.  The idea is to focus very consciously on the sensations that are arousing to you, do exactly what arouses you most, and don’t hold anything back.  Play around, and if you want to ejaculate again, go for it.  If you need a toy like a dildo or vibrator to increase the intensity of your erotic play, consider investigating the possibilities rather than holding back.

Having trouble getting an erection after ejaculating?  Try using a cock ring.  Cock rings are great when your body says “not yet,” but your desire is still flowing.  A cock ring is a flexible strap that can be secured around the base of the penis.  It works by allowing blood to flow into the penis, but not out.  You can put a cock ring on when you are soft or after you’ve gotten another erection.  While you shouldn’t leave one on for more than 30 minutes, there’s a lot you can do in that amount of time.

The major drawback to multiple ejaculations is that it can be hard to avoid post-ejaculatory stupor.  With several ejaculations, your arousal system will have exhausted itself, and you might not have the energy to go on without some sleep.

Path Two: Multiple Orgasms without Ejaculation

It’s possible to learn to stop every orgasm before ejaculating, and to orgasm several times without ejaculating at all.  Interestingly, it’s the ejaculation itself that is often experienced as exhausting, and some men who experience multiple orgasms without ejaculation notice an energizing effect.

The technique described below is essentially a prolonged session of playing “faster-slower.”  The goal is to stay somewhat aroused while you manipulate your arousal level.  Enjoy the feelings of both decreasing and increasing arousal.

Once you can do this, try masturbating to orgasm, and concentrate on the sensations of the prostate. 

You need to learn what it feels like to experience the orgasm (for most men, the prostate fluttering) before you can know when to hold back from ejaculation.  Focus on the sensations, and see if you can experience the orgasm separate from ejaculation.

Next, you will need to become aware of your personal arousal and orgasmic cycle.  It’s helpful to rate your arousal on a scale from 0-10, with 9 or 10 indicating the point of no return.  Start by choosing a number in the middle, like 4 or 5, then practice masturbating to a fever pitch and slowing down as you reach that number.  You will still be aroused with minor stimulation, and you will learn what it feels like to be aroused to a 4. 

Then, pick a slightly higher number on the scale–say, a 7.  It’s a little trickier here, but you really want to focus on lower arousal.  One thing to try is to take long slow breaths in, and let the breaths out quickly in a couple of bursts.  This helps disperse your sexual energy and take the tension out of your spine and lower back.

Another arousal-slowing technique is contracting your pelvic floor muscles.  Contract these by squeezing the muscles that run from your tailbone, around your anus, and all the way forward to the base of your penis.  When you are contracting correctly, the base of your penis will bob up and down slightly.  Next, incorporate pelvic floor contractions into your masturbation play.  Masturbate up to a 5, then contract for two seconds.  Slow and speed your self-play, and work on incorporating this PC flex into the ups and downs of your arousal cycle.

Similarly, you can control your ejaculation by pressing firmly on the perineum–the area between your scrotum and anus–while contracting your PC muscles.  This helps delay ejaculation by refocusing your attention on your arousal and interrupting the ejaculation reflex.

Perineal massage can be quite pleasurable, and some men think that it’s the greatest sexual technique they’ve ever experienced.  Perineal massage can be done by yourself or your partner, and can be performed at any time during self-play or penetration.

Okay, I’m having a blast here, but what about my partner?

With increased awareness of sexual arousal and physical cues, you can expand your practice to include partners. With a partner involved, you might have to relearn most or all of your cues.  Why?  Because it’s one thing to stop your hand, or turn off your vibrator when you need to ease off, but it’s a much greater task to communicate to your partner where you are on the arousal scale.

Fortunately, most couples report that the process of talking is in itself very satisfying, because they feel more connected than when they are silent.  Also, all of the techniques that you’ve been practicing work with partners, because none of them require that you pull out from penetration.  Your partner will have fun playing with you and your arousal, pressing your perineum and practicing your breathing techniques with you.  Learn more about your and your partner’s responses to sensation and practice expressing yourself.

Additional Resources:

The New Male Sexuality, by Zilbergeld

Male Multiple Orgasm, by Pokras

The Multi-Orgasmic Man, by Chia and Arava

The Multi Orgasmic Couple, by Chia and Chia, for heterosexual couples interested in multiple orgasms for both partners.

Most of all … have fun!



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Erectile Dysfunction

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What is ED?

Erectile Dysfunction (ED) in men is defined as an inability to achieve and maintain a penile erection sufficient for penetration. There is a broad range of erection troubles including:

•  the inability to become hard at all,
•  becoming hard only briefly,
•  becoming only half-hard, and
•  only occasionally becoming hard.

No matter your level of current function, this brochure can:

•  help you understand what’s happening in your body,
•  give you the information you need to make sure your erection problems aren’t a sign of something more serious, and
•  give you some ideas of steps you can take to improve the health, strength and duration of your erection.

Increasing focus on rehabilitation techniques for ED can also improve sexual function for men without ED. Some men want harder erections or for their erections to happen faster and/or last longer.

Why is erection capacity important?

Beyond sexual penetration, penile erections are a simple, elegant indicator of overall health and well-being. This is because the formation of erections relies on healthy physical systems and mental processes. When any part of that combined system is ill or not maintained, erections can become much harder to have or maintain.

How do erections happen?

Think of sexual arousal as a collaboration between the mind and body. When medical conditions, trauma or surgery changes structure or function, or the mind is overcome with anxiety, it is hard for the whole system to work together.

The process of becoming sexually aroused with an erection includes several types of nerves, the penile clitoris (aka corpus cavernosa) and small blood vessel function. Having an orgasm further tests the neural system, and experiencing ejaculation relies on yet another nerve system. The whole sexual system isn’t complicated, but does require many sections to work together for sexual arousal to fully develop.

There are two ways to consciously initiate penile erections. One is to physically massage the penis which causes blood flow to be released into the caverns of the clitoris. When this blood swells the caverns, the penis enlarges (mostly sideways, but also makes the penis a little longer), and traps the blood inside the caverns. The other way is to allow or create sexual thoughts or arousing ideas in the mind. The brain will translate these ideas into sexual arousal, and when the nerve impulses reach the genitals, blood flow will release into the caverns. Most men use some combination of both the direct stimulation and cognitive sexual arousal (mental) pathways to sexual arousal, and vary their techniques depending on their individual circumstances.

Types of Penile Erections

There are two types of erections in men:

Erections for oxygenation (puff erections).

The blood vessels that lead to the inside of the clitoral structure need routine blood flow for oxygen and nutrition. The body accomplishes this (without effort or awareness from the man) by lightly flooding the clitoris three to six times daily. Morning erections and slight “puff” erections during the day and evening are simply the body’s way of taking care of the genital structures. While this is not related to sexuality, the lack of these “puff” erections is a strong indication that something is disrupted and needs attention. These puff erections are not related to sexual arousal itself, since the blood flows through the clitoris rather than being trapped as it is in penetration erections.

Erections for sexual arousal.

When the blood flowing into the caverns increases at a rate greater than the outflow, the penis becomes stiff because the blood is trapped, causing an erection. When a man wants to use his penis for sexual penetration, he needs this hardness to hold his penis straight. Penetration can occur with softer erections, but the man needs to be careful not to bend the penis, since the elastic/fibrous clitoris can be broken when bent at an angle.

Physical Causes of Erectile Dysfunction

Today we know that physical causes (heart disease, diabetes) of ED are more common than psychological causes. In fact, more than 80% of erectile dysfunction is an early physical manifestation of medical illness. The connection is so strong that early erectile problems are known to precede heart attacks by an average of 3-5 years in men, many of whom never had symptoms of heart problems. For men diagnosed with diabetes, more than 90% have erectile dysfunction.

Men’s erectile function is very similar to the canary in the coal mine. If the canary is having problems, something is wrong in the system somewhere and needs close medical evaluation. Until you know better, always consider a change in erectile function as a meaningful medical event that requires the attention of a health professional.

We strongly recommend that you start with a visit to your health care provider for a physical assessment, and that you not put it off. Make sure you mention your erection difficulties at that visit, so your health care provider will have the information necessary to arrive at an accurate diagnosis. This is no time to be shy; you really need to tell it like it is. But don’t just accept a prescription for Viagra: you need to know if your heart, nerve and metabolic system is having trouble and if your early signs of erectile dysfunction are a dangerous symptom, not just an inconvenience.

Psychological Components of ED

Once your health care provider has evaluated you for physical causes of ED, look also at what emotional, psychological, or relationship issues you have. These may be either a cause of your ED, or have arisen from the experience of having ED. It can be very disturbing to have your body stop functioning as it has all of your life, and can make relationship problems difficult to solve.

You can find a professional who is particularly knowledgeable about sexual issues by going to the web site of the American Association of Sex Educators, Counselors and Therapists ( On their web page you will find information for the public on how to find a sex counselor or therapist in your area. It might be helpful to see a counselor alone, with your partner, or some of each, but you should decide what is most helpful for you.

Rehabilitation Techniques for ED

With or without a medical diagnosis, most men can increase their hardness by making lifestyle changes. Although making these kinds of changes can take some time, the positive effects on your erections will likely be noticeable sooner than you might expect, particularly if you really commit to the change. Steven Lamm’s book The Hardness Factor  explains specific lifestyle changes that can increase your firmness noticeably in as little as a week, and impressively in six weeks. Staying with those changes for the rest of your life will help you be able to become erect and stay that way well into old age.

Eat the Good Sex Diet.

There are many chemical processes in the body that contribute to your erections and orgasms, and they need good building blocks, in the form of the foods you eat, to function smoothly. Truly, eating a healthy diet (a low-carb version of the Mediterranean Diet) can revolutionize your sex life. Avoid white foods (refined grains and sugar), focus on lean proteins (beans & nuts), and lots of deeply colored vegetables and fruits.

Get more exercise.

Thirty to sixty minutes of moderate exercise every day (walking hard enough to make you sweat a bit) makes a big difference to most men’s erections, sexual performance, and libido. When you make your heart work hard, it gets better at working hard and becomes better able to meet the demands of sex. When you fatigue your muscles, your body makes more small blood vessels to carry oxygen to your tissues, which results in stronger erections. Exercise also increases sexual desire, decreases depression, and increases feelings of well being. Taking a 20 minute walk before sexual activity can prime your sexual arousal system for a perkier performance, too.

Stop smoking.

Anything that reduces your blood vessel health reduces your sexual potential. If you smoke, you can increase your hardness significantly by quitting, and some men notice a difference in as little as two weeks. Smoking stiffens blood vessels, and lowers HDL (good cholesterol) and raises LDL (bad cholesterol), which is exactly the opposite of what you want for prevention of heart problems, and ED.

Keep your alcohol use moderate.

Having more than three alcoholic drinks a day inhibits both erections and orgasms by decreasing production of nitric oxide. Nitric Oxide is the neurotransmitter molecule necessary for relaxing the blood vessel walls in the erectile tissue of the penis. Over time, use of alcohol causes nerve damage that can permanently affect your ability to become erect. Although the relaxation effect of alcohol may feel beneficial to your sexual relaxation, it is a leading cause of soft erections in men.

Don’t use street drugs.

Cocaine, LSD, marijuana, amphetamines and barbiturates all decrease your ability to become hard and stay hard. Sexual arousal is a unique balance between relaxation and excitement, and when you use substances that interfere with one part, the other components are often inhibited as well.

Refine your prescription medications.

Ask your doctor if you can refine your medication choices towards those with fewer sexual side effects.  Some medications are more likely than others to support your sexual health, and some combinations of medications could be making your ED worse. Your health care provider may be able to prescribe comparable medications with fewer sexual side effects.

Address emotional and relationship issues.

Maybe emotional issues weren’t originally any part of the cause of your ED, but if you’ve been struggling with hardness problems for some time, chances are emotional issues are present. If ED is affecting your self-image or altering your intimate relationship(s), you owe it to yourself to get help dealing with any emotional issues involved.

Have regular orgasms.

Many men can orgasm without having a completely hard erection: they just have to know that and not let the softness stop their self-pleasuring. Some men use different techniques for arousal depending on what they need in different settings. You can orgasm alone or with a partner; both ways are effective for keeping the system fit. Regardless, we recommend at least two orgasms a week (with ejaculation if possible) as a healthy sexual maintenance routine.

Any recommended devices or sex toys?

There are a number of mechanical devices that may help maintain a stronger erection, including erection rings, erection rings combined with vibrators, and penis pumps.

Erection rings are rings of material that fasten around the base of the penis. They help maintain an erection by restricting the blood flow back out of the penis. Some erection rings are stretchy silicone or elastomer, some are rubber O rings, and some are adjustable leather or synthetic bands that close with snaps or velcro. Only use easily removable or adjustable erection rings (not steel rings), and don’t leave them on for more than 30 minutes; keeping blood trapped in the penis for a long period of time can cause permanent damage. Some erection rings include a built in vibrator.

Vibrators activate the mechanism responsible for blood flow into the penile clitoris. Even if nerves responsible for sexual arousal have been damaged, when the penile clitoris and blood vessels are healthy, a vibrator may help you become hard. You need to experiment with different types of vibration and apply it to the base of your penis, along the shaft, or any other sensitive place that arouses. Use it with or without a erection ring, or choose one with a built-in erection ring. Try your vibrator for self-stimulation, or combine it with partner play.

Penis pumps are very helpful for achieving a harder erection, especially if you are able to become partially erect. Pumps work by using a vacuum to stretch the membrane surrounding the erectile tissue of the penis, allowing blood to flow in freely. A pump is often used in combination with a erection ring. First the pump brings partially oxygenated blood into the penis, and then an erection ring (placed around the base of the penis shaft) holds the blood in. Be gentle when using a pump; mild suction is all that’s needed. It is possible to hurt yourself by pumping too vigorously or for too long. Also, to avoid blood blisters, don’t use pumps if you use blood thinning medication.

Penile Rehabilitation

For men recovering from pelvic trauma, surgery (prostate or rectal), or radiation therapy, a rehabilitative therapy called penile rehabilitation (PR) has been developed. Many men don’t realize that these same techniques are helpful when recovering function for metabolic ED, too, because maintaining the flexibility and ensuring routine oxygenation is good for the penis no matter the cause of ED.

When used for PR, the goal for using a penis pump is to continue blood flow and flexibility during the healing process, when nerves have been damaged by surgery or radiation. If the nerves recover function and re-establish themselves, then the clitoral structure will be ready for action as well. If blood flow stops (without use of a pump), then anoxic damage to the clitoris may be irreversible.

Effective penile rehabilitation often involves a combination of daily medication and use of a pump daily. Ask your health care provider whether a program like PR is right for you.

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Self Pleasuring for People with Vulvas and Vaginas

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Self pleasure, also known as masturbation, specifically refers to touching yourself sexually in a way that feels good. There is no one right way to masturbate, and as long as it doesn’t hurt, there’s certainly no wrong way. Pleasuring yourself, on your own terms, is a way to deepen your relationship with the most important person in your life—you!

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Orgasms for People with Vulvas and Vaginas

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I don’t have orgasms. What can I do?

This is a very common question with some straightforward answers, yet many women can’t find enough information about their bodies to learn how to give themselves an orgasm. Often we expect our partners to know how to stimulate us, or think that we should easily have orgasms during vaginal penetration. Read the brochure to learn concrete information and solutions.

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Pelvic Floor Health for Women

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Please note: we are aware of the problematic title of this brochure, as the term ‘women’ does not adequately define people who may be transmasculine AND have a pelvis shaped by low testosterone in utero. We are in the process of consulting with pelvic floor muscle experts on how to properly rewrite this brochure, and we appreciate your patience and kindness as we attempt to both presenting accurate information and present an appropriate gender-less brochure. Thank you for your understanding that we are working on this.

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Postpartum Recovery and Sexuality

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I have many questions about my body and sexuality in this post-delivery time. Help!

Postpartum Sexual Health Issues

How can I heal my perineum?

Many women experience damage to the perineum (the area between the vaginal opening and the anus) during delivery. Here are some helpful techniques to speed your recovery:

1. Apply ice packs for the first 24 hours after delivery to reduce swelling, then switch to daily sitz baths with warm water. Some midwives and holistic practitioners recommend the addition of certain herbs to these baths. Check with a practitioner you trust for a recipe.

2. After bathing, let your perineum air dry and, if possible, expose it to sunlight.

3. Try using only soft cotton underwear. Don’t be afraid to pamper yourself with some new undies! You’ll want to change them often. If the seams chafe, wear them inside out. Some women avoid wearing underwear altogether, and wear skirts rather than pants. This helps avoid trapping moisture against the skin while healing takes place.

4. If you experience pain from urine splashing against the perineum, try using a squirt bottle filled with warm water, and pouring it over the vulva while urinating, or you could urinate in the shower. Some find that a light application of zinc oxide (like Desitin) helps, but don’t apply anything unless specifically told to do so by your doctor or midwife.

5. If at any time your perineum seems to worsen rather than improve, contact your health care practitioner. Most women feel they are completely healed after a few weeks, although some take longer. You may still have uterine spotting even after your perineum has healed.

After your bleeding has stopped and you have no pain, gently massage your perineum to soften any remaining scar tissue. Using a moisturizing, water-based lubricant like Erosense Sync or Oasis Silk, you or a partner can insert one lubricated finger just inside the vaginal canal and gently roll the perineal tissues between thumb and forefinger. Some women perform this massage nightly, which helps moisturize the tissues while you sleep.

I’ve heard rumors about women losing vaginal tone and becoming “loose” after childbirth. Is that true?

Although some skin tone and pelvic-floor tone is lost through pregnancy and childbirth, it is possible to gain most or all of it back. Breastfeeding releases a hormone called oxytocin, which naturally restores some of the tone of the pelvic floor muscles and ligaments. Pelvic-floor exercises (Kegels) will specifically strengthen these muscles. For a complete description, see our Pelvic Floor Health brochure.

Also, consider that orgasms exercise and revitalize the pelvic floor. Because these muscles stretch while carrying a pregnancy, your early postpartum orgasms may feel less intense. When you’re ready, regular orgasms are one of the best ways to increase the strength and flexibility of your pelvic floor muscles.

Postpartum Breast Issues

Is it normal to have sexual feelings while breastfeeding?

Some women experience sexual feelings during breastfeeding, while others don’t. Both responses are totally normal. Your breasts are erogenous zones, and having them touched and suckled can feel wonderful. Breastfeeding also causes your body to release a hormone called oxytocin, which creates feelings of closeness and well-being—it’s also the hormone released during orgasm. You can think of the warm, arousing sensations you experience as nature’s built-in bonus for breastfeeding.

Sometimes when I’m having sex, milk leaks or sprays from my breasts. Is this normal?

Direct nipple stimulation can cause lactation. Also, when you are aroused, your body signals the release of oxytocin and prolactin, which in turn trigger milk production. This is why you may leak milk during sex play, sometimes just a bit and other times quite a lot. Some women handle this by nursing before lovemaking. Some women and their partners enjoy this occurrence, and even incorporate lactation into their play. It’s really a matter of personal preference. Choose whatever works for you.

Is it true that you can’t get pregnant while nursing?

You absolutely can get pregnant while nursing. On-demand breastfeeding does suppress fertility to some extent, particularly if you are careful to feed at least once every four hours with no exceptions. However, ovulation precedes your first period, which means that you will be fertile before you resume your monthly bleeding. If you wish to engage in vaginal intercourse and avoid pregnancy, use a condom.

Postpartum Sexuality Issues

Since I gave birth, I have been experiencing vaginal dryness. Is this normal?

Vaginal lubrication is often an issue for postpartum women, especially those who choose to breastfeed. Pregnancy suppresses estrogen levels, which makes it more difficult for you to produce your own lubrication. It’s not such an issue during pregnancy because of your increased blood volume, but after delivery many women notice a distinct change in vaginal/vulvar moisture. Breastfeeding lengthens this estrogen suppression and can make the vaginal dryness seem more extreme.

There are several solutions to consider:

1. Warm yourself up sexually to a very aroused state before attempting penetration. Some women find that having an orgasm prior to penetration draws moisture to the genitals and adds a nice spark to the beginning of their sex play.

2. Supplement nature with a water- or silicone-based lubricant for any kind of sex play. Lubricant helps reduce the friction on your tender skin while allowing you the pleasure of penetration. See our Lubricant brochure for more information.

3. We have devised a program of moisturizing selfmassage, which is explained thoroughly in our Vaginal Renewal booklet. Although this booklet was written for women transitioning through menopause, it is also ideal for postpartum women. The massage will bring blood to the vaginal tissues, moisturizing them and increasing their resiliency.

How soon after the baby is born can I have sex?

Generally speaking, external touching and having orgasms are fine at any time. The issue is vaginal penetration by fingers, toys or a penis before healing is complete, which can put you at risk for uterine infection. Complete healing can take anywhere from a few days to six weeks, so follow the instructions offered by your health care provider. Make sure you understand clearly what is being recommended —if your health care provider says “no sex,” does that refer only to vaginal penetration, or to other activities as well? Being clear about these recommendations will help you to understand them and carry them out correctly.

Also, don’t forget to use contraception! Ovulation precedes the return of monthly bleeding, and can occur quite soon postpartum.

Now that I’ve had the baby, penetration hurts. Why?

If you are experiencing pain with penetration, it may be due to an unhealed perineum, vaginal dryness, or rigid scar tissue from a perineal tear or episiotomy. Although some bleeding with first penetration after delivery is considered normal, if you are experiencing bleeding or discomfort that is distressing to you or persists, inform your health care provider.

Since delivery, I have had very little interest in sex.

It is common for new parents to experience a drop in libido. If you experienced a difficult delivery, especially a Cesarean birth, you may still be physically recuperating. Any delivery can cause bleeding, and recovery can be slow as your body rebounds. The hormonal shifts taking place in your body, lack of sleep, and changing roles and expectations in your life can quickly put sex on the back burner. Also, the physical closeness you share with your baby may leave you feeling “touched out.”

Be compassionate and patient with yourself. Healing puts extra demands on your body, so getting adequate sleep and making sure your diet includes lots of high-quality protein sources, and fruits and vegetables with plenty of antioxidants, can be very rejuvenating. Keep up on your fluids. Consider taking, or continue to take, a multi-vitamin supplement. Depression can also inhibit libido. The “baby blues,” a common condition including sadness, crying, and mood swings, should abate a few weeks postpartum. If you find that you are experiencing these or other distressing symptoms for a longer period of time, or in a more intense form, you may be experiencing postpartum depression. Contact your health care provider, who will be able to assess your condition and help you get the proper treatment.

I’m worried my partner is getting sexually frustrated.

It is extremely important to communicate with your partner about sexual issues. Do not take for granted that your expectations and needs match. Your partner may feel a bit left out of the new bond that you and your child have formed, and a lack of sexual intimacy can add to that feeling. If you do not wish to be sexual, make sure that your partner understands why and feels reassured and loved. Try to be understanding if your partner seeks sexual outlet in masturbation or the use of erotic literature, movies, or magazines. You may even wish to use some of these things together. You never know—your support could turn into arousal.

It’s also important that your needs get met. Communicate your desires and concerns to your partner and ask for the support and reassurance that you need. Understanding each others’ expectations can also help take some of the pressure off. For instance, you may be avoiding intimacy because you are not interested in having penetrative sex or because your breasts are tender, while your partner may be quite willing to experience other kinds of closeness, like kissing and touching.

Now more than ever, your sex life will take effort to maintain. It may be necessary to plan sexual intimacy. Your baby’s naptime is a good time to get close. And don’t pass up those offers of help from friends and family—they might love to spend an afternoon with the baby, and it may just give you the perfect chance to reconnect with your partner. Remember, just because you’ve planned to have sex doesn’t mean the sex itself can’t be spontaneous! You may wish to involve games or toys to bring a sense of playfulness to sex. Sometimes non-genital forms of intimacy can be ideal. Exchanging massages, cuddling, and making out can be low-pressure ways to feel close.

Our baby has been sleeping with us since he was born. Could it be psychologically damaging to him if we make love in front of him?

Co-sleeping, or having the baby in bed with you or in a crib that adjoins the bed, has experienced a surge in popularity in the last decade. Some parents find that co-sleeping helps them relax and focus on each other without worrying about the baby’s well-being. It’s not uncommon for new parents to worry that they may harm their baby by being intimate in front of him. However, an infant is much too young to understand or be damaged by his parents’ intimacy. Certainly, if the baby is sleeping, there is nothing to worry about. Some parents nurse the baby right before putting her down for the night in order to guarantee at least an hour or two of privacy while she sleeps.

If you do decide to have sex in the family bed, you may wish to modify your vocalizations. Loud moaning and other noises may scare a baby who cannot understand that her parents are actually enjoying each other.

Most parents discontinue the practice of making love in the family bed when the baby is past infancy. As a transition, you might want to experiment with new places for your amour. The couch in the den, the living room floor, the backyard… this may be the time to make some longstanding fantasies come true.

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Pregnancy and Sex

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I have a WHOLE bunch of questions about being sexual while I’m pregnant. Can you give me some detailed information about how to enjoy sex during pregnancy?

Pregnancy is a time in which your body and your personal roles may shift dramatically. These changes can transform your view of yourself as a sexual person. You may feel newly grounded in your body, and revel in your creative sensuality. Your breasts may become larger, your genitals more lubricated and engorged with blood, leading you to feel more in touch with your sexuality than you ever have before.

Yet, you may also feel as though you’re developing a brand new and sometimes awkward body. Many women struggle with a negative body image as they gain the weight that’s necessary and healthy for pregnancy. People in your life and even total strangers may begin to see you as a mother and ignore your sexual self. You yourself may feel less sexual than you did before you became pregnant.

Sexuality during pregnancy has important benefits:

  • Being sexually intimate and aroused is a great way to connect to your sexual side, to celebrate or to remind yourself of the fact that you are a beautiful sexual creature.
  • Sex may lessen some of the aches and pains that accompany pregnancy and can even help you to sleep.
  • Orgasms can tone and strengthen your pelvic floor muscles, which help you carry the pregnancy comfortably, help assist with a vaginal delivery, and help speed up recovery after delivery.
  • If you have a partner, sex can help you feel close, have fun and play together, relieve tension, and celebrate your relationship before the changes that come with parenthood. ~For the baby, some even say that the rocking motions of intercourse, if you choose to have it, can soothe and relax her or him.

Will sex hurt the baby?

Pregnant women and their partners worry that sex, especially penile-vaginal penetration, will somehow harm the pregnancy. This is not the case. Your body was beautifully designed to protect and cushion your pregnancy. Your baby is additionally protected inside your uterus by a surrounding pillow of amniotic fluid.

The vulva and vaginal canal are perfectly capable of responding to sexual arousal, with no danger to the pregnancy. Far inside of the vagina lies the cervix, a strong, muscular, donut-shaped structure that helps hold the pregnancy in place. Since the cervix is softer during pregnancy, any sexual practices that could cut, tear, or bruise the cervix should be avoided. For most women, penile-vaginal penetration is gentle to the cervix. If you use firm/hard toys, avoid deep, hard thrusting that can harm the cervix. Also, nothing will get lost inside of you: until the very end of pregnancy, the cervical opening will develop a small mucous plug, and remain much too small for anything like a penis, fingers, or a dildo to pass through.

If you have a history of miscarriage, your health care provider may ask you to avoid vaginal penetration and/or orgasm, especially during the first trimester. There is no medical evidence that these activities cause miscarriage or that abstaining will prevent miscarriage, but it’s fine to wait until after the birth if it will help you to feel less stressed. Your midwife or doctor may also ask you to abstain from sex if your pregnancy is considered “high-risk” for other reasons. If you experience pain, bleeding, cramping, spotting, or notice any unusual discharge, call your healthcare provider, and ask for more guidance.

What if my healthcare provider says “no sex”?

Make sure that you know what is meant by “sex.” What about oral sex? Anal sex? Are you to avoid penetration or is orgasm prohibited altogether? Find out why she or he has placed restrictions on “sex” and make sure you are clear about what is being recommended to you and why. Ask about any sexual practices you enjoy which your healthcare provider has not specifically addressed. If your provider is uncomfortable or unable to answer your questions, find other sources of information—this is your body and your pleasure.

Is it OK to have sex when I’m due to deliver?

Sex can actually benefit the birthing process. When a baby is overdue, sex can be useful to bring on labor. Orgasm and nipple stimulation can help induce contractions and stimulate labors that have slowed or stopped. Some people worry that these techniques can bring on premature labor, but remember that if everything is going along as it should, labor generally doesn’t start before it is supposed to. If your partner is male, the prostaglandins in his semen can also help to ripen the cervix, which is a good thing.

While in labor, dancing, kissing, cuddling, and being caressed and massaged by your partner (although it is unlikely that you will want to do these things throughout your entire labor) are great ways to feel connected and supported. Rocking your hips and making low moaning noises, like those motions and noises you make during sex, can re-start stalled labors, make you feel focused and uninhibited, and help the baby descend into the birth canal and settle into optimal birthing positions. As midwife Ina Mae Gaskin says, “The energy that gets the baby in gets the baby out.” Some women even have spontaneous orgasms during childbirth. (For further discussion, you may wish to consult the book Spiritual Midwifery by Ina May Gaskin.) We acknowledge that this isn’t every woman’s experience or ideal, and we don’t suggest that you focus on achieving orgasm during delivery. However, we do think that it is helpful to present this rarely offered perspective on childbirth: it can be a safe, sensual, satisfying experience.

What about other kinds of sex play?

  • Oral sex is fine during pregnancy. Some women find that the increased engorgement of their vulva intensifies the warmth and sensation of oral play. However, don’t have your partner blow air into your vagina, as it could push normal bacteria up into the uterus (where it doesn’t belong), or force harmful air bubbles (“air embolism”) to travel into your bloodstream. These little bubbles can be dangerous for both you and your pregnancy.
  • Trim fingernails to prevent cutting the cervix, or dislodging the cervical plug.
  • Be careful not to transfer secretions from the anus to the vagina. Use a condom (over a toy or penis) or glove during anal play, and then remove it before moving on to some other activity.
  • For those women who enjoyed anal penetration before they were pregnant, anal penetration is often most comfortable during the first trimester of pregnancy. After that time, the increased blood engorgement of the anal area can cause veins to bulge out, and can result in hemorrhoids. The hemorrhoids themselves can make anal penetration uncomfortable. Not everyone gets hemorrhoids during pregnancy, so do what feels right for your body.
  • Anal massage, by itself or along with perineal massage is a very healthy, safe practice. The perineum, located between the vaginal opening and the anus, is where most of the stretch of vaginal delivery will occur, and moisturizing and massaging these areas allow you to prepare for the labor process, and recuperate afterwards. Remember to keep anal secretions from being transferred into the vaginal canal, because some can cause dangerous infections in the uterus.
  • Remember that safer sex counts during pregnancy. Many of the easily contracted infections (syphilis, herpes, chlamydia, HIV, gonorrhea) are very dangerous and possibly life-threatening to the baby. Pregnancy can offer a welcome break from the use of contraceptives, but don’t forget about protecting yourself and your pregnancy from infections. If you’ve been intimate without barrier protection with an un-tested partner, ask your health provider to test you and your partner for these infections.

Are sex toys okay to use during pregnancy?

Most sex toys are fine to use during pregnancy. Ideally, a toy used during pregnancy should be made from non-porous, easy-to-clean materials recommended for those with chemical sensitivities. Safe materials include silicone, lucite, or hard-shell plastic. If your toy is made of a substance that does not fit this description, such as jelly or Cyberskin, we suggest that you cover it with a latex or polyurethane condom before using.

Sexual lubricants which were designed for penetration are also safe for use during pregnancy. If you have any special concerns about specific chemical influences with the pregnancy, read your product labels.  You may choose to switch to one with fewer ingredients (like Slippery Stuff), or organic production methods (such as Sliquid Organics). Yeast infections are more common during pregnancy, so it’s a good idea to avoid lubricants that contain glycerin (see our Lubricant brochure for more information).

Vibrators are safe to use on the vulva during pregnancy. An orgasm is an orgasm is an orgasm. It is a myth that orgasms from masturbation and vibrators are too strong and can harm a fetus. Not true. Play away! You are toning your pelvic floor, and helping yourself get a good night’s sleep without medication.

Can pregnancy affect sexual desire?

You bet. Remember, your body is experiencing lots of hormonal changes, as well as shape changes. Your life is also in transition. All of these things can affect sexual desire. In some women, sexual desire is greatly increased. Other women find that their interest in sex wanes. Be kind to yourself and don’t judge yourself for these peaks and dips in desire. Likewise, be understanding of your partner. If she or he has needs that you feel you cannot meet at this point in your pregnancy, be accepting of their use of masturbation, sex toys, erotic literature, magazines or videos. It may even be fun and helpful for you to enjoy some of these things with your partner. You never know what might put you in the mood.

Just like at other stages in your life, maintaining a satisfying sex life can take some effort. You may wish to plan times to be sexual with yourself or a partner, bring a sense of play to sex with games and toys, experiment with different positions and techniques, or find non-genital ways to connect intimately, such as massage, cuddling or kissing.

Sometimes attempting to be sexual is a good way to put yourself in the mood. Start with your body and your head may very well follow. As midwife Elizabeth Davis says, “The more you have sex, the more you want to have sex.” And don’t be afraid to have fun. You may feel inundated with solemn advice about the baby and people treating you like a fragile princess—all the more reason to incorporate fun, naughtiness, and laughter into your sex play.

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Still Juicy: Maintaining Sexual Health through and beyond Menopause

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I’ve experienced several changes in my body since starting through menopause, and I’m worried that my sex life will suffer. Is there anything I can do on my own to maintain my sexy self?

Yes, there is quite a bit a person can do to maintain her sexual health and sexual vitality throughout and after menopause. This brochure describes what menopause is, what changes may occur that can impact sexual functioning, and solutions.

Please note: this brochure describes the menopausal experience of a cis woman and may not fully address other issues with hormone therapy or withdrawl for other people.