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Vaginal atrophy, dryness, and lack of flexibility

I am postmenopausal – I have vaginal penetration issues that are severe, tearing and extreme dryness as well as progressive desensitization. I am looking for ways to renew vaginal tissue and increase elasticity. Where do I begin…massage vibrator? moisturizer? kegel exerciser? estriol creams?

Begin with reading through the Vaginal Renewal program.

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Vaginal Renewal™

Download a free PDF version of this brochure

I am a cancer survivor in menopause. I don’t want to use estrogen but I am dry and sex is getting more painful. What can I do?

At A Woman’s Touch, we developed a program (beginning in 1997) for people with vaginas who are  experiencing dryness and discomfort or pain during vaginal penetration that is either diffused throughout the vagina or burning or tearing at the vaginal opening. Although originally developed for people who have had radiation therapy to the pelvis to treat different forms of cancer, people with less aggressive symptoms related to menopause also benefit from the Vaginal Renewal™ program.

We also helped manufacture vibrating wands for use in this program, which you can find by clicking on this link.

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How to keep the sexual fires burning

I suffer from a low level of sexual desire toward my husband, and it is not because I don’t find him attractive. Please help me find a way to improve or increase my cognitive sense of desire.

One of the more destructive myths that floats around out there is that sexual desire should come automatically, and should persist at a consistent level throughout the life of a relationship. In reality, nothing could be further from the truth. When interviewed, long-term couples who state that they remain interested in each other sexually talk about how they have to work at maintaining their desire and feeding their libidos. So it takes conscious effort to feed what you call the “cognitive sense of desire”.

How can we do that? There are many different tools available to couples to them help focus back on your connection and feed the sexual side of your relationship. The basic philosophy used by sex therapists when faced with a couple whose sexual life has fallen away is to help them to focus more on all the ways they are connected, and to nurture their shared experiences of all five senses. So the first step is to increase the amount of contact you have with each other – not contact that is intended to lead to sex. Spend time looking into each other’s eyes and touching in ways that feel good but aren’t specifically sexual. The stronger intimate connection you feel, the more likely you are to want to be sexual.

Other tools that help to increase libido are erotic books and movies. You can read a book yourself, or read it aloud to your partner, or do both. This can introduce some new ideas into your sexual life, spark your libido, and help you express some fantasies you may have that you’d like to act out with your partner. Many books incorporate erotic stories, suggestions on how to spice up your sexual life, and encouragement for keeping the flames of passion alive between you. Erotic movies are also good tools for sparking the libido, as well as ways to allow you to articulate fantasies (“You know, I’ve always wanted to try that!”). There are tasteful erotic movies available, meant for women and couples, that show explicit scenes of lovemaking in ways that can inspire your libido without offending your sensibility.

Another fun tool is to get an erotic game that is designed to re-light the spark between you. Games can provide a structure for you to play with desire, flirtation, fantasy, and wish fulfillment, with the goal being to inspire lust and sexual connection between you and your partner. For some couples, that gets them out of their habitual pattern of “how we have sex” and into something a bit more playful. Changing the patterns of how you approach sex can be important when trying to make it more interesting.

Last, I want to encourage you to make time in your life for both sensual and sexual contact with your partner. It also is important to accept the natural ebb and flow that your sex life will take as the rest of your life has its ups and downs. If you’ve been experiencing a lot of stress, plan a vacation (even one at home – as long as there are no kids, no phone calls, and no interruptions for a couple of days) that will allow you to de-stress enough to be able to enjoy connecting again with your partner. It takes some work, but the outcome is so worth it!

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Libido and pre-menopausal women

I’d like to get some confirmation on my experience that my interest in sex goes in waves that roughly correlate with my menstrual cycle. Am I really changing estrogen quantities sufficiently to go from nymphomaniac to happy celibate?

Sexual desire, also know as “libido”, is probably one of the most under-discussed and most-wondered-about emotions. There is lots of available information about sex and reproduction, sex and illness, or sex and advertising, but not a whole lot about personal sexual desire.

A review of physiology: If you think about a woman’s menstrual cycle as beginning the first day she bleeds, that day would be day one, and you could continue counting each day until the next day she bleeds. The average number of days between bleeding (a “cycle”) for most women is about 28 days, although there is often variation.

The cycle can be further thought of as being divided into two halves: the first half being a hormonal preparation for ovulation (the “follicular phase”), and the second half (the “luteal phase”) a preparation for menstruation. Levels of the hormone estrogen begin to rise before the first day of bleeding, and continue at a high level until ovulation. Levels of the hormone progesterone rise after ovulation and continue until a few days before bleeding. There’s more to it, but those are the basics.

Back to the question. Research shows that women, on average, report more sexual desire (libido), more sexual activity, and more interest in erotica during the pre-bleeding, bleeding, and first phase (follicular phase) of their cycles. This would seem to support a “hormone = libido” theory. For more information on this topic, read the book The Alchemy of Love and Lust, by T. Crenshaw. This book is an absorbing treatise on how sex hormones might influence our relationships.

But …! Several studies have shown that sexual desire does not correlate with estrogen or progesterone levels. Some studies have shown a change in libido which was related to testosterone levels, however, which fluctuate in both women and men. Confusing the issue more, when women reporting low sexual desire were compared hormonally to women with “normal libido”, the blood hormone levels in the two groups were statistically the same.

Is libido more linked to hormones, or to something else? Sexual desire is influenced by many different things. It’s probably the case that there are some hormonal influences on libido; however what you’re thinking (cognition) is more important to desire than hormones levels alone. There are several observations that support this:

  1. Learning more about your own arousal can allow you to achieve more arousal, even though your hormone levels stay as they always were. When women who report low libido, participate in “orgasm training” (educational effort and “hands on practice”), they report feeling more sexually aroused and more sexually assertive, even six months after the training. Their hormone levels, however, did not change one bit.
  2. Sexual desire does not change in approximately 50-70 percent of post-menopausal women. This means that when a woman has stopped cycling her estrogen and progesterone (the “pause” in the “meno”), her sexual desire is most often unaffected. This is supported by the observation that women’s testosterone levels decline, if at all, very slowly before, during and after menopause.
  3. Other social and medical factors, such as loss or unavailability of a partner, health status, or partner discord have been shown to be far more influential than postmenopausal hormone levels (including testosterone).

Testosterone has gotten lots of press, but when you look at research with willing humans, it is generally women who have other medical conditions (pituitary problems), or have had their ovaries removed who most benefit from testosterone replacement. Even then, it’s a tight-rope balance act, where too much gives you facial acne and irritability (“testy” comes from “test”osterone), and not enough leaves you without a sex drive. Other people with “normal” testosterone levels have not been shown to benefit from pills or injections of testosterone.

(An aside: testosterone creams have some effect on women’s arousal, but we wonder whether a sexual lubricant might not do the same thing. The women reported feeling “sexier” and “wetter”, which might have been from rubbing in the lotion that the testosterone was put into. Women also report that 10-20 minutes of massage with a Viagra cream helps too, but taking a Viagra pill is not effective. See a connection? No study has been done that we are aware of that uses sexual lubricant and vulvar massage for 10-20 minutes to see if that helps women’s sexual arousal. We could foresee the line of women waiting to get into that study, though.)

The answer? I suspect that the most important determinant of libido is cognition (what you’re thinking). These studies show that if you don’t have a cognitive sense of desire, that your hormonal level won’t matter much. Hormones are to libido what icing is to cake: hormones may enhance an underlying sexual desire, but aren’t responsible for developing the desire in the first place.

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Re-sparking the libido

I’ve entered perimenopause and I’ve noticed that my libido is not what it used to be. Are there things I can do to get it revved up again?

There are natural changes that happen with our libido when our hormonal balance changes at menopause. Libido, or the desire to be sexual, takes practice to happen easily, and it often goes away when you’re distracted by life’s challenges, or your physical health changes.

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. 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)

Where do I start?

To begin nurturing your libido, start with your brain. Start thinking about the good sex you’ve enjoyed. Reflect on your favorite past encounters and fantasies. Allow your body to become aroused, paying attention to the feeling of blood flowing to your genitals. You may not produce lubrication the same way you used to, and that’s perfectly normal. Try to recognize different signs of arousal: swollen labia, a flush on your chest, tension in your nipples, and an increase in breathing. If you have a partner, your partner may notice that your eyes are dilating as well. If you experience dryness of your vulva and vagina, we recommend massaging a moisturizing lubricant into those tissues twice a day. This encourages blood flow to your labia so you become aroused more comfortably.

Don’t stop now.

Allow yourself to think positive sexual thoughts throughout the day, including fantasies, remembering past sexual experiences, and envisioning wonderful sex that you’d like to enjoy. Think about the variety of sexual activities that would be pleasurable, including genital massage, oral sex (on you by a partner) and comfortable penetration of your vagina, 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 now responds to erotic thoughts, erotic stories and erotic pictures or videos. There is a lot of woman-friendly erotica available to help expand your fantasies and nurture your arousal during both self-pleasuring and partner sex.

Pleasuring yourself will help you know how it feels as your body becomes aroused, and what kinds of touch and sensation feel the best. If you enjoy vaginal penetration, include that in your self-pleasuring, exploring how deeply you like to be penetrated and what width is most comfortable. Begin with one finger, then gently introduce a second when you feel ready. If you can comfortably be penetrated by two fingers, consider using a dildo or vibrator to increase your pleasure. Then, when you choose to have sex with a partner, you can teach your partner what you’ve learned about what works best for you.

But what do I do with my partner until I’m ready for sex?

If you have a partner, make time to enjoy each other in sensual ways. Set aside time for you to give each other massages, enjoying touch and sensation without pressure to have sex. The goal is to get more emotionally connected to your partner. Encourage your partner to masturbate, adding an erotic toy if desired. When you’re ready, start with genital massage using a personal lubricant as your massage lotion (oil can be quite irritating, so avoid oil or Vaseline on the genitals). Eventually, plan to massage each other to orgasm, focusing on the sensations of arousal and orgasm. Then, if you’re interested in intercourse, have your partner massage you until you are quite aroused and ready for penetration.

Keep sex going

It helps to create space for your sex life, without interruptions. 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. If orgasms are important to you, make sure you get the stimulation you need to have at least one orgasm during sex play with your partner.

Slowly building a set of pleasurable, comfortable sexual experiences will encourage your libido to grow. Take time to cuddle afterward, and enjoy the feelings that come from pleasurable sex. The warmth of a positive sexual connection is something you can think about and enjoy when you’re ready for more pleasure.

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Do oral contraceptives diminish libido?

Is it true that birth control pills take away sexual drive?

Oral contraceptive use is common.

Over 30 million women choose to prevent pregnancy in the US.

  • The leading choice (37%) for contraception is hormonal control of ovulation (“the pill”–oral contraceptives, injections, patches & implants).
  • Non-reversible surgical sterilization (female and male) are used by 36%.
  • On-demand barrier methods (male & female condoms) are used by 18%.

What is the relationship between hormonal contraceptives and libido?

Studies evaluating a relationship between hormonal contraceptives and possible effect on sexual desire have been mixed. This is because sexual desire (libido) is multi-factorial, with three main contributors:

  • Social (relationships, availability of partners, privacy)
  • Psychological (personal attitudes, personal experiences, reaction to cultural beliefs)
  • Physical (physical pain, ability to achieve arousal, hormonal status)

Dysfunction in any or all of these areas can cause depressed sexual desire. Yet studies of the relationship between libido and contraceptive use have never distinguished between these different contributors to libido. The consequence of this faulty understanding has been a blended hodge-podge of risk-factors in research studies, leading to the overwhelming conclusion that there is no effect.

No Effect? You say “high”, I say “low.”

Consider the following likely scenario: Imagine that a group of women contraceptive-users is asked about their libido.

  • Some women, who use hormonal contraception, prevent pregnancy in a behavior that is well removed from the behavior of sexual activity. They take a pill, slap on a patch, or get an injection well away from the moment that they are sexually involved. The consequence of this would be to “increase spontaneity”, but “allow for pregnancy prevention” unrelated to the desires of their partner. These women might report a boost in their perception of sexual desire.
  • Other women, who have a prolonged depression of their sex steroids due to hormonal manipulation, might suffer physically from the effects of low testosterone. Low available testosterone levels cause known side-effects of muscle aches, fatigue, depressed mood, etc. These women might report suppression in their perception of sexual desire.

Both groups experienced a change, but in opposite directions. Add the results of group one with group two, and you get “no change” because they’ll statistically cancel each other out.

Evidence of Prolonged Testosterone Suppression

Some researchers believe that the persistent elevation in “Sex Hormone Binding Globulin” or SHBG after discontinuation of oral contraceptives leaves the woman in a persistent state of “low hormones”, specifically referring to the removal of available testosterone from her blood stream. Several aspects of this are very concerning:

  • The suppression has been shown to continue for up to 11 months after the hormonal manipulation is stopped.
  • Women are trying to prevent pregnancy, not change hormonal blood levels of non-reproductive hormones.
  • Women are not informed of this possible risk, nor the potential for the duration of effect.

Preserving Libido & Making Informed Choices

However, because libido has multiple contributors, it is not the case that every woman should stop using hormonal pregnancy prevention. Each woman should evaluate her specific risks and benefits.

  • Women who use hormonal manipulation who also notice a depression of sexual desire or energy need to consider whether stopping will bring a higher quality of life.
  • Women need to understand that it may take months after stopping before they notice an improvement in their mood, energy and libido.
  • Women who may be prone to decreased libido need to consider their options before using hormonal manipulation. The state of current research is such that it is not known how prolonged the effect is.
  • Women who use hormonal manipulation to prevent pregnancy are already at higher risk of short-term (curable sexually transmitted infections) and long-term problems (cancer, blood clots, heart attacks, stroke, and incurable sexually transmitted infections). Is this potential change in libido the additional factor which would lead her to make different choices?

Barriers Are Good Sexy Choices

For women who want to avoid unnecessary complications yet still protect themselves reversibly from pregnancy, sexual barriers are their best option.

Sexual barriers:

  • Are on-demand. You don’t need to use them when you aren’t being sexual.
  • Have no long-term, irreversible effects.
  • Prevent transmission of sexually transmitted infections.
  • Have male and female options. Women can be in control of their barrier protection.
  • Reduce the potential interactions between medications and hormone systems in your body.
  • Have no associated increased risk of cancer.
  • Reduce cervical cancer risks.

Internet resources:

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All About Libido

Libido is your personal, sexual psychic force. Because we are only semiconscious of this force, our conscious minds are not completely in control of the psychic force itself. However, although we are always in control of how we act in response to the drive, it is the less-than-conscious aspect that accounts for why it feels pushy, or external.Unknown to many people, it is true that what we do with our every moment and choices in our lives influences our unconscious psyche. People use the word “libido” and talk about libido quite a bit: “She has a super high libido.” “He doesn’t have any libido.”  “I lost my libido after we had a baby.”But do we understand what the word means, really? Libido is a word that we assume we understand, but the whole concept and it’s relationship to other features of sexual arousal is difficult to appreciate fully.

Download a free PDF version of this brochure.

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Loss of libido and long-term relationships

I have been with the same man for eight years, with an affair or two in between (not hidden; he is also comfortable w/my bi-ness). However, I just am not sexually excited by him or attracted to him at all. In fact, he kind of grosses me out. The rest of our partnership is okay – supportive and loving. What to do? Any ideas? We’ve talked about it, but it’s just not the same as good ol’ hot sex.

It is very common for long-time partners to become less attracted to each other over time, though your situation is a bit more extreme than most. I want to suggest that you answer some questions for yourself as a part of the process of sorting through this situation. Have your sexual feelings toward your partner changed over time, or have you always had less of an attraction to him than you would like? Is there something specific about him that makes you uncomfortable? If so, are you able to talk with him about it? If not, are there any outstanding relationship issues that you feel are getting in the way of your feeling intimate toward him? Those un-talked-about issues often get expressed via a lessening of sexual attraction and interest.

What you are experiencing is not actually a loss of libido if you are still sexually interested in other people or interested in being self-sexual. I want to encourage you to explore what you want out of your primary relationship, and discuss with him what he wants. Is he satisfied with your lack of sexual intimacy? Some people develop primary relationships with a partner with whom they have a lot in common as friends, and then have secondary sexual relationships with others with whom they share primarily sexual passion. While this is a difficult path for most people, it is possible to do this successfully. If you are interested, you might want to read a book to learn more about how to make multiple relationships work.

This may also be a good time to seek some short-term counseling with a certified sex therapist, especially if you feel that you want to try to develop more passion in your current relationship. Look for a therapist who is certified by AASECT (the American Association of Sex Educators, Counselors, and Therapists). This means that the person is likely to have expertise in working with sexuality issues.

I wish you luck in your quest to resolve this. You do deserve to have a fulfilling sexual life, and I encourage you to work to have as sexual a life as you want.

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Athlete’s libido level over time

I am a 42 yr old cis-woman who has been in a three year relationship with a 41 yr old cis woman who is quite active. She is involved in a tennis league and plays regularly, but more importantly, she is a runner and trains extremely hard as she is training for the NYC Marathon this year. I am an active cyclist and will workout at home when I can. Neither one of us are over weight by any means but my girlfriend is very thin and eats a mainly vegetarian diet. I, on the other hand, love to cook and will cook just about anything, keeping red meat to a minimum to once or maybe twice a month (I crave the protein and iron just before my period). Our libido levels are extremely different and it is causing a major problem between us. I should tell you that my girlfriend is hearing-impaired, works in a hearing environment in the healthcare industry and reads lips all day long and that does make her very tired. She does wear high-powered hearing aids which helps her a slight bit. I am very sympathetic to her situation being deaf and have grown to have more and more compassion for her. We do not live together but have long-term plans for that to happen. Unfortunately, we get into situations where our love making is maybe once a week when we see one another on the weekends but there are times that it is down to twice a month. This is disturbing to me as I am a very compassionate, passionate, sexual being and enjoy connecting in that way. It seems that it is unimportant to her because she rarely makes any advances towards me. I know she loves me and I know we are faithful to one another. I’m at a loss here. For the past three years we keep hitting this wall and it’s becoming discouraging. If the intimacy level in our relationship is like this now, how bad will it be if we were to live together? I hope you can shed some light on this for us.

Well…this may or may not be related to her activity level, although it is true that high performance athletes can experience a lower libido. But that is not always true. Certainly it is possible that she has very low hormone levels, but hormones are only one factor in the complex array of what makes one’s level of sexual interest. Much of what plays into level of desire has to do with what we learn about sex as we grow up, and how we perceive our bodies and our sexuality as children and adults. I would also explore whether she has had negative experiences regarding sex, or is a survivor of sexual abuse or assault.

The difference between the 2 of you is quite common, and I will be honest and say that it is most likely to stay the same or get less frequent, unless she has an interest in working fairly regularly at her level of desire. If she chooses to work on it, it could become a bit more frequent, but that’s only if it is important enough to her to make it a priority. The fact that she has to work so hard in a hearing environment is probably a huge strain on her emotionally and physically, and if she already does not have the kind of relationship to her sexuality that you do, it’s much easier to let that part of herself go.

The first thing to do is to talk about it honestly and openly. But be prepared for her to say “this is just the way I am” and know what you want to do if she does. If she is interested in learning about ways to make her libido more frisky, then you can work with a sex therapist on that. But if this is how she has always been, it is much harder to change.

Do be prepared to initiate sex, and not expect her to do so. With folks who have lower levels of desire, they just don’t think about and “feel” sex as much (or at all) as you do. If she says yes when you initiate, that’s something. If she says no often, then that’s something to talk about and negotiate. Find out what circumstances allow her to feel most comfortable having sex. Ask her to help set the priorities for your time together so that sex can be on the agenda. Find out if planning for sex ahead of time works for her, or makes her more anxious about it. These things can help the two of you figure out how to have a more comfortable sexual rhythm.

I don’t have any easy answers for you. Sex therapists report that this is the most difficult challenge that any couple faces, and if someone has a low level of desire and is not bothered by that, s/he is not likely to change it. Then you are faced with the question of whether you can accept her level of desire as enough, or if it’s so important to you that it’s a “deal breaker”.

If she is interested in seeing what she can do to help herself enjoy a higher level of desire, there are some excellent books about this topic. While many speak mostly to heterosexuals, it does not exclude lesbians from its focus.

Good luck with this. I hope you can find a way to have as much of what you want in a relationship you enjoy.