Yet another chance to listen to Dr. Mark giving the her own brand of shame-free sex information on The Stupid Cancer Show; Monday, June 8, from 6-7pm Pacific.  The Stupid Cancer Show is the voice of young adults with cancer and Monday’s episode is all about sex!  For more information check out:  http://stupidcancershow.com

Cancer sucks.  Survivors rule!

Beyond the hot flashes and sleepless nights, for some women menopause threatens the end of sexual satisfaction.  It is true that once the ovaries stop producing estrogen a woman’s sexual and reproductive anatomy goes through some pretty big changes.  And while menopausal symptoms vary from woman to woman, most will experience some degree of vaginal dryness, decreased desire, difficulty achieving orgasm, dulled orgasmic sensations, and possibly even vaginal atrophy.  Luckily you don’t have to suffer or just give up on sex.  There is no one magic bullet that will “fix” your post-menopausal sex life, however, there are several different ways in which to tackle the problem and an integrated approach may be the most prudent one.  I recommend you consider all of your options and choose the best combination for you.

While traditional hormone replacement therapy has fallen out of vogue, due to an increased risk of breast cancer, there are other hormonal treatments available.  Some women, in consultation with their doctor, use a vaginal ring that releases a small amount of estrogen directly into the vaginal tissues.  Similarly, other women may choose to use a cream that contains either estrogen or testosterone.  These products help with lubrication, sensation, desire and the overall health of the vagina.  There are also various herbs that can be used in consultation with an herbalist or doctor of traditional Chinese medicine.  As with all medications, these treatments may not be safe for all women, especially those with a history of hormone-dependent cancer.  But fear not my survivor sisters, there is research underway to determine the safety of some hormonal treatments for us so this story is to be continued.

Of course, we don’t have to rely soley on drugs and doctors to maintain our sex lives.  Remember sex is a “use it or lose it” type activity.  The more sexual you are on a regular basis, solo or with a partner, the healthier and more repsonsive your body will be.  Try Kegel exercises to encourage blood flow to the genitals and increase sensation.  Regular vibrator use will also help with blood flow to the clitoris.  If you’re feeling dry, use a good lube (avoid oil based lubes if you are using condoms).  I recommend getting a sampler pack from someplace like Good Vibrations so you can try different brands and find the one you like the best.  You can increase your desire for sex by reading erotica or watching porn.

Just remember, you deserve sexual pleasure, so don’t give it up without a fight!

Do you remember your first kiss?  First make-out session?  Are the days when you would kiss just for kissing’s sake gone?  Have your kisses been relegated to a peck hello and/or goodbye?  Is kissing just a prelude to sex?

I want to encourage you to rediscover the pleasures of kissing, for the sake of your relationship, your sex life and your overall well-being.  Kissing releases oxytocin, the hormone that promotes bonding.  So, if you’re really into someone kiss them often to keep them near.  The humble kiss is the foundation of a happy sex life.  If you can find pleasure in such a simple act, you’ve increased your ability to be sexually satisfied.  Kissing promotes stress relief by lowering levels of cortisol.  My prescription for dealing with the slumping economy - an old fashioned make-out session!

One problem I often see is an expectation that kissing will always lead to sex.  When you agree to immerse yourself in kissing without a demand for sex, you will rediscover what kissing is all about - a simple pleasure, a cheap thrill, a moment of intimacy between two people.  Whether you like to kiss hard and fast, or slow and sweet kissing is a powerful act, so pucker up and smooch away!

The best way to get what you want is to ask for it.  You wouldn’t expect someone to make you a meal without first discussing the foods you do and don’t like, whether you are allergic to anything or are vegetarian, right?  Why would you expect your partner(s) to just know what you want sexually?  Sure they may have a sense of what you like based on past experience, but just as you might want pizza one night and tacos the next, our sexual preferences change and that’s hard to follow without a little communication.

Sexual communication can take many forms.  You can ask directly for what you want, you can use body language to convey your desires, you can create your own sexual vocabulary that only you and your parnter(s) knows.  Try to stay focused on what you like, as opposed to only communicating what your partner(s) does wrong.  Reinforcing behaviors you like is much more successful than only pointing out how your partner(s) fail you.

You many want to start by having conversations about sexual topics that are completely unrelated to your sex life.  You could talk about the latest sex scandal in Hollywood or the sex lives of bonobo apes, either way it will give you practice talking about a topic that we are generally discouraged from discussing.  Once you get comfortable communicating about sex, the sky is the limit!

A few select clips from my lecture for the UCSF Cancer Survivorship Program in July ‘08. While the lecture was tailored to cancer survivors, everyone can benefit from these concepts.

So you want more sex in your life? Well, what’s your definition of “sex?” Most people equate sex with intercourse. Foreplay? That’s just what you do to get to the sex, right? Kissing? That’s just for teenagers. When is the last time you gave your partner an erotic massage? How often do you send sexy messages to your lover? Phone sex? Dirty dancing?

When you broaden your definition of sex and allow yourself to receive pleasure from various activities your sex life is increased exponentially. In sexologist speak, I’m talking about your “total sexual outlet,” which basically refers to all the sexual/sensual activities you do. If you limit yourself to intercourse you have a pretty sparse total sexual outlet and will probably end up wanting more. If, however, you get pleasure from intercourse, masturbating, cuddling, oral sex (yes, it is sex!), and foot massages then you have multiple opportunities to be sexual that require varying degrees of time and energy making it much more likely that you will be satisfied.

Remember how sex was when you first started having it?  Sure there was probably a little fumbling and bumbling, but despite the inexperience and jitters, your body reacted wildly with little to no effort.  You slowly gained knowledge of exactly what you liked to do, and have done to you, and probably settled into a nice little groove.  Maybe you’ve had to adjust to new partners along the way, but physically there were certain things you could count on.  A light touch here, a firm pressure there, find that spot and stick with it!

What happens when your body doesn’t react the way you expect it to?  What do you do when you have medical problems that alter your sexual interest, arousal or response?  As we age our bodies are slowly losing the ability to function like they did when we were at our prime, and that includes our sexuality.  There’s no way, yet, to stop the ravages of time, but the human body is a remarkably adaptable machine and with a little attention you can ride the waves of change and maintain a satisfying sex life.

The secret is in adapting to any given situation.  Take time periodically to explore your body and take an inventory of what feels good.  Pay attention to your energy level and try to avoid sex when you are feeling tired or fatigued (unless you want to use a quick orgasm to help you fall asleep!).  If you are experiencing pain, explore positions that may be more comfortable for you.  If your favorite body part isn’t functioning or missing altogether, challenge yourself to discover pleasure in another area of your body.

Change is the only thing you can count on in life.  Are you going to adapt or be left behind?