Thursday, July 10, 2008

Can Your Sex Life Be Saved? (Part II)

Can you live on biyearly trysts?

To some people, infrequent sex is not a problem. Their reaction may be to shrug and ask, "So what?" And if they both agree, that's their business. But for most couples, the fact that you haven't been intimate for six months is not quite the same thing as, say, the fact that you haven't gone out hiking together since last summer. A relationship doesn't grow frayed and testy from a lack of trailblazing. But it may well wither from a lack of sex -- because "sex is not just sex," says Bernie Zilbergeld, PhD, an Oakland, CA, sex therapist and author of The New Male Sexuality (Bantam, 1993). "It's a major glue that keeps two people together."

Indeed, studies of happy marriages find a lot of happy moments behind closed doors. "A good sex life, however the couple defines that, is at the heart of a good marriage," writes clinical psychologist Judith Wallerstein in her book The Good Marriage: How and Why Love Lasts (Houghton Mifflin, 1995). The book is based on her study of 50 happily married couples; it draws upon their experiences to distill nine fundamental characteristics of a good marriage. Sexual love is number six. "This is the domain where intimacy is renewed, and the excitement that first drew the couple together is kept alive," writes Wallerstein. "There is no better antidote to the pressures of living than a loving sex life."

That sounds wonderful -- but for most of us, it's easier said than done. Most sex therapists recognize that it's difficult for couples to get "unstuck" from a sexual slump, and the process whereby a couple reconnects with each other may require the hashing out of many issues. The first step is for both the man and the woman to acknowledge the problem -- an acknowledgment that may begin with saying something simple and straight from the heart.

The good news is that, when couples do take the time and make the effort to rediscover their sexual attraction, they are in for a very pleasant surprise. Says Dr. Holstein, "The best sex happens between couples who have been together a long time. It's better to have a foundation of commitment and emotional intimacy with an atmosphere of truth telling than it is to have high hormone levels."

When you're both ready to start rekindling those old flames, try some incendiary devices.

Not every couple can take off for Bali

Make it important
Couple "Most marriages die of neglect," says Dr. Love. "It's a process of slow erosion, and you don't know how to get it back to where it was. Well, sex is one of the ways to get it back there." But it won't happen without first honoring its importance. One of Dr. Love's clients recently came to her office with such a commitment -- actually drawn up like a legal agreement -- in which she'd promised her husband that she'd be a better lover. "She knew she had a good marriage, and she wanted to protect it," says Dr. Love. "She was smart. Her only problem was, she had no idea how!" Competent sex therapy can provide help with the details; at least she'd made the key first step. Unfortunately, Dr. Love says, she sees many couples who have an unwritten contract that's a recipe for disaster. It says, in effect, "I expect you to be monogamous, but don't expect me to meet your sexual needs."

Make time and space
"There are people who have the same miserable schedule you do, and they are having sex," says Dr. Zilbergeld. "They put sex higher on the list." There's a time and place for everything -- and the flip side of that rule is, if there's neither time nor place, it won't happen. "People bridle at this," he says. "They'll say, 'I hate to schedule time for sex.' Well, the world is on a schedule. I'm all for spontaneity -- but the problem is, in a life that's completely scheduled, whatever's not scheduled will fall through the cracks." So when he counsels couples, an expensive hour of therapy will often end with two people getting out their separate but equally fat appointment books and making a date.

Get out of town
In his book Mars and Venus in the Bedroom: A Guide to Lasting Romance and Passion (HarperCollins, 1995). Dr. Gray says the primary reason why some couples lose interest in sex is that the man feels rejected and the woman doesn't feel romanced and understood. It can get to be a vicious circle, and stress only exacerbates it. "Ironically, as we have more technological advances and conveniences, women are busier," Dr. Gray tells Prevention. "They use the time to take on more obligations and responsibilities. The more stressed they get, the more they're unable to relax. So the question is: How do you get a woman to stop and relax? The only thing that will do it is romance."

And that means getting out of town. "For a woman to feel special, you need to have special occasions," he says. "You have to deliberately create time away from stressful situations, from kids, from work. A woman has to be taken out of the stressful environment. That will allow her to feel like herself again; it takes her back to her center, back to her loving, compassionate self. In a busy, busy world, romance is the only thing that can take her back."

As for the rejected husband, "When he gets her in that place, he, too, will feel romantic again. If he takes care of her for one day, she's going to change. She'll warm up, and that will warm him up. Her responsiveness will stimulate him, and he will become aroused."

Not every couple can run off to Bali for a week, as Dr. Gray and his wife, Bonnie, did last year. But more couples could do what the Grays do -- go away somewhere overnight once a month. "It has to be just her and me, no kids and no work, for at least 24 hours," he says. "And nobody can intrude."

Get off your ass

"It's a question of seeing sexuality as a source of energy," says Dr. Holstein. "Like exercise, you don't necessarily want to do it when you put on your sneakers and start out. But you know you should. You know that, by the end, you'll feel better. So you have to be willing to start a sexual connection from zero, or even minus one on the scale of desire. Once you have made love, you are usually glad you did -- just like exercise.

It may sound like work, but we have faith in you: Your playfulness will soon carry things along, and it won't seem like drudgery after all. But face it: You need something to replace the magical attraction from your courtship days. Says Dr. Kingsberg, "People assume that if you have to work at romance, something's wrong -- when, in fact, it's required."

Actually get some exercise
As we age, the role of exercise becomes critical in maintaining sexual desire, physical energy, and self-esteem. In fact, exercise can work like an aphrodisiac to improve your sex life. A few years ago, scientists at the University of California at San Diego conducted a nine-month study of 78 sedentary men (mean age: 48). The guys who were put through some serious aerobic training for 1 hour every other day reported that, by the end of the study, they were making love 30% more often than the less-active control group.

Stop being Martha Stewart
For all the talk here about having to work at romance, please don't go overboard. "For many people, there are only two kinds of sex -- perfect sex or no sex at all," says Judith Seifer, PhD. "When I say any sex is better than no sex at all, people don't believe me." Dr. Seifer is the cocreator and host of the "Better Sex" video series, but it rankles her when she's called "the Martha Stewart of sex." Her intent is to help couples improve their sex lives, not elevate it to some state of fussed-over perfection.

In her role as sex therapist, Dr. Seifer finds that couples who come to her for counseling often have focused their frustrations on what's wrong with their sex lives, instead of trying to build upon whatever's right. She says she ends up telling them, " 'I don't want quality over quantity. That's what's gotten you to the point where you're sitting in my office today.' I suggest they get rid of the perfect-sex syndrome."

Can Your Sex Life Be Saved? (Part I)

My friend Ellen was roaming the aisles of her local BedSears store, trying frantically to keep track of her three youngsters while her mother did some shopping. At least her mother knew exactly what she wanted. She made a beeline for the sporting goods aisle, where she began strapping on ankle weights.

What's this all about? Ellen wanted to know.

"Oh, it's just a new way to stay in shape," her mother replied. Then, after looking around to see whether any grandchildren were in earshot, she confided a secret motivation. "You know, dear, your father is a very virile man."

"Oh, great," Ellen thought. It was bad enough that her own love life with her husband, Doug, had tapered off. Of course she felt guilty about that -- but their lives were just so hectic! But it took that casual remark to make her stop denying the problem. "My mom's nearly 70," Ellen said later, "and her sex life is probably better than mine!"

Too busy, too tired

If you're having a sexual midlife crisis, you may feel alone, at wit's end and unable to talk about it. What's more, the sexual anecdotes your girlfriend shares with you on Monday morning may not make you feel like other women could commiserate.

Oh, but they could.

Polls have shown that, while 85% of women are satisfied with their marriages, only 57% are satisfied with their sex lives. We're going to fast food restaurants and exercising more often than we even think about sex and romance.

A major culprit is -- no surprise -- the pace of life in the 1990s. "Day-to-day stress prevents women from being romantic and feeling responsive to a man's advances," says John Gray, PhD, author of the decade's most successful book, Men Are From Mars, Women Are From Venus (HarperCollins, 1992). "It just gets worse every day. Life is only speeding up." And under these conditions, he says, "Love alone will not create romance."

To be sure, the frequency of your sexual contacts may decrease as you age. One large recent survey of Americans' sexual practices discovered that the frequency of sex peaks for most men and women in their late 20s, when 47% of us enjoy sex two or more times a week. But among women in their late 50s, for example, more than 4 in 10 reported having no sex in the last year.

There are some age-old reasons for that. For one thing, you're not being driven by a surge of teenage hormones anymore. For another, the novelty wears off. Due to what psychologists call "habituation," a marriage can become less sexy even as it grows more comfortable each year. Patricia Love, EdD, the author of Hot Monogamy (Plume, 1995) has a colorful way of putting it: "If you live by the railroad tracks and a train goes by, you don't even wake up."

Need a (sex) vacation?

But the complexities of modern life serve to make matters worse. Couples like Ellen and Doug have to cope with two jobs, three kids, four seasons' worth of sports leagues and a multitude of responsibilities in the new downsized workplace. Millions of Americans are feeling the effects of "time famine." Put simply, they are starved for an open half hour.

Sheryl Kingsberg, PhD, an assistant professor at Case Western Reserve University in Cleveland, believes a threat to healthy marital relations can occur not just at midlife, but any time external distractions start to mount up. She wouldn't be surprised if some couples with young children are not having as much fun as their vivacious retired parents: "My sense is, as couples get older, they have more time. So their sexual relations actually can improve."

Lana Holstein, MD, director of women's health at Canyon Ranch, offers help to stressed-out couples through a four-day workshop, Sex: Body and Soul, which she leads with her husband, David Taylor, MD, at the Tucson, AZ, spa. They begin each workshop by asking the participants what has gotten in the way of their sex lives. "The number one answer," Dr. Holstein reports, "is 'too busy and too tired.' That's what comes up over and over again. I see more celibate couples now than I've ever seen." No, these people aren't taking vows to keep their hands off each other, but they may as well -- their erotic escapades have dwindled to perhaps three or four per year.

"Too tired," indeed. A busy, stressful life can leave you just plain physically exhausted. Almost 100 million Americans don't get enough sleep at night, and a quarter of the nation's workforce labors through the evening, says Michael A. Perelman, PhD, a clinical psychologist and co-director of the Human Sexuality Program at New York Hospital in Manhattan. In fact, Dr. Perelman, who specializes in sex and marital therapy, believes that fatigue is probably the number one cause of sexual distress in the U.S. This is especially true for men at midlife -- who sometimes try too hard to pretend they're still at the top of their game.

"Many men erroneously presume that they should be able to function regardless of how they are feeling," says Dr. Perelman. "Nothing could be further from the truth for most men older than 30. Fatigue can push a man over the edge of his ability." A guy who, let's say, works a 10-hour day, runs 8 miles, then has three glasses of wine will almost inevitably experience erectile failure. Then he'll have to deal with yet another stress: the fear that episodes of sexual failure will escalate.

Natural Remedies for a Low Sex Drive

Many women in my clinical practice experience low to no sex drive at various times.

There are many factors that could potentially influence sex drive: menopause- related, other hormonal changes (often following pregnancy), medications (Prozac, Zoloft, Sertraline and others), depression, relationship issues, a chronic health problem, fatigue and more. In order to diagnose the cause correctly, your health professional would have to ask you many specific questions.

Hormone levels may have something to do with low sex drive, but doctors don't completely understand the exact role of testosterone and DHEA (another hormone) in determining a woman's sex drive. Your testosterone or DHEA levels may just be too low, or low-normal, and this would have a profound effect on your libido.

Ask your doctor to do a blood test of serum-free testosterone and serum DHEA. If these are low, or even on the lower range of the normal scale, prescribing these hormones might be in order. Testosterone is available as a "natural" testosterone (still prescription) and synthetic or methyl testosterone.

Oral supplementation daily and/or a 2% testosterone cream applied to the external genital area before sex (or 2-3 times a week) is another method, used to initiate a local response. DHEA is available over-the-counter in natural food stores. See your health care practitioner for the dosage that is right for you.

I would also recommend marital therapy. Counseling with someone who is skilled in sex therapy can also be helpful.

As for as aphrodisiacs go, natural, plant or nutritional remedies that address libido only, in the absence of any other issue, can be effective but not reliable. Improving dietary habits, increasing exercise and improving general health is fundamental. Individual ingredients that may have a positive effect include the herbs ginseng and damiana, and the supplements B vitamins, adrenal extracts and DHEA.

I urge you to check out two excellent books on the subject of libido: The Hormone of Desire, by Susan Mako, M.D., and The Alchemy of Love and Lust, by Dr. Theresa Crenshaw.

Seeking a homeopathic practitioner to prescribe a homeopathic remedy like Sepia, Naturm-mur, phosphoric acid and others can often be the key, and can be done in conjunction with other treatments. Acupuncture also can treat the loss of "jing" and of "vital heat."

Don't give up. This can get better.

Is There an Herbal Viagra?

Impotence is probably among the most feared of all men's health problems. The prescription drug Viagra has solved this difficulty for many men, but its use is not without risk. Also, it's expensive.

Men continue to hope and to ask if there is a safe, effective, and inexpensive herbal remedy for impotence. As far as I'm concerned, the answer is probably not, although one herb appears to be promising.

The promising herb for treating impotence is the multifaceted herb Ginkgo. One preliminary study found evidence to suggest that ginkgo can put back the zing in the sex lives of men whose erections are affected by taking antidepressants. Though that preliminary study hasn't been followed up, you may want to try ginkgo for this troubling condition. Quick Tip: If you are taking antidepressants and have an impotence problem, try 120 to 240 mg of Ginkgo biloba extract a day. It may take eight weeks to see any improvement.

Yohimbe (Pausinystalia yohimbe) has some anti-impotence activity; its active alkaloid, yohimbine, is currently available in this country as a prescription drug for erectile difficulties. However, the German Commission E (the world's leading authority on herbs) failed to approve yohimbe as a drug because its use involves the risk of tremors, sleeplessness, high blood pressure, and rapid heartbeat, among other undesirable effects, so I can't recommend it for this purpose.

Guarana is a dried paste made by crushing the seed of Paullinia cupana, a climbing shrub native to Brazil and Uruguay. In South American countries, guarana has been used for years, just as pure caffeine is used in this country, to give a bit of a kick to soft drinks. It has a relatively high caffeine content, averaging about 3.5%. Compare this to coffee beans that normally contain 1 to 2% caffeine. I've had guarana-flavored orange soda in Peru and observed about the same effects as I get drinking a Coke or a Pepsi -- increased alertness and less fatigue. Sadly, I must report that I experienced no increased sexual desire or potency.

Guarana's purported aphrodisiac effects are probably due to overly enthusiastic marketers looking for a sales gimmick. Because of the small amount of herb added to them, guarana-flavored soft drinks usually contain less caffeine than a cup of coffee. They may perk you up, but don't expect a substitute for Viagra.

Tuesday, July 8, 2008

How to Enhance Your Sexual Pleasure

"To succeed with the opposite sex, tell her you're impotent. She can't wait to disprove it."

-- Cary Grant

You may have noticed the ads in American health magazines for various nutritional supplements promising the user fabulous sex for life. One particular product aimed at women claims to increase the intensity and ease of achieving orgasm, improve clitoral sensitivity, hasten vaginal lubrication, and enhance pelvic sensations during sex.

For men, equivalent products are said to intensify orgasm, firm up erections, prolong erections during sexual activity and reduce the time needed to produce a subsequent erection. Sound too good to be true?

While published studies have not verified that certain brand name products create the results advertised, research has indeed confirmed the effectiveness of several components of these supplements in boosting the sex lives of both men and women. If you know the ingredients of these formulas, it's easy to understand how they might work to produce such results.

The Secret Formula

It may surprise readers to know that the key ingredients for fabulous sex are virtually identical for men and women. Look for formulas containing L-arginine, folic acid, choline and pantothenic acid. These are the major nutrients working to create the breathtaking results touted by advertisers. Some of the formulas are jazzed up with supportive components like zinc, vitamin C, vitamin E, niacin and a variety of herbs.

How and Why It Works

To successfully stimulate the genital area, a naturally produced chemical is needed to relax a part of the anatomy called the corpus cavernosum. This spongy bundle of tiny nerves is surrounded and filled with blood vessels. The corpus cavernosum is located in the penis and clitoris. It becomes active when it engorges with blood during periods of sexual excitement. This activation is dependent on the relaxation of genital muscles during sexual arousal. What induces this relaxation on a biochemical level is something called nitric oxide.

About a decade ago, nitric oxide was thought of as little more than a simple, potentially toxic substance found in cigarette smoke and automobile exhaust fumes. It's been associated with acid rain, ozone depletion and possibly cancer. Research, however, has shown that nitric oxide is manufactured naturally throughout the body and plays a crucial role in regulating the function of virtually every organ. It operates in the heart, brain, liver, kidneys, pancreas, lungs, uterus and eyes. It helps regulate blood pressure, digestion, and even the behavior of erectile tissue.

Therapeutic uses of nitric oxide are probably many years off but there is one simple, natural thing you can do now to raise blood levels. Eat plenty of nuts (walnuts, filberts, pecans, Brazil nuts, almonds, cashews, peanuts) that are high in arginine, the amino acid the body converts directly into nitric oxide. Other high-arginine foods are sesame and sunflower seeds, coconut, gelatin, buckwheat, barley, chicken, chocolate, corn, cinnamon, dairy products, meats and oats. This may be one reason why some of the sizzling sex formulas contain extracts of cocoa and cinnamon.

Arginine for Arousal

L-arginine is an essential amino acid that promotes your body's natural production of nitric oxide, much like the drug Viagra. But unlike Viagra, arginine is inexpensive, has never caused any deaths and has a very low toxicity potential.

Arginine supplementation has been shown to improve low sperm counts and male infertility. It's also very effective oral therapy for erectile dysfunction, producing harder and longer-lasting erections and increasing libido.

Besides boosting nitric oxide levels, arginine stimulates the release of growth hormone, which also acts to rev up your sex drive. Still more good news is that growth hormone helps increase muscle mass while decreasing the amount of body fat. This of course will make you feel sexier and perhaps more appealing to your partner!

Women will also welcome arginine supplements to enhance their libido. Nitric oxide produced thanks to arginine improves vaginal circulation and stimulates the perivascular nerves in the genital area involved in sexual arousal.

The best way of using arginine is to take between 6 and 12 grams in capsule form one hour before an anticipated sexual encounter. If you can't tolerate this much arginine in one sitting, don't despair. You can get almost as good results on sexual performance by taking the arginine in divided doses, three or four times during the day. Alternatively, arginine comes in a powdered form and can be mixed with fruit juice.

Natural substances like L-arginine often have a multitude of benefits - unlike drugs, which typically treat the symptoms of one specific problem. Besides potentially doing wonders for your sex life, arginine helps with wound healing after surgery. It plays an important role in post-injury problems such as weight changes, nitrogen balance, fatigue and tissue healing. It stimulates the immune system and increases collagen, the main supportive fibrous protein found in bone, cartilage and other connective tissue. Arginine is useful for treating liver disorders, too, because it promotes the detoxification of ammonia, which is poisonous to living cells.

If you have kidney disease or herpes simplex, avoid taking arginine. Both conditions can be worsened by high-arginine, low-lysine foods like chocolate and nuts.

Folic acid's claim to fame is its ability to prevent neural tube defects in the developing fetus. This B vitamin is also important in the prevention of heart disease because it keeps homocysteine levels in check. Homocysteine is an amino acid that has a negative impact on production of nitric oxide, the molecule needed for an optimal cardiovascular system as well as a very healthy sex life. Folic acid supplements of 5 to 10 mgs daily help optimize nitric oxide levels.

Choline is an essential nutrient vital to building and maintaining cell membranes. Good dietary sources are soybeans and eggs. In supplement form (1,200 mgs three times daily), choline is used primarily for memory improvement.

Choline and pantothenic acid (vitamin B5, 1,000 mgs three times daily) are both used by the body in the production of acetylcholine. This neurotransmitter or brain chemical is important for healthy memory, as well as being a signal to release the enzyme nitrous oxide synthase. In the presence of L-arginine, this enzyme helps produce nitric oxide. The combination of choline, vitamin B5 and L-arginine are thus needed to produce the nitric oxide for release into the bloodstream so erection can occur.

B-complex (50 to 100 mgs daily) is required to balance the individual B vitamins taken in higher dosages. While there are no significant side effects to taking high-dose folic acid, choline and pantothenic acid, theoretically one could create relative deficiencies in the other B-complex vitamins.

Creating Your Own Formula

Well, there you have it. As long as you use the combination of L-arginine, folic acid, choline and pantothenic acid in the dosages recommended above, you should be on your way to achieving greater sexual fulfillment. Prepackaged formulas may be more convenient, but purchasing the individual ingredients is significantly less expensive.

With the exception of L-arginine, these natural health products can be easily found in Canada. L-arginine is available by mail order from many American supplement manufacturers. You can legally import a three-month supply for personal use. If you're too eager to wait for Canada Post to deliver, you could drive across the border and pick up your L-arginine at any health food store. Enjoy and tell everyone you read about it here.


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Brann, DW, and Mahesh, VB. "Excitatory amino acids: evidence for a role in the control of reproduction and anterior pituitary hormone secretion," Endocr Rev 1997;18:678-700.

Burnett, AL. "Role of nitric oxide in the physiology of erection," Biol Reprod 52 (1995) 485-489.

Choi, YD, et al. "The distribution of nitric oxide synthase in human corpus cavernosum on various impotent patients," Yonsei Med J, 38 (1997) 125-132.