In our brain, there are substances called neurotransmitters that carry the signals.  Some carry signals that increase sexual thoughts and are “excitatory” and others can blunt or flatten sexual thoughts and are called “inhibitory”.  I will try not to get too complex with this, but the message is important for you to understand.

Let’s start with the good stuff.  One of the chemicals in your body that stimulates sexy thoughts/behaviors is norepinephrine.  This is responsible for increasing attention/focus, raising the heart rate as you get excited and increasing blood flow to the muscles. It increases the energy in the body.  Wellbutrin is a medication that increases norepinephrine and dopamine in the brain.  Amphetamines also have this action.

 Next is dopamine.  This is the one that gets us into trouble!  Dopamine is involved in reward and motivation.  It is what makes you crave the feeling and when that feeling is rewarded with sex, it further increases that impulse.  I like to call dopamine the “stalking chemical” as it is responsible for drunken dialing, extramarital affairs and stalking your lover by driving by their home.  Dopamine causes the feeling of wanting and is what drives you to seek orgasm.  Things that increase dopamine are watching pornography, accumulating money, gaining power over others, gambling, compulsive shopping, and video games.  Medications such as buspirone can also moderately increase dopamine.

 Oxytocin is a hot topic in sexuality currently.  Many are aware of the role of oxytocin in initiating labor and allowing milk to flow with breastfeeding.  Oxytocin is also elevated during orgasm in both men and women.  But the newer research reveals the bonding behaviors that are induced by oxytocin, especially in men.  It allows social recognition and is often called the “love” drug.  Very high levels of oxytocin have been shown to lower norepinephrine and dopamine levels.  This promotes the bonding of the relationship and reduces the sex seeking behaviors.  Stay tuned for more on oxytocin as the research continues. 

Other stimulators of desire are the sex hormones estrogen and testosterone.  Sadly, our peak levels are in our 20’s and can be down fifty percent by our 40’s.  Supplementation as we age may be appropriate in many cases and improve sexy thoughts, energy and wellness.

Now let’s discuss the inhibitory substances in the brain.  Serotonin is probably one of the most studied inhibitors of sexual desire and arousal.  Serotonin medications are used worldwide to treat depression and other mood disorders.  The question always comes up, “is it the depression itself or the depression medication that is causing the patient’s problem?”  It is probably both.  Serotonin can blunt obsessive thinking and flatten the response to passion.  It can interfere with arousal in women and erection in men.  Do not stop your medication but rather seek a sexual health expert that can manipulate your medications to optimize your mood control while minimizing the effects on your sexuality.

Prolactin is another sex inhibitor.  Prolactin is found in both men and women and is the hormone present during breastfeeding.  This is required to produce the milk.  When prolactin is high the estrogen levels are low leading to fatigue, vaginal dryness and low sexual interest.  As though a new mother needed yet another reason not to have sex!

Another important inhibitor of sexual desire is opiates.  Yes, pain medications.  There seems to be an explosion of abuse of opiates these days and it is having a significant impact on the sex lives of those involved.  Not only does use/abuse of pain medications act as an inhibitor of sexual desire, it also interferes with our ability to appropriately treat depression.  These are often some of our most difficult patients because of their reluctance to give up the pain medications.

This is a summary of some of the common substances in our body that affect our brain and our sex drive.  Seek a sexual health expert to guide you toward those substances that will excite your passion!

Many studies site that erectile dysfunction in a younger man may indicate need for screening for depression and underlying heart disease.  Blood flow to the penis is sensitive to minor changes and this could be the earliest indicator of vascular injury from cholesterol or sugar.

In many of our couples, the male partner prefers to blame his inability to sustain his erection on the lack of interest in the female partner.  Although this can be the case, it is often just the opposite.   The female begins to lose interest because the male cannot sustain the erection long enough for her to achieve satisfaction.  Both sides must be evaluated.

Having the same, routine intercourse can lead to a flattened arousal from both parties so adding a little spice and changing up the usual moves may intensify arousal and help sustain the erection.  There are various instructional videos and books that can assist in giving ideas to either mate.  I recommend the broad array of instructional videos available at www.sinclairinstitute.com

Now back to the organic or medical causes.  Smoking and diabetes have got to be obvious causes to most of you.  QUIT SMOKING!  I cannot think of a good reason to partake in this bad habit that damages the vasculature in the area.  If men knew that smoking when young leads to ED when a little older perhaps they would stop.  Elevated blood glucose levels are a very common cause of some of our most difficult cases.  The glucose damages the small blood vessels that nourish the nerves in the penis so it creates more permanent injury if left uncontrolled.  Very strict glucose control and following a low carbohydrate/diabetic diet can sustain performance a bit longer.

Today there are various products that improve function and performance in men including the “Viagra” type medications, pumps, injections and vibrators.  Beware of the abundance of counterfeit “Viagra” type medications that are advertised on the internet.  Some studies have shown that 80% of the products purchased on-line without a valid prescription are counterfeit and may be completely ineffective. 

In some cases, lack of success with a “Viagra” type enhancer can indicate a low testosterone level.  Some studies suggest that a normal testosterone level is required to have the best results from these medications.  Discuss this with your physician and labs may be ordered.

These are just a few things you need to know to maintain a great erection throughout a lifetime.  Have a discussion with your doctor when you see the earliest signs.  If no success, seek a sexual health expert.

YOU KNOW THE TYPES—- men like Humphrey Bogart, John Wayne, Bruce Willis and James Dean.

Most of us know the more common health risks from smoking — lung cancer, emphysema and heart disease.
What is less well known is the devastating effect of smoking on sexuality.

Several recent studies have shown that smoking is a strong risk factor for Erectile Dysfunction in men.

What we know now is that smoking is damaging to every blood vessel in the body. It accelerates atherosclerosis or hardening of the arteries. Since the act of getting an erection requires a large amount of blood moving into the penis, any impairment of blood flow can impede a full erection.

Men who smoke have a much higher chance of losing erection function because of damaged blood vessels.
How can you feel like a man if you lose your ability to have an erection? This is an important message to tell young men before they start smoking. And if someone already smokes, they can stop the progression and perhaps reverse some of the damage by quitting. There are many new treatments for stopping smoking that you can learn about by talking to your doctor.

It is never too late to quit and your love life can only improve.

The diagnosis can be confirmed with blood tests to check the testosterone levels.  Other more serious causes of dropping testosterone levels must be ruled out using blood tests as well. 

The good news is that the condition can easily and safely be treated with testosterone supplementation either with a gel-applied daily or with injection every other week. 

The only contraindications to using testosterone supplementation are prostate cancer, elevated red blood cell count or untreated sleep apnea.

With the supplementation, men have less osteoporosis because they maintain their muscle mass.  They are able to move around better and are less likely to fall and fracture.

Over the years, we have been amazed at the change in the quality of life in men who have been successfully treated.   Patients see a return of their libido, energy and stamina.   They develop a sense of well-being and a sense of better focus and mental abilities.   They feel it has returned them back to the type of life they enjoyed most.  So visit your urologist or primary doctor today for this problem that is easy to diagnose and has readily available treatments.

Dr John Stripling, Urologist
www.bestsexualadvice.com
info@theCSHE.com

If the dryness is due to menopause and estrogen loss, this can lead to atrophy or dry, non-stretchy, thin skin. The cause is the loss of fat cells under the skin which is usually maintained by adequate estrogen levels during younger years. The problem generally worsens with age unless it is treated. This can be easily treated by using estrogen cream or tablet in the vagina. When used in small amounts, the estrogen works locally and does not have any major impact on the estrogen levels of the blood. Besides creating lubrication and improving elasticity, it also improves the tissue around the bladder and urethra. This is a safe therapy for almost every medical condition. For those who do not want a medication, one study suggests that three orgasms per week can maintain the youthfulness of the vagina without therapy.

Dryness due to inadequate lubrication as a side effect of medication or simply due to lack of arousal can be treated with numerous over the counter lubricants. There are water-based lubricants such as K-Y liquid or Astroglide; mineral oil- based lubricants such as baby oil and Vaseline (beware that these are not safe with condoms as they break down the integrity of the condom); and finally silicone-based lubricants such as Eros or Wet Platinum which maintain wetness longer. Zestra is a mixture of botanical oils that works well, too. Beware of K-Y intense or K-Y warming liquid in the menopausal vagina as these may cause burning.

For those trying to conceive, a lubricant called Preseed does not interfere with sperm motility.
Finally there are vaginal moisturizers such as Replens, RePHresh and K-Y liquibeads which when inserted vaginally maintains moisture for about 3 days.

This is a brief overview of products available to enhance sexual intimacy and reduce pain. For more detailed information contact your physician or call us at the Center for Sexual Health and Education.

Dr. Maureen Whelihan
info@thecshe.com
www.bestsexualadvice.com

One of the most common causes of pain during sex can be a rush to pleasure. Remember, most women take time to get warmed up to the idea and the physicality of having sex. If there is not adequate foreplay, the vagina might be dry and this can cause pain. For women who experience this, I’ve got good news. When I have patients who I suspect might be experiencing this kind of pain, I recommend that they have orgasm first, then insert the penis. Orgasm, you see, increases blood flow to the pelvic area, which lengthens and widens the vagina.

Another simple thing to remember is this.  Men do not have to thrust too deeply during sex for both partners to gain pleasure. During deep thrusting, the penis can hit the ovaries or the uterus, which in some cases can cause pain. Shallower thrusting, or a change of positions, may relieve this sort of pain. Remember, there are over 100 different sexual positions in the Kama Sutra. Have fun trying something different.

If you feel pain when a penis is inserted, it could be caused by anything from a simple yeast infection to something more complicated called vulvar vestibulitis. You need to see your doctor so they can figure out what you have. Sometimes it is an easy fix with an oral medication. Sometimes it is more complicated and could even involve a physical therapist.

Yes, I said a physical therapist. They work on muscles all over the body, including the vulva and vagina. If the muscles of the vagina are too tense, this can lead to vaginismus. Basically, what happens with vaginismus is the muscles of the vagina lock down tight and prevent the penis from being inserted

Whatever the reason, the odds are good that our experts here at the Center for Sexual Health & Education can help you find a way to get rid of your pain and help you get back to having great sex for a lifetime.

Dr Alyse Kelly-Jones   
Gynecologist – Center for Sexual Health and Education
info@thecshe.com
www.bestsexualadvice.com

Why don’t women like the lights on? Are they feeling ashamed about having sex due to a rigid upbringing? Are they embarrassed about their appearance during an orgasm? Or is it simply that they have a disturbed body image and are unhappy with the appearance of a part of the body. In today’s society, sexual desire = attractiveness and if women are concerned that they do not portray the “attractiveness” of today, they then do not feel desired.

I asked for input from both sex therapists and physician experts and the ideas were quite helpful. For those that have body image issues, let’s say the breasts sag after nursing a few babies, use a sexy push-up bra that is lacy and see-through while providing support. If she is worried about her belly fat due to a cesarean section or hysterectomy scar or perhaps too many treats over the holidays, then wear a baby doll style of lingerie that “hides” the area of concern. How about the gal with generous hips and thighs? Try a long sexy gown that directs the eye to the bust-line and away from the hips.

A better suggestion would be to stay naked but lower the lighting with sexy candles. Be sure to select a scent appealing to both partners and generally a subtle scent is best. Almond scented candles stimulate arousal. Pure Romance makes a line of soy candles and the melted wax doubles as massage oil! How sexy is that?

Wearing a blindfold will reduce her sensitivity to the light and may even heighten her anticipation of what might happen next! Luxurious linens and sexy music also create a more relaxing environment for intimacy.

I suggest that guys refrain from general comments such as, “You are beautiful, and I love all of you.” Women do not take that global acceptance well. Instead, I suggest, “Don’t worry about your belly because you have beautiful breasts….”, or “Stop worrying about your breasts because you have such a sexy butt and that is what I am looking at”. These comments draw women away from their area of concern and make them more comfortable with the other good parts they have.

Finally, it is important to love your body and appreciate what you have. A visit to the sex therapist can help you explore the anxieties related to nudity and teach you relaxation exercises to help you enjoy the intimacy.

Exercise, eat right and strive for the body you are comfortable with.
For more information find us at www.BestSexualAdvice.com or 888 569 3374

Dr. Maureen Whelihan
info@thecshe.com
www.bestsexualadvice.com

This may include Vacuum Erection Devises (VED) to be used daily to draw the blood into the penis.

In more difficult cases, injections directly into the penis are needed to create a full erection. These can be used shortly after to allow a man to be sexually active without delay.

If you hope to maintain your erections, ignoring rehabilitation after prostate cancer therapy is just not an option.

Dr. John Stripling, Urologist
info@thecshe.com
www.bestsexualadvice.com

It is not surprising that this 28-40 year old group does not think about sex, as they are constantly multi-tasking and working on the next project. The last thing the stressed out, fatigued woman wants to hear is, “Are we gonna do it today?” Perhaps it is followed up with, “We haven’t done it in over a week!” Neither comment will get you sex, so you might as well stop there. It is important to remember that males can still function despite returning home from work up-tight with stress and aggravation. In fact Sex for Men is a stress reliever while stress for Women requires stress relief.

So let’s go over a plan to bring your tired, stress-out lady back to her erotic self:

1) HE will pick any two nights of the week and must come home from work and assume all children duties, such as, feed them, clean up the kitchen, put away the toys, bathe the babies and do homework with the children.

1) HE will pick any two nights of the week and must come home from work and assume all children duties, such as, feed them, clean up the kitchen, put away the toys, bathe the babies and do homework with the children.

2) SHE will leave the house and choose one of these options:

1.  
   1. Go to the gym and exercise as women are often self-conscious about their weight and the stress-relief from cardio and weightlifting stimulates the endorphins
   2. Go for a manicure and pedicure as the massaging of these areas is relaxing and relieves stress. Nice nails are always sexy
   3. Go read a sexy novel and have a glass of wine, any Sandra Brown novel will do. This stimulates sexy thoughts and the wine relaxes and reduces inhibitions. Don’t drink the bottle!

3) SHE will return home at the designated hour and agree to an intimate encounter

Not surprisingly, this works well almost all of the time because SHE is so turned-on by the fact that he did all of those things just to have sex with her. Secondly, HE often exclaims as they climb into bed, “I’m exhausted” which validates the hard work she does.

This is a homework assignment that would work in any given week. An additional tip would be to have a “date night” on a Friday or Saturday where the kids can stay over at a friend’s or at Grandma’s and you can have a sensual evening together with a light dinner, candles everywhere and no rush or concern for kids barging in. Try this the next time and see how easily it brings the sensuality back into the relationship.