Feeds:
Posts
Comments

Birthdays are a useful thing—although it’s increasingly easier to celebrate them for our children (or grandchildren) than for ourselves. Here at MiddlesexMD, we’re celebrating a milestone: It was five years ago this month that we launched our website. While I’ve been practicing medicine for much longer (did I say it’s not easy to celebrate every milestone?), this marks five years of encouraging women to learn about and take charge of their sexual health throughout their lives.Celebrating five years

There are a number of ways to measure how far we’ve come, like marking our children’s height on a chart. The first that comes to mind is the number of women who’ve been in touch. We’ve been in contact with hundreds of thousands of women (and men who love them) from 209 countries. Many have thanked us for solving a specific problem, or for simply providing some hope and a path to follow. We’ve talked to hundreds of women in person, too, at medical conferences. Nurse practitioners and other health care providers have said how grateful they are to have a resource for patients and, because many of them are women, have shared personal stories, too.

As a physician, I have more options available to me than I did five years ago. Osphena comes to mind as a treatment for vaginal and vulvar pain. And while localized estrogen products have been on the market for a while, I’ve noticed more advertisements for them. While too much advertising—especially of pharmaceuticals—can sometimes just be noise, I see the ads as an increase in conversation about women’s sexual health. And that’s a good thing.

I’m hopeful about increased conversation at the FDA, too. Last fall I attended meetings to discuss how the agency reviewed and set priorities for drugs to treat women’s sexual health challenges. It’s been rewarding to join with colleagues in Even the Score, a campaign for women’s sexual health equity. In March, eleven members of Congress signed a letter to the commissioner of the FDA, expressing the firm belief that “equitable access to health care should be a fundamental right” and noting the disparity between the number of FDA-approved drugs for male sexual dysfunction (26) and female sexual dysfunction (0).

It will take some time for new treatments to make their way through development, testing, and FDA approval. In the meantime, I’m also happy to note more books (including my own) and websites offering information, encouragement, and community to women as they navigate midlife and beyond.

I hope you’re talking, too—to your partner, your friends, your sisters, and your health care provider. When we share our experiences, we feel less alone. And we can also learn from each other about what’s happening and what works to keep us vital and engaged. Because we know that even at—especially at—midlife and beyond, we’ve still got it!

(Through the end of April, celebrate with us by using the code PARTYFIVE to take 20 percent off your purchase from our website.)

You say you’re taking daily doses of Wellbutrin and Effexor. Effexor is the likely culprit, since Wellbutrin is actually “pro-sexual.”  Wellbutrin increases dopamine, a neurotransmitter beneficial for sex; Effexor increases serotonin, a neurotransmitter that is negative for sex—in that it can decrease libido or ability to experience orgasm.

If you can decrease the dose of Effexor without an increase in other symptoms, that may help. Decreasing the dosage may mean other symptoms comes back, or that orgasm is still out of reach or diminished. In those cases, I offer Viagra, used off-label for women. A number of clinical trials have shown Viagra to be helpful when SSRIs (selective serotonin reuptake inhibitors, a class of treatments for depression and other disorders) lead to an inability to experience orgasm.

A newer SSRI, Pristiq, is reported to have fewer negative sexual side effects. I’ve seen that to be true, but also have worked with patients who found that health insurance was not supportive, since newer drugs are often more expensive. It may be worth exploring!

Another alternative that works for some women is to take a ‘drug holiday': skip the daily dosage of the SSRI on a weekend day when they are more likely to be sexual. This doesn’t work for everyone. Some people have withdrawal symptoms or other unintended side effects with the ‘holiday approach.’

I encourage women in my practice to consider using a vibrator, which can increase sensation and sometimes lead to orgasm. At midlife, it’s important to stay sexually active (that ‘use it or lose it’ thing), so it’s worth the effort to experiment.

I see how frustrating this dilemma is for women to manage through! I wish you patience and perseverance to find the right balance of overall health and intimacy for you.

You say you’ve had itchiness and dryness and get bladder infections fairly regularly. Those symptoms are completely consistent with the absence of circulating estrogen to the genitals. Until recently, this condition would have been called vulvovaginal atrophy; its current name, genitourinary symptom of menopause, does a better job of describing that it affects both the urinary system and the genitals.

Women have estrogen receptors throughout their bodies, but they’re most concentrated in the vagina, vulva, and lower urinary tract. In the absence of estrogen, symptoms in that area are more notable. That’s the bad news.

The good news is that there are steps we can take to keep our tissues healthy and vital. See our website’s suggestions for vaginal comfort, and I encourage women to consider, with their menopause care providers, the use of localized hormones.

Just a Perfect Day

If you could plan out a perfect day, what would it look like?

Two researchers explored that question in a study, “Developing a Happiness-Optimized Day Schedule,” published in the Journal of Economic Psychology. The researchers, Christian Kroll and Sebastian Pokutta, took data on how a large number of women spent a typical day and how much they enjoyed each activity. Then they had some fun with the numbers.

Subtracting 8 hours for sleep, they were left with 16 hours to divide up, minute by minute, into a day that would offer the most pleasure and satisfaction. Here is what they came up with:

106 minutes “intimate relations”
82 minutes socializing
78 minutes relaxing
75 minutes eating
73 minutes praying or meditating
68 minutes exercising
57 minutes talking on the phone
56 minutes shopping
55 minutes watching TV
50 minutes cooking
48 minutes using a computer
47 minutes doing housework
46 minutes taking a nap
46 minutes childcare
36 minutes working
33 minutes commuting

Some journalists joked about these oddly precise numbers. Simon Kelner asks whether a perfect day is different for men (likely answer: yes) and recalls Lou Reed drinking sangria in the park in his classic song.

But the researchers’ method actually makes sense. They write, “Our research asks what a perfect day would look like if we take into account the crucial fact that even the most pleasurable activities are usually less enjoyable the longer they last and the more often we do them.”

Imagine doing a jigsaw puzzle for twelve hours straight. If you like jigsaw puzzles, you would enjoy the first hour or two, especially if you don’t do jigsaws every day. But over time it would get way less fun.

Using that idea, the researchers took 16 common activities and allotted a number of minutes to each one, so that the last minute of each offered an equal amount of happiness. The more pleasurable the activity, the longer it took for the pleasure to diminish enough to match the others.

True, anyone who tried to follow the suggested schedule would go berserk. That wasn’t the authors’ intention! It’s a thought experiment: a way to think about what’s most important for an individual or a society. As the researchers point out, their computation “differs considerably from how people usually spend their time.”

If I use myself as a test case, I ask: Only 36 minutes of working? Fortunately, I love my work. I hope my perception of pleasure throughout a whole day of seeing patients is not an illusion. And 56 minutes of shopping? That’s not at all attractive to me as a daily activity.

But the study encourages us to be intentional with what we do with our precious time. The six activities at the top of the list, which the women enjoyed the most—intimacy, socializing, relaxing, eating (eating well, we hope), praying or meditating, exercising—are all vital to health in body or mind. We can think of each one as a different color thread, and make sure to weave them all through our days—with intentional planning of time for our relationships, for example.

We will be happier, and so will the people we love.

You’ve noted that in addition to vaginal dryness, you’re now using drops for dry eyes, a treatment for dry mouth, and more hand lotion than ever before. Yes, dryness is generalized in menopause, because the estrogen receptors we have from head to toe (and especially in genital tissues) have far-reaching influence! As we lose estrogen, we lose moisture in all kinds of tissues.

Systemic estrogen is a possible solution; it can make remarkable improvement. Every woman is different, though, in the extent of the effect, so a three-month trial might be considered to see if there is a notable benefit.

Otherwise, it sounds like you’re taking advantage of the topical solutions available to you—moisturizers for every body part! This is a good time of life to develop a good hydration habit, too, if you don’t have one already.

A recent Wall Street Journal headline read, “Sex in Old Age May Lead to a Sharper Mind.” The article describes a study in which Dutch researchers looked into the way cognitive function and attitudes toward sexuality might be related among older people. Nearly 2,000 adults, with an average age of 71, were given a variety of cognitive tests. They were also asked a series of questions about sex—whether it was important for older people generally or themselves personally, whether they found it pleasant or unpleasant. They were asked whether they still benefited from intimacy and touching.

Quite a few—41 percent—said that their current sexuality wasn’t important, but 42 percent said it was important for older people in general. A quarter considered sex important or very important. Only 6 percent found sexual activity unpleasant. More than two-thirds believed that intimacy and touching were still vital.

The results of these questions and the cognitive tests were correlated. Both men and women who thought sex was important and were satisfied with their current sex lives tended to do better on the cognitive tests.

The Wall Street Journal article points out that the study made no claim that sex improves brain function, or vice versa: only that the two are associated. It can be difficult to disentangle cause and effect.

Another study looked at how cognitive function affects sexual behavior interest and sexual behavior among the elderly. The 352 Italians studied were between 65 and 105 years old. They were asked, “Are you interested in sex?” and “Do you have sexual relations?” They were also given two tests of cognitive functioning. One third were still having sex and 40 percent were still interested. This study suggested that a sharper mind might help keep a sex life going.

It could be that older people who are healthy enough to have sex are also healthy enough to do well on cognitive tests. Generally, whatever is good for the brain is also good for sex. That’s a good reason to keep on exercising, or to start.

We women deal with many physical and emotional changes during and after menopause. Both in my medical practice and as part of the MiddlesexMD team, I’m alert for “kindred spirits” who understand the transition—and are willing to talk about what changes in hormones mean for real women leading real lives. The people at Vibrant Nation, the leading online community for women 45 and older, have been among those kindred spirits. I’ve published articles on the VibrantNation.com site for almost five years and have had some of our liveliest online discussions there.

Among the things we’ve talked about is how hormonal changes—and the painful or less pleasurable sex that can come with them—can take a real toll on our relationships. And I know from the women I see in my office and the emails I get from around the world (literally!) that we’re not talking enough about how sex changes and what we can do about it. We’re not talking enough to our doctors, to our partners, not even with our girlfriends.

VN-BSB-ad-15_01-v7-300x250And for many of us, it’s hard to find straightforward, trustworthy information about how to deal with issues like pain during intercourse, diminished orgasm, and changes in libido.

That’s about to change. I’m excited to have been asked by Vibrant Nation to lead a panel of women who will share their stories and advice for getting that spark back in the bedroom. Vibrant Nation is having its first-ever live webcast discussion, Sex After Menopause, on March 31, 2015, at 1:00 p.m. EST. We’ll have real women telling their stories, with experts providing perspective and solutions. And you can participate! Pre-register by following this link (Online Form – Pfizer Attendees List – Pre-event – Barb Depree) and you’ll have the opportunity to submit your own question or story and to win a $100 Amazon gift card.

Join us. Let’s stop the silence and extend the conversation. Let’s support each other by sharing our questions, our successes, our struggles. Let’s build the community of kindred spirits!

 

Disclosure: This post is part of a Vibrant Influencer Network campaign. MiddlesexMD is receiving a fee for posting; however, the opinions expressed in this post are Dr. DePree’s. Neither MiddlesexMD nor Dr. DePree is in any way affiliated with Pfizer and does not earn a commission or percent of sales.

Follow

Get every new post delivered to your Inbox.

Join 366 other followers

%d bloggers like this: