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It’s March 1: Do you know where your New Year’s resolution is? You may be thinking, “It’s here, somewhere.”

I have a guess about where it is—collecting dust in a corner, where you left it when you “failed.” I’ve left a few there, myself.

Making a resolution is a positive step that makes it more likely we’ll change a behavior. But when we don’t follow through in the way we envisioned, that resolution becomes something that makes us feel worse about ourselves. When we don’t meet whatever goal we’ve set—whether it’s doing Kegels every day, ramping up a moisturizer habit, or setting aside time for intimacy—the easiest thing to do is give up altogether. “I don’t know why I even bother to make a resolution,” you might say. “I never keep them.”

I’d like to suggest that that’s a story you tell yourself. And the great thing about stories is that you can change them. In fact, research shows that telling yourself a different story has a lasting effect on performance. The researcher had students who thought of themselves as “bad at school” do a story editing exercise that included the idea “everyone fails at first.” Those students went on to get better grades and were more likely to stay in college.

So if you’re telling yourself that old story about your lack of self-discipline or your complete inability to follow through, stop. Retire that old story. Get yourself a new one. Tell yourself you’re learning how to integrate that new thing into your life, and learning takes time. Congratulate yourself on the effort. Look to the past for a time when you did follow through and change something about yourself or your life, and draw inspiration from it.

Then dust off that resolution—yes now!—and try again. Haven’t you heard? March is the new New Year.

How Long Should You Wait?

A heart attack, whether it’s your partner’s or your own, is a devastating challenge for any couple. Recovery may be slow. Anxiety and fear are inescapable. Depression is common. The partner who is suddenly thrust into the role of caregiver may, at times, feel overwhelmed. Amid so many physical and emotional challenges, sex may feel like a low priority.

But it shouldn’t. What both of you need most of all is comforting, and nothing comforts like the touch of the one you love.

Both partners may be afraid of risking a recurrence. Not knowing what to do, they wait. Sadly, most are not getting appropriate advice from their doctors. In a recent study of patients aged 55 or younger, only 12 percent of the women and 19 percent of the men talked to their doctors about sex, and patients were more likely than doctors to bring it up (and I’d wager the numbers grow smaller with older patients). As one man said, “The subject was never mentioned in ten weeks of after-care sessions for life style and food advice and recuperative gym exercises.”

When sex did get talked about, two-thirds of the doctors gave advice that was more restrictive than the American Heart Association guidelines. Jalees Rehman writes, “The kind of restrictions recommended by doctors in the study—and presumably by medical practitioners who weren’t polled—are not backed up by science and place an unnecessary burden on a patient’s personal life.”

Blanket restrictions are unreasonable because every patient and every heart attack is different. It’s vital to discuss with your doctor your case in particular. After an uncomplicated heart attack, one week may be long enough to wait. Or you may need longer. The important thing is to be guided by where you are in your recovery.

Having sex is like doing mild to moderate exercise. If your doctor gives you the okay—and ask if he or she doesn’t give you the answers you need!—and if you can handle such activities as climbing stairs and carrying groceries without chest pain or feeling out of breath, sex should be fine as well.

You will be adjusting to new medications. Antidepressants may lower libido, and beta-blockers may interfere with erections. If you’re in open communication with your doctor about sexual issues, dosages may be adjusted or medications switched.

Various stressors are unavoidable, but sex can relieve stress and soothe both patients and their partners. The years of cultivating awareness of your own and your partner’s body will pay off. Care in tending to your relationship in the years before a crisis is like money in the bank. You never know when you might need it.

Sex is exercise, and exercise strengthens heart muscle. Sex also strengthens relationships. It’s a medicine no couple should be without for long.

You say you’ve completed five years of regular tamoxifen, and your doctor has suggested Vagifem 10 mcg to address symptoms of dryness and itchiness. Vagifem 10 mcg is a very, very tiny dose of bioidentical estrogen, delivered as a tablet to dissolve in the vagina. I have many, many breast cancer patients who use it or other “localized estrogen” or “vaginal estrogen” options. Like you, they’ve had significant issues without it; over the counter creams, lubricants, and moisturizers may have had some benefit, but over time they’ve not done enough.

From what we know, localized estrogen doesn’t enter the blood stream and get disseminated throughout your system; it is absorbed only in the genital area where it’s needed. I like Vagifem because the dose is very low and there appears to be consistent absorption. But it is still estrogen, and there is sometimes reluctance to add this to a woman’s regimen, especially after breast cancer.

There is a new non-estrogen treatment option for this condition. Called Osphena, it is a SERM (Selective Estrogen Receptor Modulator), the same class of medication as tamoxifen. They both target tissue and affect estrogen activity: tamoxifen targets breasts to block; Osphena targets the vagina to activate. Osphena is oral, daily, and in my practice has been well tolerated and effective. While it’s been on the market for two years or so, it has not specifically been trialed in breast cancer patients (and nor have other medications, a reality I hope will change—and soon). There’s not yet data on safety for women like you, but other SERMs on the market are favorable for breast health, it makes sense to think this one may be, too.

We don’t have all the answers yet, unfortunately! Ultimately, the decision comes down to quality of life for you, and I’m glad it sounds like you have a health care provider who is helping you consider your options.

Vibrator Myth-Busting

Recently, I joined with two colleagues to produce a “continuing medical education” unit for the American College of Obstetricians and Gynecologists (ACOG). Our topic was “Vibrators and Other Devices in Gynecologic Practices” (if you’re a health care practitioner, you can investigate the CME offer here).

I was joined by Mary Jo Rapini, a sex psychotherapist and long-time friend of MiddlesexMD, and Debra Wickman, a gynecologist who teaches at the Banner Good Samaritan Medical Center in Phoenix. We talked about a 2009 study in the Journal of Sexual Medicine that says that 52.5 percent of women have used a vibrator; that led us to talk about the roughly half who have not.

A number of myths might get in their way, and we hope we made some progress in busting them.

Myth #1: Vibrators are for people whose relationships are in trouble. Based on what the three of us have seen, the opposite is true. As Mary Jo explains, “Vibrators are for couples who want to explore, who want to try new things, who want to play and have fun in their sex life.” Couples who share that desire are typically interested, trusting, and care about each other.

Myth #2: Vibrators make it hard to have an orgasm any other way. I’m happy to debunk this one with a medical reality: As the muscles involved in orgasm grow stronger, orgasm becomes easier and more intense. Vibrators are good at stimulating—and they don’t get tired or fumble, as we sometimes do as we lose a little strength and dexterity. Staying sexually active with a vibrator will increase your responsiveness to manual stimulation—that’s just the way we work.

Myth #3: There’s something sinful about a vibrator. Again, it’s Mary Jo who addresses this most directly. She’s had a number of conversations with faith leaders on her patients’ behalf, when religious concerns weighed on their minds. The ministers she’s talked to are invariably in favor of keeping marriages strong, and maintaining physical intimacy is a natural part of those relationships.

Myth #4: Vibrators are only for self-stimulation. Vibrators are good for self-stimulation, and that’s a good option for women who want to maintain their sexual health when they’re without a partner. But they’re also part of intimacy for couples. They’re especially good for couples who see a need to slow down and spend more time in foreplay. Which, now that I think about it, could be any of us who’ve achieved midlife!

If you’re among those who haven’t tried a vibrator, I support your right to decide for yourself. Here’s hoping, though, that none of these myths is what’s standing in your way.

If you don’t already have that perfect gift for your significant other, don’t despair. There are other ways to show your love. The most important thing is to be thoughtful about choosing the way that you show it. Try to set aside the traditional idea of Valentine’s Day. When you wipe away all those images of roses, chocolate, and candlelight, what’s left? You and your beloved, alone for an evening.

You may think you know where I’m headed with this, but not so fast! Take a few minutes to consider what you know about your partner. You might be familiar with the concept of emotional love languages: words of affirmation, quality time, gifts, acts of service, and physical touch. Keep your partner’s love language in mind as you plan the evening.

Also think about what your partner enjoys. A recipe that you don’t normally make because it’s too much work (or you don’t like it yourself)? Make it for him. Ice fishing? Go with him (pack hot drinks and hand warmers!). A certain junk food? Buy it, put a big red bow on it—and let him enjoy it, guilt free. Whatever it is, give it with love.

If you want to take your gift to the next level (nope, not yet), look to your shared history. What did you enjoy doing together when you were first dating or right after you got married? Maybe you can find a way to revisit that interest. It could be as simple as putting together a play list of music that was popular when you were first together and dancing to it.

And yes, of course you can think of all of this as leading to intimacy. Valentine’s Day is a great time to be intentional about working on foreplay, which many of us need more at midlife, whether or not it was important to us before. You could be sensual with a scented massage oil (Just Love is an all-natural and organic addition to our collection) or playful with something like flavored body paint. Remember the lubricant to be sure you’re comfortable, and consider its frivolous possibilities, too (Just Love is formulated for both massage and “intimate glide”).

Maybe you just don’t have the energy for any of this. Maybe you and your partner have been “running on empty” for a while. If that’s the case, then try spending the evening asking each other these 36 questions, which can result in falling in love, according to one study. (And it seems to have worked for this woman.) Can it work for falling in love again? I don’t know, but what have you got to lose?

When the one you loved—and the one who loved you—has died, how do you get through Valentine’s Day? If you’re in this situation, please accept our condolences. Perhaps just when it seems it couldn’t get any more difficult, you’re assaulted by images of love everywhere. Cards, ads, commercials, conversations are all painful reminders of the love you’ve lost.

There’s probably nothing that will ease the pain, but there may be a way of slightly shifting the way you experience it, if you’re up for trying.

First, have a plan. Ask yourself, “How do I want to spend the day? What are the things that help me?” Sometimes, that’s being with others who have gone through what you’re going through. If you can’t find that among your friends, consider looking for an online grief group, which can be a wonderful source of support.

“Isolation is such a huge part of grief,” says Ann McKnight, an experienced social worker and psychotherapist in my community. “Part of the depth of the pain of grief is feeling alone, like you’re the only one who has ever felt this way.” Connecting with others going through the same thing will help you feel less isolated. (Ann recommends GriefShare.org for a range of resources.)

If you do decide to spend time with friends, choose a friend who won’t have any expectations of you and who will give you room to do what you need to do, whether that means crying during your time together or canceling at the last minute. “Hold whatever plans you make loosely,” says Ann, knowing that you may want to change them—and that’s fine, too.

Second, remember that love comes in many forms. On Valentine’s Day, the focus is on romantic love, so it’s easy to lose sight of that. “We don’t only receive love,” Ann says. “We are also a source of love for other people in our lives.” If you have the energy, show your love to someone—a friend, a sibling, a mentor. It doesn’t have to be a big gesture. Even reaching out with a short phone call can help shift the focus of the day from what’s missing to what you still have.

Finally, don’t be surprised if the actual day isn’t as bad as you fear it will be. Ann says that many people find the anticipation of a holiday to be more difficult than the day itself. “So if on Valentine’s Day you think, ‘Hey, I’m not having a horrible day,’ that doesn’t mean you didn’t love the person you lost,” Ann says. “Grief cannot be predicted.”

Do you have suggestions that might help others? Please share them!

You say you can hold one bead, but not two. The only thing you’re doing wrong is expecting too much too soon! It takes time to increase muscle strength, and if you only recently bought the weights, you likely only need more time.

Start by using the weights for a few minutes while sitting; go to standing as you’re able. You can also increase the time as you’re able, and if you’re using Luna Beads, you can increase the weight, too, by interchanging beads. Each step can take weeks, and not everyone can build enough strength to get to the maximum weight.

If you’ve had surgery or radiation, your vagina may be too short to hold both beads. If vaginal depth is causing problems for you, dilator therapy, which also requires patience, can help to restore capacity.

Take your time, grant yourself patience, and stick with it!

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