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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!

The short answer is yes, Kegel exercises, which strengthen the pelvic floor, do help prevent and then counter incontinence. The exercises need to be done consistently, and they need to be done “correctly,” which means flexing the right muscles. You can read how to do the exercises on your own on our website, but there are also tools available that can help.

I saw in my practice last week two women who said their incontinence was 80 percent better after six to eight weeks of daily use of the Intensity pelvic tone vibrator. The Intensity uses electrical pulses to contract the muscles of the pelvic floor; the vibration leads to orgasm, which also contracts those muscles.

Simpler options for targeting the right muscles with Kegel exercises are vaginal weights (like Luna Beads) or the Energie Barbell; Luna Beads are the most popular option at the MiddlesexMD shop). Any of these options inserted in the vagina as directed will help you assure you’re flexing the pelvic floor as you intend. With Luna Beads, you can increase the weight for more resistance as you build muscle tone.

The key in any case, with or without tools, is to be faithful in doing the exercises! It’s definitely worth it–for lots of reasons that keep you active and enjoying life.

No conversation about dementia is easy, especially when it regards someone you love. Talking about sex is no piece of cake, either. But any conversation about Alzheimer’s or dementia ought to include sex.

Because sex will very likely be an issue that caregivers have to deal with at some point. A recent patient told me that sex remains a very special connection with her husband, who is in the early stages of Alzheimer’s; she looks to preserve that connection as long as possible.

We are sexual creatures all our lives. Alzheimer’s doesn’t change that fact, although it will alter the experience and expression of sex in a relationship—both for the person with dementia and for the partner. It’s better to be emotionally prepared and to have your resources in place than to be taken by surprise by loss or uncharacteristic or embarrassing behavior.

So, let’s talk.

A diagnosis of Alzheimer’s disease is heartbreaking. Its progression is long and unpredictable. There is no cure, although some drugs slow its advance. As one daughter said, “It’s like my father was taken away, little bits at a time.”

Unfortunately, it’s also becoming more common. In 2014, 5 million Americans over 65 were living with Alzheimer’s disease, two-thirds of whom were women. With the graying of America, those numbers will only increase.

You can’t predict the course of the disease or how it will affect your partner’s sexuality. Sex may be something that brings you both comfort, as my patient found. The body has its own memory, and the familiar movements and routines, the physical contact, may be reassuring and helpful to both of you.

But your partner may also become cold and withdrawn, confused and clumsy, or aggressive and uninhibited as the disease progresses.

He or she may lose interest in sex or become unresponsive—neither resisting nor responding nor initiating physical contact. This hurts, and it feels like rejection, even though you know it’s the disease talking. It may help to remember that intimacy comes in many and varied forms—as simple as brushing his hair behind his ears or a reassuring squeeze.

For all of us, touch remains a primal and powerful form of human connection. Your partner may be comforted by gentle, loving touch, and it may be an important way for you to stay connected as well. Hold hands, hug, cuddle, rub his or her back.

As your partner becomes more dependent and childlike, or the burden of physically caring for him or her becomes more demanding, you may lose interest in sex as well. Or you may lose interest in sex with your partner. You may feel guilty about this, but you may also feel frustrated or even turned off by your partner or by the intimate tasks of daily care.

This is normal and understandable. It’s tough to cope with daily life, with the grief of witnessing the transformation and ultimate loss of a lover and life-partner.

But there is another moral and legal morass to be aware of as well as you juggle your own sexual and emotional needs with the changing and sometimes ambiguous needs of your partner. Marital sex has to be consensual, but what happens if your partner no longer has the capacity to consent? Laws against marital rape at that point become murky, as this unsettling story illustrates.

At the other end of the spectrum, people with diseases like Alzheimer’s may lose inhibitions, especially sexual inhibitions. They may strip or fondle themselves in public; they may become sexually aggressive or make inappropriate comments to family, caregivers, and strangers. They may want to have sex, and then forget they just did. They may ask who you are while you’re having sex.

These actions are embarrassing, painful, frustrating, exhausting, and even scary. It’s hard to know how to respond and keep your cool.

Sometimes, your partner may not be acting out sexually at all, but may simply need to go to the bathroom or be wearing clothes that are hot or uncomfortable. You’ll need to assess these needs quickly, while both reassuring your partner, deflecting his or her confusion or embarrassment and dealing with the reactions of others.

Did I mention that you’ll need physical and emotional resources in place before the disease gets too advanced?

You may need help figuring out how to engage and reassure your partner, how to shield others, like grandchildren and caregivers, from inappropriate behavior, and how to maintain your own equilibrium during it all.

To comfort and engage your partner and to maintain intimacy and connection, you could

  • Go through old photo albums together and reminisce about the past
  • Play music—the tunes you used to listen to together or quiet, soothing melodies
  • Take walks together (exercise is incredibly important for both of you)
  • Keep children and animals in your lives
  • Do simple cooking or gardening projects or maintain hobbies your partner used to love. One woman with dementia can no longer drive, shop, or cook, but she finds release and comfort in the physical activity of caring for her garden. Are there similar activities that could continue to engage and soothe your partner?

And please don’t neglect your own health and emotional well-being. Alzheimer’s disease is long-term, and you’ll have to seek out long-term ways of coping.

  • Arrange for regular respite care
  • Find a support group of people who are also caring for loved ones with Alzheimer’s. You need to talk with people who understand what you’re going through.
  • Find stress-relievers of your own. What soothes and relaxes you?
  • Don’t neglect exercise, particularly if you can get outdoors.

After all the years together, you are the one most familiar with and comforting to your partner. The one who knows him or her best. You want to be there for the one you love, but don’t forget to put your own oxygen mask on first.

Let’s Get Specific

Like you, I feel the pull of the New Year, the impulse to fresh determination and resolve. (It partly comes, I think, from the satisfaction of packing away the Christmas decorations—much as I love them during the holidays!) I see the January magazine covers with headlines that offer a more organized, less stressed, healthier life.

And I see evidence of the season in the order trends here at MiddlesexMD. There are clearly a number of us who are making resolutions, and our fresh-start, new-focus impulse includes our sexual health.

As we’ve said before, being specific helps when making resolutions. So I dug into the data to see what other women have been choosing during this season of self-improvement. Here are the most popular choices, consistent over the past three years, and the reasons why I’d guess they land at the top of the list:

Vaginal moisturizer: I love that this lands at the top of the list. Moisturizers are used regularly (we put lotion on other body parts daily!) to strengthen vaginal tissues and keep them healthy. They supplement the moisture that we lose as our estrogen levels decline. Yes Water-Based moisturizer is our most popular, but we offer other options as well, including a subscription that keeps you stocked.

Lubricant: Lubricants are the very easiest defense against uncomfortable sex, which many of us experience with vaginal dryness. The most popular resolution purchase is the Personal Lubricant Selection Kit, and for good reason, I think. With the kit, you can sample seven different varieties, and then receive a full-size bottle of your favorite. If lubricants are new to you, this is especially helpful: The drugstore options are overwhelming, and I hate to buy a full-size bottle of something I end up not liking! All of our lubricants are selected for safety, efficacy, and fit for the needs of midlife women.

Kegel tools: I’m also happy to see these among the most-purchased at this time of year. Our upper arms are more visible, so we get a visual prompt to add them to our tone-up list. Our pelvic floors are out of sight and often out of mind—until we’ve lost enough muscle tone to experience incontinence or diminished orgasm. Strong pelvic floors do so much for us! And Kegel tools help us focus on the right muscles to flex, as well as reminding us to do those pesky flexes. Luna Beads Vaginal Weights are among the products most purchased at this time of year (and are actually the most popular of our Kegel tools throughout the year).

Just because these have been popular, of course, doesn’t mean they’re right for you; take some time to think about your own starting point and priorities. But you can also take some comfort in knowing there are simple steps you can take, and you’re not alone in the journey!

A New Way to a Better You

As we mentioned last time, 47 percent of New Year’s resolutions are related to self-improvement—losing weight, quitting smoking, getting organized, or saving money. “Improving sexual health and wellbeing” doesn’t make the list (at least not the one in this study) but we think they should.

Because—let’s face it—chances are, they won’t magically get better on their own.

They used to, though, didn’t they? Or it seemed like it. Over the course of our relationships, all of us have probably experienced sexual desire come and go, as we went through things like pregnancy, health-related issues (for us or our partners), and times of stress. Looking back, we remember that desire always bounced back, as it does for most people who are generally healthy and on the young side of middle aged.

But at this stage of the game, how long should you let it go, hoping it will self-correct, before resolving to do something about it? Our take: Not long. Start now. You’ve got nothing to lose and so much to gain in the area of self-improvement.

Although we may not think of intimacy and sex falling into the “self improvement” category, it actually does. Do you want to lose weight? Be healthier? Feel better about yourself? Then get busy, sister, because having sex can help in all those ways. Equally as important is that when sex is good, as you’ll recall, it adds 15 – 20 percent additional value to a relationship; when it’s bad or nonexistent, it drains the relationship of positive value by 50 to 70 percent.

Make 2015 the year that you make a concerted effort at doing what it takes—kegels for better muscle tone, a vaginal moisturizer as part of your skin-care routine, lubricants or a vibrator to add some spice, an honest conversation about foreplay with your partner—to get your game on in the bedroom. Don’t just say you will; make it your New Year’s resolution. Research shows that if you make a resolution, you’re 10 times more likely to have been “continuously successful” at six months than if you don’t. Good luck and Happy New Year!

A Resolution Worth Making

We know and have mentioned before that relationships and connection are what make us happy. And yet when it’s time to make a New Year’s Resolution, what do we choose? According to one study, 47 percent of us make self-improvement related resolutions, 38 percent make weight-related resolutions, and 34 percent make money-related resolutions. Only 31 percent of us make relationship-related resolutions. (Respondents could choose more than one answer.) The question didn’t break out romantic from non-romantic relationships, but it’s still fascinating that the response came in last on the list.

I don’t know why we are less likely to make resolutions about improving relationships. Maybe we think our relationships, especially with our significant others, are so deeply grooved that rejuvenation is unlikely. Maybe we underestimate our partners’ willingness to entertain the idea of change. Maybe the idea simply doesn’t occur to us.

Whatever the reason, we’re missing an excellent opportunity. I’d like to challenge you to make a New Year’s resolution to improve your relationship with your partner. It could be as simple as “I will make eye contact when we see each other at the end of the day” or “I will tell my partner one thing I appreciate about him/her every day.” Even simple things increase intimacy, which is the basis for a healthy sexual relationship.

If you have already mastered intimacy, then perhaps make a resolution to try something new in the bedroom—a new position, a new technique, or a new toy. Perhaps you and your partner could decide together what kind of resolution to make. That will increase the comfort level when you actually hit the sheets. On the other hand, don’t underestimate the power of small surprises to reignite passion. As we mentioned in a previous post on the love/desire paradox, we want security and passion, intimacy and mystery, safety and risk. So push that boundary a little and see what happens.

You can increase your chances of keeping your resolution if you:

Be specific. “I will try a new sexual position every month” vs. “I will try new things in the bedroom.”

Tell someone. Preferably your partner! But it could also be a close friend. When others know you have goals, you’re likely to hold yourself more accountable.

Write it down. There’s something about committing it to paper that makes it seem official. And it will help you remember exactly what you committed to!

There are other ways to increase your odds of making your resolutions reality, which is a good thing since only 14 percent of people over 50 keep their resolutions compared to 39 percent of people in their twenties, according to research. Apparently, those of us over 50 need as much help as we can get!

I recently read a book review recounting one woman’s harrowing passage through perimenopause. The Madwoman in the Volvo is a graphic and humorous account of emotional upheaval, distress, seismic life changes, and finally, the author is cast gently upon the slightly less fraught shores of menopause. Perhaps sadder (or more thoughtful), probably wiser, and definitely optimistic about the future.

So, in honor of this season, which is guaranteed to nudge all but the most stoic among us off the ledge, I have two messages for all of us hot-flashing, sleep-deprived, hormonal gals.

If you feel as though you’re losing your mind, you aren’t alone. Hear that? You are not alone. In fact, you are legion—there are many of us.

Google “crazy menopausal women.” Read the forums. Check out the Fourteen Best Menopause Health Blogs of the Year. Take heart. You’re in abundant, albeit somewhat unhinged, company.

There are, in fact, a silent (or, more likely, howling) army of women who feel just like you. I recall the patient who was referred to me by her new therapist, who had refused to treat her until she got her hormones straightened out. (Previously, she had been told to see a therapist by the police.)

I recall a close friend, the very picture of motherly benevolence, who hissed in my ear, “If that kid doesn’t stop yammering at me, I’m going to tape her mouth shut.” She was referring to her sweet but talkative adolescent daughter. I was shocked. A few years later, I was feeling like that myself.

You can assess your lifestyle and experiment with healthy change. You can eat kale and take vitamin B12 and black cohosh. You can meditate and do yoga. You can stop smoking and reduce your alcohol and caffeine intake. You will feel healthier, and your symptoms might become more tolerable. In case you haven’t noticed, I’m a big advocate of healthy lifestyle choices.

But, if you, like many other women, continue to feel like you’re hanging on to sanity with bloodied fingernails, and those you love are suffering right along with you, by all means see your doctor and find out what pharmaceutical options might help you.

Read this article, written by a woman with access to all the current research on hormone replacement therapy (HRT) and an enviable journalistic pedigree. Here’s what she has to say about her decision to go back on HRT:

I would like to be able to tell you that I weighed these matters thoughtfully, comparing my risks and benefits and bearing in mind the daunting influence of a drug industry that stands to profit handsomely from the medicalizing of normal female aging. But that would be nonsense, of course. I was too crazy. I went straight to the pharmacy and took everything they gave me.

Perimenopause—the hormonal roller-coaster years preceding menopause—can be a long and bumpy ride. It usually begins somewhere between 45 and 55, but can start much earlier. These are the years of unpredictably cresting and crashing hormones, when the crazies come out in all their glory. This stage can last from 2 to 10 years.

Menopause officially beings in the thirteenth month (one year) after your last period.

Which doesn’t mean you’re out of the woods. Many women still have hot flashes and emotional turbulence. But life should slowly settle down as your body adjusts to its new, post-hormonal self.

So, that’s my second holiday message: You aren’t crazy, and eventually you’ll be okay. Wiser, maybe more self-actualized, and really, really okay.

With that, a very happy holiday from MiddlesexMD to you. And as the Madwoman in the Volvo said, “Have some cake, for God’s sake.”

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