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Pleased to Meet Missy

When I first talked to Missy Lavender, I really had no idea if I would ever catch my breath. What knocked the breath out of me? Pick one: The sheer force of her charm, the drama of her comeback story, the strength of her will, the depth of her love, the remarkable cheer and impishness of her presence—even over the telephone. Or just the fact that we are on the same path, working on the same problem, with exactly the same drive… to make sure that women everywhere get to enjoy good pelvic health, for life.

With Missy, it’s been no holds barred. And so I jumped at the chance to join her advisory board, and I’m happy to be exploring what we might accomplish together. So, this post will be an introduction to Missy and her mission, because we really want you to know all about her and the Women’s Health Foundation, the organization she founded as her response to, as she would say, “things going sideways” in her pelvic life. That’s kind of putting it mildly.

But this Kellogg Business School MBA lost a lot after childbirth left her in pelvic trauma, with a babe in arms, and struggling, despite all of her many resources, to get the help she needed to recover her urinary and sexual function post childbirth. She made up her mind that the difficulty she had finding solutions to pelvic problems would never have to happen for other women.

With the kind of energy no new mother in her 40s usually has, she jettisoned her former career in investor relations, and established the Woman’s Health Foundation with the goals of improving women’s pelvic health and wellness, driving research, developing and offering education and fitness programs, fostering conversations, creating communities for women, and serving as a national resource on pelvic wellness issues.

And if that sounds like a lot to pull off, just know that now, in their twelfth year, they are doing it. All of it. And doing it really well, too, from their offices in Chicago, with their amazing and dedicated team, and largely because Missy herself is a force of nature.

We struggled and huffed and puffed, but eventually caught up with Missy, for a moment, over the holidays, for cup of tea and a chat about this path she has been on. She was preparing for yet another pelvic surgery to manage the aftermath of that difficult childbirth, a situation she will share completely with her readers in the blog she writes on the Foundation’s website, where you can keep up with all of the projects they are managing, and all of the many good souls making their work possible.

Some of the people you get to meet are her favorites, the “Grumpy Patients” and mine, the “Grumpy Patients.” Here’s Missy:

I’m a grumpy patient. Grumpy patients are a blessing! Grumpy patients have made all the difference. The proactive patients are the ones who change the world. But you ladies already know that at MiddlesexMD. Your readers are all the grumpy patients already. Seekers, I suppose.
     We all need to be turning around and talking to our female relatives who are not online, our sisters and mothers and daughters. What keeps me up at night is knowing that so many of us are out of touch with our pelvic lives. As a culture, we don’t understand our lives below the belts at all. Culturally, we aren’t raised to pay any attention to it.
     As women we should really be owning this wonderful center of our bodies, the center of our divine feminine, our procreative center, our digestive center, our urogenital center, we should understand it all, how it works, where everything is and how it functions. We should start understanding it all, in all of its dimensions, from a very early age, so we can see it all in our mind’s eye, and remain mindful and in tune with our pelvic health and well-being so that we can stay on top of problems and learn to get help quickly when things start to go wrong. Never ever just sit back and live with pain and dysfunction the way our mothers and grandmothers did. In silence, imagining this is a woman’s lot in life!
     In generations past, even now! Once a woman got past her late 30s, more than half of us, for most of us, things start to go wrong below the belt, any of a number of issues, pelvic organ prolapse, endometriosis, twisted tubes, cysts, simple fungal infections—oh, you name it—and there was very little help or information available. And societal silence!
     And then what happens? The last thing we feel like doing is having sex. Consciously or unconsciously partners, just get shut out. My hypothesis, and I’m setting out to prove it, is that more than half of marriages end because of problems below the belt, and pain and shame that is not shared or managed.
     My goal is a world in which women don’t have to stumble around. There really is so much help. There are so many therapists and doctors. It doesn’t have to cost you. There is so much that can be done that is not invasive these days. So much we can do for our own pelvic health. The point is, we have to all keep asking until we get the right answers. And we just have to make it easy to have these conversations. Take the hush-hush out of it.
     Our work has been focused on helping provide pelvic health education and outreach for every stage of a woman’s life. And encouraging sharing the transitions, woman to woman, so we know what to expect. Right now we have to fix the silence up and down the generations. We have to help our children and our mothers and grandmothers because the silence has been too big of a problem for too long.
Women just don’t have to live with discomfort and dysfunction below the belt. We don’t have to. There are so many therapies that are non surgical, and so many barely invasive surgical procedures. And so many surgeries that will simply give you your whole life back. It’s worthwhile to know all of your options.

So that’s a bit of Missy. The whole Missy is transforming. Her books (including this one for daughters and granddaughters) are charming and so worth having in your home and giving to the women you love. I’m giving them to the women I love. We’re looking into offering them through our site.

Meanwhile, do check out The Women’s Health Foundation, throwing light on pelvic health in all its complexity and beauty. Demystifying it and keeping it all working for us, happily and comfortably for life

First let me say that what you describe doesn’t make you at all unusual. You say that you require a feeling of fullness and some G-spot stimulation to experience orgasm. Your partner’s health issues make erections “fleeting,” and yet you both enjoy intimacy; you’d like to explore adding a dildo or other device to increase your enjoyment.

Most couples find mutual satisfaction an invaluable component of intimacy; a partner’s arousal and satisfaction enhances pleasure for most of us! Your partner’s situation has changed, and if you’re like most women, orgasm may have become less reliable over time, too. Now is the time to have a conversation with your partner—just to acknowledge the changes and that you’d like to try something new. (I wouldn’t recommend that you produce a surprise vibrator or dildo during a intimate interlude! At that moment it could be taken as a judgment rather than an enhancement.)

The analogy we often use at MiddlesexMD is to vision. When it becomes more difficult to read the fine print, we get “cheaters” or reading glasses! We don’t shelve our books. Why shouldn’t we take the same attitude toward sex?

You may find that your partner is relieved to have you start the discussion. You might even look at options together and make the selection as part of extended foreplay.

Have confidence! It sounds like you and your partner have conquered more daunting obstacles together. I’m certain you can navigate this one.

Before Foreplay

One of the very first blog posts I published, even before MiddlesexMD was launched, was about receiving a bouquet from a patient. She and I had talked about her options for managing changes in her sexual response, and I’d recommended a device that turned out to make the difference for her.

The flowers were an affirmation from her that she’d gotten her groove back, and I was delighted.

What I’d recommended was a device for “vacuum therapy.” It doesn’t sound very sexy, but it works for two reasons:

First, it works on the brain. Signaling to yourself that you intend to have sex becomes increasingly important as you have less of the hormone stew that supported spontaneous sex in years past. All that talk about “mindfulness” and “marking your calendar”? It’s because intention is a critical part of sexuality for midlife women.

And second, it works on the body. Less circulation results from less estrogen. More circulation is part of our sexual arousal and response. Gentle suction increases circulation to the clitoris. Stimulating blood flow and encouraging vaginal lubrication both prepare us for intimacy and make the experience more enjoyable.

I was thrilled to see, at a medical conference last summer, a new tool for women who want to keep the intimacy alive in their relationships. While previous options have looked a lot like medical equipment, theFiera Arouser is designed to be an intimate aid. It’s discreet and sleek. It combines gentle suction and vibration patterns. And it’s been tested in clinical trials, which documented the “engorgement” that triggers arousal.

How’s it used? The designers of the product call it “before-play,” and it’s where the effects on the brain come in. It’s used in advance of a sexual encounter to increase both your arousal and your responsiveness—which means a more pleasurable experience for you (which means a more pleasurable experience for your partner!). You tuck the Fiera into place, over the clitoris and under the labia, and your hands are free for… other things. Five to fifteen minutes is recommended.

Although it vibrates, the Fiera is not a vibrator. You may still want one of those, too, for increased sensation to experience orgasm. If you’re finding you don’t get to that point as often as you’d like these days, you might find the Fiera Arouser—and the intention to put it to use—to be helpful.

When I saw this product at that medical conference, it wasn’t yet in production. I asked my team to nag—I mean, follow up—with the manufacturer so we could add it to our shop just as soon as it was available. We’re delighted that it’s now in stock, and that we’re partnering with the manufacturer to make it available for women to experience!

Use the coupon code 8AMORE to receive a $49.99 discount on the Fiera Arouser on our site. And let us know how it works for you!

Our friends at The National Association for Continence recently reported that fully 40 percent of women are doing Kegel exercises incorrectly.

Oh dear.

We want to do our part to correct that, because for one thing, it’s not really that hard to do them right. But most especially because, you really can’t do a single solitary thing to help you maintain pelvic health throughout your life that is more beneficial than Kegels. To avoid incontinence, pelvic organ prolapse, uncomfortable sex, urinary tract infections, a host of difficulties as we age.

Not. One. Thing.

And that goes for your mom. And your daughter.

And guess what? For any man in your life, too.

Yeah! Everybody!

Everybody! Do the Kegels!

But, well, we have a focus here at MiddlesexMD, so our links and discussion might be a bit more female-anatomy-ish. But here’s a very specific link for the men, just so you know I’m quite bullish about Kegels for men, too.

Okay. Let’s get our Kegels on.

First, if you need a refresher, on your the pelvic floor muscles, I wrote all about that here. I encourage you to review that post so you can envision the lovely figure-eight sling of muscles that hold all of your important organs in their proper places, happily chugging along as you move through your busy day.

Once you have a clear sense of that pelvic sling of yours, find a place to sit quietly, feet on the floor, straight out from your hips, hands just folded quietly in your lap, eyes closed, breathing softly, with the space and time to give this practice a little focus.

Are you there? Good. Now, as if you were stopping the flow of urine mid-stream, tighten the muscles around your vagina. That’s all, just as if you were stopping the flow.

And there they are! Those are the primary muscles we will be working!  Well done, you!

Let’s take it another step. Working just a little harder, imagine that you are sucking a heavy, marble ball into your vagina. But, let’s make it a warm one, and well lubricated!

As you develop your sense of your inner landscape, try tightening your inner pelvic muscles to draw your pubic bones and tailbone together or imagine trying to draw your “sit bones” toward one another.

But! And here is where things can go wrong, and where people tend to run off the tracks. When you are doing your Kegels, you should not be tightening your buttocks. Let those stay relaxed. Don’t tighten your inner thigh muscles, either. Let those stay soft.

Definitely don’t hold your breath. Breathe softly. Do not suck in your gut. All is soft except that sling under your organs. Focus. And breathe. This thing that takes some concentration at first will become so natural with practice you will be able to do it while waiting in line at the grocery store.

Here are further ways you can help yourself really refine your practice, and I love these recommendations, and very much encourage you to actually do them!

First, get up close and personal. Use a hand mirror and a good light to watch what happens when you contract these muscles. That’s right—look in the mirror at your pelvic floor in action. It’s pretty cool to see what you can do when you are working those muscles!

Second. Remember they are muscles, and like all muscles, they have a full range of motion that should be worked. Most of us do our Kegels just contracting them. But it’s good practice also to stretch, or elongate them. And one of the best ways to think about that is the Elevator visualization. It goes like this:

Think of your relaxed pelvic muscles as the first floor. Contracting your Kegels as we did for the urine-stop visualization is like taking them to the second or third floor. The marble sucking exercise is maybe the fourth floor. And if you use actual Kegel weights or barbells you can go to the higher floors still. But elongating, or stretching the muscles, is taking your pelvic floor to the basement. Something that’s very good for them. Elongation tends to happen naturally when you yawn. But it’s a nice thing to do for them at the beginning and end of your Kegel sessions. Stretching is a kind of pushing action, a little bit of a bearing down, to stretch the connecting ligaments a little bit, get the blood flowing.

So, I hope that clears thing up. Don’t be among the 40 percent. And don’t let anyone you love be, either. Good pelvic health is everyone’s right. We ought to be the generation that ensures this for everyone.

A Watershed Moment

It may surprise you to hear a practicing doctor readily admit that there are vast fields of uncharted forest in human medicine.

I knew that when I began my studies, and now, many years later, I still find the constant learning that the discoveries my scientific sisters and brothers bring to my field my greatest hope and challenge. And sometimes it’s a source of frustration too, but today I’m focused on hope.

For quite a few weeks now I’ve been able to offer my patients something new. Addyi, the trade name for Flibanserin, the much talked-about prescription drug designed to treat Hypoactive Sexual Desire Disorder (HSDD), a disorder that I’m all too familiar with in my practice, a heartbreaking condition faced by so many of my patients and their loved ones.

But back to the question of advancements in medicine. When I think of this moment. I think of a parade of watershed moments in medicine. I know it may not seem like this to many people on the surface of it, but the approval of this drug, to doctors who serve women with sexual disorders, is HUGE. In my field it’s up there with, say, the dawn of anti-septic operating procedures. Think: we’ve only been washing our hands carefully before surgery since the 1860s. In the scheme of things, not that long ago! Or another watershed moment for women, the publication of Our Bodies, Ourselves by the Boston Women’s Health Collective in 1973, a book that changed everything, utterly. Or the Public Health Service Act of 1975, which made gender inequality in medical education illegal for the first time and propped open the doors for my own education… Finally.

And when I think of my ability to write Addyi prescriptions for my patients, that’s mainly what I think. I think…Finally! As hard as it was to get this one single drug for female sexual dysfunction (compared with 26 for men?) approved, and with all of the weight of its warnings and the hoops of physician training and the cost of it — despite the weight of all of that, through all of that — the FDA heard us. THEY HEARD US.

And that is the win.

So. Addyi is my new septic procedure. The one that will start saving lives immediately, one way or another. I can’t tell you what it means to me to have at least one arrow in my quiver for the women, LOTS of women, suffering, in my practice, because they WANT to want to feel the fullness of their sexual selves come alive. A basic human right, says the World Health Organization. A basic human right.

(By the way, did you know that Joseph Lister, the inventor of septic operating procedures was ridiculed widely and run out of this country, had to work extra hard and fought a difficult uphill battle to convince people that, really, anti-septic procedures in surgery would save lives? True story… If people had only believed him right away…. )

The outcome of the past few years is a watershed, a turning point because through the process of approval, the FDA has gotten the message: They now completely understand that this previously misunderstood disease — or the complex of Female Sexual Dysfunction, is very real. These women are suffering. So are their partners. They deserve focus, research, discovery, and treatment. And judging by the most recent news that the FDA has recognized Female Sexual Dysfunction as one of the 20 key unmet medical needs in the United States, they will be getting it.

HUGE.

Meantime, Addyi will help some of these women. Maybe your sisters or daughters. Some with Hypoactive Sexual Desire Disorder will improve with this treatment. At least they will know within a month or two of trying, and for those suffering, the option is available to them right now.

These women will need to talk to their doctors about Addyi. Women who don’t think they need it can help their sisters by asking their doctors about it, showing that it matters. Doctors will need to complete a short online training course to familiarize themselves with the new drug. It’s very short, and found right here. The sooner doctors get their training in, the sooner they can start prescribing the drug, the sooner women can at least try it, to see if it will work for them. I started prescribing in October, so expect to hear in December, after the recommended two months, whether it’s been beneficial.

If it works, happier lives. Fuller, happier lives. The medicine will keep getting better. Have hope!

The American Cancer Society has released new guidelines for Mammogram Screenings. We know you’ve likely read a lot about it. I thought I’d hand it over to our old friend and writer Julie, a longtime MiddlesexMD blogging pal, who has breasts of her own and some thoughts to share on what to do when new guidelines hit the airwaves.

Guideline Headlines!!! Okay girls! Grab them and run! But which way! When? Where? But wait!!! No!

No! These guidelines are saying to maybe squish less often? For some of us? Really? To not start so soon? Who are these people?

I’m confused.

With the latest release of Breast Cancer screening guidelines from the American Cancer Society, it’s easy to feel a little—entangled—in questions of when and whether to handle our screenings. And no wonder. The discussions are very much in the air, and the experts are agreeing to disagree. Very politely.

It wasn’t the intention of the committee to create this confusion, of course.

They truly wanted to offer up more leeway in guidelines, particularly for women with average risk of developing breast cancer—and that’s most of us. But leeway is very hard for most of us to interpret. Most of us just want very clear direction. We want safety and assurance. We want to avoid unnecessary exposure to radiation and unnecessary medical procedures. That’s not too much to ask, is it?

Well, we can’t have absolute assurances from medical guidelines. It would be so nice if we could. We can only get the best advice from smart committees working from what data they have to keep the greatest number of us safe most of the time.

So the new guidelines ease up on the youngest women, aged 40-45, saying they don’t need to start screening if they have average to low risk of breast cancer. Of course we women in menopause are already screening our breasts, have already been at it for years by now. Now we are wondering what to tell our daughters. And we will be getting different advice from at least three of the six breast-cancer-guideline-writing organizations in the US alone.

In fact all of those concurrent guidelines exist out there already, in our doctors’ heads. And online. And in our restless heads and hearts. So what do we do with all of this various information?

First… We breathe.

Then…  We remember, that we are each in charge of our own bodies. Guidelines are there just as a framework of reference. In practice, we each are working on our particular realities, which must be dealt with in the particular, with a plan that takes in all of the unique, unusual, specific aspects of our own bodies, or our daughter’s, their daughter’s.

So, I’ll take me, for example.

Those guidelines would suggest, since my breasts have been around for 55 years (well, one of them. The other seems much, much older), and in my family there is no history of breast cancer at all, and I have no current cancer markers, good and good. But… I’ve had so many surgeries and lung problems my chest as been radiated enough in my lifetime to light up Tokyo on a moonless night, which is not so good, and I’ve had to have a few lumps biopsied here and there, which have markers they like to peek at now and again, so….. Yeah I’m signed up for annual scans. Am I worried? Not really. But I’m committed. My sister, with the same family history, may logically choose to scan less often. Because she’s been much healthier throughout her life.

A young relative in my family? Just turned 40. Did she need to go for her first exam? Not really, but she and her friends made a party of it at the local breast exam clinic. Wine and bites and breast squashing in paper robes. She could have put it off another 5 years, but she prefers to get this ball rolling. Preference plays a roll here. She is being cautious.

You see how this rolls. Family history + conference with your physician over your own medical history + your own ideas and feelings about medical tests at this time in your life, taken together with a careful review of the recommendations = your best plan for screening. That plan for screening? It changes year over year as you age. That’s how you do this. Review your plan each year for you. Discuss it with the women in your family. And your friends. Like. Discuss it. Out loud. Over coffee or tea.  Like, “What’s your breast scan plan, Mom?”

Like that.

It’s not rude.

No. It’s not.

Happy deciding, everyone.

It sounds like what you’re experiencing is “bridging.” There’s a “bridge” of tissue at the base of the opening of the vagina. When stretched, it will occasionally separate or tear. As we lose estrogen through menopause, those tissues lose elasticity; there’s also narrowing of the opening of the vagina.

A very successful solution is a “perineoplasty,” a surgical modification of that tissue. Like a small episiotomy (sometimes done in labor to ease childbirth), it involves a small incision and repair to relieve pressure. In this case, the repair is made from front to back rather than from side to side.

This procedure is done in the office, under a local anesthetic, with just a few absorbing stitches. In my experience, it’s very successful and much appreciated by women. Keeping things comfortable will often require some combination of localized estrogen, vaginal moisturizer, and a lubricant with intercourse.

 

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