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Archive for February, 2010

Talking about sex.

I live and practice in the Midwest, where open discussion about sex is just not part of the culture. Even among close-knit groups of girlfriends, it’s a rare discussion, at least not past a certain age. I’m trying to remember when I stopped talking about sex openly with my friends…

I remember it was a subject of great interest and fascination when I was very young. Whispers, conjectures, a lot of mis-information and tall tales. By high school, we knew more, the better informed among us bringing along the uninformed.  In college, we received a great deal more detail as data from actual, rather than fictional, experimentation became more commonplace.

I suppose it is marriage that closes our mouths. We may have been willing to share exploits or guess at sex before we chose our mates, but once we do, the walls of privacy go up, and silence rules our sexual lives.

And that’s okay, so long as we have opportunities to continue to learn and explore, and provided we have some source of information and aid when things aren’t working. Because, let’s face it, we aren’t trained in sexual techniques. There is no sexual master class. No black belt to earn. And sex isn’t always smooth sailing. Our anatomy isn’t flawless or consistent in its function. We need information as we grow and change sexually, and most particularly when we enter the menopause.

In some cultures discussion about sexual technique among same-sex family members and social sets is nearly endless. But in our Puritan-influenced culture, silence is golden. So what are we to do? It isn’t likely that we’ll change a whole culture any time soon.

Well, online, we have a real opportunity. Here, we can talk to and learn from each other without sacrificing the privacy and propriety we hold dear. The online environment we want to build is one where we can share reliable, well-researched information that will help us understand and share not just matters of sexual health, but of sexual technique, too.  A good, safe, monitored discussion place to learn from each other and from the research and writings of sexual health practitioners.

We are busy gathering a good collection of information, but we’ll want to hear from you, too. What has changed for you with the menopause? What questions do you have? What has worked for you? What have you learned from others? What experiences are daunting? What Aha!s can you share?  Post under your own name, or under another name you choose — either way, we’d love to hear from you.

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The post title is just tongue-in-cheek, folks. A little health writing humor, poking a stick at the whole idea of health “secrets.”

We don’t believe in keeping information about attaining good health secret.

So here, today, long before going live with our website, we are happy to divulge our recipe for sex after menopause. The ingredients are:

Tada!  Whooot!!! We have balloons falling and confetti rising over here at MsMD headquarters!! How about you?!  No?

Wait, No?

Maybe you don’t realize how hard it is to distill good-sex-after-menopause down to an easy-to-remember system? So let me explain: Months ago, we began our work with a hard look at the American Psychiatric Association’s DSM-IV description of disorders contributing to Women’s Sexual Dysfunction (There’s a phrase we won’t use a lot around here, because it worries us. If we don’t yet understand Women’s Sexual Function, how can we comfortably describe its dysfunction?).

We embraced (and strive to remain mindful of) the point of view of women’s sexual problems developed by the New View Campaign, and their concerns about the medicalization of human sexuality. We reduced by our focus on peri-menopausal and menopausal women. Filtered all of these concerns through recent research and publications by members of the North American Menopause Society (NAMS) and the International Society for the Study of Women’s Sexual Health (ISSWSH).

We surveyed current literature on female sexuality. We added recent work by sex researchers and therapists and coaches, relationship coaches and mindfulness gurus.

That was the first step.

The next step was sorting all of the helpful advice, tips, skills, and learning into clear descriptions of conditions and pragmatic actions so that women in menopause can understand exactly what is going on with their bodies and what they can do about it if they want things to be different.

We didn’t go looking for the recipe. It surfaced from the work, organically. We began to see how all of the latest and best advice of medical, psychiatric, and sex researchers and coaches, seeking to help older women enjoy their sexuality, clustered into just a few central goals. What does a woman need to do to enjoy sex after menopause? (Assuming, of course, that she wants to enjoy sex after menopause at all. Because that is still her choice.)

1. Knowledge

She needs to know the physiology of menopause, so she understands what is happening when it happens, and especially that though her experiences are unique to her, she’s not alone. And she needs to know some new sexual techniques that will keep sex enjoyable as she ages.

2. Vaginal Comfort

She needs to learn how to take care of her vulvo-vaginal tissues so that sex remains comfortable.

3. Pelvic Tone

She needs to learn how and why to strengthen and maintain her pelvic girdle to encourage circulation and maintain or strengthen her orgasms.

4. Genital Sensation

She needs to compensate for less blood flow and less sensitivity in her genital tissues by providing herself with more stimulation, more sexual sensation.

5. Emotional Intimacy

She needs what every woman needs at every age for sex to be good. Sex needs to be intimate. It needs to mindfully create and reinforce a real connection.

There it is. No secrets. When we take our site live in April, you’ll get all the rest, descriptions of conditions that get in the way of achieving these five goals, actions you can discuss with your doctor or take on your own to enjoy sexuality for life, and products we have selected to help you on your way.

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MiddlesexMD began with a business plan I wrote for my Masters in Medical Management program at Carnegie Mellon University. Its essential proposition — offering women over 40 the information, advice, and products they need to sustain good sexual health as they age — is all there in my original paper.

Taking a business from paper to reality takes a lot of work, and skill, and putting in hours doing things you might not have ever pictured yourself doing. But in this life, a woman’s got to do what she’s got to do to get it all done. Right?

I was lucky enough to find the right business partner, a woman I like and respect who has impressive business credentials, is reaching midlife herself, and understands the need for better information for women of our generation.

So when she suggested, early in our business planning, that we head to a trade show for sex products, both to shop for appropriate products for menopausal women, and to learn about the industry, I took a deep breath, and swallowed hard. She knew it was the right thing to do, and I knew she knew what she was talking about.

So off we went to the AVN Novelty Expo in Los Angeles.  Three days of product and toy makers hoping to entice buyers from all of the big sex stores and distributors. Thousands of people familiar with the trade and the spectacle and the atmosphere of the Los Angeles sexpo… Plus the two of us: A gynecologist from the Midwest and her friend, the corporate exec.

We stayed close to each other as we breezed past the signs suggesting we had to be over 18 to enter the show. And, you know how it is, waiting for your eyes to adjust when you’ve walked into harsh lighting after being in a low-lit room? At first you blink a lot, but before long you can make out where you are?

I suppose going to this show for the first time was a bit like that. We spent the morning blinking, remembering to breathe, feeling a bit jumpy. But after a while, our agenda kicked in.

What surprised us more than anything was the prevalence of really poor quality products made of questionable materials, with no warranty, yet made to be used inside the body. As a doctor, that’s a little hard to see.

But among all the thorns there were really great products too, ones designed with health and durability and a great experience in mind. And products with smart, dedicated people standing behind them. We  found all of those that we could.

By the afternoon it was easy for us to cruise down those aisles and aisles of multi-colored, throbbing, bobbing, moist, flavored, leather-covered, studded, and hinged things, to find the exact products and people we needed to meet.

– A guy who developed an organic line of glycerin-free and paraben-free lubricants because his wife was allergic to everything on the market.

– The woman from the UK whose target market was menopausal women, her products developed to function exactly as we need them to.

– Companies whose sexual aids are designed by thoughtful designers, in beautiful, tactile materials. These aren’t toys. They’re objects so lovely and well-made anyone would want to own them.

My partner was right. We did need to see that show. We learned what we needed to know and found what we needed for the store faster than we could have sitting at home with our search engines.

We have pulled together a really nice collection of products, spanning price ranges and functions. We’ll be able to show you the results of our shopping expedition in April, when the site is ready. Meantime we’d love to hear your questions, advice, and experiences in finding and using the products that work for you.

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Since launching MiddlesexMD, I have to say, my dinners have gotten a lot more spicy.

You know how it is when dining with buddies. It’s polite — required — for them to ask what you’ve been up to lately.

When I tell them about MiddlesexMD, you would think it might stop the conversation cold, but I’ve found just the opposite is true.

My friends do want to talk about this. It’s not surprising when men are there that they are a bit more quiet, but they are engaged, too. We all appreciate our partners’ attention to these discussions — because we’re not always alone with these changes. They affect our sexual partners, of course.

I had dinner the other night with an old friend. The subject of our conversation turned to the idea of how important it is, especially for long-partnered people, to keep their sexuality top-of-mind if they want to keep their sex life going. I talked about how older women, particularly, need extra stimuli (both physical and emotional) as they get older.

We need more opportunities to think about sex, consider it, fantasize about it, and more emotional intimacy throughout the day to find or sustain the mood.  Sex is like any pursuit, if you want to get better at it, it requires your attention. Some call this “work” Awareness or Mindfulness. And I think this dimension of a relationship is valuable enough to “do the work.” (Smile.)

It was a simple conversation. I didn’t think it had any sort of profound effect at the time. But I ran into that friend a few weeks later. She pulled me aside, and whispered,

“Hey Barb! Thinking about sex more? It WORKS.”

I wasn’t surprised, if it works for me, it should for you too!

Gee, I love my job.

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Writing for my gynecologist friend has included a lot of Aha! moments. I admit some of this learning makes me blush. It’s not just because I blush when talking about sex — though, I do. It’s because I’m embarrassed when I’m caught not knowing things I think I should have known a long, long time ago.

So, I’m reading along in Dr. Barb’s enormous textbooks on female sexuality, when I come across an illustration of the clitoris, sort of like the one below. I nearly passed it over, because, what’s to know at my age? I’ve lived with this equipment for 50 years. I’d like to think I know my way around it.

But this illustration colored in the entire structure of the clitoris. Not just the glans, but also the shaft and the crus clitoris, or crura.

Excuse me… the shaft?… and the crura?

No.. please picture me picking my head up like a prairie dog, looking around my office, and asking the air…

“The shaft?!”

“And the crura!?!”

Somehow in all my curious, bookish, research-happy past, I never learned more about the clitoris than about the little button — the glans — the part that sticks out from the prepuce at the top of the labia.

Who knew my clitoris had legs? And a shaft, even?

But yes, indeed. It’s practically a little penis under that hood. With long, long legs that extend waaay back toward the perineum, which fill with blood when I’m aroused.

Now, of course, the cool, rational part of my mind tells me I have enjoyed my crura — and possibly even the shaft — because they’ve been there all along. But I would have liked to know about them from the start. I can’t help but wish for a few years back in which I could quite clearly visualize my long, leggy crura.

What can we do with this information? Well, with age, the clitoris loses some sensitivity. We may find it useful to use warming oils and gels or vibrating sex aids to increase stimulation to the clitoris as we prepare for or engage in sex.

And of course, to do that, it really does help to know where it is.

Back to the books…

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