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Archive for June, 2010

While we are on the subject of finding medications and supplements that can help us… a quick note about using herbal remedies to help alleviate the symptoms of menopause and/or to boost your flagging libido and support your vaginal tissues…

Herbal supplements, for the most part, are developed and marketed in the U.S. as food stuffs. For this reason they do not require clinical studies to test their efficacy or to measure their side effects. They are also not subject to manufacturing rigor that would guarantee their potency. So I can’t promise or deny their effectiveness or safety.

At the same time, there is no doubt some of my patients have experienced some relief of their symptoms by using various supplements. Very few of the herbal products designed for menopause support are known to be harmful, and trying them yourself may be the best way to learn of any benefit. It’s your body. How these supplements work for you is really the question.

A good way to test their efficacy and safety for you is to keep a symptom journal for a week or so before starting a new supplement, and then for 12 weeks after starting it, tracking the type and severity of your symptoms, and how they change over time. The accepted wisdom for herbal supplements is that 12 weeks is an adequate time to determine whether a supplement will help your symptoms or not.

There are so many supplements out there thought to support us as our hormones are changing. What has been your experience of supportive supplements? Any that have helped you? Any cautionary tales?

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Vagifem is a low-dose ‘localized’ estrogen. It is delivering estrogen to the vagina and adjacent tissues, but not to areas outside of this area (that’s why it’s called ‘localized’ vs. ‘systemic’).  This is a great choice for maintaining vaginal health, since estrogens improve blood supply to the area.

By the way, Vagifem has just come out with a lower dose — 10 mcg as opposed to the typical 25 mcg — that seems to work just as well.

There is another prescription alternative:  a low-dose ring and cream to deliver estrogen to the area.

An over-the-counter option could be vaginal moisturizers used consistently. Moisturizers don’t improve blood supply, but they do work to keep the vagina moist and supple. You might also benefit from a lubricant during sex.

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The real difference between a lubricant and a moisturizer is duration. Lubricants coat the vagina to ease penetration, which adds comfort during intercourse. They provide a benefit at the time of use, but are not designed to last.

Moisturizers (like Yes, which we offer at MiddlesexMD) are designed to be longer lasting. They replenish and help maintain water content in the vagina, clinging to the vaginal walls so they are effective for several days. Mineral- and vegetable-oil-based moisturizers are not recommended because they can cause irritation, providing a habitat for abnormal bacteria. Vitamin E oil, on the other hand, can be a helpful ingredient.

Yes can be applied as a vaginal moisturizer every 3 days. Some women prefer more frequent use, others need it a little less often to stay comfortable. You can determine your own frequency with use.

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I find I am surprising people when I say I will be shocked and disappointed if the FDA agrees with its advisors and rejects Flibanserin, a new drug from Boehringer Ingelheim, shown to help some women recover sexual desire.

And I’m shocked and disappointed by agencies and colleagues who are condescending to women, assuming they are unable to think through marketing hype to make decisions about their own health.

In my menopause care practice, the women I see who are experiencing difficulties with their sexuality are often deeply informed about their conditions even before consulting me for help. They do not rely on advertising or television to inform their own sexuality. They consult experts. They consult their physicians. They are perfectly able to sort fantasy from reality.

Their concerns about their lack of desire are real. Their experiences of desire leaving them are real. The effect that this has on their well-being is real. And there are very few tools available to help them.

Maybe Flibanserin as a treatment for Hypoactive Sexual Desire Disorder (HSDD), isn’t the perfect tool for every woman experiencing depleted sexual desire. But for some women, some of the time, clearly it helps. Help begets hope, and as a doctor, I’ll tell you that hope is as important as any pill in restoring good health.

I myself suspect that “HSDD” is an invention — a committee invented a new name for a cultural issue as old as time. There has never been and will never be a time in human history when the libidos of men and women match up perfectly forever. I am not interested in medicalizing what may be a woman’s normal or even beneficial biological response to stress and aging — our libidos may well drop for very good reasons.

Nevertheless, I have had women in my office, losing sleep, depressed, miserable, because the lack of intimacy where it is wanted often has a domino effect, destroying communication, trust, a couple, a family. For these women, overcoming our ancient biological responses to stress — in a modern world where stress is constant — is what they want and need, and as a doctor, I would like to be able to help them.

I really don’t think the pharmaceutical companies are the bad actors in this case. Human tensions create business opportunities. You can’t blame a pharmaceutical industry for doing what it does.

But I do worry that the FDA will overstep by taking this choice away. The side effects reported in the trials are not life-threatening. They are not ubiquitous. They are a risk many of my patients may be perfectly willing to take for any advantage, even a slight one.

We are able to make our own decisions about what is best for our health and our lives. Really.

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Studies consistently show that estrogen use is not associated with weight gain. The estrogen ring (you are probably referring to Estring, although there are other estrogen ring products) should not be a factor causing weight gain.

More common contributing factors are age and lifestyle, unfortunately. As we grow older, we need to be more active to burn the same number of calories.

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Zoloft is an SSRI (selective serotonin reuptake inhibitor), which increases serotonin. That improves mood, but more serotonin is not good for women sexually. Sometimes changing meds within that same class can have different side effects.

Wellbutrin (buproprion) is an antidepressant that increases dopamine. That can have the effect of improving libido, so sometimes adding it is helpful. In this situation, it might also be helpful to measure free testosterone and consider adding testosterone if it’s low.

If you consult with your physician and can’t change your anti-depressant, you’ll find some other ways to help with libido on our website.

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Part 3 of 3

Shopping for vibrators can be fun, and really very interesting. These devices come in many configurations and with many options, because, well, we’re all different. What one woman or couple likes and needs can be a real turnoff for the next.

While my partners and I shopped for the collection we offer at our online store, we kept these factors in mind:

Size and Shape
Vibrators come in sizes and shapes destined for specific as well as general use. You will find mini vibrators great for clitoral and prostate stimulation. These small devices may fit in the palm of your hand or strap to a finger (especially good for making love in the dark).

There are larger clitoral vibrators shaped to cup the clitoris and labia. These can be combined with a dilator or dildo, used during intercourse, or used on their own to help stimulate vulvo-vaginal tissues.

Midsized vibrators are often wand-shaped for vaginal and g-spot stimulation. Large women find these useful for the reach they provide, and they can also provide leverage for women who have difficulty with hand strength.

Massagers are dual use devices, used for vulvar stimulation as well as massaging muscles anywhere in the body (really!). Attachments for these devices can transform them into vaginal and g-spot stimulating wonders.

Power
Older women generally need more power, both a stronger vibration and a longer session time. For that reason, rechargable batteries or plug-in devices are usually a better bet than disposable battery-operated devices.

Materials
Hard plastics and stainless steel are easy to clean. Look for materials that are guaranteed to be phthalate-free. Silicone surfaces are wonderfully warm to the touch, with a skin-like feel. They clean up with soap and water or with cleaners made especially for sex aids, but owners need to be careful not to use them with silicone-based lubricants. Some manufacturers now use anti-microbial plastics, medical-grade materials formulated to discourage bacterial growth.

Heat Feature
Vibrators that warm up before and during use are great for those of us who flinch from the cold

If that’s too many variables to maneuver in one shopping experience, may we make a recommendation? If this is your first vibrator ever, why not start with one designed specifically for clitoral and labial stimulation? That way you’re sure to have a device that will help you improve circulation, keeping your vulvar tissues responsive and ready for sex when you are.

When you have your new device in hand, be sure to charge it fully before you use it. Start slowly and gently, using plenty of lubricant with the device, learning what your device will do and how your body likes it. If it’s been awhile since you have had any sexual stimulation at all, be patient. Give your body time and a number of sessions to awake to this new sensation. And if you’re bringing this new toy into an old relationship, talk through it, explore this device together. The more communication, the better.

And you tell us! What advice or questions or stories do you have about selecting a vibrator or bringing one into your sex life for the first time? We would love to hear from you!

Return to Pt 1 of 3

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Part 2 of 3

Of course, I can explain why we need more vulvo-vaginal stimulation at our age to nearly any woman in my office, and she may understand and fully accept what I’m telling her. But her next step is to go home and discuss this with her partner, if she has one.

Many times, at our age, we’re talking about spouses — sexual partners we’ve had for a very long time. And if that sexual partnership has not included the use of any sexual aids, bringing that first vibrator to bed can be a daunting change.

The truth is, we don’t know how our partners will respond to our need or desire to use a vibrator until we raise the subject. One good way to do that is to say — “Well, Dr. Barb said this could help.” Show your partner these blog posts, and browse the MiddlesexMD.com website together, where you’ll find lots of information that can help you communicate what your body is going through and what you and your partner can do about it to continue to enjoy your sex life.

It can help to shop for your first vibrator together, whether in a store or online. The lines of vibrators we’ve gathered at MiddlesexMD.com are designed especially for women in midlife who need vibrators that will hold a long charge and deliver a strong vibration.

But even with all this information at the ready, one or both of you may be suffering from some vibrator mythology that will make you hesitate to use one of these devices. So let me do a little dispelling:

Myth 1: Vibrators are for people whose relationships aren’t strong — Actually vibrators work best for couples whose intimacy is solid and secure, playful and creative. Introducing a vibrator at our age can awaken those qualities in a strong relationship, and underscore an important lesson, that the nature of our sexuality shifts as we age, period. Accepting that with grace and creativity is important for any partnership.

Myth 2: Vibrators make it hard to have an orgasm any other way — Actually the exact opposite is true. The more orgasms women have, the more easily we can achieve them. Every orgasm helps to strengthen the muscles and nerve pathways that ready us for our next one. While, having easier orgasms with a vibrator may encourage its regular use, no vibrator can ever replace human contact. Women generally crave intimacy first.

Myth 3: Vibrators are for masturbation — While that one is true, vibrators are not only for masturbation. They have gone mainstream among couples who have figured out that vibrators are great for stimulating every erogenous zone, and in addition to the boost they give women, are particularly good for stimulating a man’s prostate. They are great for foreplay, during sex, and for gentle stimulation after intercourse, too.

Myth 4: Vibrators are for sex maniacs — Sex maniacs may like them. But so may your neighbor, your pastor, your doctor, your auto mechanic. We’ve been using electronic vibrators since we harnessed electricity, and they are more mainstream than you might expect.

On to Part 3 of 3…
Or go back to catch Part 1.

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Part 1 of 3
“A Vibrator? Me? At my age?!”
That’s a pretty common response when I recommend — actually prescribe — using a vibrator to the patients I see in my menopause practice. I live in a small city in the middle of the Midwest, where sex aids are of course in use — as they are everywhere and for millenia — but they are hard to find and almost never openly discussed, at least not among the generation hitting menopause right now.

But, yes, Virginia, a vibrator, for you, and especially now. Here’s why… As we approach menopause, our sex hormones are in a constant state of flux. Perhaps flooding our systems one minute, depleted the next. What they are, especially, is unreliable. They are just not reliably there when you need them to do their work in bringing you to arousal, helping to lubricate your vagina, to make sex possible, much less pleasurable.

Then, once we have fully reached menopause, our hormones are more predictable, but they’re in shorter supply. That might not bring any measurable sexual changes for one woman, but for another, it can feel like a door has been shut in her face. Her vaginal tissues may not respond to the same sexual stimulation that always worked in the past. That can leave some of us feeling as if we have just stopped functioning, sexually.

Of course, the whole point of this blog and our website is to share the news that it ain’t over until you say it’s over. The secret to keeping sex alive after menopause is MORE. Follow our recipe: More knowledge, more lubrication, more stimulation, more intimacy, more exercise.

What came without trying when we were young — reading the small print, responding to sexual stimuli — now requires assistive devices. Reading glasses… and a vibrator. (And moisturizers, maybe dilators, a sexy movie or two, a pillow?…)

But especially vibrators. And not just any vibrator, but a vibrator with more power and endurance than a young girl needs. Clitoral stimulation at our age needs to overcome the sluggish circulation in a clitoris that, if unused, will go dormant, pulling up into the body. Our vibrators need more power, over a longer period, to replace that circulation and encourage a clitoris to come out to play.

On to Part 2 of 3…

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It’s been great to hear from a number of you after the opening of our shop. You’ve validated my suspicion that, for lots of women, there just weren’t good sources for information and products they felt comfortable perusing. These are two of the comments that have made me smile in the month since we’ve opened:

“…Thank you so much! I happened upon your site and it is exactly what I need to see at this point in my life. I’m so happy! I’m finding all kinds of info that I haven’t seen anywhere else and just in the nick of time. What a relief to find that I’m not alone, that someone understands, and what a wealth of useful information. Thank you, thank you, thank you! I’ll be back often.”

“…My entire experience was perfect. I was a little self-conscious reading and browsing at first, but soon I was so absorbed in the information/sexual aids that I had my Gigi vibrator and other items selected and bought before I knew it! When I opened the box and saw the card and tissue paper and all the care that went into making my first intimacy purchase special, I knew that I would not be disappointed. And I wasn’t! And neither was my husband. I have no words to describe how much we’ve been enjoying each other! It’s like we’re on our honeymoon!!”

Like these women, many of you are exploring sexual aids for the first time. One of our most popular products has been a lubricant selection kit. Women who buy it get seven samples of different kinds of lubes—water-based, silicone, and hybrid. After they’ve experimented, they can tell us which they like best and receive a full-sized bottle of their favorite. If you have suggestions for other ways we can make it easier for you to figure out what works, let us know!

We’ve certainly been hearing from people who want to “Ask Dr. Barb,” as we invite you to do on our website. I’ve been answering the questions directly via e-mail, but I’m sure others of you are wondering about similar issues.

To expand the discussion, we’ll start posting the answers to common questions sent to “Ask Dr. Barb” here on our blog—of course, we’ll protect the privacy of the people who asked! And remember, there’s no substitute for talking to your own physician for specific advice for you. But we hope our exchanges here will help you feel comfortable knowing what questions to ask—and inspire you to sustain your sexuality just as long as you’d like.

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