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Archive for December, 2010

I was struck by this sentence in a report on research with women aged 45 to 65 experiencing menopause: “As a generation, they have yet to develop a voice for this situation, and many remain silent rather than proactively seeing help.”

Really? We are the generation who, in high school, bought Our Bodies, Ourselves to better understand menstruation and sex. We pushed the boundaries to study science, go to medical school, become executives, compete for construction jobs, run our own businesses. We bought Marlo Thomas’s “Free to Be You and Me” for our kids.

But in my own experience as a physician, I see evidence that it’s true. When my practice included women of all ages, patients came in ready to talk in detail about physical symptoms—and emotional effects—related to pregnancy or fertility or uncooperative or uncomfortable periods. I don’t recall as many conversations about symptoms of menopause, especially as they related to sexuality.

In the last few years, since I’ve focused my practice on mid-life women, those who come to see me are ready to talk. This may have encouraged me to think we’ve made more progress than we have; this “REVEAL” (Revealing Vaginal Effecs at Mid-Life) study is a useful reality check.

This research found that 41 percent of postmenopausal women had not talked to anyone about their sexual health in the previous year. Just over a third had talked to a health care provider; fewer—30 percent—had spoken to their partner or significant other.

The oldest women in the study—60 to 65—were least likely to have spoken to anyone at all. The younger women—45 to 49—were more likely to have spoken to someone: health care providers, partners, and then female friends.

Why does any of this matter? Consider the other findings of this research:

  • While almost all of the women surveyed were familiar with hot flashes as a symptom of menopause, fewer than half were aware that vulvar/vaginal pain was another symptom.
  • A quarter of those surveyed experienced pain during sex; most of those women still have sex—in spite of the discomfort—at least once a month.
  • The majority—80 percent—of the women who experienced pain during sex assumed it was a “normal part of getting older.”

That’s a whole lot of women who aren’t aware that sex can still be pleasurable and pain-free, even after menopause. And it’s a whole lot of women who won’t even broach the topic with their health care providers, because they assume that nothing can be done.

So! Clearly, it’s up to you! I imagine a whole lot of conversations between best women friends, women and their partners, sisters… and, for the sake of the next generation, between us and our daughters.

There are symptoms of menopause beyond hot flashes, night sweats, and mood swings. Decreasing hormone levels affect our vaginal and genital tissues, but they don’t spell the end of sexuality—or comfortable intercourse. There are things any woman can do to restore or preserve her sexual health, and we need to talk about them!

Sounds like a great resolution for 2011.

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When the results of a new AP-LifeGoesStrong.com poll of the boomer generation about sex and relationships were released last month, the news media highlighted two seemingly contradictory findings, illustrated by these headlines:

  • “Poll: Baby Boomers Sex Confident”
  • “AP Poll Says Boomers Are Unhappy with Sex Lives”

The first story focused on the fact that the majority of people between the ages of 45 and 65 believe that they have “pretty much learned everything there is to know about sex.” The second article reported on the percentage of boomers who say they are “dissatisfied” with their sex lives. Nearly a quarter — 24 percent — of the 45-65 group said they were frustrated with their lovemaking (compared to 12 percent of 18-29 year olds and 17 percent of the 66-plus crowd).

Hmmm. I wonder if there’s a connection.

My first reaction — and I speak as a medical doctor who specializes in menopause care and hears about the sexual lives of boomer women on a daily basis — is that I don’t believe a person of any age can know everything there is to know about sex. In my experience, it’s hard for a person to understand her own sexuality — how her body works, what she really needs and wants — and impossible for her to know everything about her partner’s desires and expectations in the bedroom.

A closer look at the poll’s results reveals a significant gender gap around these findings in the 45-65 age group. While 59 percent of boomer women said they know all there is to know about sex, only 48 percent of their male counterparts share that level of confidence. On the other hand, 48 percent of men age 45-55 said that their partners don’t want to have sex as often as they do, while only 13 percent of women in that age group made the same complaint.

Sex therapist Dr. Ruth Westheimer, who helped develop the questions for the poll, says that the most important issue the findings highlight is that men and women in this age group have very different expectations in bed.

“We worry so much about teens and sex, but this poll indicates a need for a call to action for this segment of the population to become more sexually literate,” she says. “It is not necessary for a couple to be in exact sexual synch, but if a couple’s appetites grow too far apart, then that indicates that there is not enough communication about sex in the relationship.”

Of course, communication is an essential component of satisfying sex. But I also wonder if what women who say they know everything there is to know about sex are really saying is that they’ve lost interest in sex as they know it. That the kind of stimulation that excited and satisfied them when they were younger no longer does the trick. Real “sexual literacy” for both women and men at midlife requires knowledge about how our bodies are changing and what we can do to help each other have physically and emotionally satisfying sex lives as we grow older.

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Vagifem will have some influence on tissues within four to six weeks; I hope it won’t be long before you note some benefit.

Beyond tissue health and lubrication, having comfortable sex depends on vaginal “capacity.” I’ve recommended vaginal dilators to a number of women who’ve found them helpful; dilators are smooth cylinders of graduated sizes used to gradually, gently stretch the vaginal opening and depth.

If it really is just dryness (did I say “just dryness”?) making intercourse painful, the Vagifem and a good lubricant should get you back on track. And, of course, remembering to take the time you need for arousal!

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I’m sure I’m not the only one who gets sentimental during the holidays. As my family gathers in a home that looks better than usual, preparing gifts and eating more-than-usually festive food, I can’t help but feel fortunate.

Part of what I’m grateful for is the response to MiddlesexMD, which we launched at the beginning of the year. I’ve had a few years of experience focusing on mid-life women in my medical practice, including the satisfaction of hearing from women who’ve gotten their sex lives back. Through MiddlesexMD I’ve been able to have a broader conversation with more women and more health care practitioners.

There have been very specific comments from people—both women and their partners—who’ve found success with information or products they’ve found on our site. Health care practitioners I’ve met at conferences have endorsed what we’re doing with some variation of “This is exactly what I’ve been looking for to help my patients!”

In the midst of this holiday season, then, I’d like to say thank you—to the readers of this blog, our correspondents and customers, my health care colleagues, and the MiddlesexMD team. I wish for all of you a very happy holiday season—full of joy and leisure and seasoned with romance!

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HPV (Human Papilloma Virus) is so common that the lifetime cumulative risk of being an HPV carrier is 80 percent. In other words, we’re nearly all carriers of HPV.

Fortunately, most people do not suffer adverse effects. Reactions to HPV exposure depends on our immune systems and whether we are exposed to high-risk or low-risk HPV types. The most common consequences for women are vulvar warts or abnormal pap smears, but, again, most women have no symptoms at all.

So you can assume two things: That your partner (like 80 percent of adults) is an HPV carrier, but that the likelihood of a health consequence is small. If this proves to be a long-term relationship, enjoying sex without a condom will be acceptable and safe for you.

For anyone entering into a new relationship: Getting screened for sexually transmitted infections is smart–and it’s a way of signaling you care about each other and the new beginning you’re making together.

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Too Much Sugar Can Sour Sex

You may have heard about the Centers for Disease Control and Prevention’s prediction that by 2050, one in three Americans could have diabetes. One in ten already do, although many of them haven’t yet been diagnosed. A noticeable increase in thirst is one of the first, best-known signs of diabetes. I’m thinking about another, less-well-known symptom: a decrease in sexual enjoyment.

A recent University of Chicago study found that while women and men with diabetes had sex about as often as their non-diabetic counterparts, both women and men enjoyed it less. Women reported having more difficulty in achieving satisfying orgasms. And, worse, women were less likely to talk about it with a doctor.

It’s difficult, I know, for many women to talk to their doctors about sex to begin with. They might feel more comfortable bringing it up if they understand the connection to diabetes.

It’s a hormone, again, that’s causing the disruption; just not the usual ones we talk about with mid-life sex. This time it’s insulin, which regulates blood sugars. With diabetes, the body is unable to make or respond to insulin. Without treatment, sugar builds up in the blood and a number of functions don’t work normally.

High blood sugar levels can lead to vaginal dryness and painful intercourse. Even if it’s not painful, there’s a good chance that intercourse will be less pleasurable. Eventually, the extra blood sugar damages blood vessels that supply nerves; as those nerve endings become less sensitive, sex becomes more ho-hum. (A similar thing happens to blood vessels in the penis, which can lead to erectile dysfunction for diabetic men.) The more time goes by without treatment, the more damage is done.

If you already know you have diabetes, make sure you’re following your doctor’s advice on controlling your blood sugar through a combination of diet and medication. If you’re experiencing changes in your sexual response, take the initiative to discuss it with your health care provider.

If any of this sounds familiar and you haven’t been diagnosed with diabetes, ask your health care provider about being tested. The sooner you start treatment, the more damage you can delay or avert.

And if you aren’t diabetic, do everything you can to stay that way, especially if you have risk factors like obesity, diabetes in pregnancy, or a family history of diabetes. Eat a healthy diet that’s low in cholesterol, exercise for 30 minutes five days a week, and maintain a healthy weight (a body mass index of under 25). Finally, if you smoke, quit.

If nothing else motivates you to stay healthy—or make healthy changes in your lifestyle—perhaps the thought of better sex will!

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We’ve talked before about the fact that sex is different for women. Rosemary Basson, MB, FRCP, of the University of British Columbia, describes a couple of ways that women experience arousal differently.

First, women are more likely to respond to stimuli than to have an interest in sex sparked out of thin air.

Second, emotional intimacy matters to women. A lot. It’s usually a prerequisite for becoming sexually aroused.

I mention this now, in the weeks leading up to the holidays, for a reason. Holidays are often an emotional time to begin with: Will the kids get home? Will they spend time with me? Will the ex cooperate in scheduling events? Will my mother-in-law/grandson/nephew be polite about the gifts I’ve found?

The women I know also carry more of the burden for preparing for the holidays than their partners do—however well intentioned those partners may be! There’s decorating, cooking, baking, shopping, wrapping—all on top of a social calendar that’s more full than usual.

It’s easy for the holidays to fall short of expectations, partly because we’re so busy, partly because we’ve been encouraged (remember Norman Rockwell!) to think of holidays as idyllic family times. And, many of us harbor hopes that—somewhere—our holidays will also have some romance.

That’s why I come back to Rosemary, stimuli, and intimacy. As you’re navigating the next few weeks, carve out some time for you and your partner. Spend some time together—even in the midst of a holiday party. I’m reminded of the hints Marnia Robinson includes in Cupid’s Poisoned Arrow: From Habit to Harmony in Sexual Relationships. She calls them “attachment cues”; you can read more about them on our website, but here are some I think you can get away with even at the office party:

  • smile, with eye contact
  • touch with skin-to-skin contact (a hand, a cheek)
  • prepare your partner something to eat (or drink)
  • gaze into each other’s eyes

Give it a try, and let me know if it helps you feel more connected amidst the hustle and bustle. And if you have a way to preserve room for yourself and your partner during the holidays, please share. What makes for romantic interludes for you?

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Another Way to Stay in Touch

We love hearing from our readers and our customers. We’re thrilled when we hear from someone who’s gotten unstuck in her sex life because of information or products we’ve been able to supply.

Two recent messages, for example: A husband e-mailed us in happy disbelief that his wife’s use of vaginal dilators had enabled them to have comfortable sex for the first time in two years. A woman e-mailed to say that Yes vaginal moisturizer had eliminated her pain.

On a lighter note, we got a lot of response on Facebook when we shared—just in time for Thanksgiving—research that proved the scent of pumpkin pie is arousing—especially for men! A few extra pies were baked, we’re guessing….

We keep looking for ways to continue the conversation. We’ve started an e-mail newsletter so a couple of times a month we can highlight recent research or discussions, tell you about new products, and report on other events we’re involved in. We’ll even, from time to time, offer special gifts to folks who subscribe to the newsletter. (From now through Christmas Eve, for example, you can receive a free Skinny Dip massage candle with any $25 purchase and the coupon code SANTA.)

Even if you’re already a blog subscriber, we invite you to consider signing up for the newsletter or “liking” us on Facebook. Hey, consider it a practice of mindfulness: We know that the more we think about sex, the more sex we have!

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When they listed “communication” as an essential component of “optimal sexuality,” participants in the groundbreaking study published last year in The Canadian Journal of Human Sexuality were talking about a lot more than talking.

Their descriptions of “extraordinary communication” often suggest a state of “heightened empathy” in which partners share themselves with each other completely, using touch and other senses as well as words. Nonverbal communication, the ability to convey and understand feelings and desires purely through physical contact, was considered essential — before, during, and after a sexual encounter.

In fact, the kind of communication the study participants refer to seems to have little connection to the conversations about sex that therapists and doctors like me recommend to couples experiencing problems with their sexual relationships. That kind of talk — I like when you touch me here, how does it feel when I do this, would you like to try something new? — may be important, even necessary, to achieve the “extraordinary communication” that makes for great sex. But the actual experience of it takes place in the moment, in the acute and continual awareness of how partner and self interact and respond.

As one study participant puts it, extraordinary communication is the ability to recognize “even if you’re not told, that one kind of touch elicits a certain response in your partner and another does not.”

It occurs to me that this deep empathy is what my patients are expecting, looking for, hoping for when they protest that talking about sex diminishes or even ruins the act itself. We all wish our partners could know exactly what we want and how we feel without being told.

But in my experience, this kind of extraordinary communication doesn’t happen unless couples first invest time and effort in a lot of pretty ordinary communication — honest and explicit talk about sex and feelings and desires.

What’s your experience?

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Vaginal moisturizers can typically be applied in two ways: either with your fingertip in the vagina and externally as needed, or with an applicator in the vagina. Applicators often come pre-filled (like the Yes product offered at MiddlesexMD) for one use, but, in general, the amount to use is an individual decision based on the degree of dryness or discomfort.

Manufacturers of vaginal moisturizers generally recommend application every 3 or 4 days, but, again, it’s you who will need to find the frequency that works best for you.

Women I talk to often like the pre-filled applicators for “maintenance” application, and then to use a bulk bottle when they need lubricant for sexual intimacy. And, of course, you might find that a personal lubricant in addition to regular moisturizing is what you like best.

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