Archive for January, 2011

Hot flashes. They’re the stereotypical symptom of menopause, the subject of T-shirts and mugs: “It’s not a hot flash, it’s a power surge.” But when you say to yourself or your partner, in an intimate moment, “I’m hot,” you want to feel sexy, not soaked.

Unfortunately, among the things that trigger hot flashes is arousal itself. And as uncomfortable as you may be—both physically and emotionally—this is no time to put your sexuality on hold. Remember our “use it or lose it” discussion?

There’s not a lot we can do to disconnect the arousal trigger for hot flashes. What we can do, though, is look at other triggers to make sure we’re not making ourselves overly susceptible.

  • Quit smoking. As a physician, I list that first because it contributes not only to hot flashes but also to other serious medical problems. I don’t smoke, so I know it’s easy for me to say, but if you’re still smoking at mid-life, it’s time to take that tough road to being smoke-free.
  • Drink less. A glass of wine can be part of a romantic evening, but be aware that alcohol can be a trigger for hot flashes. You can do your own experimentation to see if alcohol’s a trigger for you, at what level and with which kind of alcohol.
  • Eat well. Smaller meals of low-fat, high-fiber food will keep your digestive system from heating up from overwork and acting as a trigger. Spicy food can also sometimes be an aggravating factor.
  • Exercise. Women who exercise regularly have fewer hot flashes than women who don’t. More good news: Sex is exercise!
  • De-stress. Easier said than done, I know, but the more stressed you are, the more hot flashes you’re likely to have. You can’t remove all the stressors from your life—some of them are people you love!—but you can develop mindfulness practices that help you manage them more easily.

On that romantic evening, especially, plan your activities to minimize your triggers. Drink cold beverages. Eat a light meal, not excessively spicy. Wear natural fabrics (like cotton) that will breathe and keep you cool. Make sure that the temperature in your bedroom is cool, or position a fan. Use cotton bedding and layers of light blankets that let you adjust. And remind yourself to keep breathing.

It might help reduce your anxiety (remember stress is a trigger!) to have a conversation with your partner about how to stay in the mood with a hot flash.

For a few of us, none of these strategies contains the damage, and hot flashes really interfere with our lives and sexuality. None of these options is perfect for everyone, but hormones, anti-depressants, and blood pressure medications have each had some positive effect. Your care provider can help you balance treatment of hot flashes with your health history and other medical conditions you may have.

And finally, remember that there is sex after hot flashes. Most of us, a year or two after menopause, are completely hot-flash-free. Staying sexually active through this transition keeps us able to continue to enjoy intimacy. Because, you know, we’re still hot!

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Both Replens and Yes, the vaginal moisturizers we offer at MiddlesexMD, are perfectly safe for oral sex. In fact, all of the products we offer are chosen with safety in mind.

Your partner may have personal reactions to a taste or texture of either product, or to personal lubricants. Feedback through our personal lubricant selection kit proves just how individual those reactions are!

If you or your partner isn’t happy with a moisturizer or lubricant, don’t think you’ve got to give it up! Just check out some other options to find one that works for both of you.

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You say you don’t have issues with vaginal dryness, but you did feel discomfort–difficult to sit comfortably, spasms of pain–for at least a week after intercourse. It does sound as though you experienced some trauma.

It’s likely that though you’re still experiencing your own lubrication when stimulated, you’re experiencing some atrophy, too. I’d suggest that you start using a vaginal moisturizer (like Yes or Replens) or a localized estrogen to maintain moisture all of the time–not just when you’re aroused.

If you and your partner aren’t able to be intimate often (and I’m afraid the definition of “often” varies from woman to woman), you might think about some of the additional options I talked about in a blog post about “Staying Ready for Sex.” It’s easier to maintain your sexuality than to restore it!

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“I just want to want sex again.”

I can’t tell you how many of my patients have expressed — in one way or another — this simple desire for the desire they experienced in their 20s and 30s, when their bodies were flooded with procreative hormones.

Wouldn’t it be great if I could mix up a love potion to send home with them and to share with you here? Some powerful concoction of roots and herbs perhaps, a magic elixir guaranteed to bring it all back?

Well, here’s the next best thing. A recipe you can use to produce your own personal, all-natural love potion. For free.

Oxytocin, a hormone produced by the pituitary gland, has long been recognized for its role in childbirth and lactation and mother/child bonding. Women in labor are sometimes given a synthetic oxytocin to stimulate contractions. And mothers and babies both experience the pleasurable effects — calmness, trust, contentment — of the natural oxytocin that is released into their brains and blood streams during breast-feeding.

Recently though, research has been identifying the significant effects that “the cuddle hormone” have on men as well as women — and on their desire for (and enjoyment of) sex that isn’t about making babies.

Both men and women experience rising oxytocin levels in response to being touched anywhere on their bodies. The effects promote a bond of closeness that increases sexual receptiveness — and the desire for even more touching. Even more touching leads to even more oxytocin which leads to even more arousal and even more desire for even more touching. Isn’t it beautiful how that works?

There’s more: high levels of oxytocin cause nerves in the genitals to fire spontaneously, triggering powerful orgasms. And during orgasm the body releases — you guessed it — more oxytocin. (Which, as it turns out, is good for you in all kinds of ways. Research indicates that oxytocin helps people sleep better, enhances feelings of well being, and counteracts the stress hormone, cortisol.)

The best thing about this amazing hormone for women our age is that — unlike estrogen and other sex hormones — you can make it yourself. Caressing your partner, enjoying a massage, bringing yourself to orgasm are all ways to get more oxytocin into your life. In fact, many women find that self-pleasuring is the best way to boost a sagging libido. More orgasms = more oxytocin = more desire.

Check out our website for information and products that can help you get this wonderful pleasure cycle up and running!

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Absolutely not! As we grow older, it takes more stimulation for us to arouse and lubricate, and that stimulation can come in many forms–physical or mental. If watching an erotic video provided visual stimulation for you… well, you’re not alone!

It’s sometimes a challenge to find the right material–arousing but not offensive–but it sounds like you found it! Don’t feel guilty or embarrassed. Most women need to change things up a bit and adding erotica is a perfectly acceptable option.

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When a patient tells me that she no longer enjoys sex, one of first things I ask her is to tell me about something that she does enjoy.

If she isn’t able to come up with a fairly quick answer, in my experience it’s likely that depression is playing a part in her loss of libido.

Anhedonia — the inability to gain pleasure from normally pleasurable experiences — is a core clinical feature of depression. And because depression affects nearly twice as many women as men, and because recent studies suggest that midlife is a period of increased risk for depression in women, I am always on the alert when a patient mentions that she has stopped enjoying activities — like sex — that used to give her pleasure.

The cause-and-effect relationships between menopause and depression and between depression and loss of libido are complicated — to say the least!

Some studies suggest that changes in hormonal levels, such as those that occur during the transition to menopause, may trigger depression. The production of mood-enhancing neurotransmitters is boosted by estrogen. Lower levels of estrogen that accompany menopause can mess with the brain’s chemical balance, leading to depression. Other biochemical changes that come with age, such as those that result from decreased thyroid function, have also been linked to the onset of depression.

But the pressures and stresses associated with midlife surely play a role as well. The loss of our youthful looks, of our reproductive and mothering roles, and sometimes even of our jobs or life partners — all make us vulnerable to depression as we move into and through our menopausal years.

Whatever the cause — and at whatever age — depression has a significant impact on sexual function and enjoyment. Nearly half of all women — and men — diagnosed with depression report that it interferes with their sexuality.

The good news: If depression is behind your loss of interest in and enjoyment of sex, there is an array of proven treatments to relieve the underlying cause and its symptoms. Your doctor can help identify and treat medical causes, such as thyroid problems. In some cases, hormone replacement therapy that elevates estrogen levels may be effective. Antidepressants that help correct chemical imbalances in the brain help many (although these may have their own sexual side-effects). Regular exercise, improved sleep habits, and dietary changes can help to counteract depression, and counseling and support groups are other options to explore.

Don’t let depression drain the pleasure from your life. Talk to your doctor. See our website for more information on hormonal changes and therapeutic resources. And if you have experienced and overcome anhedonia in your own sex life, we’d love to hear your story!

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“There are many paths to heaven, and sex is one of them.”

–Abraham Maslow

Maslow, the humanist psychologist who invented the term “peak experience,” would know exactly what participants in the “Optimal Sexuality” study mean when they say that “transformation” is an essential part of extraordinary sex.

People interviewed for a groundbreaking study published last year in The Canadian Journal of Human Sexuality used words like “bliss,” “peace,” “awe,” and “ecstasy” to describe this transcendent aspect of peak sexual experiences. Some compared it to the “high” that cam be achieved through meditation. Others used religious language to describe the feeling, calling it “revelatory,” “eternal,” “an epiphany.”

“At this moment,” one participant said, “we were in the presence of God.”

It can seem a little over the top, I know. But while not all of us can say (like one study participant) that we’ve experienced sex that felt like “floating in the universe of light and stars and music and sublime peace,” many of us can relate to what singer Marvin Gaye called “sexual healing.” Physical and emotional intimacy can simply make us feel better, more in harmony with ourselves and our partners.

The transformative power of great sex that “can change you, can make you more than you are,” goes beyond the bedroom, I think. True sexual healing carries over into our everyday lives, makes us calmer, happier, more loving people.

For some of us, hormonal changes or the special stresses of midlife have reduced the power of sexual healing and transformation in our lives. Remember, though, if we understand what’s happening to our bodies, we can find ways to bring that power back. Check out our recipe for enjoying sex after menopause, or our selection of books and CDs on mindfulness and sexual health.

You can find your own little piece of heaven, right here on earth.

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I’m still thinking about the research that says lots of post-menopause women have sex even though it hurts. The study I read said many of them think there’s nothing that can be done—that painful sex is a normal part of being a mid-life woman.

I pick up clues to another obstacle in the e-mails I receive as Dr. Barb: We women are reluctant to include our partners in addressing difficulties with intercourse. I’m not sure why this is. Maybe we’re in denial about the changes we’re experiencing. Maybe we’re too used to being the caretakers in our households. Maybe we’re still shy about talking about our genitals and our pleasure.

If I overdo in the garden, my husband will give me a back rub. If a shipment of products for MiddlesexMD arrives after hours, he’ll help me carry the heavier boxes in. When we entertain, we clear the clutter together.

I guess I’m suggesting that you see maintaining your sexuality as the ultimate couples project. A partner who loves you will not want you to endure pain to give him pleasure; and will want you to enjoy intimacy as much as you are able.

You’ll have to talk about it—as you’d tell him where the muscles are knotted after weeding. You can send him this blog post or sit down with our website together to get the conversation moving.

He can plan to take more time to increase your arousal and natural lubrication. Together, you can use lubricant as part of foreplay to increase your comfort. The two of you can experiment with warming lubricants or a vibrator to increase your sensation. And your partner can support your work with dilators or other tools to regain your sexual health.

It’s not too much to ask. Really.

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I’ve talked about a couple of general topics prompted by reading the REVEAL research results: that lots of women aren’t aware of the effects of menopause on sexuality and that many of us aren’t talking about it. There’s one more topic that’s on my mind, because I hear about it every day in e-mails I receive from the “Ask Dr. Barb” link on our website.

It’s painful intercourse. In the study, 36 percent said that pain during sex made them stop having sex. That’s one issue. The other issue is that 59 percent of women who experience pain during sex still have intercourse on a regular basis. About three-quarters of those women have sex at least once a month, on average; a third have sex at least once a week.

The good news for the women among the 59 percent is that they recognize their sexuality as an important part of their selves and their relationships. The bad news, of course, is that it hurts. And more bad news is that not enough women realize that it doesn’t have to.

When midlife women talk about their sexuality, pain with sex is easily the most common physical complaint. This pain may feel superficial or deep. It may feel like burning or aching. It may happen only on initial penetration or only with deep thrusting.

The medical name for this is “dyspareunia” (dis-pu-ROO-nee-uh). It’s a tongue twister of a word, I know, but it comes from “dys” (as in dysfunctional) plus a Greek word that means “lying with”—so it’s as simple as “lying together doesn’t work.” It’s a general diagnosis that needs more investigation, because many things can cause the pain, and the pain can be experienced in a number of ways.

Another scary part of the research: A quarter of the women who experience painful intercourse thought that there was “nothing that could be done medically” to address their pain; I assure you that’s not true. There are solutions ranging from regular use of moisturizers and personal lubricants to overcome dryness to vaginal dilators to restore vaginal caliber (size and depth of the opening) to systemic or vaginal estrogen to maintain tissue health.

About a quarter also felt that their pain during sex was “an inappropriate conversation” to have with their health care provider; that’s not true, either.

Easy for me to say, I know, since I specialize in mid-life women’s health. Whoever your health care provider is, he or she will recognize the importance of sexuality to a full and healthy life. And if you don’t sense that, it’s worth it to find a sexually literate health care provider. Really.

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A woman born in 1850 could expect to live just past her 40th birthday. A woman born in 1900 was likely to make it to 50—assuming she survived the flu epidemic of 1918 and other hazards. I looked up this life-expectancy data to help me understand why we have so little shared understanding of how menopause affects women.

We think of biology as something that changes very slowly, if at all. Since the beginning of time, we think, girls have menstruated, grown up into women, entered perimenopause, and then, at some point, achieved menopause. And then…

This is where the big change (no pun intended!) has happened. Our life expectancies have increased dramatically. Only 100 years ago, it was typical for women to die before they reached menopause. Our generation, in contrast, will live a third of our average-75-year lives post-menopause. Our granddaughters (born in 2000 or later) could be post-menopausal for closer to half of their 80-year-plus lives.

A third of our lives post-menopause? That’s good reason to make sure we women know that menopause is not the end of our sex lives. Sex is good for our health: it bolsters our immune systems, releases good hormones, helps protect (like other exercise) against heart attack and stroke, burns calories, relieves chronic pain.

Sex is good for our mental health, too, protecting us against depression and stimulating feelings of affection and intimacy. And sexuality is part of our identities, part of what we are.

Sex is part of a life that is not just longer, but happier.

It’s a research report I read recently that’s brought all this to mind. Most of the REVEAL (Revealing Vaginal Effects at Mid-Life) study participants said they weren’t aware of all the effects of menopause—on their vaginal tissues, in particular. Eighty percent of the participants who experienced painful intercourse said they’ve “learned to live with the vulvar and vaginal symptoms… as a normal part of getting older.” And 61 percent of those women felt it was “still taboo” to acknowledge menopause symptoms like painful intercourse.

Live with this for a third of our lives? Give up on—or suffer through—an aspect of who we are and what makes us happy? I don’t think so.

I often use a reading glasses analogy: When, as a part of aging, our eyesight is less acute, we get reading glasses, or a stronger prescription, or bi- or tri-focals. We joke about the type size on menus, and we ask for more light in the restaurant. We don’t give up on seeing! There’s too much of life still before us.

We need to understand the changes that are affecting us. We need to know there are ways to compensate—as with reading glasses—so that we can maintain our sexuality. And we need to let go of the notion that our health and happiness for a third of our lives is somehow a “taboo” subject to talk about—with our partners, our friends, our health care providers.

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