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Archive for June, 2011

Long, long ago, when humankind first stood up on two feet, some bit of engineering seems to have gone missing. As a result, back pain is practically programmed into the human condition. The lucky ones may experience temporary pain from strained muscles, but for many, back pain can involve severe and constant pain from malfunctioning disks, nerve issues, bone issues, and a host of other maladies.

Unfortunately, nothing saps enjoyment and energy from life like pain. Whether intermittent or chronic, back pain can lay the sufferer, literally, flat on his or her back. Sex, obviously, becomes an early casualty. A 2008 survey found that most people who suffer from back pain have less sex, and they don’t enjoy it much. They say the pain has affected their relationships, but they don’t tend to talk about it either with their partners or their doctors.  (And apparently, their doctors don’t bring up the issue of sex, either.)

There are ways to work around this state of affairs, however, from communicating with your partner and your doctor to experimenting with positions that might make intercourse more comfortable. One doctor even says that sex can actually help ease back pain by “mobilizing ‘stuck’ segments in the spine” and by releasing “feel good” endorphins in the brain. Not to mention returning a sense of intimacy and normalcy to the relationship. So, nurturing a sense of intimacy in your most important relationship is probably worth working on, right?

We’ve beaten this drum before, but communication is critical. First, it’s important to talk to your doctor. Do you have a diagnosis? Do you know what’s causing your back pain? If pain, depression, or fear is affecting your sex life, your doctor may well have some advice, from changing the dosages of your medication to suggesting positions that might alleviate pain.

Second, talk to your partner. Chronic pain is hard to understand if you’re not experiencing it. It feels like the “not now, dear, I have a headache” routine. It feels like rejection or at least avoidance.

If you’ve been avoiding sex, clear the air with your partner. You both need to express how you feel. Are you afraid that sex will hurt your back even more? That you’re somehow “damaged goods”? Does the pain sap your energy? Do you feel depressed? Listen to your partner’s fears and frustrations, too. If the conversation is too difficult, maybe you and your partner should discuss it with a therapist. The good news is that, with some courage and experimentation, intimacy and intercourse don’t need to be held hostage to back pain.

Take it slow. Prepare yourself. Take a warm bath to relax muscles. Plan your rendezvous for a time of day when you tend to feel good. Take your pain meds. Set the mood (candles, incense, music). Good sex is as much about the ambience as about acrobatics anyway.

Plan your positions. Depending on the type of back pain you experience, different positions will help ease your pain. Use firm pillows for support under the small of your back, under your neck or head, under your knees—wherever it feels comfortable.

Those with herniated discs tend to feel better when the spine is extended (arched). Use a pillow under your back for the missionary position or have your partner sit on a chair while you straddle. Both these positions tend to keep your back straight or slightly arched.

For those with spinal stenosis, on the other hand, slightly flexing (humping) the back feels better. Keep your knees pulled toward you in the missionary position or drape your legs over your partner’s shoulders. Both positions keep the spine arched.

Try lying on your side. Or lie on the side of the bed with your legs dangling off the side. Just be sure you’re well-supported on a firm surface. Use the pillows wherever you need more support. The rule of thumb is that the partner without the pain should do the work. Take is slow, and if something hurts, stop!

Do kegels. Besides strengthening your pelvic floor muscles, which is good for sex, this exercise also develops your core musculature, which is good for your back.

A highly recommended book specifically dealing with this issue is Sex and Back Pain: Advice on Restoring Comfortable Sex Lost to Back Pain, by physical therapist Lauren Andrew Hebert.

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Just when you thought you were home free—the kids are grown, and you’ve somehow gotten through multiple birds-and-bees talks. But now you find the shoe is on the other foot, and you’re the one needing information about sex. Maybe a health issue is affecting your sex life, or maybe your body is responding differently, or maybe you’re just not as responsive as you used to be. Where do you go for straight talk about these nitty-gritty topics?

According to a presentation I heard at the International Society for the Study of Women’s Sexual Health (ISSWSH) conference “physicians often do not talk to their patients about sex.” It occurred to me that the effect of this oversight is similar to neglecting the “talk” with our kids, i.e. you end up muddling along with misinformation, rumors, or half-truths.

Oddly, doctors cite similar reasons (excuses?) as the rest of us for avoiding the “talk” with their patients: They don’t have time; they don’t feel comfortable; they don’t know enough about this medical subspecialty to feel competent and helpful.

To be honest, doctors do operate under very tight time constraints in the course of a normal day. Also, sometimes, after talking about health and body parts for years, we forget how uncomfortable it might be for you to bring up what you consider an embarrassing problem. Rest assured, however, that we’ve probably discussed that problem before with someone.

None of this lets anyone off the hook. Sex is an important component to physical and mental health and well-being, and if you have questions or problems, who better to discuss them with than your doctor? If your doctor isn’t taking the initiative, here are some ways to help get the conversation started.

  • Write down your questions. This exercise may help you clarify what you want to talk about, and it will definitely help you to remember everything.
  • Prime the pump. At the beginning of your appointment, mention that you’d like to discuss some sexual issue that you’ve been experiencing. Or, get more specific—that you’d like to explore your options for vaginal lubricants or whether your medication might be diminishing your sexual interest.
  • Be clear, specific, and thorough. Don’t leave something out because it’s too embarrassing or doesn’t seem pertinent. You wouldn’t neglect to mention to your mechanic the little whirring noise in the rear axle when you turn left. Why would you omit an itch or pain or change you experience in your body?

Once you get over the initial hurdle of actually saying the S-word in front of your doctor, you may find it much easier to talk about sex the future. After all, as you told your children all those years ago, sex is just a natural part of life.

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Sleepless Isn’t Sexy

Last month we talked about some of the disincentives to sex, and fatigue was one of the top three. As you may know from your own experience, getting a good night’s sleep during or after menopause is often a challenge. Hormonal fluctuations are often the culprits; lack of progesterone and estrogen can bring on night sweats and hot flashes, and who can sleep with all that going on! (Chances are your partner can’t either–a double whammy.)

Insomnia, snoring, sleep apnea, and restless leg syndrome are also very common among menopausal women. In fact, in one study, more than 40 percent of post-menopausal women polled reported waking up frequently during the night.

Lack of sleep can really take its toll on you, physically, mentally, and emotionally. You walk around like a zombie the next day and don’t feel like doing much of anything, least of all having sex. And if it becomes chronic, happening night after night, it can create a vicious cycle of constant fatigue that can have some serious repercussions, including:

  • Inability to concentrate
  • Reduced memory function
  • Increased irritability
  • Problems in relationships
  • Becoming accident-prone
  • Tendency to overeat

Chronic sleep disorders can also lead to depression and anxiety, creating a whole new set of problems that can be difficult to treat—and that can further handicap your sex life. That’s why it’s so important to do something about it right away.

First, try some of these steps, which many sleep experts recommend:

  • Go to bed at the same time every night and get up the same time each morning.
  • Use the bedroom only for sleep—and sex (and having sex just before sleep might help, too!).
  • Get 30 minutes of exercise during the day (but not after 8 p.m.).
  • Limit fluid intake in the evening.
  • Avoid alcohol and caffeine (many sodas have caffeine).
  • Practice relaxation techniques, such as meditating or visualizing yourself in a calm, restful setting.

If none of these techniques work, talk with your doctor about the possibility of taking medication. Sometimes it’s just a matter of breaking the non-sleep cycle. There are some good over-the-counter drugs and herbal remedies available, too. If the problem persists, you might consider going to a sleep clinic.

Just don’t allow a sleep disorder to rob you of the things you love to do. Keep trying until you find a solution that works for you.

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The odor and discharge that you describe sounds most consistent with bacterial vaginosis; it’s not a result of your partner’s medications. This infection is not serious or particularly worrisome, but the symptoms are certainly a major annoyance!

You could first try RepHresh, a product that may alleviate the symptoms by correcting the vaginal pH (you can read more about pH in this recent blog post). Vaginosis can also be treated with an antibiotic, administered orally or vaginally.

Douching is not helpful and can be harmful: It disrupts normal bacteria in the vagina and makes you more susceptible to infection.

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The Nose Knows

We all know how powerful scents can be, from cinnamon rolls baking in the oven to the first lilacs of spring. Our sense of smell, which stimulates nerve endings behind the nose, can trigger many different emotions: It’s tied directly to the part of the brain that’s linked to memory and emotions.

You’ve probably heard of aromatherapy, the practice of using natural oils extracted from botanicals—flowers, leaves, stems, and other parts of plants—to enhance psychological and physical well-being. It’s been around for thousands of years, and as aromatherapy practitioners (and perfume researchers) know, it can also be very sexually stimulating. In fact, it’s referred to in the Kama Sutra, and rumor has it that Cleopatra used a special blend of oils and spices as an aphrodisiac to seduce Marc Anthony!

While I can’t say for certain whether that’s true, I do know that aromatherapy can “spice up” your sex life by helping to set the mood and stimulate desire. You can use it to create a sensual and romantic atmosphere right in the bedroom. It’s easy and requires very little effort. Candles, incense, potpourri, perfumes, and oils all offer a wide variety of soothing scents and can be found anywhere from health food stores to gift shops—and MiddlesexMD.

You’ll probably have to experiment a little to find the fragrances that appeal to you and your partner, but that in itself can be a fun exploration. You could start by using massage oils, combining scents with physical contact.

Scents that are said to be especially enhancing to sexual enjoyment:

  • Jasmine has a “quiet” aroma, which is not only exotic, but calming and comforting, too.
  • Cinnamon is a perfect blend of sweet and spicy (and who doesn’t love it?).
  • Basil also has a somewhat sweet aroma, but very pleasant.
  • Vanilla, soothing and familiar, is used in many perfumes for its universally appealing scent.
  • Rose, the symbol of love, is said to be emotionally uplifting.
  • Sandalwood has a woody, earthy aroma that many find relaxing.

If you’re using oil, remember that a little goes a long way. You don’t want the aroma to be overpowering, just to put a hint of sensuality in the air.

Using scents to enhance your sexual desire can be a rewarding and erotic experience, so if you don’t get it right the first time, try again. Finding the perfect blend will be well worth the effort!

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The popular TV show Modern Family has a running joke with Clare and Phil, a 40-something couple with three kids: They go to a hotel once in awhile pretending to be strangers who meet in the bar and flirt like crazy with each other. They do it just to liven up their sex lives a bit. And guess what—it’s not a bad idea!

Flirting, the real thing, is not just for the young, or the single. Flirting at any age is a turn-on, especially when it’s unexpected. It’s a way to say “I love you” or “I want you” in a fun, sexy way. It helps you make those important human connections that lead to real intimacy. It can be a great prelude to great sex—the start of foreplay, really.

To get yourself in the mood, try thinking about what initially attracted you to your partner all those years ago. His voice? His smile? His laugh?

Or maybe look at some photos of when you first met and remind yourself of what it was like to flirt with him.

Because unlike orgasms, you can’t really fake flirting; you have to mean it. And once you get back into it, you’ll see that flirting can help increase your sexual confidence, too, making you feel like you’ve still “got it” when it comes to being sexy and alluring.

If you’re a little out of practice, here are some things you can try:

  • Use your eyes; they’re two of your sexiest body parts. For example, next time you’re sitting across the room from your partner—say he’s reading the paper—grab his gaze and then wink at him. Trust me, you’ll get a reaction.
  • Or stare at your partner in a loving way and let him catch you looking. Then smile and say something nice. (“I was just thinking about how cute you looked last night…”)
  • When you go out to dinner, wear a top that shows cleavage and play with your necklace running your fingers along the tops of your breasts.
  • Next time you give him a hug, make it last a little longer… shoot for 10 seconds.
  • Send him a sexy text (just make sure you’ve got the right number!).
  • Leave a note under his pillow some night saying you’re ready for some fun.
  • Rent an erotic or romantic movie and set the stage for watching it later together.

You can turn almost any situation into a flirtatious encounter, just by having the idea in your head. Now that it is, why not try it out this weekend? Let us know what happens!

For more on the subject, check out Alternatives to Intercourse on our website and “How to Flirt Over Age 50” on ThirdAge.com.

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In the last post, we talked about how pH levels affect the vagina. The second part of good vaginal health has to do with moisture. As we say at MiddlesexMD, moist tissues are strong tissues.

Normally, your vagina moisturizes and cleanses itself by secreting a clear fluid that seeps from blood vessels in the vaginal wall. When you become sexually aroused, blood flow increases, and so does the lubrication. Unfortunately, this process is regulated by estrogen, and we all know what’s been happening to that hormone lately.

With decreasing estrogen levels and circulation, vaginal tissue becomes thin and dry. Maybe you’ve noticed that you don’t lubricate as easily during sex so that penetration is difficult or painful, or maybe you’ve experienced vaginal dryness and discomfort at other times as well.

The good news is that this condition is easy to fix. You moisturize your skin regularly; you should do the same with the vagina.

First, a little refresher on the difference between vaginal moisturizers and lubricants. Lubricants may be used in the vagina and on the penis or toys during intercourse to help with penetration and to make sex more pleasurable. Lubricants come in water- or silicone-based varieties or a hybrid of the two, and in various viscosities (thick to thin). Choice of lubricant is a highly personal preference and may depend on the activity you have in mind. Because it’s helpful to try different kinds, we’ve compiled a sampler kit of our favorites.

Lubricants last several hours, and the only rule of thumb related to vaginal health is that no oil-based product, including petroleum jelly, should be used in the vagina. They’re hard for the vagina to flush out; they tend to disrupt pH balance; and they also tend to deteriorate condoms. Lubricants can be used in addition to a moisturizer.

The sole purpose of vaginal moisturizers, on the other hand, is to keep vaginal tissue moist and healthy. Moisturizers last two or three days and should be used regularly, just like facial products. And just like anything you use on your body, you want your vaginal moisturizer to contain natural, high-quality ingredients.

A few common ingredients in vaginal moisturizers (that are also present in lubricants) bear some examination:

  • Glycerin. Widely used in moisturizers and lubricants, glycerin is a colorless, sweet-tasting substance that can exacerbate a yeast infection by giving the organisms sugars to feed on. If you’re susceptible to yeast infections, find a glycerin-free moisturizer.
  • Parabens. In all their hyphenated mutations (methyl-, ethyl-, butyl, and propyl-) parabens are a widely used preservative and anti-microbial agent. While some contamination-fighting ingredient is a good idea in these personal products, a few recent studies have found very slight health issues that may be linked to parabens. A bigger problem is the potential for an allergic reaction that could be related to parabens or other ingredients in moisturizers.
  • Propylene glycol. Used as a fragrance and to control viscosity, propylene glycol has also been linked to skin irritations and allergies.

While none of these substances present major health risks, it’s a good idea to make an informed decision about your personal care products. Read the ingredient list in your moisturizer; the fewer unpronounceable names, the better. If you can find a product that uses natural ingredients and that works for you, wouldn’t that be your first choice?

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When you think about it, the vagina is a pretty undemanding organ. It’s cooperated through childbirth and nights of passion; it’s soldiered on uncomplainingly throughout years of menses and the occasional “oops”—such as the patient of mine who applied Retin-A skin cream instead of Vagisil, or the friend who used Ben-Gay. Her vagina did a little complaining then, but soon returned to its cheerful self.

Because the vagina has rarely been the squeaky wheel, we’ve tended to tend to take it for granted. As we age, however, vaginal tissue thins, loses elasticity, and becomes dry, so, like other parts of our bodies, that wheel tends to squeak a little louder.

Often, vaginal troubles can be addressed—or avoided altogether—with some TLC. While few of us think about how to maintain optimal vaginal health, maybe it’s time to give that longsuffering organ some extra attention. The two major factors in maintaining a healthy, uncomplaining vagina are a good bacterial balance and moisture.

First, a science lesson: pH is a measure of how acidic or alkaline (basic) a substance is. The pH scale ranges from 0 (very acidic) to 14 (highly alkaline) with seven being neutral. A healthy vagina is slightly acidic, in the range of 4.5 to 5. This acidity is maintained by a delicate balance of organisms, notably the bacteria lactobacillus that produces lactic acid. This slightly acid environment helps to ward off infection.

When the pH level in our vagina is out of whack, unwanted bacteria and other organisms can flourish—Candida albicans, for example, which is the fungus causing yeast infections. Sometimes it doesn’t take much to upset the balance. A surgary diet, some kinds of soap, a round of antibiotics, or even one of those nights of passion can upset the flora in the vagina. Sperm, for example, is alkaline with a pH of 7 to 8, and so is blood with a pH of 7.4, which is why hygiene is especially important if you’re still menstruating.

Here are some suggestions for maintaining a good pH balance and for overall vaginal hygiene.

  • Don’t douche. Douching actually increases the risk of bacterial infection and reduces the “good” lactobacilli in the vagina. The vaginal walls produce a clear fluid to flush out foreign substances (more on this in the next post), so douching is both unnecessary and harmful.
  • Maintain good air flow. Wear cotton panties and loose clothing—at least some of the time! Avoid relying on silks and synthetics that trap moisture on the vulva. Don’t wear thongs. Change out of wet bathing suits or clothing promptly.
  • Avoid scented products: feminine sprays, soaps, bubble bath, scented pads or tampons. They can be irritating, allergenic, or alkaline.
  • Wash your bottom with warm water. Soap is drying to the delicate vulva and inner labia, and some soaps are alkaline.
  • Use tampons rather than pads and change them regularly.
  • Keep bacteria where they belong. Wipe from front to rear.
  • Avoid sugars and refined carbohydrates. They can create an environment that feeds fungi.
  • Talk to your doctor about maintaining good vaginal health if you’re prescribed antibiotics. He or she may suggest eating yogurt, for example, or taking Lactobacillus acidophilus tablets.
  • Wash underwear with mild soap, such as Woolite. Rinse well. Avoid scented fabric softeners.

At the end of the day, all our parts are interconnected, so it’s not possible to maintain good vaginal health if the rest of your body is unhealthy. Smoking, obesity, and diabetes are all conditions that compromise health, including vaginal health. Good general habits, such as a healthy diet and exercise to maintain good muscle tone, are probably the most critical elements to a healthy vagina.

But you knew that.

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Yes, your vibrator or other toys are safe with estrogen creams, often prescribed for vaginal dryness.

What you’ll want to be careful of is silicone-based lubricants. Whether they’re safe to use with your vibrator depends on the materials used; silicone lubes will ruin the surface of a silicone toy. The instructions that came with your vibrator (or are available online) will usually tell you what’s safe and what’s not.

I’ve seen patients have good results with estrogen cream; hope you have the same!

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It’s been a long time since your partner’s been able to “get it up.” And truth be told, you’d grown accustomed to a platonic relationship. You haven’t missed the sex. Frankly, it was never all that great, anyway.

Now, thanks to the marvels of medical science, your man’s erectile dysfunction is a thing of the past. In fact, he may be more “vigorous” now than ever before—and more eager to test his newfound prowess. Which certainly presents you with a challenge. And some choices.

You can roll your eyes and sigh. You can respond in a way that communicates indifference or irritation and that perpetuates the status quo. And, indeed, if the lack of intimacy in your relationship reflects problems with trust or resentment, suddenly regaining the ability to have sex won’t mend the relationship—or make sex any more appealing.

But you could also analyze the reason for your mixed feelings. Maybe your lack of interest stems from remembering a former boring sexual rut. In all likelihood, you’re experiencing physical changes of your own that make it harder to respond to your partner’s new emotional and physical demands. Or maybe your own passivity contributed to the lackluster sex—you always took the passenger seat, never the driver’s seat.

But could it also be possible that your partner’s new ability could be the catalyst for a renaissance of romance in your golden years? For an unexpected reawakening of desire and intimacy? Stranger things have happened.

Embracing this new situation enthusiastically needs to take place at two levels: first, rekindling the emotional connection in the relationship and second, fine-tuning your body to be a sexual creature again. For women, sexual desire and arousal is part of a complex brew of intellectual belief and emotional feelings about yourself, your partner, and sex in general. You need to feel emotionally connected to your partner in order to respond well sexually. For men, it’s just the opposite: It’s the sex that creates intimacy.

Working on the intimacy that can rekindle desire can be as pleasurable and easy as spending time together, lingering over coffee in the morning, taking a walk, holding hands. Remember the romance? Even if you don’t, it isn’t too late to learn.

Second, you’ll need to recondition your body, especially if you’re dealing with menopausal changes. Consider yourself an athlete in training. Regular use of vaginal moisturizers may improve the overall health and condition of your vagina. Don’t overlook the use of lubricants during sex, which not only improve comfort, but can also make intercourse more exciting. You might benefit from a regimen of vaginal dilators to improve your “vaginal capacity.” Talk with your doctor about using a topical estrogen product in your vagina, which can improve elasticity and lubrication, or your doctor might recommend testosterone therapy to boost your libido. In fact, talk to your doctor about any sexual issue that arises; it’s his or her job to have resources to help.

While you’re working on rekindling intimacy and rebuilding your sexual muscle tone, you can also take an active role rebuilding your reinvigorated sex life. It’s too easy to write off sex as a nuisance when you haven’t done anything to change the script. You now have a second chance and the maturity to create the sex life you always wanted as a full and equal partner. Experiment. Play. Communicate.

In the end, your partner’s newfound prowess could be a catalyst for reenergizing your relationship and for rekindling passion. The process may be uncomfortable; it may be a little scary, even; and it will definitely take work. But doesn’t anything worthwhile?

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