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Archive for October, 2011

I’m glad to hear that a vibrator has been helpful to you! Women our age often need extra stimulation for arousal and orgasm, and many find that a vibrator provides just what they need. If you’re looking for more, here are some things you might consider:

  • A stronger motor: Not all vibrators are created equal. Check for motor strength, because it really does matter to midlife women: a stronger motor (Emotional Bliss offers the strongest in our store) means more stimulation. You can also check for the number of pulse patterns offered; there’s nothing magic about them, but they make experimentation easier.
  • Get versatile: If you’ve started with an external clitoral vibrator, you might want to try a vibrator that can be used inside the vagina, too.
  • Size differs: You’ll notice I didn’t say that size matters, but different sizes do offer different sensations. The Womolia is almost two inches in diameter, for example, as compared to an inch for the Liv; vibrators also vary in length.

Finally, stay playful and stay connected to your partner when you’re being intimate. While vibrators are great as both tools and toys, especially for us as women, the emotional connection is arousing, too!

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Staying Close after Cancer

“Women often shut down emotionally from their partners [after a cancer diagnosis] for a number of reasons,” says Maureen Ryan, sex therapist and nurse practitioner. “Maybe they’re scared; maybe they’re afraid of what’s to come. So they shut down and build a wall against intimacy.”

It makes sense. Survival has suddenly become a priority. You’re faced with complex decisions, a long and difficult treatment with a big question mark at the end. You may already be stretched emotionally and physically with a career and children at home, and maybe other obligations as well. The demands of a relationship seem overwhelming.

Sex? Fuggedaboudit.

While you probably won’t be interested in sex for a while after treatment, staying connected—maintaining the bonds of intimacy—with your partner is critical. “Studies show that if you had a rewarding sex life pre-cancer, that’s the best indicator about your quality of life post-cancer,” Maureen says.

And if you didn’t, maybe this illness will be the catalyst that allows you to focus on what’s important as a couple. In a speech, sex therapist Emily Harrell points to a Canadian study of breast cancer survivors that found “almost half the couples felt the cancer brought them closer.”

Here are suggestions from doctors and therapists for keeping the flame alive through the tough times:

Talk. This is such a tired bromide, but without communication, what do you have left? Set aside time to talk when you usually feel good and are without interruptions—no cell phone, visitors, or television. You each need to share your thoughts, fears, and anxieties. You need to talk about decisions. You need to explain what you need. If either partner shuts down, the other will feel rejected and isolated. This is a fragile time. You need all the support you can get.

Talk about sex—how you feel about it, what feels good, and what you can’t tolerate right now. “It’s important to tell your partner that even if you don’t want [sex] right now, that you’d like to regain your desire again,” Emily says. “You’re hoping to one day feel the desire to be intimate again.”

And don’t forget to talk about the good stuff. “I think the biggest thing is not letting the cancer consume the relationship,” Emily says. “This can… happen to a lot of couples. Try to spend some time not focusing on the cancer.”

Touch. “We need touch from the moment we’re born until the moment we die,” Maureen says. Touch releases oxytocin—the cuddle drug—and that makes you feel better, like a big belly laugh. Touch heals and reinforces connection.

As Mary Jo Rapini mentioned, it’s important not to make assumptions about your partner’s motives for touching you. He’s probably not after sex, just the feeling of intimacy that can drain away without sex.

If touch is painful, Maureen suggests creating a body map. Draw a simple outline of a body, like a gingerbread figure, and mark the spots where you like to be touched. You can even prioritize what feels good, better, best. Also mark with a red X where you don’t want to be touched. This is a graphic, non-verbal aid for your partner.

Finally, sensate focus is a program developed by Masters and Johnson that incorporates gradually increasing levels of touch, from very light, non-sexual touching and increasing over time to include sexual touch. This can be a gentle way to introduce sexuality slowly and at a pace you can tolerate.

Move the goal posts. As we’ve said many times on MiddlesexMD, sex is much broader than the old penis-in-vagina experience. Explore new avenues of sexual satisfaction, from kissing and cuddling to erotic massage. Take it slow. Do what feels good. Take performance anxiety off the table.

Your body may feel and respond differently now, and sex may be different. But this doesn’t always entail less or loss. According to many couples, the sex can be better. In fact, a new study by the Duke Research Institute found that while cancer changes sexual intimacy and function, often for a long time after treatment, this didn’t correlate with a lessening of sexual satisfaction.

“Sex is about connection,” Emily says. “It’s about love; it’s about intimacy, and that can look a lot of different ways. I find that most rewarding skills that couples learn is not having goal-oriented sex, but really just exploring each other without judgment and experiencing each other and the emotions that they really feel for each other.”

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Vagifem is a vaginal estrogen, applied locally. It is safe for someone with your medical history, posing no risk of thrombosis. Only oral estrogen, which enters the system rather than being applied directly to vaginal tissues, poses some risk of thrombosis or clotting.

You might find an earlier blog post about localized estrogen helpful; in it I described the benefits, forms, and cautions for using vaginal estrogen.

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“I cannot give you another regimen that has as many good health benefits as exercise. Hands down. Exercise improves life energy and sexual energy; your body image will improve. I can’t give you a better, free intervention.” So said psychologist Helen Coons in a recent speech to breast cancer survivors.

Any gentle exercise regimen during recovery is good. It helps ease many of the distressing symptoms of cancer treatment: insomnia, fatigue, weight gain, depression, poor body image, sexual dysfunction.

Yet, one of the best forms of exercise, according to several recent studies, is yoga.

Yoga combines gentle stretching and holding of various positions, which helps with balance, flexibility, and muscle tone. But it also involves a meditative component. The breath work in yoga “stimulates the parasympathetic nervous system and causes the body to relax and the blood pressure to drop,” says Maureen Ryan, sex therapist and nurse practitioner.

Yoga also encourages a sense of mindfulness—being aware of the moment and present to it. When the recent past is full of pain and the future is full of fear, “mindfulness brings people back to the present moment,” says Ms. Ryan. In one study of women with gynecological cancers who were experiencing difficulty with sex, the most helpful component of the experimental program was the practice of mindfulness.

Yoga is so effective because it exercises the body and calms the mind.

A small but significant study found that several weeks of Restorative Yoga, which involves gentle poses, usually with support from pillows and other props, reduced depression by 50 percent in women with cancer. (All had breast cancer; about one-third were still in treatment.)

Another larger study focused on the effect of two types of yoga—Hatha Yoga and Restorative Yoga—on cancer survivors who were having difficulty sleeping, a common problem for survivors and one that isn’t easily alleviated with medication.

Half the group attended 75-minute yoga classes twice a week and also practiced yoga at home. At the end of a month, this group was sleeping better with less medication than the control group. The group also reported less fatigue during the day.

In yet another study, breast cancer survivors reported better body image and less self-consciousness. After doing yoga for two months both at home and in group sessions, these women also had less pain, better muscle tone, more flexibility, and greater weight loss than a control group that had just exercised minimally for 30 minutes a week.

In fact, yoga is seen to be so effective in recovery that several top cancer centers, such as Memorial Sloan-Kettering and Stanford Cancer Center, provide their own yoga classes to patients.

Any form of exercise is helpful, but evidence suggests that the kind of mind-body regimen that yoga offers is particularly effective. Yoga classes are also easy to find—most communities offer them, and they are affordable.

Besides, anything that reduces depression, increases energy, improves body image, and reduces pain has to be good for sex, too.

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This is such a tough question. I brought one of our advisors, Mary Jo Rapini into the conversation, since she’s a therapist who often deals with this issue.

Two things we think it’s very important for you to know: First, you are not alone. Porn addictions are becoming a very frequently seen issue in Mary Jo’s practice. Second, this isn’t really about you, so, as hard as it might be, do everything you can to recognize your partner’s problem and work hard at feeling good about yourself.

Your partner may have sex fantasies that he isn’t able to tell you about; he may not know how to talk about sex or sexuality. Pornography is so easily available–and requires no face-to-face contact, so it’s easy to keep an addiction going and very difficult to combat it.

Both Mary Jo and I recommend couples therapy if your husband is willing, and counseling for you if he’s not so you have support in seeing the situation clearly–and yourself as a worthy and lovable person!

Mary Jo has more resources on her website, starting with this article: “Addicted to Porn? It’s a Family Affair.”

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Here is the second part of our talk with Mary Jo Rapini, a therapist who specializes in intimacy counseling (the first part focused on the mind). She often receives referrals from oncologists who have treated women and men for cancers that, post-treatment, require a re-thinking, re-learning, re-framing of their intimate life. Says Mary Jo:

When a couple is referred to me, it’s usually because the cancer part of their life is now under control. That is, they have their diagnosis, understand staging, and have been receiving treatments, with some evidence that treatments are working. Until that point, survival is the critical concern for most couples.

This time of diagnosis and sheer survival can actually bring couples closer — they realize that what they used to argue about is petty. On the other hand, really bad relationships will many times get worse. Women who are sick might ask themselves what they’re doing, what happened in their relationship. When that’s the case, my first step is figuring out the emotional environment. Where is this couple now, at this moment in time?

When we do come around to talking about intimacy in the relationship, my first concern is with pain. Painful sex is a really common problem for survivors. Low energy is another problem. People receiving treatments or recovering from extensive treatments have very low stores of energy.

Women recovering from surgery and radiation for any kind of cancer, including breast or uterine cancers, may be adjusting to new losses and scars that affect body image, sensation, mobility, or all three.

And while thinking about restoring sexuality may be pretty far from her mind, the truth is that reengaging with a lover has been shown to really help with recovery. Sex is very healthy—for our bodies and our minds—and a loving intimacy is certainly one of the best things we have to live for.

Get help. Your intimate life may have been perfect your whole lives, your relationship sound, your commitment to one another unshakable, but still a good counselor can give you things to think about, assignments and exercises that can help you to re-engage after harrowing course of treatment. Consider it a gift to yourselves, a reward for surviving.

Planning is everything. Spontaneous sex was great when you were teenagers, but now things are different. Intimacy is best now when it is anticipated and planned. Choose a day of the week when nothing much else is going on. Choose a time in that day when you are likely to have less pain. Be sure you have an hour of pain medication in your body before engaging in cuddling and caressing.

Set a new goal. Sexuality is often so goal-oriented we forget that sex is good for more than just orgasm. When orgasm is difficult to reach—for either of you—why not take it off the table and enjoy the benefits of sexual intimacy without it? Massaging erogenous zones is extremely pleasurable—provided there is no pain—whether we achieve orgasm or not. It still circulates blood, increases healthy hormone production, and helps couples bond to one another. Set a new goal: bonding and intimacy. Use that vibrator to make one another purr, and let purring be enough for a while.

Become a prop master. Pillows, pillows, pillows. If you spend any time in a hospital, you will notice that nurses really know how to use pillows to prop people into comfort in bed. Well, we can use them too, to prop us into comfortable positions for intimate caressing and lovemaking. We may not have needed them before surgeries or treatment, but may really need them now, when a slight change in position or angle may make a huge difference in comfort and painless lovemaking.

Patient exploration is the key. Most of us don’t know how our bodies will respond to treatment. Our mileage varies. So patiently exploring how treatment may have changed our sense of touch and taste and smell, in addition to pain and pleasure—this takes time. Be a scientist about it. Experiment, experiment, with all the patience of a field biologist!

Use a light touch. When we get chemo, our skin can become very sensitive. Chemo changes the epidermis of the skin. Our sense of touch shifts. That’s where things like feathers, mitts, and lotions become so important as tools for exploration, because your body is different on chemo. Figuring out those changes is the work ahead for both of you.

Some of the chemos are so toxic any intercourse would be too rough on fragile tissues. That’s a good time to think about a different form of expression, beyond intercourse. Find new ways to connect.

Wetness now, more than ever. Most women can’t handle intercourse during treatment. Chemotherapy can be very drying, and our skin, our vaginal tissues, are just too fragile. But if you are going to try intercourse during treatment, lubrication is extremely important. Try a lube that has a trace of silicone. I especially like Liquid Silk and Yes for this purpose. A little bit of silicone can give that lube sticking power. Too much is hard for a dry vagina to clear on its own.

Slow down. Pretend you are new lovers, virgins, even. Go very slowly. Be prepared to relearn everything about to make love to each other. Kissing can change. Taste can change. Relax, take interest, explore, report, and learn.

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“Not everything that is faced can be changed, but nothing can be changed until it is faced.”     –James Baldwin

We’ve been hearing from many women who are receiving treatments for various forms of cancer: What about us, they ask. Post-menopause is one thing, but what about post-cancer treatment? Or mid-treatment? How do we maintain intimacy when we are going through chemo or radiation or when surgery has changed our bodies and the way we feel about them?

We sat down to discuss these very difficult questions with our pal and counselor, Mary Jo Rapini. Her practice gathers couples referred before, during, and after cancer treatment to talk about sexuality and intimacy and how to maintain physical expressions of love when we are sick. This is a big subject, with many possible angles, so we will break it down into two pieces: the mind and the body.

Here’s part of what Mary Jo told us:

I see lots of women with breast, ovarian, and uterine cancer in my practice. I ask to see her first, before meeting with the couple together. Women have a strong protective instinct; they will put up walls when they get sick, in part to protect themselves, but also to protect their loved ones, to avoid burdening them. I will coach her to share this crisis. That protective sense turns out to be too distancing. Whatever she is going through, whatever she decides for her course of treatment, the people who love her are in it with her. Their world is changing too, and it’s important to respect that and bring them along on the journey, consult with them. It’s important to have a team in this fight.

When a couple comes to me mid-treatment or post-treatment, they walk through the door with the goal to restore their sex life. The first thing I do is to slow them down, to hit the reset button. I give them a list of things to think about that goes like this:

  1. Focus on the positive.
  2. Take intercourse off the table until you have the energy for it, but don’t stop thinking about sex. Don’t stifle your own sexual thoughts out of guilt. Tell your partner, I still really desire you and wish I could make love to you.
  3. Remember sex is more than intercourse.
  4. Discuss your fears of the cancer.
  5. Consider buying your partner something sexy or feminine that will help her feel like a woman.
  6. Be a good listener and let her set the pace.

My focus for couples at this important time is to feel pleasure and relaxion first, before working on feeling excited. Excitement is exhausting, and exhaustion can lead to failure and frustration. I ask them to just flat out remove the goals of intercourse and orgasm from the picture. I promise we will get to these, eventually, but for now, let’s not worry about it.

I had an aneurysm that nearly cost me my life. For me, orgasms changed a lot. For one thing, they made my head ache. With a clip on arteries in my brain, and my blood flow trying to figure out a new path—orgasm took a lot out of me. Sex didn’t give me the energetic feeling I used to have. Instead, orgasms robbed me of energy for the rest of the day. A lot of my cancer patients tell me that intimacy tires them, so planning is important.

A recovering cancer patient has to plan how she will spend the little energy she has on home and health and relationships. This is a very important adjustment, especially if a couple has always enjoyed a spontaneous sex life in the past.

I prescribe a lot of hand-holding and hugging. We know the importance of hugging now, how it builds and maintains bonds for us. Most men will tell me that when their partner is sick, this is what they miss more than anything. The worst thing people can do when they can’t have sex is to withhold all touch. When a couple only touches as a pre-cursor to sex, touch can be loaded with expectations, and we need to break through that. We need to experience touch as a pleasure in itself.

During treatment, during chemo and radiation, just take intercourse off the table, but replace it with lots and lots of touch. Hand holding, back scratching, feather-brushing, rubbing hair, petting. Have fun touching, kissing, necking, without the worry of failure. Just revel in closeness.

Once you’ve gotten this connection really going, add water. Because water is relaxing. Shower together. Or take a bubble bath (but stay away from very strong scents). Light candles, bring in soft music. Focus on enjoying each other. Wash each other. Especially, wash each other’s feet. When something feels especially good, say so.

When you are in treatment for cancer, self exploration is really important. Experiment with self touch, especially where you have had surgery. Touching helps you deal with grief of loss and letting go. If you have lost a breast, you need to feel that void and be able to grieve it. Whether to include your partner in this exploration is entirely your choice, but it can very helpful for both you and your partner to join in this exploration and support you in your grief.

With any kind of an illness, the ill person asks, “Who am I now?” A serious illness changes the self, sometimes just a bit, but often profoundly. And if one self in a couple changes, then it follows that the couple’s sense of couplehood changes. Talk together about the changes you experience and notice.

A healthy partner often feels guilty about wanting sex; he knows a sick partner doesn’t have energy for sex. The healthy partner is a caretaker and not a lover right now. Talking about that is very helpful and important. Getting a counselor to talk with both or either of you during this time of adjustment can be the best investment you’ve ever made.

If you are sick, don’t underestimate your lover. We are all pretty good at putting our sexual needs on the shelf, as long as we feel loved. The most helpful way to show your love is through touch. Touching can make talking more available. Some things you hate to tell your partner. But if you are touching them while you talk, there are moments when the communication is so authentic, you will find you can say anything. And that is the sound of real intimacy.

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