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When women in my practice have vaginal dryness or atrophy, I typically start by recommending a vaginal moisturizer. The key is to be faithful, using the moisturizer at least two times each week. Yes is the most popular vaginal moisturizer at MiddlesexMD; the fact that it’s available in pre-filled applicators is definitely a plus for women who don’t like the mess of other options!

If the dryness or atrophy is not effectively managed with a moisturizer (which can happen over time), then I add a vaginal (localized) estrogen product.

I should also mention that a new oral medication for vaginal dryness or pain was approved by the FDA this summer. Non-hormonal, it’s called Osphena and is available by prescription. Because it’s oral, there’s no mess! But you do need to make the consistent commitment, again, to regular use.

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Here’s the scene. A “mature” couple is sitting companionably together in the living room, reading. He looks over the top of his paper.

“Hey, Snookums, you look remarkably fetching tonight. Want to get to bed early?

She, thinking: Oh, lord, he hasn’t seen me naked since I gained the last five pounds. Fat on top of cellulite. Saggy bags over saddlebags. “Well. Hmmm. Just let me finish my… knitting. I have to finish my knitting. Then I’ll be right in, honey.”

He, thinking: Yeah, knitting. Bet she’d be ready to jump the bones of some musclebound hunk with hair instead of a bowling ball and a six-pack instead of a whale gut.

And what he does not dare to articulate even to himself is whether she might also be left unsatisfied with his, um, slightly spongy and not-so-reliable accoutrement.

So they sit, each in his or her own corner, licking the wounds of engrained insecurities and missing out on the sweetest years they have left together. All because they misinterpreted each other’s insecurities because they were so completely snowed under their own.

The song may be different for each of us, but too often, the dance is the same.

Body image is powerful no matter what side of the gender gap you fall on. And while men rarely discuss their insecurities, in one study, 38 percent of men would sacrifice a year of their lives for the perfect body—a higher percentage even than women, according to this article in the Guardian.

“These findings tell us that men are concerned about body image, just like women. We knew that ‘body talk’ affected women and young people and now we know that it affects men too,” said Dr Phillippa Diedrichs, who conducted the study of almost 400 men in Great Britain.

While women focus on losing weight, men obsess about losing muscle. While women struggle with vaginal dryness, men struggle with losing their ramrod hardness. While women worry about their stomachs, thighs, and boobs, men worry about their stomachs, muscle tone, baldness, and man-boobs (moobs).

Blame the media. Blame your mother. We’re old enough now to identify and grapple with our own insecurities. And to get over them, already.

No matter how good you look, you’ll eventually become invisible in a culture that is focused on youthful beauty. In her poem I Met a Woman Who Wasn’t There, Marge Piercy writes:

The CIA should hire as spies
only women over fifty, because
we are the truly invisible.

This makes some women feel free and unburdened, and it makes others desperate to turn back the clock, fueling the cosmetic surgery industry, which has grown 77 percent in the last ten years, according to a 2012 AARP article. For their part, men may turn to Rogaine and Viagra and red convertibles—and cosmetic surgery, but in the end, we all—men and women—have to make our peace with growing old.

Because that train is coming, like it or not. And it’s a whole lot nicer to ride out the last adventure of our lives in the same berth.

Here are a few ways to do just that:

Send your body some luv: “The mind is the most powerful beauty tool in your makeup bag,” writes a woman in this article.

Stop the negative chatter, says MiddlesexMD advisor, MaryJo Rapini, who writes frequently about body image issues. In this blog post, MaryJo lists 15 things you should say to your body, such as: “You are my body, and I claim you, and I will take care of you.” And: “I love the way you make me distinguishable that someone can recognize me by my voice, my eyes, or the gait of my walk.”

Do sensual things for yourself and with your partner: Have a massage. Luxuriate in a scented bath. Go all out, if you can, with a week (or a weekend) at a spa. When your body is touched respectfully and sensually, it helps you to remember how good it feels.

Have more sex. The more you have, the better—the more sensual and sexy—you feel.

“Give yourself over to the pleasurable experience and sensation of sex itself, drawing on the depth of your emotional connection with your partner. Issues with physical imperfections can melt away in the face of this focus on mutual sharing of pleasure,” suggests this article from the North American Menopause Society (NAMS).

Keep your body healthy and moving. Forget about looking young. Focus on being healthy. “Consider exercise and weight loss as aphrodisiacs,” says the NAMS article. “Exercise is like Miracle Gro for your brain and body,” says the AARP.

Get the picture? As you age you simply will not feel good about yourself unless you exercise moderately and eat healthfully. Exercise helps keep blood flowing to your brains and keeps your joints lubricated, not to mention keeping your muscles toned, strengthening your bones and boosting your immune system.

What are you waiting for? Get off the couch.

Be gentle with each other. It will just take longer for your man to get an erection, and it doesn’t have anything to do with his attraction to you. And he needs to understand that you’ve been conditioned since childhood to believe that youth equals beauty. You need to hear that he still finds you irresistible.

If you have a same-sex partner, you’re looking in the mirror at your mutually aging bodies. Make sure you each know that’s okay.

As Dr. Eleanor Hamilton, author and sex therapist, writes in this beautiful article, “They both need to reassure each other that their love and the intimacy they share and the long years of increasing trust that has built between them are far more important ‘turn-ons’ than the young, sleek, over-eagerness of youth.”

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Many women go through menopause with little more than irritability and hot flashes. In our last blog post, we reviewed research that suggests, though, that if you’ve experienced postpartum depression or hard-core premenstrual syndrome, you may be at higher risk for depression during perimenopause or menopause. Awareness and perhaps some preparation for this challenging transition might be prudent. It’s like an athlete training for a race. You want to be in shape before you hit the tarmac.

And even if you’ve never had a down day in your life, some commonsense lifestyle adjustments as you approach your “window of vulnerability” might ease the transition. What you absolutely do not want is to be taken by surprise at the intensity of your emotions, as this couple, tragically, was.

Forewarned, as they say, is forearmed.

So here are some suggestions for greater awareness and healthy lifestyle changes that, honestly, are never too late (or early) to adopt:

Nutrition. Eating sensibly is a good foundation for the inevitable metabolic changes that happen during menopause. Go heavy on whole grains and fresh fruits and veggies, ideally from local, organic sources. Lighten up on fats and sugar. Take your vitamins.

If you need to lose some serious weight, now’s the time to get serious about it, before menopausal changes really kick in.

Get moving. Lack of social connection and daily activity intensifies a sense of isolation and lethargy. Create a routine of exercise and involvement. Volunteer for a few organizations you believe in or enjoy. Exercise regularly. Get outdoors—don’t just walk from house to car. Surround yourself with healthy activity and people you like.

Explore treatment options. Some studies indicate that, for perimenopausal depression, hormone replacement therapy, sometimes in conjunction with antidepressants, can ease the mood swings, hot flashes, and insomnia, especially during the early stages of menopause.

St. John’s wort may also relieve mood swings and anxiety during menopause. (But don’t take any natural remedy without talking to your doctor first.)

Build your network. It’s comforting to know that people you trust have your back. And it’s a lot easier to find helpers before you’re in the thick of things.

Maybe find a therapist you like. Maintain connections with good friends.

And if you find yourself overwhelmed with feelings of unworthiness, or are unable to get out of bed or to function normally, for heaven’s sake, tap into that support system. Call your therapist or doctor. Call someone you love.

Menopausal depression is treatable and usually resolves itself once you’re through the change. Then you’ll be back to your sunny, even-keeled self.

In the meantime, it’s just your hormones talking.

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We’ve talked about depression during menopause. It’s a common, joy-sapping beastie that rears its ugly head during this time of whacked-out hormones and middle-age adjustment.

After all, what with hot flashes, insomnia, loss of libido, mood swings, who wouldn’t feel depressed?

While we may not exactly sail through menopause, most of us make it through “the change” relatively unscathed. But for a few, the hormonal fluctuations that may precede menopause by a number of years is part of a larger picture—sort of a déjà vu experience that we ought to be aware of so as not to be blindsided by it.

Episodes of depression are common, and they are more common for women than for men. About 20 percent of women—one in five—will experience major depression at some point in life, and that’s twice the rate at which men become depressed, according to this report in “Dialogues in Clinical Neuroscience.”

Why this happens is unclear, but one obvious culprit is the normal hormonal fluctuations that occur at predictable points in a woman’s life: puberty, menstrual cycles, childbirth, and menopause. Some women appear to be more sensitive to these hormonal changes, and depression—sometimes crippling in its intensity—can result. These predictable points at which female hormones are on a roller coaster may be considered “windows of vulnerability.”

Perimenopause—the years immediately preceding active menopause—seems to be the point at which depressive episodes are more frequent. Even before a woman’s menstrual cycle is changing, her hormones may be dancing the rhumba. Perimenopause can last for five years, on average, and 95 percent of women enter it between the ages of 39 and 51.

“These periods are not only marked by extreme hormone variations but may also be accompanied by the occurrence of significant life stressors and changes in personal, family, and professional responsibilities,” writes researcher Claudio Soares in this report for Biomedcentral.com.

The thing to be aware of, however, is that the biggest predictor of perimenopausal or menopausal depression is a prior episode of depression. And the “reproductive life cycle event” most strongly correlated with perimenopausal depression is postpartum depression—the “baby blues.”

“We also found, however, a correlation between perimenopausal mood ratings and ratings at other reproductive cycle events, especially between perimenopausal depression and postpartum depression,” write the authors of this study published in the Journal of Clinical Psychiatry. “This suggests that there may be a subgroup of women who have a specific vulnerability to developing reproductive cycle event–related depression.”

Other well-regarded studies have confirmed these correlations.

What this means for you, as you head into your final and very challenging “reproductive life cycle event,” is that if you’ve experienced postpartum depression or hard-core premenstrual syndrome, you may be at higher risk for depression during perimenopause or menopause.

In fact, if you’ve had one prior incident of depression, your chances of having another are one in two (fifty percent). If you’ve had three previous depressive episodes, your likelihood of experiencing another is 95 percent, according to The Massachusetts Health Study cited in this report.

But that doesn’t mean you’re without resources: Forewarned, as they say is forearmed. In our next blog post, we’ll talk about what you can do to increase awareness and keep yourself healthy—in body, heart, and mind.

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Why Menopause? Ask Darwin.

Pity the poor chimpanzee. She lives scarcely 40 years in the wild, bearing young the entire time. She is fertile throughout her lifespan, growing old and gray while birthing baby chimps to the end of her days.

That’s just the way things are in the natural world. Only a couple kinds of whale—and human women—live beyond their years of fertility. This is because the evolutionary purpose of a species is to procreate, according to natural selection. If you’re not furiously making babies, you’re hogging precious resources, and if that state of affairs persists, you just may be relegated to the dusty Darwinian basement of interesting but extinct species.

Yet, human women can expect decades of life after fertility. And you can bet that evolutionary anthropologists are having a heyday with this nugget. “Human menopause is an unsolved evolutionary puzzle,” write the authors of “Mate Choice and the Origin of Menopause” in the June 2013 issue of Computational Biology.

Long age, scientists thought that women experience menopause simply because they run out of viable eggs. The ovaries are stocked with a finite number of eggs, as opposed to sperm, which is continually regenerating. Women’s reproductive systems last 30 to 40 years and then the ovaries fail and the eggs run out. The explanation for continued survival beyond menopause was a mystery.

A more recent view suggests that the difficulty and danger inherent in birthing human babies (large neonatal head size relative to the space in our upright-walking pelvis) along with the many years our helpless spawn require before they are able to hunt and gather on their own (not counting the cost of hockey gear and college tuition) are partly responsible for menopause and an infertile older age.

According to this view, it makes some evolutionary sense to limit the years of fertility so a human mother could focus on rearing the children she has instead of taking on the risk of having more children that she might not live long enough to see into adulthood. In other words, quality trumps quantity.

“There may be little advantage for an older mother in running the increased risk of a further pregnancy when existing offspring depend critically on her survival,” according to “The Evolution of Human Menopause,” a report by a pair of researchers at the University of Newcastle.

Then came the Grandmother Hypothesis. This theory emerged from the work of anthropologist Kristen Hawkes, at the University of Utah. In her study of the Hadza, an indigenous tribe in Tanzania, she observed that the tribe’s ace-in-the-hole with regard to survival was the grandmothers—the older, infertile women. These industrious gals spent their days foraging for food, which they distributed among the mothers and children. The grandmothers were a resource that assured not only survival, but also robust health for the Hadza’s most vulnerable members.

The Grandmother Hypothesis suggests that, given the rigors of rearing children, older, infertile women play a critical role in helping assure the survival of their children’s offspring. Those of us who have spent a month—or more—helping out after the birth of a grandchild know there might be something to this. An experienced caregiver in the household who can cook and clean and who just happens to love that new little bundle to pieces makes a huge difference. Plus, she’s free.

These theories may provide parts of the answer to the reason for menopause, but recently a team of researchers from McMaster University in Hamilton, Ontario, published the findings of yet another hypothesis in Computational Biology.

Ready for this?

Men are the cause of menopause, and specifically, their preference for younger women. After generations of being chucked for the spring chicken, so the theory goes, older women developed genetic mutations that selected against fertility but not against longevity. Thus, men remain fertile throughout their lifespan, while women go through menopause. Because apparently, fertility is wasted on us older hens.

But those rabble-rousing researchers didn’t stop there. Next, they tweaked various parameters of the mating preference paradigm with varying results. When the model allowed men and women to mate without regard to age, both genders remained fertile throughout their lifespan.

But when the computer models were adjusted to account for male preference for younger women, Voilà! Menopause. Older women gradually became infertile.

“If women were reproducing all along, and there were no preference against older women, women would be reproducing like men are for their whole lives,” says Rama Singh, an evolutionary geneticist and co-author of the study in this article in Science Daily.

You know, ladies, I think we owe those cradle-robbing men a debt of gratitude. Annoying as it may be to inevitably become the losers in the marketplace of youth and beauty, can you imagine having children in your 80s? From that perspective, menopause never looked better.

And never fear. Natural selection evens the score—on the computer models, at least. When our intrepid scientists adjusted their computers to create a female preference for younger men, then the old geezers lost their fertility, too, experiencing a male menopause just like ours.

Poetic justice, perhaps?

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Fifteen Facts about Your Vagina

Out of sight; out of mind. That’s how it is with the vagina. As long as it’s working and isn’t causing a fuss (which, granted, becomes more iffy at this stage of the game), we forget about it.

Nothing wrong with that.

But, ladies, your vagina is a marvelous thing, so in the interest of a little community ed on this underappreciated organ, here are some fun and quirky facts—maybe things you didn’t know—about your vagina.

  1. The word vagina comes from the Latin word for “sheath” or “scabbard.” Those Latin lovers were all about their swords. The word orgasm originated with the Sanskrit word for “strength.”
  2. The hymen is named after, um, Hymen, the Greek goddess of marriage. It’s a membrane that partially covers the vaginal opening before puberty to protect it until normal changes during puberty. It’s broken with a girl’s first sexual penetration, and the attendant show of blood is the traditional “proof” of her virginity.
  3. As you might imagine, the vagina has accumulated many colorful names over the centuries. A few of the, ahem, more decorous are: camel toe, honeypot, cock pocket, vajayjay, meat wallet, muff, bearded clam, fish taco, crotch mackerel, hot pocket, bikini biscuit, panty hamster, yum yum, twat, hoo ha, and, of course, pussy and cunt. Enough already!
  4. The vagina proper begins at the mouth of the vulva and ends at the cervix, which is that bottlestopper at the base of the uterus. So the vagina is the conduit—the “potential space,” the empty sock without a foot in it—that leads from outside the body to the small opening in the cervix that allows sperm to pass through.
  5. While the vagina is only 3-4 inches long, it balloons to 200 percent its normal size (to accommodate those Latin swords as well as babies of various sizes). This impressive ballooning effect happens because the vagina is pleated like a skirt with a bunch of folds, called rugae, which expand when extra space is needed.
  6. We talked about the normal variations in the way your outer genitalia may look, but for the most part, vaginas all look the same.
  7. Like your oven, your vagina is self-cleaning. So, for heaven’s sake, don’t douche. You’ll upset the delicate balance of good bacteria that live in there. Wash your external genitals with warm water and some gentle, unscented soap.
  8. Your vagina has its own unique odor, which is determined by your diet, the normal variation in bacteria, sweat, and hygiene.
  9. Your pubic hair isn’t just an annoying decoration. In days of yore, it was a “reproductive billboard” announcing that over yonder was a fertile female. It also traps your scent, leading suitors to the honey pot. Times have changed since caveman days, and a healthy mat of hair may not be quite so irresistible today. Pubic hair has a life expectancy of only three weeks versus head hair, which stays put for about seven years.
  10. The normal pH balance in your vagina is slightly acidic, similar to wine or tomatoes. That normal balance can get out of whack if you have an infection, douche, or through exposure to semen, which is more alkaline.
  11. Sex keeps your vagina moist and flexible, especially after estrogen levels drop. “Safe vaginal intercourse can help keep the vagina healthy and dilated,” says Dr. Courtney Leigh Barnes, a gynecologist at the University of Missouri in this article.
  12. Vaginal farts (also called queefs or varts) happen to every female at one time or another, especially during sex or exercise. So don’t be embarrassed.
  13. Gravity is as hard on your vagina as it is on your breasts, face, and buttocks. It sags, and sometimes, it falls out. This is called a prolapse. While it may be uncomfortable, it’s usually painless and can be fixed.
  14. Most women (about 70 percent) don’t orgasm through vaginal stimulation alone, but through a combination of clitoral and G-spot action.
  15. The first two inches in the vagina have the most nerve endings and are the most sensitive.

Don’t say we never told you.

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Life is scary after a heart attack. You’re not sure what to expect. You may be depressed. You’re probably on several medications. You may be confused about what you’re allowed to do and when.

Like sex. When is it safe to have sex again?

Chances are, your cardiologist hasn’t discussed that topic. For one thing, your doctor is probably more concerned with saving your life at first, and then with the details of your recovery, like rehab and medications. When to resume your sex life just isn’t high on the radar of topics to discuss post-surgery.

And for another, most physicians don’t bring up the S-word at any time, as we’ve discussed before. But a new study of women who have had a heart attack confirms that “most women don’t have discussions with their doctors about resuming sex after a heart attack, even though many experience fear or other sexual problems,” says Emily Abramsohn, one of the study’s researchers, in this article from Medical News Today.

Patients are often uncomfortable broaching the topic, and their caregivers also hesitate to bring it up. Their partners may also be afraid to do anything that might cause pain or induce another attack. “I had to convince my husband that I wasn’t going to die in bed,” said one woman in the study.

Now, new guidance for doctors from the American Heart Association (AHA) encourages doctors to discuss sex with their post-surgical patients and to advise them about when it’s safe to resume their sex life and how to do it.

The guidance, which is based on a review of scientific literature and is the first statement of its kind from the AHA, acknowledges the importance of resuming an active sex life. Sex is a return to normalcy and re-establishment of intimacy, and as such is an important element in the healing process.

Along with the position statement from the AHA, a new study from a group of researchers at the University of Chicago surveyed 17 women who had survived a heart attack within the past two years. The average age was 60. The study found that:

  • Most women were fearful about resuming their sex life
  • The doctors discussed sex with about one-third of their female patients
  • Frequently the conversation was initiated by the patient, who generally found the information to be unhelpful
  • Most women began having sex about a month after their heart attack; all but one had resumed sex within six months

The AHA guidelines could clear up some hesitation and confusion among physicians as to what, exactly, to tell their patients. The guidance states that sex is safe for most patients who are stable and without complications. If you can climb two flights of stairs, you can probably have sex, which is considered only moderate exercise.

But if you’re scared or unsure, then ask. “Know that you’re not alone in having fears surrounding sexual activity,” Abramsohn said. “And if you are concerned, bring it up with your doctor.”

“Dr. Ruth” Westheimer even weighed in on the topic in this article, “What I suggest is that people write down their questions and send it to the doctor in advance of their appointment. That way they’ll be sure the question gets asked, and the doctor will have had time to get prepared to answer it.”

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A New Breakfast of Champions

It all began when entrepreneur Peter Ehrlich took a stroll through a vegan food fair in Toronto. If your livelihood depends on generating ideas, I guess that part of your brain never sleeps.

Suddenly, he realized that there was healthy, organic, non-GMO food for all kinds of health—except for sexual health.

This was Ehrlich’s Eureka! moment. Everybody eats cereal, he reasoned. Everybody wants to be sexy, and everyone wants to be healthy. Let’s bring it all together in one slick package.

Thus was Sexcereal conceived. After conception, the road to market dominance was easy. Ehrlich hired a “team of nutritionists and quality control experts” to create two recipes: one for “HIM” and another for “HER.” A very important step, apparently, was the packaging: a 300-gram bag of cereal with vintage, slightly come-hither, and very healthy-looking images of a guy and a girl. (The size of the guy’s spoon has gotten a lot of quips in the media.)

Besides a generous portion of rolled oats for both genders, which gives the cereal a granola-y look (Don’t call it granola, however; Ehrlich doesn’t like that.), the cereal “for him” has chia seeds, blueberries, black sesame and pumpkin seeds, cocoa nibs, bee pollen, goji berries, and maca powder. “She,” on the other hand, is indulged with wheat germ, soy protein, ginger, cranberries, almonds and flax seeds.

Sounds good, doesn’t it?

Sexcereal is described as a nutritious and tasty whole food with lots of fiber, iron, energy, and Omegas 3 and 6. It’s supposed to boost testosterone and promote hormone balance. Certainly, its makers want to be taken seriously as having created a good product.

But it costs $10 for that 300-gram packet, and it’s so popular that you’ll have to wait 10 days before your mail order is even filled.

The science behind the product? Not so much, as far as I can tell. Sexcereal’s success is all about the concept, the novelty, the marketing, and the media hype. Sex sells, as we all know.

So, maybe sample a packet of Sexcereal out of curiosity or send one as a gift to that person who has everything, but don’t expect a surge of white-hot passion. No matter what they say on TV.

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Can’t remember the name of the new work colleague? Forgot the city your best friend lives in? Can’t recall the movie you saw last week?

Join the club.

A little-known fact about loss of estrogen is that it takes a bit of memory with it when it goes. That’s why memory decline is a common feature in post-menopausal women.

Insult to injury, if you ask me. Let’s face it, at this stage of the game, we can ill-afford to lose any bit of that precious function.

In a new study, however, Australian researchers have found that small daily doses of testosterone gel applied to the upper arm improved verbal memory in postmenopausal women.

Testosterone is an androgen—a male hormone—that governs all kinds of things in men, especially sex drive.

Women produce testosterone, too, in the ovaries and adrenal glands, but in miniscule amounts, and its function is not well understood. Testosterone levels drop quickly as women age until at age 40 a woman usually has about half the level of a 20 year old.

It affects libido and has been used successfully to treat low sexual drive in women, but its long-term effects—or even correct dosages—haven’t been rigorously studied.

Testosterone treatment for women hasn’t been approved in either the U.S. or Canada, so it has to be prescribed “off-label.” That means either the physician prescribes an FDA-approved male pharmaceutical product in very small doses (usually about one-tenth of dose recommended for men) or the hormone is compounded specially by a pharmacist.

In the Australian study, researchers found an intriguing link between verbal memory and testosterone in women. In the study, 92 post-menopausal women (between 55 and 65) were first given standard tests for cognitive function. Then they were randomly assigned to receive either a placebo or dosages of testosterone gel for 26 weeks.

At the end of the treatment period, the women receiving testosterone had higher levels of the hormone in their system, and they scored 1.6 times better in tests of verbal memory (recalling words from a list). Scores on other tests remained the same between the two groups.

While these results aren’t game-changers, they do represent one of those incremental steps that can lead to significant advances. “This is the first large, placebo-controlled study of the effects of testosterone on mental skills in postmenopausal women who are not on estrogen therapy,” said Dr. Susan Davis, principal investigator in the study.

Since there is currently no treatment for memory loss, and since women suffer from dementia in greater numbers than men, this link between testosterone and memory could be an important finding.

Not to mention the potential side effect of improved libido.

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An older couple walked into the therapist’s office. The marriage had been a bit rocky from the get-go, but now the woman had completely lost interest in sex. The therapist recommended that the woman seek sexual counseling.

Now, that might have been all right except that the therapist had no understanding of the very normal changes to libido brought on by menopause and thus wasn’t able to address that possibility or access resources to either reassure or help the woman.

The couple never came back.

Sue Brayne, a British therapist and author of Sex, Meaning, and the Menopause, commented in her blog on a recent workshop she conducted: “…it continues to amaze me that in a room full of therapists on their way to fifty, or who are well into their fifties and even sixties, this workshop was the first time most of them had ever spoken about the menopause in any depth, or admitted to how it is affecting their lives.”

So, while many healthcare professionals have personally experienced menopause, very few have actually received professional training or information to help others.

In a survey of 900 women conducted by womentowomen.com, 80 percent visited their doctors for help with menopausal symptoms and 60 percent came away feeling as though they hadn’t had a “supportive, honest discussion about menopause options.”

Therapists in Brayne’s workshop complained that, “their GPs [general practitioners] had no interest in the menopause, and they were often ‘fobbed off’ with unwanted prescriptions for HRT [hormone replacement therapy].”

As patients, we are often shy about discussing sexual issues to begin with, and as we’ve mentioned before, doctors rarely initiate that conversation. Throw menopause into the mix, and you may be met with discomfort, avoidance, or the “fobbing off” that Brayne mentions.

Many doctors and therapists simply aren’t equipped to understand the array of menopausal symptoms. Menopause isn’t a disease or a medical condition. A doctor can’t “fix” it. Menopause is complex in that it affects a whole bunch of physical and emotional systems, and there’s no one-size-fits-all remedy.

That said, you have every right to expect your medical practitioner to knowledgeably address your menopausal symptoms during this transitional time. And you should be able to talk openly about them. Yes, that includes sex.

So, how do you get the ball rolling with your practitioner?

  • First, ask for a 15-20 minutes consult to discuss these issues with your provider. A discussion can happen during a routine appointment, but let your doctor know you want some time to talk.
  • Make a list of questions, issues, symptoms, concerns. Write them down and don’t be hesitant to refer to the list.
  • Pay attention to your symptoms, when they happen, how often, how intense. Mention changes that you might not associate with menopause, like sleep disturbances and intermittent memory loss. When did they start? Have they changed? What have you done to find relief?
  • Be honest. It’s tempting to fudge the truth about drug or alcohol use, diet and exercise. But how can a practitioner help you without all the facts? You can go a long way down a dead-end treatment regimen if you aren’t honest with your provider.
  • Identify your own expectations. What do you want from your provider? Do you need moral support, perhaps in the form of counseling? Do you need relief from particular symptoms that are affecting your quality of life? Does your partner need information about what to expect and how to cope with the changes you’re experiencing?
  • Trust yourself. You’ve lived in your own skin for a long time. You probably have a good sense of what’s been normal in the past.
  • Ask questions. Sometimes it’s hard to think of everything during a discussion, but don’t let questions go unanswered. Ask your doctor for the best way to communicate if you think of something later.

If you’re frustrated in your attempts to communicate with your regular provider, or you feel you’d benefit from a specialist with targeted knowledge about menopause, the North American Menopause Society has a menopause certification program as a way of assuring basic competency and assuring high-quality care. You can find a NAMS-certified practitioner in your area by searching here.

Medical professionals may sometimes struggle to find the information they need to support and treat their menopausal patients, but as patients communicate (nicely) that they expect support and knowledgeable treatment from their doctors, everyone is nudged along the road toward greater awareness.

And that can only help us all.

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