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Posts Tagged ‘advice’

“Concern” is a relative term. If you mean should you lose sleep, no. If you mean should you work with your health care provider for an explanation or monitoring, yes.

Pap tests (also called a Pap smear or cervical cytology screening) are used to look for changes in the cells of the cervix; abnormal cells can be identified early and treated appropriately. Pap tests provide information on both whether cells have changed and how much cells have changed, so  “abnormal” covers a range of possibilities.

The most common cause of abnormal Pap results is HPV (human papillomavirus) infection, and HPV also suggests a range: there are many types of HPV. Some lead to nothing at all, some are linked to genital warts, and some are linked to cancers of the cervix, vulva, and vagina. And, let me repeat, some lead to nothing at all.

When a Pap test returns an abnormal result, it’s typical either to monitor (repeat the Pap test in six months or a year) or to take an additional diagnostic step. A colposcopy is the most common; it sounds scary, but it’s really only a close visual exam of the cervix with a magnifying device. There are several tissue sampling procedures that take cells for additional lab examination.

About 70 percent of mildly abnormal results revert to the “normal” range at the next screening. That said, it’s important to follow your health care provider’s recommendation for a follow-up test. This is not the time to procrastinate on that office visit!

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Did you know that the whole idea behind MiddlesexMD is based on a recipe? You could call it the MiddlesexMD formula for really juicy sex. Officially, we call it “our recipe for women’s sexual health.”

We think our recipe is so important that our entire website is organized around what we’ve identified, after a lot of thought and research, as the five necessary ingredients for a satisfying love life at midlife. You can add your flavor of whipped cream and lingerie, but if those five ingredients aren’t in place, sex just won’t work very well.

These ingredients may be surprising (knowledge? emotional intimacy?), and some are unique to our stage of life (vaginal comfort, genital sensation, pelvic tone). We try to help you understand why they’re important and to give you tools and tips for understanding what they are and for incorporating them into your life.

Here’s a tool someone at a recent conference told us about; it reaches the same destination by a different path. It’s a fun quiz put together by the Association of Reproductive Health Professionals (ARHP). Sounds like place to get blood drawn, I know, but behind that bland façade is a sexy little quiz that reinforces a lot of the thinking behind our recipe.

To start, click on your age in the circle that says, “It [sex] could be better…” The questions cover a range of life issues, from physical health to libido to emotional well-being—because, as we’ve said, sex involves all our parts, including our psyche and our emotions.

While the assessment tool is meant to be light and fun, it also delivers good advice. Be honest with your answers (who’s looking, anyway?), and you’ll get some targeted, useful information to improve your sex life. And maybe the rest of your life.

You’ll discover, for example, that about 20 percent of women (of all ages) have a hard time getting turned on, and that it’s one of the most common sexual complaints. That a woman’s sexual response is complicated and affected by things like self-image and stress. (Click on the right-side box that explains how men and women are different.) The tool reassures you that most women can’t orgasm with penis-in-vagina sex alone, but need clitoral stimulation as well.

Nothing earth-shaking, but some nice reinforcement and some good tips. Take the quiz. Read the results, then dig around in MiddlesexMD for more in-depth information. We have lots of information about pain during sex. And we’ve certainly explored the female sexual response cycle. We’ve clarified the difference between moisturizers and lubricants, and we sell them both in our shop.

So, use the assessment as a fun way to pinpoint areas you might need to work on in your sex life, and then dig into our blog and website for the meat and potatoes.

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One of the advantages of having an advisory board is the different perspectives we bring to the same set of problems. In our last conversation with Mary Jo Rapini, the issue of body image came up: the fact that we women are sometimes our own worst enemies when it comes to nurturing our sexuality. The topic clearly hit a chord with Mary Jo–she’d also been coming across examples of it–and she offered to write this blog post.  

I was recently at a meeting that explored the literature and dealt with issues of sexuality, dysfunction, and relationships. The most popular theme in each educator’s presentation, no matter what their field of study, was the importance of body image in influencing women’s libido. Although many of the diagrams and graphs were complicated, the message was not. How women feel about their bodies influences their libido.

It makes sense, especially if you are a woman yourself or are close to one. You know how it feels when you feel bloated or fat and your partner wants to get naked. There is a sense of dread and duty; either you acquiesce or you find an excuse. It doesn’t matter how beautiful your partner tells you they believe you are, or what you’re wearing; if you don’t feel good about your body you don’t look forward to being vulnerable or wanting pleasure. Both of these are important when making love.

When I see women who are struggling with their body image I find myself reciting things I have heard or read that help. For example, experts tell women to focus on an area they like and to appreciate and dress in to flatter that feature. For many women, this may be helpful, but my practice is full of women who can only admit to liking a very small limited area. Let’s face it; if you tell me your favorite area is your eyebrows, I’m going to struggle with how to help you build a better body image using your eyebrows–any expert would.

Body image can include areas that aren’t exactly body related. For example, many professional women boast a high body image and self esteem due to their careers. They may not like their body or parts of it, but they don’t let it hold them back sexually.

What we say to ourselves is much more important than what others say. A recent report I read said that women routinely say over twenty derogatory things about their bodies each day. These same women suffer from how they view their body emotionally, physically, and sexually. It doesn’t matter if their husbands love their bodies, comment on the beauty of their bodies, or tell them how attractive they are: These women are destroying their concept of themselves from within. Media is an easy target to blame, but media is not the entire problem. What we say to ourselves is the problem. What we think to ourselves is the problem. What we say to our friends about our inadequacies is a problem. All sex talk begins with what we say to ourselves. No sex talk will make women feel sexier, hotter, or more desired if they have destroyed their sense of sexiness from within. Hormone therapy can make you feel more like having sex, but if you don’t feel good about your body, you will be reluctant to act on your feelings.

Since this is an inside job we do to ourselves, the work to stop perpetuating a poor body image is also up to us. It means you have to take a stance and begin by advocating for yourself, for your intimacy/sex life with your partner. That means sitting down with your partner and directly addressing what happens to you when you talk to yourself. Usually loving men will do anything to help their partner if they understand the mission.

  1. If you are highly suggestive and seeing a photo of a taut, scantily dressed woman with sex appeal makes you feel and talk badly about yourself, then rid your home of these types of magazines, TV shows, or whatever you are currently seeing.
  2. Movement is linked to many sensory areas of our brains. Movement makes our mood better, our affect more animated, and our sense of sexuality healthier. You don’t need to run marathons to feel and be sexy, but you do need to exercise each day. Ten minutes is better than no minutes. An hour a day split up any way you want is best!
  3. Begin a journal to yourself listing derogatory comments you remember being said to you prior to the age of eight. These comments may have been made as “jokes” by warped people, but they weren’t jokes. They are wired into your brain, and you may be repeating these to yourself as part of your negative mantra.
  4. Catch yourself. Whenever you make a derogatory comment about some part of your body, picture a stop sign and say aloud, “No.” Ask yourself, “What right do you have to abuse anyone including yourself?” Then think of who in your life made you think this was okay. Sometimes you will remember things your dad said, but more likely your mom used to insult herself as well.
  5. If anyone in your life right now insults your body, that is a huge red flag. Tell them they are waving a red flag, and abusing you with negative comments is not okay. If your kids hear this message, they will begin early protecting their body image.
  6. Women are much more critical of their bodies than men are. Part of this is due to the fact that women are more sensitive and do not abuse men’s bodies with negative comments to the degree men do with women. One way men will learn how to treat women is if a woman stands up to them when they make a derogatory comment instead of joining them in their taunts.

Couples will spend money to enhance their sex life with products, medications, and exotic vacations. However, the least expensive and perhaps most effective is to begin changing how we talk to ourselves. The first sex talk you get is not the one you get from mom or dad during a formal birds and bees lecture. It’s the mini body image lectures we give ourselves when we are children. These mini body image insults we say each day to our bodies are more potent than any sex product, medication, or exotic vacation we could ever afford.

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Our culture sends lots of messages about sex, through TV shows and movies, articles, girlfriend talk, and “wisdom” from our mothers (some of it really was wise!). Some of these messages become self-perpetuating, whether or not they have any basis in fact. Here are three in particular that I hear and wish would go away:

  • Men like sex more than women do.
  • Men are always ready for sex.
  • Men should always initiate sex.

What I don’t like is the ways in which these statements can be internalized in ways that affect women’s own sexuality, that lead them to second-guess or doubt what they’re really feeling or wanting. Every woman’s sexuality is individual—and, to be fair, every man’s is, as well.

Let’s take those statements one by one.

There was a time when women were reputed to “suffer through” sex, just to keep their husbands happy. There wasn’t a lot of understanding of the mechanics of women’s pleasure, which, thank heavens, has changed by now. The women I see in my practice like sex and recognize it’s an important part of their lives—which is why when they have problems, they’re looking for solutions.

The other issue I’ve got with us thinking men like sex more than we do is that we’re more likely to let them off the hook. For foreplay, for example, which we need more of as our hormone levels change. What we certainly have in common with men is that we both like good sex, although our definitions of that may differ. And that, by the way, is one more reason to talk about what we like and what we’re willing to do.

Men “always ready for sex” is another one that makes me crazy. Call me a radical, but my experience says that men are people, too. Where I see this one get women in trouble is that in the absence of open communication about sex in a relationship, we start to imagine reasons why our partner may not be in the mood. We miss cues about his overall health. We start to look at ourselves more critically, to notice the extra pound or the new sag, to lose perspective on the inevitable imperfections in our relationships, even to have a sneaking suspicion, sometimes, that our partner is finding affection somewhere else. Stop! Ask! Men get headaches, too, and they get distracted by deadlines at work, projects in the garage, and family drama.

And that brings us to the final “myth,” that men should always initiate. That is the way most of us were raised: We had to wait for the boy to call, stand on the sidelines until he asked us to dance, see when he would attempt that first kiss. Whether or not that’s still true for our daughters and granddaughters, it certainly doesn’t need to be true for us in our relationships. Did you feel some sympathy for those poor boys, facing the potential of rejection? Did you feel some envy for their position of power?

Well, it’s about time to share both in your relationship, if you haven’t already. If you’re in the mood, show your interest by taking the first step. Flirt. It’s fun, it’s empowering, and it will send all kinds of arousal cues to your body. And there’s nothing more “ladylike” than that. Your partner will be flattered and receptive (and if not in this moment, see above: he’s human, and there will be another time!).

I’m not going to debate whether these messages are myths or truisms. What I will do is encourage you to live your own script. Set aside what doesn’t fit for you, regardless of how many times you’ve heard the messages. Sex is a wonderful part of an intimate relationship, and both partners can invest equally in keeping it vibrant! It’s one of life’s greatest pleasures. And that’s a message I’ll keep spreading.

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In 1968, she was Barbarella, the fresh-faced ingénue in shockingly sexy outfits. Then she was Hanoi Jane protesting against the Vietnam War. She was the prostitute in the movie Klute, for which she won an Oscar for Best Actress. She became our Fitness Queen in 1982 literally inventing the workout video. The “Jane Fonda Workout” is still the bestselling video of all time (17 million).

Whatever you might think of Jane, she’s always been at the cutting edge, always willing to forge new paths, and she’s always relevant.

Now Jane is at it again, tackling stereotypes and pummeling barriers with her latest book, Prime Time, an uncensored examination of “love, health, sex, fitness, friendship, and spirit.” This time she’s taking on the stereotypes of aging. With a freshly remade face (about which she is unabashed) and characteristically toned body, she looks many years younger than 73. Yes, you read that right. Seventy-three. In a quintessentially Jane statement, she attributes her appearance to 30 percent good genes, 30 percent lifestyle, 10 percent plastic surgery, and 30 percent good sex.

As you might expect, Jane doesn’t pull any punches about the sex. She has sex, and she likes it. Her frank, 50-page chapter on sex in Prime Time (“The Changing Landscape of Sex When You’re Over the Hill”) is a refreshing peek behind a curtain that is ignored at best and considered unmentionable at worst.

Perhaps the first important revelation is that she is doing what she can to continue enjoying sex with her longtime boyfriend, music producer Richard Perry. She was on hormone replacement therapy until she was diagnosed with breast cancer in 2010. Until recently, she also took testosterone, which “makes a huge difference if you want to remain sexual and your libido has dropped,” she says. She stopped taking it recently when she developed a stubborn case of acne.

In her book, she discusses masturbation, sex toys, and resuming sex after a hiatus. After divorcing Ted Turner, she was alone for six years before meeting Perry. “If you have been celibate for a long time and then begin a new love affair, be aware that your vagina is likely to need some attention,” she said in a recent interview.

Jane’s done her homework, and her advice is solid. But her most important contribution is to broach a subject that is socially taboo. When a celebrity and role model talks about having sex at 73, it becomes okay for other people to talk about.

That was a conscious decision on her part. “I wanted to go into such detail about sex because it can be very important in later life,” she said. “There are all kinds of changes that no one ever tells us how to handle. One of the things I kept hearing from the sex doctors was that very few people come to them with their problems… So I thought it would be helpful to go into detail about that.”

She also reveals another little-known secret of aging in Prime Time—that it can be the best time of your life. People over 50 tend to be less hostile, less stressed, and more capable of maintaining intimate relationships. And the sex can be better, too. According to Jane, all this adds up to happiness.

Thanks, Jane.

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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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It’s estimated that 60 to 85 percent of all adults have come in contact with HPV and are therefore carriers. Any HPV that you or he introduced to the relationship 20 years ago, you were both exposed to initially—and remember, we basically all bring HPV into every relationship! If you have been in the same, monogamous relationship for 20 years, you cannot be ‘re-infected’ by the same HPV type. There’s no need for concern–or for condoms or other preventive measures!

There are over 100 different subtypes of HPV. Fortunately, nearly all are ‘low risk,’ and only a few are ‘high risk’. The low-risk types are now felt to be mostly an inconvenience without any true long-term risk. The few high-risk types (e.g., type 16, 18, 35) have a risk of causing progressive cellular changes, putting a woman at risk for cervical cancer.

Relax and enjoy sex without a condom within your relationship! (Just remember, if over time you do have a new partner, you can expose him to the HPV type that you carry. A condom will reduce the risk of exposure).

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

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

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

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

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

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

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

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A magazine in my waiting room cites a study that suggests 40 ounces of caffeinated coffee a day to prevent memory loss. The downside, of course, is that you may not sleep at night—which would certainly interfere with my brain function! You may have heart palpitations. And you may become dehydrated. As with any decision about your health, there are trade-offs and implications to consider.

That’s the message I’m sharing with patients who have more anxiety about hormone options after last month’s report from the Women’s Health Initiative (WHI) on a link between hormone therapy and breast cancer. Complexities and trade-offs don’t make good headlines, but we need to think them through to make decisions about our own health.

Here are a few of the things beyond the headlines I’d like women to consider before ruling out any kind of hormone therapy:

Every death from breast cancer is, of course, tragic. Too many women are fighting this disease. But for context, the increased risk the WHI points to is 1 in 10,000. According to the National Cancer Institute, 12.2 percent of American women will be diagnosed with breast cancer at some point in their lives.

The data reviewed by the WHI was of a study using a particular combination of synthetic hormones: estrogen plus progesterone. What’s underreported is that there was a decrease of 23 percent in breast cancer risk with estrogen alone, and that the study did not compare other formulations of hormones.

The age at which menopause happens plays a part in breast cancer risk. The risk from hormone therapy described in the study is roughly the same as the increased risk that happens naturally if a woman’s menopause happens five years later—because of the longer exposure to her own natural estrogen and progesterone.

Obesity is a risk factor I wish got more attention: Women who are 20 pounds or more overweight when perimenopausal are twice as likely to develop breast cancer after menopause, and nearly half of breast cancer patients are obese (nearly half of U.S. citizens, too). Fat tissue produces estrogen, which gives an obese menopausal woman higher estrogen levels than women of healthy weight.

Quality of life counts, too, in evaluating risk, as a friend realized when she found her 80-year-old mother up a tree picking apples. My own mother would have benefited from the bone health that hormone therapy can provide. She had a hip replacement in her 50s and didn’t walk again. My bone health, on the other hand, is still good, partly as a result of careful hormone therapy.

If your menopause symptoms make you miserable, I’d encourage you to consider all of the options open to you. Consider your entire health picture, including your medical history, your weight, and how active you are. A good menopause care provider can help you explore your options and risks, and, if it’s appropriate for you, prescribe the lowest effective level of the fewest possible hormones for a period of time to help you through the symptoms that are keeping you from living the life you’d like.

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