Feeds:
Posts
Comments

Posts Tagged ‘menopause’

Remember in middle school (we called it junior high in those days) when the boys and the girls were shepherded into separate rooms for those awkward films? It might have been presented by the gym teacher or the guidance counselor; maybe your school was large enough to have a health teacher who presided as we were introduced to the signs and effects of puberty—and the dangers of acting on urges.

My conversations with women lately have reminded me that while we take great pains to introduce our younger selves to their biology, we don’t quite follow through. In the sex ed I’m familiar with, the story stops with the fertile years. We don’t introduce the full cycle we can all expect to experience if we only live long enough.

Yes, breasts bud and menstrual cycles begin. We have children, or we don’t; we may have illnesses or surgeries. At some point, the cocktail of hormones shifts, and the parts of our bodies once prepared for reproduction begin to change once more. Our periods become unpredictable and eventually stop (a year without defines menopause). Our tissues become dryer, more fragile, less elastic. Without care and attention—and often in spite of them—our vulvovaginal tissues atrophy, which means they actually shrink.

And where do we learn this? Not in a gym or a cafeteria with a hundred of our same-sex classmates! For too many of us, we learn it only through our own experience, at a point in life when there aren’t many people we’re talking to about sex. We’re tempted to think this is an odd thing that’s happening only to us. We’re a little embarrassed, maybe a little ashamed.

There’s so much more common about our experience than most women think! If only there were a middle school for midlife, so we could all get together and learn about this next phase of physical transitions. As we thought (or it was hoped we were thinking) back in the original sex ed, knowing what’s ahead is the first step in making good decisions and taking charge of our own sexual health.

I haven’t yet figured out where to offer my midlife sex ed classes, or how to get busy women to attend! So I’ll keep having conversations with women one on one in my practice and through the MiddlesexMD website. I hope you’ll be having conversations, too, because even without the awkward films, we’re all in this together.

Read Full Post »

Itchy beyond words. Crotch of underwear rubs painfully against labia. Sensation of being on the receiving end of a vulvar wedgie. Feels like tiny razor blade nicks in my vagina during intercourse without lube or adequate foreplay. Also difficulty with penetration.

Doesn’t that sound awful? If that were you, I wouldn’t be surprised that you’re not thinking about sex. Just as awful, about half of us think that vaginal dryness is something we just have to live with—and about the same number of us are hesitant to raise the topic with our doctors.

The truth is that vaginal dryness does not need to end the intimacy you have with your partner—or the afterglow you experience yourself after sex.

First, a word about what’s happening: Yes, it’s likely hormones. As estrogen levels decline, the vaginal lining changes. It becomes more delicate and less stretchy. There’s less lubrication and less circulation. Vaginal dryness is a typical first sign of vaginal atrophy, when vulvo-vaginal tissues shorten and tighten. It’s common; you’re not alone, and you’re not deficient.

If you’re just beginning to notice some discomfort, you can take the easy step of adding lubricant to your foreplay. Lubricants come in three types: water-based, silicone, and hybrid. My patients with dryness issues typically like the silicone and hybrid best, because they last the longest without reapplication, and because they seem just a little bit slipperier to some. Lubricants are made specifically for safe use on and in your vagina; if you want to experiment with a few, you can try our Personal Selection Kit (and read more about it here).

Next, you can add a vaginal moisturizer. While lubricants provide temporary comfort, reducing friction during sex, moisturizers work to “feed” and strengthen vaginal tissues around the clock. Moisturizing here is just like moisturizing your neck or your face: You have to be faithful! I recommend application at least twice a week. Moisturizers need to be placed directly in your vagina, which can be done with an applicator or a clean syringe you reserve for that purpose.

For some women, these two products—and the right amount of foreplay—are enough to make a difference. If they don’t do it for you, please talk to your health care provider, even if you think it will be awkward: Your sex life is important! There are localized estrogen products and a relatively new oral medication (called Osphena) that may be helpful for you, but you’ll need a consultation with your physician and a prescription.

This isn’t the end; it’s only a transition, which we as women have a lot of practice with. Take heart and take charge!

Read Full Post »

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.

Read Full Post »

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.

Read Full Post »

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?

Read Full Post »

I suspect you’ve been reading the fine print on an advertisement or packaging for one of the estrogen products—for which I congratulate you! It’s good to learn as much as you can about your treatment or options.

The mention of dementia is part of the “class labeling” required by the Food and Drug Administration since the Women’s Health Initiative in 2002. Even some non-estrogen products in this class receive the same labeling.

In one WHI study, there was a slight increase in dementia for women who used hormone therapy, but it’s important to remember that the women entering the study averaged 64 years of age. Additional studies have not replicated those results. It’s also worth noting that post-menopausal women have a greater risk than men of developing Alzheimer disease; estrogen has a role in protecting the brain and its function.

For anyone considering hormone therapy, her age and the age at which she entered menopause are critical considerations for heart and brain health. And, as I’ve said before, every woman, in consultation with her knowledgeable menopause care provider, must weigh the benefits and the risks of hormone therapy for her specific quality of life.

Read Full Post »

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.

Read Full Post »

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.

Read Full Post »

The Wrong Kind of “Hot”

Now that the FDA advisory panel has pulled the plug on two nonhormonal drugs to treat hot flashes and night sweats, what’s a grumpy, sleep-deprived, sweaty, menopausal woman to do?

For most of us, hot flashes are uncomfortable and inconvenient. For some of us, hot flashes are debilitating and make it hard to sleep or function normally. And except for hormone therapy, no treatment regimen is guaranteed to alleviate them.

So, chalk up yet another inhibitor to sex (as if we needed one). It’s hard to feel “in the mood” when your nightie’s soaked and sweat is running down your back—and this is pre-foreplay.

It may be possible, however, to manage the frequency and intensity of hot flashes with some simple home remedies. For some women, these techniques work well; for others, not so much. As in so much of life, it’s a matter of experimenting until you discover what works for you.

These more natural approaches fall into four categories: lifestyle changes, identifying the triggers, controlling your environment, stress management, and botanical remedies. If you’re bothered—or handicapped—by hot flashes, a combination of these might help. Even if the cure isn’t perfect, your overall health should improve. In the long run, that’s a whole lot better than popping a pill.

Lifestyle changes

A generally healthy lifestyle goes a long way to making you feel better all over. You’ll mitigate other problems, like diabetes and obesity, and you just might find your hot flashes are less frequent and intense as well.

A healthy lifestyle includes

  • A diet of high-quality, fresh fruits and vegetables, whole grains, low in fat and processed foods
  • Regular exercise that gets your heart-rate up and doesn’t injure your joints: brisk walking, swimming, free weights, yoga, tai chi
  • Losing weight, if necessary. You may have put on some menopausal baby fat (haven’t we all?), but be aware that a higher body mass index is related to more frequent hot flashes, according to the North American Menopause Society (NAMS).

Identifying triggers

While hot flashes are maddeningly unpredictable, they often seem associated with certain triggers, which are unique to every woman. Try to identify yours. Common triggers include

  • Caffeine, alcohol, and cigarettes (even passive smoke may be trigger one)
  • Anxiety, stress, and stressful situations
  • Hot drinks and spicy foods. If you’ve ever watched someone eating a habanero pepper, well, that’s enough to give you a hot flash right there.
  • Stress
  • Hot, stuffy, or crowded rooms
  • Activities that produce heat—ironing clothes, washing dishes, strenuous exercise
  • Did we mention stress?

Managing stress

Stress is linked in several studies to more frequent hot flashes, and you can bet they’ll happen at the most inconvenient times. When you’re heating up at a stressful moment, remember that, while embarrassing and uncomfortable, hot flashes aren’t life-threatening or even particularly noticeable to others. A few inconspicuous comfort measures will help you get through the moment, even in tense situations:

  • Breathe. Instead of panicking inwardly, consciously take deep, relaxing breaths.
  • Get up and walk around.
  • Open a window.
  • Try meditation, massage, yoga, relaxation or other therapy.
  • Maintain a sense of humor. You have to admit, the whole thing is kind of funny.

Conrolling the environment

Because the hormonal changes you’re experiencing have temporarily (or not so temporarily) messed with your body’s temperature-regulating mechanism, you can compensate (in part) by controlling the ambient temperature. Some easy ways to do this include

  • Keep the house, especially the bedroom, cool and well-ventilated.
  • Cotton (or fibers that wick moisture away from your skin) is your friend. Use cotton bedclothes and keep a spare pillowcase handy. Or, check out cooling bedsheets like those at DriNights. Keep a clean, cotton t-shirt beside the bed.
  • “Keep a frozen cold pack under your pillow, and turn the pillow often.” (From NAMS)
  • Check out the Dry Babe website for a line of “absorbent sleepwear for hot mamas.” These could lead to a little heated action of their own.
  • Wear clothes in layers that you can shed or add as necessary.
  • Carry a pretty Oriental fan in your purse.

Botanical remedies

Finally, a few botanicals have been associated with relief of hot flashes. Again, research is inconclusive: Some women are helped while others aren’t. But the remedies are relatively safe and free from serious side effects. You could try:

  • Black cohosh. Already commonly used in Europe, this member of the buttercup family may be the most promising herbal treatment for hot flashes.
  • Soy and red clover contain plant-based estrogen, which isn’t as effective and doesn’t work the same way as the estrogen synthesized for hormone treatments. Still, some women say they help.
  • Vitamin E. Again, scientific evidence is scant, but some women say these supplements work for them.

Just because a supplement is “natural” doesn’t mean it’s automatically safe for everyone. Some herbal supplements are quite potent, and others could interact with medication you’re taking or exacerbate a physical precondition you already have. So consult with your doctor or pharmacist before taking botanical remedies.

If you discover a remedy that works for you—please share!

Read Full Post »

More from the Trenches

In a previous post Dr. Susan Kellogg Spadt, a MiddlesexMD medical advisor, described some of the impediments to sexuality that she sees affecting women as they age. The list, which began with internalized ageism, sexual scripts from our families of origin, and low self-esteem, continues in this post…

Performance anxiety. Men aren’t the only ones who worry about “performing.” All those physical changes to our sexual apparatus that are discussed on MiddlesexMDvaginal dryness, pain, reduced sensation, lack of interest—can contribute to performance anxiety for women, too.

As one 52-year-old woman said, “I can no longer tell how my body is going to behave. It makes me nervous in bed.” As with men, this inability to trust or predict how your body will respond can affect your ability to enjoy or your desire to have sex. Some women (and some men) just decide not to be sexual anymore.

Women need to know that there is help for these physical changes—again, all the things discussed on the blog and the website—such as moisturizers, lubricants, vibrators, and dilators. These tools can help us remain comfortable and familiar with our changing bodies, so that we’re less anxious when we’re with our partner.

Depression. Older women get depressed at somewhat higher rates than younger women. That’s what the research says. Not only that, but the side effects of some antidepressants include decreased desire, vaginal dryness, and delayed orgasm.

So what’s a woman to do?

Talk to your healthcare provider. You need counseling for the depression, and if medications are affecting your libido, discuss alternatives with your provider. It’s not easy, but you could end up feeling better and enjoying sex again.

Lack of attraction to partner. Yes, I hear this from women—the spark is gone. They just aren’t attracted to their partner anymore.

Maybe the relationship was always difficult or lacked physical intimacy, and the couple stayed together for practical reasons. Or maybe physical changes due to the partner’s aging or illness have affected the woman’s physical attraction. According to the literature, this happens in both women’s heterosexual and lesbian relationships.

Fantasy is one way to mitigate the “turnoff.” Use your imagination to turn the frog into a prince. Sex therapy may be another aid to establishing intimacy.

Lack of partners. There’s no sex without a partner. Duh! Demographics and life expectancies being what they are, the older we get, the fewer our options for partners.

Some of us may be able to date casually or to self-pleasure for sexual release, but for others, this may not be an option. Again—no easy answer.

Making peace with the situation. “Normal” covers a lot of ground. And while we clinicians are always seeking to define it, the fact is that “normal” for one patient may be very different for another.

Despite all the impediments and changes, I’ve found that women generally find their way to a sense of equilibrium with regard to their sexuality. And we clinicians have to respect that.

You define what’s normal for yourself. If you are at peace with your decision to abstain from sex, then abstinence is normal for you. Likewise, if you choose to be sexually active well into your nineties, then that’s also normal.

However, if you experience frustration, anxiety, discomfort, or pain regarding your sexuality, then you should bring this up with your healthcare provider. We can help, and sometimes the solutions are simple.

Read Full Post »

Older Posts »

Follow

Get every new post delivered to your Inbox.

Join 298 other followers

%d bloggers like this: