Feeds:
Posts
Comments

We blather on regularly at MiddlesexMD about the importance of good health—staying active, eating well, exercising, maintaining a healthy body weight. Given the many exercise fads that come and go (remember Jazzercize?), maybe it’s time to get specific about ways a mature woman can stay in shape.

Yoga is one of the best. Hardly a fad, yoga’s been around for at least 5,000 years; the earliest mention is in sacred Ayervedic texts in northern India. In the US, it’s now a $10 billion-a-year industry with 20 million practitioners.

As you can imagine, many styles of yoga have developed over the millennia, but the main forms you might encounter are:

  • Hatha. The most familiar style that focuses on the breath while holding various poses.
  • Vinyasa. Series of poses that flow smoothly into one another.
  • Bikram. You might have heard of this “hot” yoga style that involves a specific series of challenging poses done in a very hot room.
  • Iyengar. This type uses props, such as foam blocks, straps, or blankets to maintain comfort and good form during poses.

What all these flavors have in common is a focus on the breath as a meditation and on moving at various speeds through a series of poses, which are sometimes very challenging. As such, it combines the calming effect of meditation with bodyweight strength-training of held poses.

The benefits of a regular yoga practice are impressive. Yoga clearly increases flexibility and strength, and improves balance. According to a slew of studies, the mind-body effect of yoga may also relieve stress and depression, lower blood pressure and heart rate, stabilize blood sugar levels, relieve chronic neck and back pain, and even improve brain function.

Referring to a 2015 study published in The European Review of Preventive Cardiology, an article in the Harvard Heart Letter reports, “over all, people who took yoga classes saw improvements in a number of factors that affect heart disease risk. They lost an average of five pounds, shaved five points off their blood pressure, and lowered their levels of harmful LDL cholesterol by 12 points.”

Despite the fact that some of these studies are small and not terribly rigorous, the consistent result is that, while yoga isn’t a cure-all, it helps to relieve some surprising conditions.

One of those small studies published in the Journal of Sexual Medicine reported that yoga can even improve sexual function. In this study, 40 women practiced yoga for an hour every day for 12 weeks. At the end of the study, 75 percent of them reported improvement in sexual satisfaction on several assessment areas, such as lubrication, desire, arousal, and pain. Women over 45 showed the most significant improvement in lubrication, arousal, and pain.

The good thing about yoga is that you can jump in and feel challenged at any fitness level, from couch potato to workout devotee. It’s low-impact, so it’s easy on the joints. It isn’t competitive, so you shouldn’t be looking over your shoulder (or between your legs) at the next person. It doesn’t require any equipment other than a mat, so don’t stress the gym wardrobe.

You can find yoga workouts online or on DVDs, but classes are offered everywhere as well. The glut of choice actually makes teasing out the best choice for you more challenging. It took hours of online searching to find a workout that fits my ability but that also avoids an annoyingly smarmy monologue or off-the-wall comments about hairstyle or the leader’s latest manicure. (Not kidding.)  I ended up sampling the beginner clips from this list.

Taking a bricks-and-mortar class may be the best option for maintaining motivation, but also for feedback and advice on proper form and avoiding injury. Check out the background of the person leading the class. Barriers to entry are low, so anyone can teach yoga with a few hours of training. You’ll want someone with experience and many years of practice in the discipline.

“To my mind, a good teacher always asks, ‘Are there any injuries or conditions I should know about before we get started?’” writes Julie Corliss, editor of the Harvard Health Letter.  She also advises checking out a few different classes to find a good fit.

 

You say that you and your partner use manual and oral stimulation, since you’re no longer able to have intercourse. Your partner requires extended stimulation, and you’re wondering what might help.


Stronvivo is a nutritional supplement developed for men’s cardiovascular health; it’s been found to significantly improve sexual health–because circulation is integral to arousal and orgasm. It is used for both male and female sexual health, improving both desire and function (ability to arouse and orgasm). I’ve had many women report improved ability to orgasm, and the clinical trials report the same for men.

The other factor to consider is medications that may be interfering with orgasm, or hormonal factors, like low testosterone. I’d strongly recommend a conversation with his physician, if he hasn’t already had one, to see whether there are health factors to consider.

Good luck!

You say you’re using a vaginal estrogen cream, and using Kegel weights with an aloe vera gel. You’ve had two yeast infections since you started using both.

You asked. Dr. Barb answered.If you are fairly new to using estrogen vaginal cream, it may be the cream that is causing the vaginal yeast infections. The estrogen cream lowers your vaginal pH (and a lower pH is a healthier status; here’s a summary of healthy pH levels) over the first 8-12 weeks of use. The transition from the higher pH (atrophic) to the lower pH puts women at risk for yeast infections. This should not persist, and in the end the estrogen cream is likely to be beneficial to you.

Using the kegel balls shouldn’t cause a yeast infection, but if you’re prone to yeast infections, a pH-balanced lubricant like Yes WB may help prevent them. pH matters!

 

Sex after menopause can be challenging. This website and my medical practice is dedicated to addressing those challenges, so topics like dry vaginal tissue, pain with intercourse, loss of libido get a lot of press here at MiddlesexMD.

But for once, let’s turn the picture on its head. Let’s look at postmenopausal sex from the sunny side of the street.

Sure, menopause isn’t for the faint of heart. It’s a hormonal roller-coaster with a chaser of unpleasant side-effects. Sex can become collateral damage during all the turmoil.

But the big picture? The view from the top of the hill? Not so bad at all. In fact, depending on your inner resources and resolve, both sex and life after the big M can look pretty darned sweet. Some women even report experiencing a resurgence of desire, sort of golden age of post-menopausal sex.

Several elements tend to coincide during those post-menopausal years that contribute to a more serene, predictable life and the potential, at least, for a renewal of romantic zest. For example:

  • More time; less stress. Retired or not, you’re probably past actively building a career. The kids are independent and maybe out of the house. You aren’t completing financial reports while sitting at basketball practice. You can linger over a pinot grigio and actually listen to the Tchaikovsky Concerto in D Minor without the distracting din of kids fighting.
  • No periods; no pregnancies. A lot to celebrate here. The years of birth control (and worry about the Whoops! factor), the discomfort and nuisance of menses—all in the rearview mirror. You can sleep in and take the triple gatehook locks off the bedroom door. Canoodling can last as long as you want.
  • Financial freedom. Generally speaking, the hamburger years are over. You can afford steak, a night out, a nice bathrobe, or even a romance-inducing cruise. All of which can make you feel relaxed, sexy, and vital—and more connected to your honey.
  • Fewer crazies. As the hormonal ride levels off, you’ll feel more stable, mature, and confident. You know what you want, sexually speaking and otherwise, and you know how to ask for it. You’re coming into your own—no one is the boss of you.
  • Synchronicity. With maturity, the sexual needs of men and women tend to converge. Men slow down and value emotional connection. Women become more assertive. It can be a great time for playful exploration on all levels.

Intimacy at midlifeGranted, aging comes with challenges, and they can be unpredictable. But growing older and staying sexy is more about your attitude, and the resources you bring to bear than what’s happening below your neck. “So here’s the big reveal,” writes Barbara Grufferman in this article. “After 50, we’re at a sexual crossroads, and need to make a choice: We could go through menopause, shut down that part of ourselves, lock the door and throw away the key. Or we could embrace this new life with a sense of freedom and fun…”

So that’s the thing: it’s a choice. There are no wrong answers (unless they hurt your partner); instead, you have lots of options. Barriers to good sex are very fixable, both for men and women.

Here’s a list of simple things you can do to enjoy these golden sexual years to the full:

  • Preheat the oven. You are responsible for your own arousal, so get to know your body and what it likes. Read erotica. Play with toys. Then teach your partner. Don’t wait passively for Prince Charming to ring your chimes.
  • Just do it. Sometimes you have to begin in order to get aroused. Start the kissing and cuddling. It’s quite possible that your brain will catch up. “If you’ve been ignoring, neglecting or denying your sexual self for a while, then you must consciously decide that you want sex in order to even let yourself feel desire,” writes Grufferman.
  • Sex leads to more sex. “Women who have regular sexual activity have less sexual dysfunction [and fewer] complaints,” says Dr. Madeline Castillanos, a psychiatrist and sex therapist in New York City. It’s that “just do it, you’ll like it” thing again.
  • Take your time. You don’t have to hurry, and you don’t even have to please your lover. Turning you on is a big turn on for him, too. So you can relax and let go of the worn and useless sense of duty about getting him and yourself off expeditiously.
  • Engage in outercourse, says Dr. Sheryl Kingsberg, a psychologist with University Hospitals Case Medical Center in Cleveland. Involve all the senses; practice luxurious, languid, voluptuous sex that may or may not actually require penetration. Most of all, have fun doing it.

According to the experts, the most dependable predictor of good sex after menopause is good sex before menopause. And if it wasn’t so great before, time’s a-wasting. You can apply your hard-won life skills and your intimate knowledge of your partner to begin addressing the issues that stand in the way of intimacy and a solid sex life.

You say you’ve had a period and some breast tenderness after three years of hormone therapy (HT). I hope you’ll make an appointment with your health care provider: Any bleeding that occurs postmenopausally (after 12 months with no bleeding) is considered “abnormal uterine bleeding” and it really deserves evaluation. This is true whether or not you’re on HT.

The evaluation is usually an endometrial biopsy, a quite simple office procedure. Women on hormone therapy are at very low risk of developing uterine cancer, but we still want to make sure the proper evaluation takes place. Usually the biopsy is completely benign or normal, and we aren’t able to explain why it happened.

You asked. Dr. Barb answered.When the bleeding is accompanied by other associated symptoms, like breast soreness, it is tempting to attribute it to a “last hurrah” or one last period, but that is unlikely. Any missed doses of the HT or changes in dosing can occasionally contribute to some breakthrough bleeding. The most likely scenario is that the hormone therapy contributed to the symptoms of the breast soreness and the bleeding, but without any changes it’s hard to explain why that might have happened now, three years after menopause.

Again, evaluation usually confirms that all is normal, but it’s worth making the effort to be sure!

Not much is known about addiction to pornography, not the numbers of people affected; even the definition is hazy. There just isn’t a body of research surrounding the issue.

“There is a real dearth of good, evidence-based therapeutic literature,” says Dr. Valerie Voon, a neuropsychiatrist at the University of Cambridge in this article.

The relatively recent advent of the Internet has revolutionized the world of porn, serving up  raw, unfiltered, hard-core, and nonstop stimulation. The result is a cohort of (mostly) men who have become addicted and desensitized to the dopamine rush of a constant barrage of online porn. Occasional porn consumption is common, but therapists and doctors are seeing more relationship and sexual performance difficulties among heavy porn users—behavior that looks a lot like addiction.

Discovering that your partner uses porn addictively is a crushing, confusing experience. Women compare it to the betrayal of discovering an affair, except that the “other woman” is a computer screen that is available 24/7 and that doesn’t look or act like a normal woman.

A partner’s initial response is often denial: Is it really so bad? Doesn’t everyone view porn sometimes? Is this normal?

The morality or “normalcy” of porn use is a different conversation, but when a partner becomes secretive and withdrawn, when he can’t stop the behavior even at work or, as one woman discovered, during a weekend visit to her parents; when porn use creates difficulty in real-life sexual performance; when it causes pain and conflict, then it’s an addiction and it isn’t normal.

Porn addiction is socially anathema—people don’t talk about it or easily admit to having a problem with it. Support groups for partners of porn addicts are rare. And research-driven treatment for porn users themselves is also rare. The most common treatment is called a “reboot” in which porn users are counseled to stop masturbating to online porn until their brain chemistry and ability to engage in real-life sex is regained, which may take months.

The behavior of porn addicts is similar to other addictions. They minimize their porn consumption or outright lie about it. They may accuse the partner of causing the problem. They withdraw and hide what they’re doing. They may gaslight—a newly vogue term that refers to undermining the partner’s grasp on reality by lying, evading, bullying, and blaming.

This dynamic is devastating and toxic. Partners of porn addicts are often recognized as having symptoms of PTSD-like trauma.

The non-porn-using partner may try to control “the addict’s access to porn through anger, snooping, crying, guilt tactics, threatening, shaming and blaming the addict. This destructive behavior was once considered co-dependent, but those of us who work with partners of porn addicts now view these actions as symptoms of trauma,” writes Mari A Lee, sex addiction therapist and co-author of Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts.

As with any addiction, the path to recovery is difficult and riddled with relapse. The harrowing challenge to a partner of a porn addict is to maintain her own integrity and emotional health while offering her partner forgiveness and the space and support to manage his recovery, if he so chooses.

Women who’ve been there say:

  • This isn’t about you. Your partner’s behavior has nothing to do with how you look, how much you weigh, or your performance in bed. Don’t take the blame. “[P]orn addiction is not about [the non-addicted partner’s] worth or value, it is not even about sex; instead, porn addiction is about soothing pain,” writes Lee.
  • “You did not cause it. You cannot change it, and you cannot control it.”
  • Try not to let your partner’s addiction take over your life or consume your thoughts. Set goals. Stay active. Stay healthy.
  • Try to find support—a therapist, a group, a trusted friend.
  • Respond to your partner with as much compassion and forgiveness as you can muster without becoming sucked into the addiction.

A partner’s addiction may be one of the most painful and difficult knuckle sandwiches that life can smack you with. It attacks the very foundation of trust, security, and intimacy that a relationship is built on.

However, there is hope, both for your own healing and the recovery of your partner. “When each person makes the choice to end the destructive dance of addiction, blame, shame and hurt, and instead chooses to move toward healing and recovery – miracles can happen and relationships can heal,” writes Lee.

A patient came to see me a few days ago. She had been in a sexless marriage for years—and she had recently discovered at least part of the reason. Her husband was addicted to pornography.

This is more common than you think. It’s also not a simple problem.

Lots of people—men and women—consume porn at least occasionally. Estimates range from 50 to 99 percent of men and 30 to 86 percent of women—numbers that are so broad and vague as to only suggest “a lot.” Women tend to watch porn with their partner and to consume softer types—erotica might be a better term. Women usually report feeling greater intimacy with their partner after viewing porn.

Men tend to consume porn alone, and it portrays sometimes aggressive and sometimes deviant forms of sex. A heavy diet of this can cause them to withdraw from intimacy and to feel “increased secrecy, less intimacy and also more depression,” says Dr. Ana Bridges, a psychologist at the University of Arkansas in this article.

Porn has been around since time immemorial. What’s changed is the amount and type of porn that’s available online all the time. We aren’t talking about the Playboy or Hustler magazines from a previous generation. This is hard-core, porn-on-steroids content served up in any flavor to satisfy the wildest imagination. These aren’t normal bodies, it’s not real sex, and it’s available any time, day or night.

Although the scientific community has been hesitant to label such consumption as an addiction, and although many people, perhaps most, view porn occasionally without guilt or moral quandary, plenty of anecdotal evidence suggests that a problem is brewing.

Whatever you call it—addiction or compulsion—when an activity becomes uncontrollable and consumes many hours; when it affects performance at work, compromises intimate relationships, and physical or emotional health, then it’s a problem.

Therapists and doctors are increasingly seeing patients who report less interest in sex and sometimes an inability to have sex in real life. Erectile dysfunction is showing up in greater numbers, especially in young men who began viewing porn while still in their teens.

Or, like me, healthcare practitioners are hearing from confused, distraught partners who don’t understand what’s happening to their partner and to their relationship.

The mechanism that creates the problem is only beginning to be studied and understood. Consuming porn many times a week over a period of months (or years) is a solitary, alienating, guilt-inducing pastime.  It frequently changes the way a person interacts sexually with a partner in real life—the person is often more impersonal, distant, and sometimes rough or demanding. Sometimes the person withdraws from the partner altogether.

Heavy porn viewing actually changes brain chemistry. In a small but carefully conducted study, a group of German researchers determined that high levels of porn consumption results in a shrinkage of gray matter in a specific region of the brain. Researchers were unsure whether this reduction was caused by the “wearing and downregulation of the underlying brain structure” due to hours of porn consumption or whether the subjects consumed porn because they had less gray matter in this area to begin with and needed more stimulation to experience pleasure.

Generally, however, the hypothesis is that heavy porn consumption desensitizes the viewer, so that more intense levels of consumption are required to reach the same level of satisfaction. “You need more and more stimulation as you build up this tolerance, and then comes your reality with a wife or partner, and you may not be able to perform,” said Dr. David Samadi, chairman of urology at Lenox Hill Hospital in this article. “It’s a problem in the brain, not the penis.” As such, drugs for erectile dysfunction, such as Viagra, aren’t effective. The penis may engorge, but orgasm doesn’t follow.

Obviously, ongoing porn consumption is problematic for a relationship. It can persist for years, with trust and sexual intimacy almost inevitably becoming collateral damage. The situation is confusing, hurtful, and debilitating to a partner, in part because the issue is so socially unsavory and so rarely discussed.

I’m thinking it’s time to crack open the door and begin talking about porn addiction, how to recognize it, and what a partner can do about it.

 

 

%d bloggers like this: