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You asked. Dr. Barb answered.You say you’re hoping to enjoy intercourse again after a five-year hiatus, but that you experienced some discomfort with your last gynecological exam. The prescriptions offered to you (which I assume were localized estrogen) are not in your budget, so you’re wondering about other options.

A vaginal moisturizer, used regularly, can help you regain some tissue elasticity. Any of the moisturizers we offer might be an option for you; they’re intended to be used regularly, from daily to several times a week.

Along with thinner and fragile tissues, in menopause, without estrogen and without sexual activity, the vagina will become more narrow and shortened. You may need the gentle stretching of dilators to help restore vaginal capacity.

I’m hopeful that, with some effort and regular attention, you can restore vaginal health to resume pleasurable intercourse!

New Year Resolution #1

Resolutions are easy to make and hard to keep (most people don’t). However, as we mentioned before, certain psychological tricks can increase your chances for success, and sheer persistence is one of them.

In the spirit of successful resolutions, I propose devoting January (yes, the whole month) to specific health-related resolutions. In fact, each one focuses on an often neglected body part that is critical to good sex and/or well-being.

First up? The pelvic floor.

You might not think much about your pelvic floor, but it affects you every single day. That surprising leakage after your firstborn child? That need to pee every half hour now that you’re post-menopausal? The more frequent UTIs? The slack “vaginal embrace” during sex? That really annoying pelvic organ prolapse that’s causing all manner of issues?

Strengthen your floorAll these annoyances (and more) are related to the muscles in your pelvic floor. That’s why we write about pelvic floor health and doing kegels so much on MiddlesexMD. That’s why a healthy pelvic floor is part of our recipe. That’s why we have products to help you do those kegels right.  It’s all because a healthy pelvic floor is so darned critical to our quality of life, especially as we get older and lose muscle tone and elasticity.

While many lifestyle improvements—losing weight, not smoking—will coincidentally improve the pelvic floor, they aren’t the stuff of resolutions that are easy to keep. Kegels, on the other hand, are specific, countable, time-limited, and realistic—all the elements of a solid, successful program.

And now, they can be fun! (Another element of success.)

A new smartphone app combined with a high-tech vaginal tool was recently launched on the crowdfunding website Indiegogo. Perifit is an exercise tracker/trainer for your pelvic floor. It’s comprised of a flexible, bulbous, silicone tool that goes in your vagina and sends low-energy Bluetooth signals to an app that is downloaded onto your smartphone, tablet, or laptop.

For resolution success, make it specific.If you’re successfully tightening your pelvic floor, a butterfly stays afloat on your device. The tighter you squeeze, the higher it flies. Not only will you know if you’re tightening correctly, but the tool also measures both deep and shallow muscles contractions as well as their effectiveness against four parameters: force, endurance, reflex, and agility. You also get to choose among several training programs targeted toward specific issues, such as different types of incontinence or post-childbirth trauma.

The program isn’t cheap, and it’s also new, but it’s a hugely fun concept and casts the notion of doing kegels in a refreshingly different light. If nothing else, watch the video with the adorable baby and draw comfort from the fact that women of all ages are working on their pelvic floor.

Like any workout, developing pelvic floor muscle takes time and consistency. Whether your success with this program depends on a butterfly video or vaginal weights or your own self-discipline, you have choices among several tools, one of which might align well with your personality.

The last element to a successful resolution is persistence. Of course you’ll forget or skip days or get lazy. The secret is to pick up where you left off and keep on going. Set up a realistic, measurable program. Healthline recommends holding a kegel for a 3 seconds; releasing for 3 seconds and working up to a 10-second hold.  Three sets of 10 ten-second reps a day is a good goal.

Developing pelvic floor strength isn’t as obvious or satisfying as working on tanktop arms or a bikini belly (if that’s even possible anymore), but it is arguably more important. Avoiding or reducing incontinence, UTIs, and pelvic organ prolapse while increasing sensation and vaginal strength for better sex is nothing to sneeze at.

I’m afraid this is a complicated issue. A dozen different contributing factors are possible, and the challenge you and your wife face may be a combination of them. You’re not alone, which is, I recognize, both bad news and good news.

I’ve addressed low libido and many of the contributing factors in blog posts before. Here’s the introduction to the topic on our website; here’s a blog post with additional explanation. Here is a list of answers to specific questions readers have submitted, including certain health conditions or medications which can inhibit libido as a side effect.

You asked. Dr. Barb answered.You didn’t describe your wife’s overall health; I hope she’s had a recent evaluation from her health care provider and has mentioned her loss of interest in intimacy. He or she can help to determine the cause, which will then point to the best options for treatment. You may also find a couples therapist or a sex therapist to be helpful, since emotional as well as physical factors come into play in intimacy.

I do wish you the best with finding the cause and some ways to address it! Physical intimacy adds meaningful dimensions to our relationships.

So Grateful For You!

This is my quiet moment—the pause between the years, the time of taking-stock. One thing I know for sure—I have a lot to be grateful for this year!

Here's to good health and good sex.It’s been more than ten years already since I decided to specialize in the sexual needs of women in midlife—women like you and me. As I mention here, I wanted to provide clinically sound, research-driven information to women who are caught in the throes of the menopausal transition. I wanted to address our sexual issues head-on, without embarrassment or beating around the bush. I also wanted to provide a safe, tasteful environment in which you could actually buy the products I was recommending—vibrators, lubricants, moisturizers, dilators, vaginal weights.

That was the rationale behind MiddlesexMD. I envisioned a space in which to communicate with a lot more of you than I could see in my clinical practice. A place where you can ask questions or start a conversation and where I can discuss whatever’s on my mind—from research on new drugs and therapies to tips on maintaining sexual intimacy. And we did put together a shop, where you can find those safe, tested, high-quality products, and have them mailed to you in discreet packaging.

It’s been a journey, that’s for sure—rewarding, challenging, busy, and sometimes unexpected. In 2013, the North American Menopause Society awarded me the “Certified Menopause Practitioner of the Year.” Late last year, I published my book, Yes, You Can: Dr. Barb’s Recipe for Lifelong Intimacy. The book uses my recipe for sexual health and draws from the accumulated wisdom on MiddlesexMD—your questions, the blog posts, and my own thinking.

Response to the book has been wonderful. It was a banner year for interviews on various media outlets about the book and my work. I’m grateful for these opportunities to communicate to a broader circle of midlife women that they have options, that sex can still be rich and fulfilling, and more importantly, that they are not alone.

When I began this endeavor, I couldn’t have anticipated how gratifying it would be to meet such resilient, independent, inquisitive women who are tackling life’s challenges gracefully and well. I’ve been honored to share this journey with you and to provide some support and information that may make the experience easier and, I hope, more joyful for you.

So, my friends, here’s to good health and good sex. Thank you for sharing your journey with me.

One Year to Better Sex

The Art and Science of Resolutions You Can Keep (Sexually Speaking)

What is it about that first, unblemished day of a new year? The first white page of a journal? The hush that follows merrymaking; the pause before the quotidian rushes in again?

I’ve always loved that moment of held breath after one year ends and before the next begins. For me, it’s a day (or, more realistically, an hour) of reflection when I remember, take stock and my own measure, of what the year has brought, and how I’ve responded to it.

Resolutions, however? Not so good.

Turns out, there’s a bit of art and science to resolution-making—a few principles that increase our odds of success. In the spirit of helping us all out to a solid start, let’s explore ways to make our resolutions stick. (Success is always affirming.)

And secondly, instead of resolutions focused on self-improvement, let’s explore resolutions that focus on relationship-improvement.
Don't give in. Get up and start again.Far be it from me to diminish the value of losing weight (#1 on the list of New Year’s resolutions for 2015) or of “staying fit and healthy” (#5), but I would suggest that, in addition to these worthy goals, you get a lot of bang for the buck when you work on your sex life. According to relationship consultant Dr. Sheryl Kingsberg, a good sexual relationship adds significant value to a relationship (15-20 percent), whereas a poor one actually drains a relationship significantly and negatively (50-70 percent).

Since only 8 percent of the people who make resolutions actually achieve them, let’s look at ways to beat those dismal odds.

  1. Make it fun. The good thing about improving our intimate relationship is that it doesn’t have to be a grinding exercise in self-discipline. In fact, it shouldn’t be. You want to tickle the most primitive pleasure centers in your brain—the part that eons of evolution fine-tuned so that sex is pleasurable and intimacy is deeply satisfying. So, for this resolution at least, a light touch and playful intent is better than acts of will and grim resolve.
  2. Make it specific. Grandiose is good but measurable is better. Dr. Paul Marciano, author of Carrots and Sticks Don’t Work, advocates SMART goals: Specific, Measurable, Achievable, and Time-bound. What this might look like vis-à-vis our sex life is: This month I will improve my pelvic health by using vaginal moisturizer daily and a few reps of kegels four times a day. Or: I will notice at least one thing I like about my partner every day, and I will express appreciation for it. Or: I will suggest one new position for us to try each month. Or: We will reserve two evenings a month for a romantic date.
  3. Be realistic. I had a friend who would periodically go on an extremely rigorous regimen of weight loss and exercise. She’d cut out all sugar and strictly limit caloric intake; she’d walk four miles every day, and she’d do this for month. She’d lose weight and look great. But inevitably, the sheer difficulty of her regimen was its undoing. She couldn’t keep it up. So, she’d crash and burn with the same intensity, putting all the weight back on and then some. It was painful to watch.

Even with something that’s supposed to be light-hearted, like improving your sex life, you should realistically assess what is likely to work for both you and your partner. Maybe planning a romantic evening at home would work better than a night out. If your partner isn’t entirely on board, maybe you’ll work on your own sexual health and subtly introduce changes

  1. Write it down. Or better yet, get your partner’s suggestions and buy-in, so both of you are involved. Resolutions are more likely to be successful when you’ve made a verbal or written commitment.
  2. Persevere. Of course your resolve will wax and wane. Of course you’ll forget about your date night or run out of nice things to notice about your partner. We are all inextricably pulled back toward the dog path. We are all tempted by that niggling voice that whispers, you’ve already missed two months. Just give up.

Don’t give in. Get up and start again. That’s the very essence of discipline—keeping on.

Next January 1, when you reflect on the year just passed, I hope you can derive some quiet pleasure in having moved the intimacy needle a bit and generally banked some points in your sexual wellbeing account.

I know it can seem like ob/gyn offices are full of pregnant women! And while general practitioners can be extremely helpful, sometimes you want the extra training and focus of a menopause care specialist.

You asked. Dr. Barb answered.I recommend finding a menopause provider in your area by going to the North American Menopause Society (NAMS) website, where you can enter your zip code and specify a mile radius to find a practitioner near you. Note that you can also check the box (NCMP) to limit the search results to NAMS-certified providers, who have completed additional focused training and receive ongoing updates on research and recommendations from the society.

Continuing with our series of tips for holiday sanity, and even enjoyment, this is the most fun suggestion of all: Schedule a quick, romantic getaway for after the holidays to re-connect with your honey and get some downtime in a sweetly unfamiliar place.

You want to keep the emphasis on the fun and not get carried away with anything elaborate and expensive. A weekend away with minimal planning increases the chance that you’ll actually do it—no good excuses, and it’s easy to find someone to check in on the cat.

A quickie in midwinter can be especially economical and especially delightful. You’ll encounter a laid-back and welcoming atmosphere that’s lacking in the midst of summer tourist season. You’ll also encounter off-season rates.

Give yourself a treat.I fondly recall a midwinter weekend in a tourist town near my West Michigan home. Yes, some places were closed for the season, but the rest of the town was just as scenic and beautiful in winter. We eavesdropped on local chatter in the diner and neighborhood pub that had been crawling with tourists just a few months before.

So, here’s my down-and-dirty guide to a relaxed, relationship-rejuvenating weekend in the middle of the long winter night.

  1. Keep it simple. Vacations can be exhausting, but you’re already exhausted, so don’t engage in deficit energy spending. Don’t plan rounds of museum visits or post-holiday shopping. Don’t plan to do anything, unless both of you really want to. Make that a ground rule.
  2. Keep it local. You don’t want to add an 8-hour drive to both ends of your weekend. Unless you live in the middle of the Badlands, you probably already know about cool places within a few hours—maybe a B&B you always wanted to visit or a quaint town with a couple good restaurants and a sweet vibe.
  3. Make it about the two of you. You don’t have a lot of time, so make it count. One nice meal. A few nice bottles of your favorite beverage. You can always stream a sweet or sexy or even erotic movie in your room. Don’t forget your toys, lubes, and oils.
  4. Get your sexy on. Don’t go overboard. (See #1) But a new camisole can make you feel like a million bucks. A nice lotion or essential oil on your skin. A shave. The little things.
  5. Only pillow talk. Don’t bring up anything more challenging than what movie to watch or whether to go out for dinner or order room service. Lay unpleasantries firmly aside. There’ll be plenty of time for the serious stuff when you get back.
  6. Create memories. Bring a favorite playlist or a wine you both love or a movie that’s significant. Pack a few favorite snacks. You could bring photo albums of Christmases past to browse through.
  7. Just do it. Don’t overthink. Don’t plan. Don’t put it off, or your calendar will fill up. Pick an inviting location nearby; pick a weekend; make a reservation; go!

Keep the emphasis on the fun.You are now approaching the crescendo of holiday preparation. Give yourself a treat to look forward to. A weekend getaway won’t break the bank but will ease both of you out of the post-holiday, wintertime blues. And maybe just knowing you have this special weekend on the calendar will remind you to be more gentle with each other during the holiday frenzy.

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