Archive for March, 2010

As a general rule, women over 40 need more stimulation to become aroused enough for good sex. When we were young, just thinking about making love with our partners may have been enough to arouse us physically, but as we grow older, as sex hormones decrease and distractions build, it takes more. But not too much more. For some of us, reading a steamy novel will do it. For others, visual stimulation works better. A hot movie, for instance.

Ever since I first conceived of MiddlesexMD, one of my goals has been to gather a tasteful collection of erotica, visual and verbal art that will stimulate arousal in older women. All we had to do is find it, right? How hard could that be?

None of us at MiddlesexMD had really explored the world of erotic art. So we set our product buyer to work, buying up a sampling of the “state of the art,” beginning with films. She studied and chose a good selection, from how-to films to soft-boiled, story-centered erotic movies. We chose films targeted at women. And films targeted at older women. As the DVDs piled up in our product room, we decided to take an analytical approach to our selection.

Sort of analytical. We each invited a few girlfriends over for glass of wine, a viewing and a discussion.

Our goal was to review these films to gather criteria and characteristics of films that most appealed to our friends — some way to inform our buying choices for the store.  Which would they use? Which would they recommend to their friends or watch with their partners? How would they rate them? What, specifically did they like about each? We had our notepads and our pens poised. We had poured the wine, curled up in front of the TV…

And then, showtime!

One film after another… fell flat on its face. We couldn’t watch more than a minute or two of any of them without reaching for the eject button. There was no analysis, no rating, no pulling apart criteria. We all… hated everything about all of them.

And we were disappointed. Really? Does it all really have to be so awful? We began again, discussing scenes in mainstream movies that we love, that work for us.  We could easily name dozens of scenes that made us blush just recalling them. Scenes from the English Patient, Room with a View, Breathless, Nine and a Half Weeks, Body Heat, The Piano, Atonement, Shakespeare in Love, The Unbearable Lightness of Being, Looking for Mr. Goodbar, The Godfather, Sweetland, The Graduate, Under the Tuscan Sun, Thief of Hearts, Vicky Christina Barcelona, Moonstruck, anything with Daniel Craig in it. We exausted ourselves thinking of the scenes.

And what characteristics did these movies and scenes have that mattered to us? The story is important, the emotions feel real. There is a buildup of passion, tension, and release. The woman’s seduction receives detailed attention. In short, there is romance.

What we didn’t like? Explicit sex. Mechanics. We really enjoy using our imaginations to fill in, and are perfectly happy with closeups of rapt faces.

We learned a lot from each other that night. We learned, too, that among our friends, at least, we’d all rather read a good sex scene than watch one. So now we’re looking for really good erotica to offer in our store.

How about you? Have you found tried-and-true erotica that works for you? What do you like about it? Have you failed to find anything? What is it about the works you’ve tried that doesn’t work for you?

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A lot of the patients in my menopause practice are single women. My patients who have no sexual partners can be quick to dismiss my questions about sexual symptoms, figuring that without a partner in their lives, they have no sexual concerns.   I have two worries about that.

First, you don’t need a partner to have orgasms. Self-satisfaction is good for us physically and mentally. As a doctor, I often encourage women to consider this, particularly older single women, because of the health benefits.

Second, self-stimulation helps us maintain patent vaginal tissues.

My friends would like me to point out that “patent” is a term doctors use when talking about tube-like structures. Patent means “open.”

Maintaining patent vaginal tissues means making sure your vagina remains open, usable, in case one day you do find someone worthy of a sexual relationship.

If you have lived with your vagina for 40 years without giving it much of a thought, you should know that its patency has been maintained largely through hormonal influence. Now, as estrogen declines, particularly if it declines abruptly (as it does in surgical menopause), the tissues of your vagina will become thinner and more fragile, and circulation to those tissues will decrease.

If your vagina isn’t receiving any stimulation, those changes will happen more quickly. The more you use your vagina, the slower the changes go. When we say “Use it or lose it,” this is what we mean.

I have met plenty of patients who did not know that vaginas need to be maintained. When you can’t see the vagina and have little use for it, it’s easy to completely forget about it.  Tissues became thin and dry, in more extreme cases the walls of the vagina adhere to one another, losing patency. In lay terms, vaginas begin to close up.

This can be very upsetting when love comes along later and we are faced with months of therapy to reopen and restore the vagina. It can be done, but it’s so much easier to maintain patency than to lose it and then work to get it back. Often you can’t completely restore what is lost.

What does it take to maintain patency? There are plenty of options ranging from localized estrogen therapy you can discuss with your doctor, or use of vaginal moisturizers, lubricants, and dilators. We also recommend regular clitoral stimulation, to maintain blood flow and keep your clitoris strong and responsive. And of course, Kegel exercises, which will not only help us maintain strong orgasms, but helps us retain urinary continence too.

We work hard after 40 to maintain our skin, our hair, our bodies, brains, and hearts. Why not our vulvovaginal tissues too? Strong vaginas are not just for couples!

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None of us get through our adult lives without some questions about sexual functioning. And we go lots of places for answers, consulting family, friends, texts, the Internet, piecing together a quilt of inter-generational wisdom and ideas, sifting through marketing hype at the drugstore, trying to self-diagnose our situation and find the fastest-best-cheapest way to make it better.  Or sometimes we simply live without answers to our questions, wondering and miserable.

This is a time-consuming and inexact way to learn that can lead to some uncomfortably misguided behaviors (Yogurt douche, anyone?).

Is there a better way? We think there is: You deserve a Sexually Literate Doctor.

Surveys tell us only 14 percent of men and women between ages of 40 and 80 have EVER discussed sexuality or sexual health with their doctors.  I attended a women’s sexual health conference this month, and out of 100 people in the audience, only one had EVER been asked by their doctor about sex.

That is, women who have worked for years with their gynecologist to bring their babies into the world don’t discuss sex with them. When discussing menopause symptoms and treatment, sex doesn’t come up. Women are more comfortable ignoring the sexual changes or treating  sexual difficulties from drugstore or pantry shelves than through interaction with their health care providers.

And there’s good reason. For most of our lives, our physicians couldn’t help us. Most of them simply didn’t know how.

Until very recently, not many doctors had the training to discuss female sexual function, and particularly post-menopausal sexual function. As recently as 10 years ago it was common for a physician to receive just an hour or two of training in female sexual function during their entire residency.

That’s why I started MiddlesexMD!  Sexual literacy among physicians is getting better every day, but until thorough sexual health training is common in our medical schools, we still have to look around a bit to find a Sexually Literate Doctor who can answer our questions when we need help.

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