Archive for March, 2011

Of course, we’d all love to enjoy good health and great sex until the day we die peacefully in our sleep. While we can control many aspects of our health, sometimes we just draw the short straw. Conditions like arthritis, heart disease, cancer, and lung problems can change our lives, our self-image, our relationships, what we’re capable of doing, and our experience of the world.

And without attention, our sex life with all its pleasure, tenderness, and intimacy can become collateral damage in the wake of illness.

MiddlesexMD_BirdIt doesn’t have to be this way. In fact, it’s a shame to forgo that shared pleasure and special bond just when it’s most needed. Despite the challenges, there’s no need to lay aside your sexual self in the face of health issues. And there’s every reason to make the effort to reinvent and reinvigorate the way you experience and express sex in your relationship.

In fact, illness could challenge you to communicate in ways you never did before. You might learn to enjoy the moment and be grateful for what’s left—or at least take less for granted. And the physical limitations of illness could lead you and your partner to become more sexually aware, patient, and experimental than ever before.

Recently, I attended a conference of the International Society for the Study of  Women’s Sexual Health (ISSWSH) at which a presentation on sexual rights reminded me of the many patients who try so hard to maintain normal lives in the face of life-changing health issues. This declaration of sexual rights is derived from a more extensive document first articulated by the IPPF.  Here are the sexual rights as they relate to you—mature women who are redefining their lives, including their sexual lives, in the face of illness. You have the right to

  • the highest level of sexual health you can attain
  • information related to sexual health
  • decide whether or not to be sexually active
  • consensual sexual relations that are free from abuse
  • a satisfying and pleasurable sex life

So, in the spirit of these sexual rights, I’ll explore some health conditions that can make sex—and life—challenging and suggest ways that might help bring back the joy of sex again. With education and commitment, you can still enjoy the highest level of sexual health possible. Despite limitations, you can express your sexual self with confidence and vitality.

(If there’s a health issue in your life that you’d like to read more about, let me know!)

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Your description of pain with the vaginal opening makes me think a really careful exam is your next step. It sounds like vulvodynia (also called vestibulodynia) should be considered. This condition results in pain with penetration, usually described as a burning or tearing sensation.

A lubricant can make penetration less uncomfortable, but it doesn’t make it comfortable.

Another possibility is that the absence of estrogen has led to atrophy, resulting in the loss of caliber (size of the opening) of the vagina. If that’s the case, using vaginal dilators may restore size and comfort.

In either case, I’d encourage you to see your healthcare practitioner. Stick with it! I know you can be comfortable and revive your sex life!

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The Magic Touch

More and more research is being done these days about the powerful effects of human touch, with study subjects ranging from newborns to NBA basketball players to sexually dysfunctional couples. And what researchers are finding is that touch is such a basic human need it should not be neglected. One scientist, Tiffany Field, PhD, director of the Touch Research Institute at the University of Miami School of Medicine, goes so far as to recommend getting some sort of touch experience for at least 10 to 15 minutes every day!

Whether by hug, massage, or a pat on the back, connecting physically with another person signals safety and trust; it’s so soothing that it can actually reduce stress and anxiety and lower blood pressure. That’s because touching releases two powerful natural hormones, oxytocin and serotonin. Known as the “love hormone” oxytocin (not to be confused with the pain-killer oxycontin) is thought to be connected to compassion, while serotonin increases feelings of pleasure or rewards.

Needless to say, intimate touching can also enhance your sex life. But it’s like everything else in our busy lives; if it’s not on our minds, we probably aren’t doing it as much as we should. Well, maybe it’s time to start.

Here are some suggestions:

  • Next time your partner has had a hard day, offer to give a nice massage. (More about “sexy massages” in a later post!)  Make an “appointment” for 15 minutes; then go into the bedroom, shut the door, put on some nice relaxing music and just rub your partner’s back and shoulders, kneading gently in tense areas. (If you happen to have a tennis ball, it feels great to roll it over the neck!)
  • Offer a big surprise bear hug the next time your partner walks into the room. You’ll probably get a reaction like, “What’s that for?” so be prepared to answer with something complimentary. And remember: Giving a hug feels just as good as getting one.
  • When you’re driving somewhere in the car, or even out on a walk, reach over and grab your partner’s hand and just hold it for a few minutes, lightly stroking his fingers.

The more you start doing things like this, the more natural it will feel. And before you know it, that hug will lead to a caress… and the caress will lead to a kiss… and the kiss will lead to who knows what!

But it all begins with that one little touch.

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Great question–without a simple, single great answer!

Women who have lost their ovaries have lost not only their source of estrogen, but also a significant source of testosterone. I find many, but certainly not all, women benefit from adding back testosterone. That requires a conversation with your provider to determine if that is an option for you. We don’t yet have an FDA-approved product for women for that indication. It requires an ‘off-label’ prescription of a male testosterone product (used at significantly lower doses) or a compounded testosterone. Another medication option may be wellbutrin (buproprion), an antidepressant that can have favorable sexual side effects. This, too, is considered ‘off label,’ or not FDA-approved for this indication. Again, it requires a conversation with your provider as to whether that could be an option for you.

For women, a ‘jump start’ usually starts with intimacy. Our website has a section dedicated to that (the recipe element of ‘Emotional Intimacy’), and it is why we offer candles and massage oils, for instance. Sometimes that can be a small but strong message. A great resource to consider is the book Cupid’s Poisoned Arrow: from Habit to Harmony in Sexual Relationships, by Marnia Robinson.

The message here really is that there is no single spark to jump start the process. It is a complicated interaction that needs to be re-invented with new approaches and discoveries, not an easy thing to accomplish in what is often a long-established routine. I hope you agree it’s worth the investment of time and trials!

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People often make jokes about snoring (the word itself is kind of funny), but if you’re losing sleep because your partner is a loud snorer, you know it’s anything but humorous. Not only are you fatigued the next day, but that often leads to feelings of resentment, which is hard on the relationship, especially over time.

There are lots of remedies available for snoring, but if none of them work, what do you do? Or what if you can’t agree on the temperature of the bedroom or the depth of the blankets—you’re hot and your partner is cold? You work different schedules or your internal clocks put you to sleep or wake you up at different times?

A lot of women at this stage of life choose to move into a different bedroom, especially if the kids are gone. And while that may be a good solution for a good night’s sleep, what does it do for their sex lives?

There’s nothing more intimate than sleeping together. But if you can’t just roll over and initiate sex, will it still happen?

The answer is, yes. But it might require a little more work. You may have to become more conscious about having sex, and that can be a good thing. It might mean you cuddle up while you’re watching a sexy movie on TV. Or move your partner’s hand somewhere intimate while you’re sitting together on the couch.

Indeed, not sleeping together may actually rekindle some of the passion and make sex more exciting. It might also keep you from taking it for granted. Because it’s true what they say about absence making the heart grow fonder. If your partner isn’t so readily available anymore, it might actually make you want intimacy more often.

So not sleeping together does have its benefits (including the fact that you’ll feel a lot better once you start getting a good night’s sleep!)

The important thing is to keep the fires burning one way or another. Don’t allow not sleeping together to become an issue or get in the way of having a healthy sex life. Instead, use it to your advantage. Talk about it with your partner and communicate your true feelings: It’s not about him; it’s about getting a good night’s sleep. And if your relationship is good, things might even improve in that area.

If you’ve had experience with this situation, let us know what’s worked for you so we can share it with others!

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HPV is the most common cause of abnormal pap smears.

It is only fairly recently that we get more specific results with pap smears, telling us whether an ‘abnormal’ finding is related to a low-risk or high-risk HPV type. If it’s low-risk, we treat it like a normal pap smear, with a recommended annual test. High-risk HPV requires further follow-up, typically a colposcopy and possibly a biopsy. (Don’t be alarmed by “colposcopy,” by the way. I know it’s a scary word, but it only means using a bright light and magnification to inspect the cervix.)

These more advanced pap smears, by telling us more about the HPV, save many women the inconvenience, cost, and discomfort of those further tests.

We’re not sure why women develop an abnormal pap smear 10 to 15 years after an initial exposure to an HPV type. It probably has to do with the viral type of HPV (remember most are low risk), your immune system, and other factors we don’t know. A new ‘abnormal’ pap smear result is not evidence that you have been re-infected. If you have been with the same partner, had an occasional abnormal pap, but nothing has progressed significantly, you are unlikely to have an aggressive, high-risk HPV type.

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Good health and good sex? It’s that chicken and egg thing. Being sexually active improves health in some powerful ways, but good health is also an important foundation for good sex. Sex may improve aspects of your health, but your sex life will be more frequent, enjoyable, and robust if you’re healthy to begin with (could that promise be the extra incentive you needed?).

That’s one finding of a landmark study on the sexuality of older adults (ages 57 to 85) completed in 2006 by the University of Chicago. According to the research, health rather than age is more closely linked to an active and satisfying sex life for both men and women. Respondents who rated themselves in very good or excellent health were more likely to be interested in sex, to have sex more often, to be satisfied with their sex lives, and to be sexually active longer than those who ranked themselves in fair or poor health. And many of these participants reported being sexually active well into their 70s and 80s.

It makes sense. People in good health tend to be pain-free; they’re probably stronger and more flexible than people in poor health; they probably feel good about themselves. All these factors improve the quality of both life and sex.

That’s good news because whatever your state of health, you can always do something to improve it. Health is something you have some control over. You can always exercise a little—or a little more. You can eat healthfully—less convenience food, less fat, more fruits, vegetables, and whole grains. You can maintain a healthy weight. You can work to eliminate bad habits, like smoking. And to all the many benefits of good health, now you can add more years of an active and enjoyable sex life.

MiddlesexMD_FoodSince the quality of your sex life also depends on the continued good health of your partner, and since you both have a vested interest in staying healthy, you might leverage that common motivation into a joint self-improvement plan. You could alternate cooking healthy meals, join Weight Watchers (or some other program), participate in an exercise regimen together—walk, swim, do yoga, join a gym.

And when you’ve finished working out together, don’t waste that rosy glow. Why not enjoy the fruits of your labor? (Another study suggests that women taking antidepressants who had just exercised lowered their barrier to arousal. Just think what exercise will do for you!)

While good health is largely the result of a healthy lifestyle, it’s also affected by environment, fate, and genetic factors. And of course, we all tend to accumulate aches and pains as we age. In future posts, I’ll explore some ways to deal with common health problems, such as arthritis and heart disease, that can profoundly affect the quality of both our lives and our sexuality. An active, loving sex life is possible, and even desirable, despite these health challenges. Patience, commitment, good communication, and a few tools can help maintain this important part of life.

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