Archive for January, 2012

The stroller is in mothballs, along with the Little League jersey and the Cub Scouts uniform. Just when the kids can brush their own teeth and maybe drive themselves to hockey practice, just when you thought the never-ending physical demands of raising children might slack off. Just when you thought you and your partner might finally, finally get some time alone, you realize that:

  • Your mom isn’t doing well and needs more support, probably from (who else?) you!
  • You’ve unmistakably entered “the change” and your ability to roll with the punches isn’t rolling anymore.
  • Instead of becoming more independent, your teenaged children have only become more mobile, not necessarily more trustworthy; they are also acutely aware of what goes on behind closed doors. Your closed door, in particular. Plus, they stay up until all hours, while you are practically going to bed with the sun.
  • Or (alternate scenario) your 20-something was just sucked into the economic downdraft and lost his job. He’s moving back until he finds another.
  • Neither you nor your partner is getting any younger, to which your rickety knees, complaining back, and unsteady blood pressure can attest.

Sex? Can you spell that?

According to the North American Menopause Society (NAMS), fatigue, stress, and lack of privacy are three common bogeymen of midlife sex. Maybe you once thought you’d have everything figured out by now. As it turns out, the reality on the ground looks much different.

You belong to the sandwich generation, remember? You care for aging parents and your own growing children—who stay up late and are acutely aware of sexual innuendo. The boomerang kid lands at your doorstep. And just when your own career is at its most demanding, you’re tossing at night from insomnia and hot flashes and don’t perform well at the morning meeting with (choose one) the partners, the customer, the staff.

While you can’t magically fix everything at once—stress and fatigue won’t dissipate overnight, and you won’t be able to leap passionately into bed tonight with a rose clamped between your teeth—yet, you might keep in mind the airline attendant’s advice: Put the oxygen mask on yourself first. Because if you can’t breathe, what earthly good are you to anyone else?

You can’t do anything about your teenagers’ sensitivity or your parents’ fragility or your menopausal discomforts, but you can pay attention to your physical and psychological health and to the partner who, God willing, will still be around when the other demands have eased.

Try these stress-busters:

  • Eat healthfully. You’ve heard this before, but the wisdom of the ages bears repeating. Your body simply won’t keep up with all the physical demands if you’re overeating or consuming the bad stuff. Think fruits and veggies, not fries and burgers. Think whole grains, not white rice and Wonder bread. Avoid refined sugars, fats, and processed foods. Avoid alcohol. Cut back on caffeine, which, according to NAMS, elevates levels of cortisol, the “stress hormone.”
  • Meditate.  Guided imagery or mindfulness meditations are simple and surprisingly effective techniques to help you relax and check in with yourself emotionally. They’re refreshing to the spirit and the closest thing to magic at relieving stress. For a superb two-fer—a stress-relieving meditation and a gentle workout, try yoga.
  • Exercise. If you don’t stay active, your body simply won’t work well. Exercise is the third leg of the stool to lowering stress, improving your mood, and keeping joints, organs, and muscles functional. It doesn’t have to be strenuous, but it does need to be regular—30 minute sessions four to five times a week. If you can get outside, all the better.

Now for the fun stuff:

  • Relax and do something nice for yourself. Take a bath. Get a massage. Get a makeover. Go out with friends.
  • Laugh. It makes you prettier and it relieves stress. All the experts say so.
  • Create a boudoir. If your kids are going to smirk and giggle anyway, give them something to be really embarrassed about. Make your bedroom a sexy little place just for you and your partner. Your kids will never again enter without knocking.
  • Play with toys. Sex will take longer and may require some props as you both grow older. But according to several studies, you’ll enjoy it more. So what are you waiting for? Check out our website, both to educate yourself and for our selection of sex enhancing toys.
  • Take your time. Maybe you’ve noticed that most of these suggestions require time, which may seem as scarce as snow in Tahiti. But that’s just the point, isn’t it? You have more demands than ever on your time and energy. But if you don’t fill the gas tank, you’ll be running on empty.

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A male reader wrote to me recently. He’s “turned on” at the thought of his wife using a vibrator and wants to incorporate it into their sex life. The problem is that his wife is “creeped out” at the thought and won’t consider it.

This dilemma presents several issues that I think can be instructive to explore.

The first issue has to do with respect. We’re all at different points with regard to what turns us on and our openness to new approaches. Trying something new takes a willingness to explore and be vulnerable—and that can’t be forced, especially in intimate relationships. Otherwise, rather than feeling close and connected, your lovemaking will feel tense and coerced. Respecting boundaries is fundamental to a loving relationship.

That said, it’s also important to keep an open mind about what pleases your partner. Grownups do all kinds of things in bed, and as long as it’s safe, consensual, and pleasurable for both partners, there’s no right or wrong. The willingness to try something new, especially if it’s a “turn on” to your partner, is a loving act. And, who knows, you might like it, too.

When you encounter resistance from your partner to an idea or suggestion, you need to take a step back. Maybe discuss exactly what turns her off about, say, using a vibrator. Maybe she’d be more receptive to something smaller and less intrusive. Maybe she needs to try it alone first.

On the other hand, you could also talk about what your partner finds arousing. What has she always wanted to try? What are her fantasies? Try a trade-off. You do something for your partner, then switch roles.

There are some very good reasons to use a vibrator. They help us maintain vaginal health and boost blood circulation. They give us the strong, consistent stimulation we may need to reach orgasm. Using a vibrator, either alone or as a couple, isn’t “creepy” by most standards, and it isn’t particularly unusual. In fact, studies consistently show that introducing new things to your sexual routine in the form of toys, sex aids, or places and positions is helpful in maintaining a healthy sexual relationship.

If you’re at an impasse, you might consider continuing the discussion with a sex therapist, who can provide perspective and suggestions for moving forward in a loving way. But the bottom line is that you need to respect your partner’s boundaries, communicate about your desires and fantasy as well as your fears, keep an open mind, and be willing to incorporate new things into your sex regimen.

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Hm. We could have told you that.

Recently, we reported on the results of an international survey that explored how satisfied older couples are with their relationships and sex lives. Turns out that sex continues to be important to older women, and it’s an important element in overall satisfaction with their relationships—and sometimes it’s even more important to the women than to the men.

Now, another survey adds a little more texture and depth to that glimpse behind the bedroom curtain. Gals, we’re sexier than we thought.

Since 1972, researchers from the University of California San Diego School of Medicine have regularly surveyed a group of residents of a southern California community to track various characteristics of health and aging.

Recently, the results of a new survey of this group were published in the January 2012 issue of the American Journal of Medicine. Several hundred older women in the community were questioned about their sexual activity. In a mail-in survey, they were asked about how often they’d had sex in the past four weeks, about hormone use, lubrication, orgasm, and level of satisfaction.

“Sex” was broadly defined as “caressing, foreplay, masturbation, and intercourse” (of the penis-in-vagina variety). The women didn’t need to be partnered, and they didn’t need to be sexually active. Slightly over 800 women responded, ranging in age from 40 to 99 with a median age of 67. Most (90 percent) were in good to excellent health. Almost two-thirds were postmenopausal and 30 percent were on estrogen therapy.

What the researchers found, somewhat to their surprise, was that half the women reported being sexually active in the previous four weeks. Unsurprisingly, sexual activity declined with age (83 percent of younger women were sexually active versus 13 percent of the oldest women). Yet, one in five of the sexually active women over 80 reported arousal, lubrication, and orgasm “almost always” or “always.” They were also as satisfied with their orgasms as the youngest women in the study. (You go, girls!)

Sexual desire (libido)—or lack of it—was another surprise. One would think that desire might precede the act itself, but not so. What the researchers found in this study was that one-third of sexually active women had little or no sexual desire. Yet, most of them (61 percent) were satisfied with their sex lives. This suggested to the researchers that “women engage in sexual activity for multiple reasons, which may include nurture, affirmation, or sustenance of a relationship.”

The interesting thing about desire was that, although the younger women had the highest levels of desire, they were less satisfied with sex. They were also more likely to be distressed about their relative lack of desire (low libido). The oldest women, on the other hand, were more likely to be content with their sex lives and less bothered by lack of desire. But that doesn’t mean they weren’t getting any. The oldest women in the study who were sexually active experienced orgasm with the same frequency as the youngest women.

Hormone use was linked to higher libido and to greater sexual activity, but that doesn’t translate to greater emotional closeness with a partner. Emotional closeness wasn’t linked to age or use of hormones, but it was linked to more frequent sex. And most of the sexually active women in the survey were emotionally close to their partner. The researchers didn’t address the question of whether emotional closeness leads to better sex or whether good sex creates emotional intimacy. Cause or effect? Chicken or egg? I’m not sure anyone cares.

The final nugget unveiled by the study was that almost half of the women who aren’t sexually active are satisfied with their (non)-sexual lives, too. The researchers guess that they “may have achieved sexual satisfaction through touching, caressing, or other intimacies that have developed over the course of a long relationship.”

Overall, the survey seems to suggest that, given good health and a capable partner, older women are sexually active and quite content with that activity, and that, despite lack of desire, they enjoy sex just as much as younger women.

“A more positive approach to female sexual health focusing on sexual satisfaction may be more beneficial to women than a focus limited to sexual activity or dysfunction,” writes Susan Trompeter, MD, and one of the study’s authors.

Amen to that.

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That’s one of the questions MiddlesexMD medical advisor and sex therapist Sheryl Kingsberg often hears. I asked her to write about how she answers it.

Each of us is unique, with varied interests, beliefs, backgrounds, and experiences. Given how different we all are, it is often very difficult to define what is “normal.” This difficulty in pinning down such a definition holds true for many things, including one’s sex drive–everyone’s is a little different.

As a woman’s life changes, her sex life and interest in sex may change as well. For examples, at midlife, her balance between career and family may shift; perhaps more of her time and energy is pulled in a different direction. This may affect her interest and energy for sexual activity, and her idea of a normal sex drive may change as well. She may not have the same desires she felt when she was younger, or she may often find herself thinking about her to-do list and not about sex. However, it’s important to note that her sex life is still an important part of her personal life and her overall health.

For some women, however, it can feel like sexual desire is nearly gone, sexual thoughts or daydreams are rare, or other sexual problems develop, like difficulty with arousal, lubrication, or pain. These changes may not simply be due to changing priorities, other physical problems, age, or situational stress. In this case, women may be experiencing a sexual dysfunction.

While anyone who owns a television and has seen ads for Viagra or Cialis knows that sexual problems are common in aging men, there is much less discussion about aging women. The reality is, sexual problems affect over 40 percent of adult women and can present themselves at any stage of their lives. There are several specific sexual disorders, including Hypoactive Sexual Desire Disorder (HSDD), Female Sexual Arousal Disorder (FSAD), Female Orgasmic Disorder, Sexual Aversion, Dyspareunia (pain with sexual penetration), and vaginismus (the inability to have wanted sexual penetration due to an anxiety response).

HSDD is the most common sexual problem for women. Nearly one in 10 women reported low desire with sexually related personal distress; the distress associated with it can affect more than just a woman’s sexual life. Research has shown that the impact of HSDD can extend further, causing detrimental effects in other aspects of her life. These can include difficulty with personal and social relationships, a poor self-image, mood instability, and even depression.

As a clinical psychologist, I see firsthand how HSDD and other sexual problems negatively affect women’s lives. A woman’s sexual health is a basic human right and an important part of her overall health and well-being. It is normal for a woman’s desires and sex drive to fluctuate given all that life throws her way. However, a significant lack of desire, and/or absence of sexual thoughts or fantasies that causes distress, is a sign that this is not just a normal fluctuation but rather may be HSDD and should be discussed with a healthcare professional.

What is a “normal” sex life for a woman? It may be different for each woman, but it comes down to whatever she feels is right for her and her relationship. It’s not about how often a woman engages in sexual activity, but rather that her desire remains satisfying to her.

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You’ve been through a lot. After surgery or chemo or radiation therapy, you may feel like you inhabit the body of a stranger—it doesn’t look, feel, or behave like the body you once knew so intimately. You may feel as though your body has betrayed you. You may disassociate from your body—it’s there, but you aren’t. Or, you may grieve over the loss of your former self, scar-less, energetic, attractive.

Recovery is a long and challenging road, and like any journey, you’ll probably find the way littered with unexpected difficulties as well as sweet surprises. Initially, however, it’s mostly uphill.

You may find that your body simply doesn’t respond the way it did “before.” You may find your self-image seriously shaken by the scars, the hair loss, the weight gain. You may find it hard to care about anything because you’re exhausted—or depressed. Feeling attractive and desired is an important component to sexual responsiveness for women, and you may feel anything but.

This is a fragile time. You’ll need to become acquainted with your new body and to accept and even embrace it with all its limitations. And maybe this acceptance will open the doors to a new kind of sexual partnership as well. Maybe one that’s more honest, that expects less, that laughs more.

First, however, you need time to heal and to regain energy, and this can take months. Go easy on yourself. “I think the one gift I’ve had from breast cancer is that I’ve never made myself go back to the same level of pushing as before,” writes Dr. Su Kenderdine, in a Q&A at breastcancer.org. Rest is as restorative as exertion, she says.

Second, pamper your body. Do the small things that make you feel sexy—get a manicure, buy lingerie and nice sheets, take long soaks in the tub, style your hair (or buy a wig you like), get a makeover. Lavish your body with good energy, and your sexual responsiveness may pick up, too.

“Eroticize your body,” says Sabitha Pillai-Friedman, a well-known sex therapist and breast cancer survivor. “We have scars. Our bodies have changed. It’s very important for us to sort of look at ourselves. We can look at ourselves with scars, but we can also look at ourselves with the scars enhanced with sexy lingerie. Right?”

Third, get to know your new body. You may discover new erogenous areas as well as reawaken old ones. How does it feel to stroke your belly? To massage your ears? The back of your neck? The inner thigh? The feet? Harness the power of all your sex organs—your skin and sense of touch as well as your mind. Fantasize. Read sexy stories.

“Your vagina responds to your mind and your feelings about yourself, so if you feel like ‘damaged goods,’ too heavy, or in any way undesirable, your vagina will stay relatively dry and unresponsive,” writes Dr. Marisa Weiss, president and founder of breastcancer.org.

Surround yourself with positive thoughts. Visualize yourself as attractive and desireable. Confidence is sexy.

Fourth, get a vibrator and some lubricants and use them by yourself first. “Once we’ve had surgery and treatments… our body’s response changes, so we need to really figure out what works for us before we can share our bodies,” says Dr. Pillai-Friedman.

Prime the pump, so to speak. Arousal may take more or a different kind of stimulation, so find out what works for you now. Also, self-pleasuring will wake up sleepy nerve pathways and improve blood flow to your genitals.

Finally, don’t neglect your partner. Talk about how you feel and what you’re doing. Essentially, you’re working hard to regain something important both to your relationship and to your own sense of well-being—your sexuality. If you lay the groundwork well, everyone benefits. And in the meantime, don’t withdraw. Keep the intimacy alive with lots of touch and cuddling.

Also, don’t make assumptions about what your partner feels or thinks. Don’t project your own discomfort with how you look or assume that if he touches you he wants sex. It’s highly likely that he or she is looking for cues from you and will accept whatever makes you comfortable. If you’re not sure how he or she feels, ask rather than guess.

When you make love again, experiment with positions that might be more comfortable. If you’re on top, you can control the depth and speed of thrust. A spoon position is close and loving, but also visually more private. Use pillows, props, supports. Use lots of lubricant. Wear something sexy—and you don’t have to take it off if you don’t want to. Don’t forget to laugh.

Who knows. This might be the start of something newly beautiful.

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Estimates say that up to a fifth of heterosexual couples have anal intercourse at least intermittently, more rarely exclusively.

The risk of sexually transmitted infections is the same or perhaps higher with anal than with vaginal penetration. There’s more likelihood of trauma, since anal intercourse requires complete relaxation of the rectal sphincter muscles before penetration. Trauma or injury to those muscles can lead to loss of muscle tone or control. That makes this form of intimacy not entirely “safe,” but, more importantly, consent freely given by both partners is an essential feature of sexual activity in a loving relationship.

You asked whether this was a new phenomenon and whether you were “too old” to adapt! I don’t think it’s new (or, at less than 20 percent, a phenomenon), but our notions about sexuality and what’s “typical” or even erotic are very complicated and influenced by many factors. You may never become comfortable with this form of intimacy, but you are never too old to explore options and be open to new sexual techniques.

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At MiddlesexMD, our approach to sex at midlife didn’t spring to life fully formed. In fact, it’s the result of a lot of thought and discussion about the kind of information women need during and after menopause to stay sexually healthy and functional.

We were concerned that a lot of the chatter surrounding sex during these years is based on hearsay and old wives’ tales, and it’s often cast in terms of dysfunction—of what’s not working right anymore. Also, in case you haven’t noticed, a lot is still unknown about normal female sexuality after menopause. (So let’s not be quite so quick to label it dysfunction.)

From my years in practice, I know that women don’t talk about these issues. They may associate hot flashes and mood swings with menopause, but changes that affect their sexuality aren’t widely known and don’t tend to enter into the doctor-patient conversation. I suspect that many women don’t exactly know what questions to ask.

So we envisioned MiddlesexMD as a forum and a clearinghouse for reliable, current information about changes to your libido and sexual organs during menopause. We also tried to organize this information in a way that is understandable and easy to manage. And that’s how we came up with the “Recipe.”

Our Recipe for Sexual Health coalesced after we reviewed a lot of research and looked at reports from the North American Menopause Society and the International Society for the Study of Women’s Sexual Health. We considered what sex therapists and researchers, counselors and relationship coaches, alternative medicine gurus and mindfulness gurus had to say.

We took all that information, mulled, mixed, and digested it, and voila! the ingredients for our Recipe rose like cream to the surface. Our website and our blog are organized around those five ingredients:

Knowledge. So you can understand what happens physiologically during menopause as well as learning some techniques for staying sexually healthy and functional.

Vaginal comfort. From my clinical experience, vaginal dryness and discomfort are the most common and annoying changes that women mention, and they happen to all of us. A lot of the information on our blog and the website discuss ways to maintain vaginal health.

Genital Sensation. So you can find ways to compensate for diminished blood flow and loss of sensation.

Pelvic tone. So you can understand why a well-toned pelvic floor is important, and how to develop those muscles.

Emotional intimacy. Because your body won’t respond if your heart and mind aren’t engaged. We feel this is, and always has been, the most important ingredient to a great sex life.

Since the launch of MiddlesexMD.com almost two years ago, you—our readers—have reinforced some of our educated guesses. How common and distressing vaginal dryness can be, for example. Also that sex for women is complicated. Unlike men, the path from stimuli to desire to arousal to the big O is far from linear. And the unpredictability of our responses only intensifies during menopause.

As we age, we can develop other heath conditions, like hypertension or diabetes. Then it becomes more difficult to tease out the effect of these conditions from sexual problems. Plus, both the physical condition and the medications used to treat it can affect sexual responses.

We’ve also come to appreciate the difficulty of putting some heat back into a long-term, ho-hum sex life (or maybe completely reinventing it).

You remind us that that sex is a very individual matter—certainly not a one-size-fits-all affair. That’s the beauty—and the challenge—of claiming, or reclaiming, your sexuality

We’ve been impressed with the fact that, contrary to some stereotypes, we’re still pretty sexy ladies at midlife. We like having sex, and we want to keep on enjoying it. That’s what MiddlesexMD is all about—creating a forum and providing the information that will keep you sexy for a long time.

So, how are we doing? Do you have unanswered questions? Have we missed anything in the recipe? Can you find what you’re looking for?

Let us know, because we like many cooks working on our recipe.

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