Feeds:
Posts
Comments

Archive for April, 2013

I never knew what it meant to prime a pump until I watched a plumber work on one at my cottage. To prime a pump means to pour a little water into its fill cap to create suction and, with luck, to pressurize the thing so it draws water rather than spurting air.

The hydraulics metaphor may be more appropriate for men, but I’m betting that some of your orgasmic pressure has leaked out over the years, too. Or, maybe it wasn’t very dependable to begin with. According to some studies, from 25 to 50 percent of women have trouble achieving orgasm.

There are, however, ways to repressurize your orgasmic system—techniques that may help get the sexual juices flowing again. It’s not magic—there is still no pink Viagra that guarantees an orgasm, given that the female sexual response cycle is a lot more complicated than a water pump.

If your orgasmic mechanism needs a little priming, here some holistic ways to repressurize.

  1. Exercise. (I heard that groan.) Good orgasms require good circulation to keep all that oxygenated blood flowing to your genitals. Aging does a number on the blood flow and nerve endings in the genital area, making them sluggish and less responsive.  Exercise helps maintain good circulation. It also keeps blood circulating nicely to the brain, which, as we’ve said, is really your biggest sex organ.
  2. Kegels. C’mon. These are easy and painless (there are tools available), and they do you a lot of good. Kegels tone and strengthen your pelvic floor muscles; those muscles keep you from leaking urine when you sneeze as well as holding your internal organs in place. Strong pelvic floor muscles also create a firm “vaginal embrace,” which is nice for your man, but also gives you a more powerful orgasm.
  3. Check your medications. Several categories of drugs are libido killers, including some antidepressants, but also some drugs that reduce cholesterol and high blood pressure. If you suspect that your meds may be messing with your sex drive, talk to your doctor.
  4. Masturbate. You need good circulation down there, right? Self-pleasuring helps. It also helps you identify what you like and how to “do it” the way you like it—so you can tell your partner.
  5. Get a vibrator and other sex toys. There are all sorts of physical reasons to use a vibrator. (See #4 above.) Toys may help you release some inhibitions and learn to play.
  6. Drink a little (not a lot.) Sharing a little pre-sex cocktail can create a cozy sense of intimacy and also help lower your inhibitions. Drinking too much is a libido-killer. Share a glass of wine in front of the fireplace and move the action to the bedroom—or keep it by the fireplace.
  7. Fantasize. Think of it as your personal romance novel. You can sleep with anyone you want and do anything you want. You’re only limited by your imagination. Fantasy helps some women “get into their heads.” Try it.
  8. Positions. If you’ve been using your vibrator, you know where your sweet spots are, and the missionary position often misses them. Try the back entry “doggie-style” position which is good for hitting the G-spot, although not so good for the clitoris, or try sitting on his lap, which is good for all kinds of things.
  9. Foreplay. If you take seriously Esther Perel’s statement that, for erotic couples, “foreplay pretty much starts at the end of the previous orgasm,” you may extrapolate that good sex arises from consciously introducing sensuality into your relationship in a sustained way. Touch. Snuggle. Sextext. Write love notes. Introduce beauty and sensuality into your life that might leach into lovemaking as well.
  10. Have sex. This cannot be repeated too often. The more you have it, the more you want it, and the better at it you become. As one happily married husband said: “Practice, practice, practice.”

Read Full Post »

Most women have very normal sexual function without a cervix. I have seen reports that suggest an issue, but in 24 years of practice, I can’t recall a single woman who was impaired by the absence of her cervix.

There are complications that result if the cervix is left after a hysterectomy, including abnormal pap smears and continued bleeding. If there is any remaining endometrium (the membrane lining of the uterus) and you consider hormone therapy in menopause, you will need progesterone as well as estrogen. I’ve seen women less fond of progesterone than estrogen.

Whether you’re able to keep ovaries in a hysterectomy is a bigger issue to sexuality—and in fact overall health—for women. Even after menopause, the ovaries continue to produce hormones. Those hormones not only mitigate some of the effects of menopause, but they also promote bone and heart health. There are times when it’s appropriate to remove the ovaries as part of a hysterectomy, but the decision needs to be made based on each woman’s health and history.

Glad you’re thinking about your continued sexual health, and good luck with your recovery!

Read Full Post »

Now that the FDA advisory panel has pulled the plug on two nonhormonal drugs to treat hot flashes and night sweats, what’s a grumpy, sleep-deprived, sweaty, menopausal woman to do?

For most of us, hot flashes are uncomfortable and inconvenient. For some of us, hot flashes are debilitating and make it hard to sleep or function normally. And except for hormone therapy, no treatment regimen is guaranteed to alleviate them.

So, chalk up yet another inhibitor to sex (as if we needed one). It’s hard to feel “in the mood” when your nightie’s soaked and sweat is running down your back—and this is pre-foreplay.

It may be possible, however, to manage the frequency and intensity of hot flashes with some simple home remedies. For some women, these techniques work well; for others, not so much. As in so much of life, it’s a matter of experimenting until you discover what works for you.

These more natural approaches fall into four categories: lifestyle changes, identifying the triggers, controlling your environment, stress management, and botanical remedies. If you’re bothered—or handicapped—by hot flashes, a combination of these might help. Even if the cure isn’t perfect, your overall health should improve. In the long run, that’s a whole lot better than popping a pill.

Lifestyle changes

A generally healthy lifestyle goes a long way to making you feel better all over. You’ll mitigate other problems, like diabetes and obesity, and you just might find your hot flashes are less frequent and intense as well.

A healthy lifestyle includes

  • A diet of high-quality, fresh fruits and vegetables, whole grains, low in fat and processed foods
  • Regular exercise that gets your heart-rate up and doesn’t injure your joints: brisk walking, swimming, free weights, yoga, tai chi
  • Losing weight, if necessary. You may have put on some menopausal baby fat (haven’t we all?), but be aware that a higher body mass index is related to more frequent hot flashes, according to the North American Menopause Society (NAMS).

Identifying triggers

While hot flashes are maddeningly unpredictable, they often seem associated with certain triggers, which are unique to every woman. Try to identify yours. Common triggers include

  • Caffeine, alcohol, and cigarettes (even passive smoke may be trigger one)
  • Anxiety, stress, and stressful situations
  • Hot drinks and spicy foods. If you’ve ever watched someone eating a habanero pepper, well, that’s enough to give you a hot flash right there.
  • Stress
  • Hot, stuffy, or crowded rooms
  • Activities that produce heat—ironing clothes, washing dishes, strenuous exercise
  • Did we mention stress?

Managing stress

Stress is linked in several studies to more frequent hot flashes, and you can bet they’ll happen at the most inconvenient times. When you’re heating up at a stressful moment, remember that, while embarrassing and uncomfortable, hot flashes aren’t life-threatening or even particularly noticeable to others. A few inconspicuous comfort measures will help you get through the moment, even in tense situations:

  • Breathe. Instead of panicking inwardly, consciously take deep, relaxing breaths.
  • Get up and walk around.
  • Open a window.
  • Try meditation, massage, yoga, relaxation or other therapy.
  • Maintain a sense of humor. You have to admit, the whole thing is kind of funny.

Controlling the environment

Because the hormonal changes you’re experiencing have temporarily (or not so temporarily) messed with your body’s temperature-regulating mechanism, you can compensate (in part) by controlling the ambient temperature. Some easy ways to do this include

  • Keep the house, especially the bedroom, cool and well-ventilated.
  • Cotton (or fibers that wick moisture away from your skin) is your friend. Use cotton bedclothes and keep a spare pillowcase handy. Or, check out cooling bedsheets like those at DriNights. Keep a clean, cotton t-shirt beside the bed.
  • “Keep a frozen cold pack under your pillow, and turn the pillow often.” (From NAMS)
  • Check out the Dry Babe website for a line of “absorbent sleepwear for hot mamas.” These could lead to a little heated action of their own.
  • Wear clothes in layers that you can shed or add as necessary.
  • Carry a pretty Oriental fan in your purse.

Botanical remedies

Finally, a few botanicals have been associated with relief of hot flashes. Again, research is inconclusive: Some women are helped while others aren’t. But the remedies are relatively safe and free from serious side effects. You could try:

  • Black cohosh. Already commonly used in Europe, this member of the buttercup family may be the most promising herbal treatment for hot flashes.
  • Soy and red clover contain plant-based estrogen, which isn’t as effective and doesn’t work the same way as the estrogen synthesized for hormone treatments. Still, some women say they help.
  • Vitamin E. Again, scientific evidence is scant, but some women say these supplements work for them.

Just because a supplement is “natural” doesn’t mean it’s automatically safe for everyone. Some herbal supplements are quite potent, and others could interact with medication you’re taking or exacerbate a physical precondition you already have. So consult with your doctor or pharmacist before taking botanical remedies.

If you discover a remedy that works for you—please share!

Read Full Post »

In January, I was working on an article I’d been asked to provide to OBG Management magazine. They’d asked me to talk about why I offer products through my practice—which was, actually, the same motivation that led me to found MiddlesexMD: There are some simple products available that can help women remain sexually active, but it’s not always easy—or comfortable—to buy them.

As I wrote the article, I wondered how you as patients feel about products being offered through your doctors’ offices, so I asked. And a number of you responded, either on the blog or directly, with your thoughts. You were overwhelmingly positive, assuming that your relationship with your health care provider was one based on trust to begin with (and I hope we’re all that fortunate!).

OBG Management published my article, called “Vibrators, Your Practice, and Your Patients’ Sexual Health,” in their April issue. Read it if you like, and take a copy to your next doctor visit if you think it would be helpful in opening a discussion about how he or she can be more helpful to you and your sexual health!

Thanks to all of you who voiced your support or concerns. We’ll keep learning together—and stay as sexually active as we choose!

Read Full Post »

So much for WISHes.

Following the approval of Osphena, a nonhormonal drug for vaginal pain, or dyspareunia, an advisory panel for the Food and Drug Administration (FDA) just voted against approving two nonhormonal drugs for the treatment of hot flashes.

Hot flashes, night sweats, and the sleep disturbance that accompanies them affect about 75 percent of perimenopausal women. Often, they are merely inconvenient, but for some women, they are severe enough to affect sleep, sex, and overall well-being. And they may continue for years—long after menopause is over.

However, based on the results of several rounds of clinical trials for gabapentin, a drug already used to treat seizures and nerve damage from shingles, and other trials for paroxetine, an antidepressant (the active ingredient in Paxil), the FDA panel voted overwhelmingly to deny approval.

The panel’s objection to both drugs was that their effectiveness didn’t outweigh the risks and side effects associated with their use. The most common side effects of gabapentine are dizziness and drowsiness. The most common side effects of paroxetine are nausea, sweating, drowsiness, and headache.

According to a recent New York Times article, women in the gabapentine trial experienced an average of 11 hot flashes a day. At the end of 12 weeks, they were down to about 4 per day. But the women on placebos saw almost as much relief—their hot flashes had dropped to about 5 per day. Thus, “women taking placebos in the trials experienced a substantial reduction in hot flashes that the drugs could not beat in any pronounced way.”

Women in the paroxetine trial fared slightly better, but the FDA panel decided that it still hadn’t cleared the bar for approval.

Voices on both sides of the debate are intense.

“They don’t work and cause dangerous side effects,” the consumer advocacy group Public Citizen testified before the FDA panel.

On the other hand, Linda Keyes, one of the panel members who voted to approve the drugs, said that the need for nonhormonal treatment “is high enough that I feel that a very modest reduction [in hot flashes] is still acceptable, assuming the risks are known and carefully watched, which I believe they can be,” according to an article on WebMD.

Obviously, these results are disappointing for women who are looking for a safe, federally approved, nonhormonal treatment for hot flashes and sleep disturbance. Currently, the go-to treatment for these menopausal symptoms is hormone therapy, and many women either can’t take hormones or choose not to because of the risk of stroke and breast cancer.

Both gabapentine and paroxetine are available off-label, and doctors have been prescribing them for menopausal symptoms for years. They, and other off-label options, can still be considered for treatment of menopausal symptoms—yet another reason for a detailed discussion with your health care provider so you’re making the best—and best informed—choices for you.

Read Full Post »

Ouch! That’s a description I hear more often than you think. You’re not alone. Other women also describe the sensation as sandpaper, cutting, burning, or ripping.

When a woman describes that sensation, it’s usually caused by vaginal atrophy, or more likely vestibulodynia/vulvodynia. A careful msmd-features-368x368_yesexam is needed to determine exactly what’s happening; proper treatment can make sex comfortable again.

It’s likely that vaginal estrogen is necessary to make those tissues healthier; that alone may solve the issue. If that doesn’t completely resolve the pain, treatment options for vestibulodynia or vulvodynia should be explored.

The good news is that there is nearly always successful treatment! You can regain the intimacy you’re missing in your relationship.

Read Full Post »

Yeah, I know. You’ve been doing the contraception shuffle for, oh, decades now. Isn’t it “safe” yet? After all, you’re past 40. Maybe you’ve even missed a couple periods.

Not so fast.

You’re in the midst of a very hazardous crossing—those uncertain years between fertility and menopause during which you are less likely to get pregnant, but, make no mistake, you still can!

While women are indeed less fertile after 40, they absolutely can get pregnant. In fact, women can conceive even during perimenopause, when the menstrual cycle is beginning to become irregular.

For some reason, however, women seem to become more casual as they near the goalposts. How else to account for the fact that women over 40 are the least likely to use birth control of any age group, and that their abortion rates are as high those of adolescents, according to a 2008 USA Today article.

In Great Britain, women in their 40s are now called “the Sex and the City generation,” and they, too, have grown careless. In the UK, abortions within the over-40 age group have risen by one-third in the past decade. In the US, 38 percent of pregnancies in women age 40 and older are unplanned. Of those, 56 percent end in abortion, according to this article in HealthyWomen.org.

By the time they reach 40, women are generally old hands at birth control. But at this point in life some reevaluation may be in order. Levels of fertility are decreasing, and hormonal levels are (or soon will be) in flux. Some women may not want to have children; others may want to keep the option open. In any case, an unplanned surprise complicates life really fast.

This is a good time for a conversation about birth control with your healthcare provider, and you may have to initiate it. While you have more options than ever, the best one for you might be different than what worked for you in your 20s.

And just so you know, current guidelines advise that you remain on birth control until one year after your last period, the official definition of menopause. Complicating the picture is the fact that with hormonal forms of birth control, such as the pill, your cycles may be irregular or may stop completely, which masks the onset of menopause. And the withdrawal bleed during the week off the pill isn’t considered a true period.

Birth control after 40 falls into several categories: permanent, long-term or short, hormonal or barrier method. They vary in levels of effectiveness and in the side effects you may experience. And remember that condoms are the only type of birth control that protects against sexually transmitted infections.

Probably your most immediate decision is whether to end childbearing permanently. Tubal ligation is a laparoscopic procedure that happens under general anesthetic in a hospital. There’s also a new, non-surgical option that a doctor can do with a local anesthetic right in the office.  Or, of course, your partner could have permanent sterilization as an outpatient office procedure.

Hormonal types of birth control are very effective, but can have both side effects (bloating, risk of stroke for some women) as well as protective benefits (against bone loss and some forms of cancer, for example).  It is very important to carefully review your health history with your health care provider to select the best option for you.

Short-term hormonal options include

  • Combined estrogen-progestogen pill (COCP). This is “the pill” you are probably familiar with. Since it now has very low estrogen levels, it’s considered safe for women who have no risk factors until age 55.
  • Progestogen-only pill (POP), which is a good option for older women. It must be taken regularly at the same time of day, however.

Long-term hormonal options include

  • Progestogen shot, which is a once-every-8-12-week option.
  • Progestogen implant, in which a tiny rod is inserted in the upper arm. It lasts for three years.
  • Vaginal rings release low dosages of estrogen. The ring is kept in the vagina for three weeks, then removed for a week.
  • A patch, which also releases low dosages of estrogen and progestogen.
  • An IUD impregnated with progestogen, which is highly effective and lasts for years.

The old non-hormonal standbys still include

  • Condom. Again, the only birth control that also protects against STIs.
  • Non-hormonal IUD. Also highly effective and long-lasting.
  • Diaphragm with spermicide, cervical cap, or spermicidal sponge.

Your choice of birth control at this point should be informed and careful. You need a plan to carry you through menopause, and you need to begin the dialog with your healthcare provider.

Since the consequences of ignoring the issue are so life-changing, this conversation ought to begin now!

Read Full Post »

%d bloggers like this: