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Archive for July, 2013

It all began when entrepreneur Peter Ehrlich took a stroll through a vegan food fair in Toronto. If your livelihood depends on generating ideas, I guess that part of your brain never sleeps.

Suddenly, he realized that there was healthy, organic, non-GMO food for all kinds of health—except for sexual health.

This was Ehrlich’s Eureka! moment. Everybody eats cereal, he reasoned. Everybody wants to be sexy, and everyone wants to be healthy. Let’s bring it all together in one slick package.

Thus was Sexcereal conceived. After conception, the road to market dominance was easy. Ehrlich hired a “team of nutritionists and quality control experts” to create two recipes: one for “HIM” and another for “HER.” A very important step, apparently, was the packaging: a 300-gram bag of cereal with vintage, slightly come-hither, and very healthy-looking images of a guy and a girl. (The size of the guy’s spoon has gotten a lot of quips in the media.)

Besides a generous portion of rolled oats for both genders, which gives the cereal a granola-y look (Don’t call it granola, however; Ehrlich doesn’t like that.), the cereal “for him” has chia seeds, blueberries, black sesame and pumpkin seeds, cocoa nibs, bee pollen, goji berries, and maca powder. “She,” on the other hand, is indulged with wheat germ, soy protein, ginger, cranberries, almonds and flax seeds.

Sounds good, doesn’t it?

Sexcereal is described as a nutritious and tasty whole food with lots of fiber, iron, energy, and Omegas 3 and 6. It’s supposed to boost testosterone and promote hormone balance. Certainly, its makers want to be taken seriously as having created a good product.

But it costs $10 for that 300-gram packet, and it’s so popular that you’ll have to wait 10 days before your mail order is even filled.

The science behind the product? Not so much, as far as I can tell. Sexcereal’s success is all about the concept, the novelty, the marketing, and the media hype. Sex sells, as we all know.

So, maybe sample a packet of Sexcereal out of curiosity or send one as a gift to that person who has everything, but don’t expect a surge of white-hot passion. No matter what they say on TV.

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Can’t remember the name of the new work colleague? Forgot the city your best friend lives in? Can’t recall the movie you saw last week?

Join the club.

A little-known fact about loss of estrogen is that it takes a bit of memory with it when it goes. That’s why memory decline is a common feature in post-menopausal women.

Insult to injury, if you ask me. Let’s face it, at this stage of the game, we can ill-afford to lose any bit of that precious function.

In a new study, however, Australian researchers have found that small daily doses of testosterone gel applied to the upper arm improved verbal memory in postmenopausal women.

Testosterone is an androgen—a male hormone—that governs all kinds of things in men, especially sex drive.

Women produce testosterone, too, in the ovaries and adrenal glands, but in miniscule amounts, and its function is not well understood. Testosterone levels drop quickly as women age until at age 40 a woman usually has about half the level of a 20 year old.

It affects libido and has been used successfully to treat low sexual drive in women, but its long-term effects—or even correct dosages—haven’t been rigorously studied.

Testosterone treatment for women hasn’t been approved in either the U.S. or Canada, so it has to be prescribed “off-label.” That means either the physician prescribes an FDA-approved male pharmaceutical product in very small doses (usually about one-tenth of dose recommended for men) or the hormone is compounded specially by a pharmacist.

In the Australian study, researchers found an intriguing link between verbal memory and testosterone in women. In the study, 92 post-menopausal women (between 55 and 65) were first given standard tests for cognitive function. Then they were randomly assigned to receive either a placebo or dosages of testosterone gel for 26 weeks.

At the end of the treatment period, the women receiving testosterone had higher levels of the hormone in their system, and they scored 1.6 times better in tests of verbal memory (recalling words from a list). Scores on other tests remained the same between the two groups.

While these results aren’t game-changers, they do represent one of those incremental steps that can lead to significant advances. “This is the first large, placebo-controlled study of the effects of testosterone on mental skills in postmenopausal women who are not on estrogen therapy,” said Dr. Susan Davis, principal investigator in the study.

Since there is currently no treatment for memory loss, and since women suffer from dementia in greater numbers than men, this link between testosterone and memory could be an important finding.

Not to mention the potential side effect of improved libido.

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I had never thought of bringing together these two very personal and powerful actions until I read this post by psychotherapist and MiddlesexMD advisor Mary Jo Rapini. She writes, “One method not as well studied but also valid in bringing a couple closer together and improving sex lives is prayer.”

Well, that got my attention! Prayer, however you express it, has always seemed like something you do alone and in private, although we pray with others in certain contexts, such as liturgies and church rituals.

Sex, on the other hand, is an intimate and private act between two people, who may sometimes struggle with the vulnerability such intimacy demands.

But bringing the two together? Doesn’t that seem, um, odd if not downright sacrilegious? After all, one is sacred and one is, um, fairly creaturely.

Actually, prayer and sex are the most natural intertwining of intimate acts in the world.

If you believe in any sort of Higher Power, bringing that Being consciously (through prayer) into your sex life could open a new level of intimacy between you and your partner. It could also sweep away those musty, Victorian notions that sex is somehow “of the flesh” and therefore opposed to things of the spirit. Which may be where that stubborn scent of guilt that clings to sex originates.

Nothing could be further from the truth. There is no such dichotomy, even though we tend to create one. Male and female become “one flesh”—that’s how we were made, to be sexed creatures. We were made this way by the God whom we would prefer to exclude from the bedroom.

“See, sex in not an afterthought, a way to make more babies. Rather, it is an indispensable quality woven in the fabric of each life on this planet. Sex is not first something we do; it is primarily who we are,” writes Dan Hayes in this post about sex and prayer.

Why not invite God in? Consciously. By praying together. You don’t even have to belong to the same religion—you just have to believe. (God is there anyway; it’s just helpful for us to acknowledge it.)

Sex is a sacred act. That concept is the foundation of many Eastern practices, such as the Tantra. Sex is sacramental—the most intimate physical joining that human creatures can attain. Prayer acknowledges this, and it introduces a different kind of intimacy and perspective between partners.

A few of the effects of bringing prayer into sex, according to Mary Jo, are that by acknowledging a higher power, our own ego and self-righteousness dissolve, unspoken barriers between partners are broken down, and the bond between them is strengthened.

Praying together begets acceptance and forgiveness. It softens the sharp edges that creep into a relationship over time.

So, in the midst of using all the other tips and tricks we’ve discussed so much on this site, why not also pray together? You can do it in any way that’s comfortable for you. You don’t have to use words, but it might be helpful for each of you to hear the prayer of the other.

Join hands. Be still. Quiet yourselves.

Then pray. Together. With or without words.

If you don’t know what to say, here’s a starter:

Father, send your Holy Spirit into our hearts. Place within us love that truly gives, tenderness that truly unites, self-offering that tells the truth and does not deceive, forgiveness that truly receives, loving physical union that welcomes.

Open our hearts to you, to each other and to the goodness of your will. Cover our poverty in the richness of your mercy and forgiveness. Clothe us in our true dignity and take to yourself our shared aspirations, for your glory, forever and ever.

(“A Prayer Before Sex” from Patheos.com)

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Estring, a vaginal ring, is one method for delivering localized hormones—in this case estradiol. The ring itself includes silicone polymers, so I recommend to my patients that they use a water-based or hybrid lubricant. Among water-based lubricants, Yes (which is also a moisturizer) and Aloe Cadabra are often ordered. ID Silk is popular among post-menopausal women; as a hybrid lubricant, it has the benefits of water-based but is more long lasting, like silicone-based.

Silicone-based lubricants aren’t recommended for use with products made from silicone—like the Estring and some vibrators or other sex toys—because the formula may cause disintegration of the surface.

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A definition first: The endometrium is the mucous membrane that lines the uterus. For women who have had hysterectomies, the endometrium is not an issue in planning hormone therapy (HT).

For others, the endometrium is a “target tissue” (like many others) for estrogen and progesterone. During our reproductive years, those hormones signaled the lining of the uterus to thicken (proliferative endometrium influenced by estrogen) and then to shed (secretory endometrium influenced by progesterone), over and over in our menstrual cycle.

Endometrial cancer is a well-recognized consequence of “unopposed estrogen,” a continual message to proliferate and thicken without the proper “opposing” influence of progesterone. Nearly all endometrial cancers will be “estrogen influenced.”

When we plan HT for a woman in menopause with a uterus, we must balance estrogen and progesterone. (And, in fact, for a woman in reproductive years who doesn’t ovulate, which typically triggers progesterone, we’ll compensate with progesterone therapy.)

As with most cancers, there are factors we can’t always explain. Obesity, however, is the most common risk factor; in fact, obese women are at higher risk than their friends on HT including both estrogen and progesterone. Fat (adipose) tissue produces estrone, an estrogen that is very weak but does influence the endometrium. Sometimes we biopsy obese women and find “precancer” of the endometrium; part of our treatment is progesterone in an effort to reduce their cancer risk.

Just one more reason, I’m afraid, to make healthy habits a priority—and to work with your health care provider for HT that takes your health history and priorities into account.

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An older couple walked into the therapist’s office. The marriage had been a bit rocky from the get-go, but now the woman had completely lost interest in sex. The therapist recommended that the woman seek sexual counseling.

Now, that might have been all right except that the therapist had no understanding of the very normal changes to libido brought on by menopause and thus wasn’t able to address that possibility or access resources to either reassure or help the woman.

The couple never came back.

Sue Brayne, a British therapist and author of Sex, Meaning, and the Menopause, commented in her blog on a recent workshop she conducted: “…it continues to amaze me that in a room full of therapists on their way to fifty, or who are well into their fifties and even sixties, this workshop was the first time most of them had ever spoken about the menopause in any depth, or admitted to how it is affecting their lives.”

So, while many healthcare professionals have personally experienced menopause, very few have actually received professional training or information to help others.

In a survey of 900 women conducted by womentowomen.com, 80 percent visited their doctors for help with menopausal symptoms and 60 percent came away feeling as though they hadn’t had a “supportive, honest discussion about menopause options.”

Therapists in Brayne’s workshop complained that, “their GPs [general practitioners] had no interest in the menopause, and they were often ‘fobbed off’ with unwanted prescriptions for HRT [hormone replacement therapy].”

As patients, we are often shy about discussing sexual issues to begin with, and as we’ve mentioned before, doctors rarely initiate that conversation. Throw menopause into the mix, and you may be met with discomfort, avoidance, or the “fobbing off” that Brayne mentions.

Many doctors and therapists simply aren’t equipped to understand the array of menopausal symptoms. Menopause isn’t a disease or a medical condition. A doctor can’t “fix” it. Menopause is complex in that it affects a whole bunch of physical and emotional systems, and there’s no one-size-fits-all remedy.

That said, you have every right to expect your medical practitioner to knowledgeably address your menopausal symptoms during this transitional time. And you should be able to talk openly about them. Yes, that includes sex.

So, how do you get the ball rolling with your practitioner?

  • First, ask for a 15-20 minutes consult to discuss these issues with your provider. A discussion can happen during a routine appointment, but let your doctor know you want some time to talk.
  • Make a list of questions, issues, symptoms, concerns. Write them down and don’t be hesitant to refer to the list.
  • Pay attention to your symptoms, when they happen, how often, how intense. Mention changes that you might not associate with menopause, like sleep disturbances and intermittent memory loss. When did they start? Have they changed? What have you done to find relief?
  • Be honest. It’s tempting to fudge the truth about drug or alcohol use, diet and exercise. But how can a practitioner help you without all the facts? You can go a long way down a dead-end treatment regimen if you aren’t honest with your provider.
  • Identify your own expectations. What do you want from your provider? Do you need moral support, perhaps in the form of counseling? Do you need relief from particular symptoms that are affecting your quality of life? Does your partner need information about what to expect and how to cope with the changes you’re experiencing?
  • Trust yourself. You’ve lived in your own skin for a long time. You probably have a good sense of what’s been normal in the past.
  • Ask questions. Sometimes it’s hard to think of everything during a discussion, but don’t let questions go unanswered. Ask your doctor for the best way to communicate if you think of something later.

If you’re frustrated in your attempts to communicate with your regular provider, or you feel you’d benefit from a specialist with targeted knowledge about menopause, the North American Menopause Society has a menopause certification program as a way of assuring basic competency and assuring high-quality care. You can find a NAMS-certified practitioner in your area by searching here.

Medical professionals may sometimes struggle to find the information they need to support and treat their menopausal patients, but as patients communicate (nicely) that they expect support and knowledgeable treatment from their doctors, everyone is nudged along the road toward greater awareness.

And that can only help us all.

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