Archive for August, 2013

What you describe is a natural result of the loss of natural estrogen through menopause. There are a number of localized estrogen options, including Estrace and Premarin creams, Vagifem tablets inserted in the vagina, and Estring, which is a ring also placed in the vagina.

The therapeutic dose of Estrace is 1 gram applied to the vagina and vulva two times a week; using less than that will be, as we doctors say, “subtherapeutic,” which means it won’t have sufficient effect! While the creams are effective when used as prescribed, many of my patients prefer and get more consistent doses from the ring or tablets.

You mention a family history of breast cancer. None of these options is “systemic,” which means that they can be used by women with breast cancer risk factors–even by some breast cancer patients. There’s a new option, too, that’s non-estrogen: Osphena is an oral daily medication that showed “statistically significant improvement” in vaginal and vulvar pain.

Moisturizers and lubricants can also help to increase comfort while a full treatment plan is taking effect.

It takes attention and consistency to regain comfort after being sexually inactive, but I’m sure you’ll find it’s worth the effort!

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Out of sight; out of mind. That’s how it is with the vagina. As long as it’s working and isn’t causing a fuss (which, granted, becomes more iffy at this stage of the game), we forget about it.

Nothing wrong with that.

But, ladies, your vagina is a marvelous thing, so in the interest of a little community ed on this underappreciated organ, here are some fun and quirky facts—maybe things you didn’t know—about your vagina.

  1. The word vagina comes from the Latin word for “sheath” or “scabbard.” Those Latin lovers were all about their swords. The word orgasm originated with the Sanskrit word for “strength.”
  2. The hymen is named after, um, Hymen, the Greek goddess of marriage. It’s a membrane that partially covers the vaginal opening before puberty to protect it until normal changes during puberty. It’s broken with a girl’s first sexual penetration, and the attendant show of blood is the traditional “proof” of her virginity.
  3. As you might imagine, the vagina has accumulated many colorful names over the centuries. A few of the, ahem, more decorous are: camel toe, honeypot, cock pocket, vajayjay, meat wallet, muff, bearded clam, fish taco, crotch mackerel, hot pocket, bikini biscuit, panty hamster, yum yum, twat, hoo ha, and, of course, pussy and cunt. Enough already!
  4. The vagina proper begins at the mouth of the vulva and ends at the cervix, which is that bottlestopper at the base of the uterus. So the vagina is the conduit—the “potential space,” the empty sock without a foot in it—that leads from outside the body to the small opening in the cervix that allows sperm to pass through.
  5. While the vagina is only 3-4 inches long, it balloons to 200 percent its normal size (to accommodate those Latin swords as well as babies of various sizes). This impressive ballooning effect happens because the vagina is pleated like a skirt with a bunch of folds, called rugae, which expand when extra space is needed.
  6. We talked about the normal variations in the way your outer genitalia may look, but for the most part, vaginas all look the same.
  7. Like your oven, your vagina is self-cleaning. So, for heaven’s sake, don’t douche. You’ll upset the delicate balance of good bacteria that live in there. Wash your external genitals with warm water and some gentle, unscented soap.
  8. Your vagina has its own unique odor, which is determined by your diet, the normal variation in bacteria, sweat, and hygiene.
  9. Your pubic hair isn’t just an annoying decoration. In days of yore, it was a “reproductive billboard” announcing that over yonder was a fertile female. It also traps your scent, leading suitors to the honey pot. Times have changed since caveman days, and a healthy mat of hair may not be quite so irresistible today. Pubic hair has a life expectancy of only three weeks versus head hair, which stays put for about seven years.
  10. The normal pH balance in your vagina is slightly acidic, similar to wine or tomatoes. That normal balance can get out of whack if you have an infection, douche, or through exposure to semen, which is more alkaline.
  11. Sex keeps your vagina moist and flexible, especially after estrogen levels drop. “Safe vaginal intercourse can help keep the vagina healthy and dilated,” says Dr. Courtney Leigh Barnes, a gynecologist at the University of Missouri in this article.
  12. Vaginal farts (also called queefs or varts) happen to every female at one time or another, especially during sex or exercise. So don’t be embarrassed.
  13. Gravity is as hard on your vagina as it is on your breasts, face, and buttocks. It sags, and sometimes, it falls out. This is called a prolapse. While it may be uncomfortable, it’s usually painless and can be fixed.
  14. Most women (about 70 percent) don’t orgasm through vaginal stimulation alone, but through a combination of clitoral and G-spot action.
  15. The first two inches in the vagina have the most nerve endings and are the most sensitive.

Don’t say we never told you.

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Life is scary after a heart attack. You’re not sure what to expect. You may be depressed. You’re probably on several medications. You may be confused about what you’re allowed to do and when.

Like sex. When is it safe to have sex again?

Chances are, your cardiologist hasn’t discussed that topic. For one thing, your doctor is probably more concerned with saving your life at first, and then with the details of your recovery, like rehab and medications. When to resume your sex life just isn’t high on the radar of topics to discuss post-surgery.

And for another, most physicians don’t bring up the S-word at any time, as we’ve discussed before. But a new study of women who have had a heart attack confirms that “most women don’t have discussions with their doctors about resuming sex after a heart attack, even though many experience fear or other sexual problems,” says Emily Abramsohn, one of the study’s researchers, in this article from Medical News Today.

Patients are often uncomfortable broaching the topic, and their caregivers also hesitate to bring it up. Their partners may also be afraid to do anything that might cause pain or induce another attack. “I had to convince my husband that I wasn’t going to die in bed,” said one woman in the study.

Now, new guidance for doctors from the American Heart Association (AHA) encourages doctors to discuss sex with their post-surgical patients and to advise them about when it’s safe to resume their sex life and how to do it.

The guidance, which is based on a review of scientific literature and is the first statement of its kind from the AHA, acknowledges the importance of resuming an active sex life. Sex is a return to normalcy and re-establishment of intimacy, and as such is an important element in the healing process.

Along with the position statement from the AHA, a new study from a group of researchers at the University of Chicago surveyed 17 women who had survived a heart attack within the past two years. The average age was 60. The study found that:

  • Most women were fearful about resuming their sex life
  • The doctors discussed sex with about one-third of their female patients
  • Frequently the conversation was initiated by the patient, who generally found the information to be unhelpful
  • Most women began having sex about a month after their heart attack; all but one had resumed sex within six months

The AHA guidelines could clear up some hesitation and confusion among physicians as to what, exactly, to tell their patients. The guidance states that sex is safe for most patients who are stable and without complications. If you can climb two flights of stairs, you can probably have sex, which is considered only moderate exercise.

But if you’re scared or unsure, then ask. “Know that you’re not alone in having fears surrounding sexual activity,” Abramsohn said. “And if you are concerned, bring it up with your doctor.”

“Dr. Ruth” Westheimer even weighed in on the topic in this article, “What I suggest is that people write down their questions and send it to the doctor in advance of their appointment. That way they’ll be sure the question gets asked, and the doctor will have had time to get prepared to answer it.”

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Yeast infections occur when there’s an overgrowth of yeast that inhabits the vagina normally. Yeast isn’t transmitted from men to women.

A healthy vagina is slightly acidic, measured by pH level. A pH level of 4.0 to 4.5 is healthiest for women; menopause sometimes affects pH because the loss of estrogen reduces circulation and lubrication. Semen has a higher pH level, which means it makes the vagina briefly and temporarily more alkaline and more hospitable to bacteria.

Condoms will prevent that brief pH disruption, which may be helpful for some women. Others use RepHresh, a pH balancing product, to prevent bacterial infections after intercourse, but note that only condoms provide an effective barrier against other sexually transmitted infections.

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I suspect you’ve been reading the fine print on an advertisement or packaging for one of the estrogen products—for which I congratulate you! It’s good to learn as much as you can about your treatment or options.

The mention of dementia is part of the “class labeling” required by the Food and Drug Administration since the Women’s Health Initiative in 2002. Even some non-estrogen products in this class receive the same labeling.

In one WHI study, there was a slight increase in dementia for women who used hormone therapy, but it’s important to remember that the women entering the study averaged 64 years of age. Additional studies have not replicated those results. It’s also worth noting that post-menopausal women have a greater risk than men of developing Alzheimer disease; estrogen has a role in protecting the brain and its function.

For anyone considering hormone therapy, her age and the age at which she entered menopause are critical considerations for heart and brain health. And, as I’ve said before, every woman, in consultation with her knowledgeable menopause care provider, must weigh the benefits and the risks of hormone therapy for her specific quality of life.

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For years, the dominant theory among anthropologists and evolutionary biologists has been that men are lusty, sexual creatures, primed by eons of evolution to spread their seed far and wide, assuring the propagation of their genes.

Women, on the other hand, mind the hearth and home. They trade sex for security and protection, saving the sweetest honey for the most viral suitor, who is also the one most likely to provide, protect, and produce robust offspring. Thus, women prefer monogamy and fidelity over sexual exploits.

That theory fits the predominant cultural paradigm. It’s a comforting, unthreatening explanation of how things are.

Except that it may not be accurate. Exactly.

Lately, this tried-and-true evolutionary theory has come under fire. Maybe the sexes don’t fall so neatly into “his” and “her” categories. Maybe previously overlooked research casts a different light on how humans interact sexually.

Maybe, for example, women aren’t so monogamous and passive. Maybe, despite even their own self-described diffidence, women are just at lusty and promiscuous at heart as men. That’s the thesis behind the new book What Do Women Want? Adventures in the Science of Female Desire by Daniel Bergner.

“Women’s desire—its inherent range and innate power—is an underestimated and constrained force, even in our times,” writes Bergner.

Consider that passion is one of the first casualties of long-term, committed relationships. According to Bergner, “flagging sex drive is not just an inevitability for women—it is specifically the result of long-term monogamy. Even [effects of] the hormonal decrease of menopause can be entirely overridden by the appearance of a new sexual partner.” (qtd. in this article in The New York Times. My italics)

So, dangle some studly dude before a menopausal lady, and she’ll be giggling like a teenager, but serve up the same old spouse and watch the sizzle drizzle.

Bergner references several studies that underscore the raw lust of the “gentle sex.” Female subjects were hooked up to a machine that measures vaginal blood flow. Then they were shown images of heterosexual and homosexual sex and even pictures of sex between bonobos—a species of ape. Women were turned on by all of it—even the apes—according to their vaginal reaction.

When heterosexual men were shown the same images, the response was predictable: they were slightly turned on by photos of men masturbating and male homosexual scenes, but they were overwhelmingly aroused by heterosexual and homosexual images of women.

But the really interesting thing?

In this study, both men and women also self-reported their levels of arousal as they watched the images. The men’s written responses were completely consistent with their physical responses—body and mind told the same story.

Not so with the women. Even though the instruments showed wide-ranging arousal at all the images, the women’s self-reported assessments were very different. The heterosexual women said they were turned on by the men but not by sex between apes or women. Right in line with cultural expectations and maybe their own idea of how they ought to feel.

Except that their bodies were telling a different story.

This female dichotomy between self-reporting and physical arousal has been repeated in several experiments that indicate women are turned on a lot more and by a wider range of sexual situations than previously thought, and also that women either aren’t aware of their own arousal or consciously under-report it.

Why is this? Why is the suggestion that women are naturally lusty such a shocking and forbidden topic? Why does this rattle the cage of cultural morés and expectations?

Women have, since time immemorial, been the kin-keepers, the caretakers, the foundation of the family, the social glue. But at what cost? Denial of their own primal sexual urges? Settling for sexual repression and boredom for the greater good?

No one is suggesting that monogamy, commitment, and long-term relationships ought to be tossed out, or that women should act on their urges. Clearly, stability, attachment, and intimacy create strong societies and families. Despite whatever sexual frustration it entails, monogamous relationships work for raising children and also perhaps for long-term psychological contentment.

But repression doesn’t work very well. So long as women feel they ought to ignore, deny—or to be puzzled or embarrassed by—urges that seem unacceptable or culturally unsanctioned, they will continue to be confused by and out of touch with their most primal urges. And maybe lose out on some healthy sexual energy as well.

No one has to act on their impulses, but acknowledging and accepting that they exist might be a healthy psychological choice, and one that puts women in touch with their sexuality.

How do men feel about all this female sexual sturm und drang? Well, “this scares the bejeesus out of me,” said one man in this article. The notion that, roiling beneath the domestic façade of the little woman tending hearth and home, may lie scary sexual urges has always been deeply unsettling, especially to men. Who’ll mind the children and navigate the social contract? Who’ll be the faithful one?

The growing scientific suspicion that women have a lot more going on beneath the surface than we let on or the culture sanctions is an interesting theory. While it may not be the whole story, I think somewhere we recognize it as at least partly true.

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