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Archive for September, 2014

You’ve noted that your clitoris appears to be smaller, which is a normal part of aging. With the absence of estrogen, it’s estimated that a woman loses 80 percent of her genital volume—unless there is some intervention. The two most effective ways to minimize this diminishment are to remain sexually active (that “use it or lose it” thing I’ve talked about before) and to use localized estrogen. Both help to maintain the integrity of the genital tissues.

Our intent is not to “prevent” menopause, because it’s a normal part of our lives. With my patients, my aim is to mitigate enough of the symptoms of menopause to be able to maintain the sexual intimacy that’s an important part of life for many of us.

More often than you’d think, a patient who thought she was “done with sex” comes to me for help when she enters a new relationship. It’s possible to reverse some of the atrophy that happens naturally with inactivity, but it’s more difficult than maintaining sexual health along the way. If a woman is certain that she has no interest in being sexually active, there’s no negative health effect of the genital atrophy—beyond the loss of the positive health benefits of sex.

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What you describe is going from arousal to “resolution,” without experiencing what you used to as orgasm in between.

The first thing I’d check if you came to my office is whether you’re on any medications that could interfere with orgasm. The biggest class of medications in this category are the SSRIs—antidepressants like Prozac and Zoloft. If you are, you can talk to your health care provider about alternatives that would have the effects you need without the same side effects.

Difficulty with arousal and orgasm are more common as our hormones change through menopause. The loss of estrogen diminishes blood supply to the genitals, which affects sexual response. There are a few ways to counter that loss:

  • More direct clitoral (external) stimulation can help—and not all of us are accustomed to needing that. A good vibrator is effective; we encourage women to consider vibrators with stronger-than-average vibration strength, and choose the products we offer at MiddlesexMD with that in mind.
  • Localized vaginal estrogen can also be helpful; you’ll need to talk to your health care provider to see whether a prescription is appropriate for you.
  • Keeping the pelvic floor muscles in shape is a critical piece of enjoyable sex, too. Strong muscles are part of strong orgasms–as well as preventing incontinence. We offer a new product, the Intensity pelvic tone vibrator, that uses electrical stimulation to contract the pelvic floor muscles in addition to its vibration patterns.

One more thing to consider: Women have at 50 about half the testosterone she had at 25, and testosterone plays a critical role in libido and ability to orgasm. There’s no FDA-approved product for women, unfortunately, but I prescribe testosterone off-label for patients with good results. Off-label use of Viagra or Cialis is also helpful to a few women. All of these off-label prescriptions require a conversation with your health care provider—and consideration of your overall health.

There’s every reason to be optimistic about regaining satisfying orgasm!

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Whether you have a little twinge or serious back pain during sex (and who doesn’t now and then?), these preventive measures can help ease the pain.

Explain the problem. Don’t leave your partner in the dark. Chances are, if you seem unwilling to have sex, your partner may interpret that as rejection. That’s almost as painful as back pain.

It’s hard to admit to physical limitations, especially in the sexual arena, but this is one of those topics that need airing. Then, it’s possible for your partner at least to understand the issue and more likely to become an ally in the search for solutions.

Medicate. Take an ibuprofen-type medication before sex. Or discuss using another pain-killer with your doctor.

Prepare. If your muscles tend to spasm, a hot shower before sex and cold compresses after could help. Or work a little massage with painkilling cream into your foreplay.

Innovate, don’t stress. Take your time. At this stage of the game, sex is more about connection than athletics. It’s more about enjoying the moment than setting off fireworks. Depending on the type of pain, try positions that support your back and reduce spinal movement. Experiment with support pillows to see what keeps you both comfortable. Or switch to other types of pleasuring if things get too gnarly.

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Connect the dots for me here:

  • Research consistently ranks good sex as an important component of quality of life.
  • Back pain is a serious deal-breaker to good sex because when your back hurts, sex does too.
  • About 31 million people suffer from low-back pain in the US, according to the American Chiropractic Association.
  • From 34 to 84 percent of those people have sex less frequently, depending on what study you read.

Ergo, if you suffer from back pain—and a whole lot of people do—you’re probably having sex less and enjoying it less, as well.

That’s a lot of lost quality of life.

Now, for the first time, a group of researchers from the University of Waterloo in Canada actually studied how the back moves during sex, adding some hard data to support, and in some cases, debunk, the common advice doctors give their patients.

The first phase of this research focused on how the spine moves in a normal, healthy male during sex. To do this, lead researchers, Natalie Sidorkewicz, MSc, and Stuart McGill, M. PhD, recruited 10 heterosexual couples who did not have back pain.

Then they wired them with reflective sensors and told them to “move as naturally as possible” in five different sexual positions: two versions of the missionary position, two versions of the “doggy-style” position, and “spooning” or side-lying (the most common position recommended for people with back pain).

The researchers analyzed the data and identified the positions that were most “spine-sparing”—involving less movement—for different types of back pain.

Some people—and this is more common with age—experience back pain when they sit or bend forward. This is “flexion-intolerant” back pain. The best position for the flexion-intolerant is the quadruped or a missionary position with the male on his hands.

A second type of back pain is called “extension-intolerant,” which means that lying on the back or stomach is painful. For this type of back pain, spooning may be a better position.

For some people, any movement causes back pain, and for these “motion-intolerant” types, sex remains challenging. In general, however, movement (and pain) is lessened when it is shifted to the hip and knee, as in the quadruped position when the female is on her elbows.

With any of these positions, small adjustments—whether a person is on elbows or hands, for example—significantly changes the amount of back movement involved.

The best option for the person not controlling the movement (the females in this study) is to keep the spine in a neutral position, by supporting the small of the back with a pillow in the missionary position, for example.

A chart illustrating the best position for different types of pain is here.

Future research will focus on female back movement during sex and how the spine is affected by orgasm. The researchers also want to study the effect of various positions for actual back pain sufferers.

All this is the beginning of good news for people with back pain. Previously, medical recommendations have relied on “conjecture, clinical experience, or popular media resources,” according to the University of Waterloo study. Hard data is a welcome addition.

Researchers also hope their work will spark more dialog between patients and health care providers about sex, now that practitioners have real research to refer to in discussion with patients with back pain.

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