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Archive for October, 2015

I’ve got much to catch up on, study up on, and share with you from my trip to the North American Menopause Society (NAMS) annual meeting a couple of weeks ago. It was a whirlwind of great talks, and such a marvelous time to catch up with colleagues who are doing wonderful work.

One of my all-time favorite people, Dr. Susan Kellogg-Spadt, who’s been a medical advisor here at MiddlesexMD, spoke at the conference! She was fantastic, of course.

She’s a nationally recognized expert in pelvic and vulvar pain and the Director of Female Medicine at the Bryn Mawr office of Academic Urology at the Center for Pelvic Medicine, in Rosemont, Pennsylvania. She treats patients throughout the United States as a vulvar specialist, sexual dysfunction clinician and therapist.

At her NAMS talk, Susan talked specifically about the sexual needs of menopausal women, and in some detail. We gain so much from having her in our field! But without further, um… gushing? Here are Susan’s top clinical pearls for our sexual health and happiness:

Add moisture daily. If we use a water-based, bio-adhesive lubricant several times a week, regardless of sexual frequency, we can get a lot more comfort and satisfaction with sex and just make it easier to have an orgasm whenever we want to.

Nourish yourself. A Mediterranean diet has been shown to promote sexual function, (and, we just learned, perhaps lower breast cancer risk). And regular exercise improves mood and overall health, both of which contribute to better sex.

Talk it out. When we use “I” language to talk with our partners about sex honestly and in a non-accusatory way, we increase the chances of sexual success. Your NAMS doctor or therapist can help provide the vocabulary and communication tips.

Prioritize pleasure. Don’t wait for intimate time to just happen. Even a 20-minute block of time, scheduled weekly, for touching and intimate conversation can clear the way to better sex. Putting it on your checklist may seem like a cold thing to do, but trust us, it gets hotter with practice.

Mindfulness matters. Reading or watching even the softest erotica, being mindful of erotic thoughts as they occur, and focusing on sensation rather than distractions during arousal are all important. All mindfulness training can contribute to your ability to stay in the moment during your most intimate moments.

Intensity, baby. After menopause, many women need more intense stimulation to reach orgasm. Consider introducing vibrators into sex play. The term, “Doctor’s orders!” can be very useful here. You have our permission to use it.

Do try. Just opening up and talking about sex problems, and finding what can still be sexual successes, shows that a woman is committed to her partner, and taking action shows her level of care and concern for the relationship. Mutual affection, honest attempts at exploring what is possible, comfortable, what still feels good, does amazing things for a relationship.

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So my medical journals are telling me, again, that I need I need to eat better and keep moving. Gee, folks, thanks for the news!

But I rarely receive such specific advice as I have these past few weeks. They have handed me very, very clear directions:

  • Eat a Mediterranean Diet including extra-virgin olive oil.
  • Exercise 300 minutes a week.

Wait… Really?

Specifically….  for menopausal women… my medical journals are suggesting we do this to avoid breast cancer.

Well! That’s pretty specific! And pretty awesome when scientists are paying special attention to my favorite people!

So let’s look at these studies suggesting ways we just might, through diet and exercise, provide our bodies an optimal environment for fighting off breast cancer.

The PREDIMED study, published in JAMA, September, 2015, was conducted in Spain from 2003 to 2009, wherein more than 4,000 women at high cardiovascular risk, aged 60 to 80, were randomly placed on three diets: the Mediterranean diet, supplemented with extra-virgin olive oil (first cold-pressed), The Mediterranean Diet supplemented with mixed nuts, or a Low-Fat diet.

The results of this study have been coming out for some time, and have been fascinating. This latest release shows that those on the olive-oil-supplemented diet had a 68-percent lower risk of developing breast cancer than the other participants in the study. It’s one study, of course, and needs to be repeated, but it’s rather fascinating. Earlier outcomes of the PREDIMED study suggested the same diet resulted in a delay in cognitive decline for the same population. There will be more news from this cohort. We will stay tuned.

By the way, when shopping for olive oil, it is best to stick with first-cold-pressed, extra-virgin olive oil for your good health. It costs a little more, but that’s the healthy choice that this study is based upon. Cheaper oils have been heat-treated or chemically treated, and are no longer a healthy choice for your body.

The exercise link is a the Breast Cancer and Exercise Trial in Alberta, Canada, published in JAMA Oncology in 2015. The study followed 400 women. Half of them worked out for a half an hour a day, 5 days a week. The other half worked out for an hour a day, 5 days a week. They worked out at 65 to 75 percent heart rate for at least half of their workouts. All without changing their usual diets. The women were overweight, disease-free non-smokers, and they were followed for three years. Subcutaneous and abdominal fat and waist-to-hip ratio decreased significantly more in the high-exercise-volume group.

Since body fat increases postmenopausal breast cancer risk, this suggests this higher dose is a better dose of exercise for us to keep the weight off, the body fat down. Lower body fat is a better environment for lower breast cancer risk.

So I’m going to take a brisk walk to the grocery store, buy two big bottles of my favorite extra-virgin oil, and do biceps curls with them on the way home. Or maybe I’ll just stay a little longer on my treadmill and have a nice salad with dinner.

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You say you’ve been using Replens regularly, and have noticed that hydrogenated palm oil is among the ingredients. You’ve heard that hydrogenated fats are unhealthy, and wonder whether you should be concerned.

You’re right to be concerned about ingesting hydrogenated palm oil in food products, especially if you have elevated cholesterol and triglycerides. As an ingredient for a topical product, though, like a vaginal moisturizer, the oil is safe and won’t affect your lipids. Applied to the surface of your skin or tissues, the moisturizer is not absorbed into your bloodstream.

Keep using that moisturizer! Keeping tissues health goes a long way toward comfort and enjoyment.

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I started MiddlesexMD because I wanted to help women to stay as sexually active as they choose for as long as they choose. I’d heard from too many women in my medical practice who assumed that they were “over” that part of their lives, whether or not they liked the assumption. Discomfort, downright pain, less pleasure, and diminished libido appeared to be barriers they just couldn’t see past.

I thought I was in a unique position to help: I’d practiced obstetrics and gynecology for a couple of decades, had become qualified as a menopause care specialist, and had myself reached what we call “a certain age.” I could explain the medical realities from the perspective of a woman who shared experiences and day-to-day impact.

And I hoped to contribute to breaking the silence about midlife sexual health, since so few of us have talked to our friends, our doctors, and even our partners about what’s changing and what we might want to change.

It’s been rewarding. An unexpected benefit for me—and in some ways for you, too—is all of the people I’ve met who share the vision: of women taking control of their health and wellness, including their sexuality, as they move through midlife.

The MiddlesexMD team first met Rebecca Posten, CEO of PrevaLeaf, at a conference for nurse practitioners in Savannah. We were struck by the similarity in our missions and values. PrevaLeaf’s purpose is to “provide women with gentle and natural products to maintain their intimate wellness.” When Rebecca says she’s all about “helping women stay in control and stay well,” she’s speaking my language.

She and I have other things in common, too: We’ve both had medical training specializing in ob/gyn; we’ve both networked with women entrepreneurs who had practical experience in bringing a vision to life; she shares my interest in spreading the word about women’s health; we both have daughters who know much more than their peers about women’s anatomy and sex.

None of those, though, are the reasons I feel good about offering PrevaLeaf™ products. As a physician, I share PrevaLeaf’s bias toward prevention and wellness, and the intensity of their focus on women’s health. I like how seriously they take natural ingredients; they’re a member of the Natural Products Association and follow their guidelines for ingredients and manufacturing processes.

But the proof is in the products, so I invite you to check them out. PrevaLeaf Oasis is a water-based vaginal moisturizer for daily use. PrevaLeaf Soothe is for those occasions when discomfort calls for some additional relief.

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You say you experienced “pins and needles” during intercourse in your last relationship, and of course it’s difficult to feel amorous when you’re expecting pain. That’s a common description of what it feels like to have genitourinary syndrome of menopause (also called vulvovaginal atrophy) or vulvodynia. A careful pelvic exam by a skilled practitioner can diagnose the condition.

There are treatments available, starting with moisturizers and including hormones, either local or systemic, and other medication options. But a clear diagnosis is the first step.

And then the relationship component. A strong and supportive relationship is an important part of libido and desire for most women. At midlife and beyond, though, we face the “use it or lose it” phenomenon: Here’s a blog post that addresses a “maintenance plan” so that when you find the relationship that’s worth it, you’re ready for intimacy.

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