Archive for April, 2016

Q&A on women's sexual healthWhat you describe is “clumps” of discharge, which might be consistent with a yeast infection except that you have no other symptoms  (redness or itching, for example). It’s also unlikely that this is skin cells sloughing. What’s most likely is that you’re having a reaction to some of the ingredients of the moisturizer: I’d recommend that you try another variety and see if you have the same symptoms.

Women typically see maintenance results in four to six weeks of twice-a-week application of vaginal moisturizers. And I do recommend the use of moisturizers! Moisturizers and lubricants are the simplest steps women can take to maintain vaginal tissue and comfort during intimacy.

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This is the fifth post in our occasional series inspired by the results of a survey we co-sponsored withPrevaLeaf, makers of natural products for intimate wellness. You can read our first post here and browse back to this one from there: You spoke. We’re listening.

We’ve already established that the women who took our survey tend to talk openly and regularly with their doctors and partners about their issues with vaginal dryness (and, presumably, about other menopausal symptoms as well).

This is excellent!

But I was puzzled by your responses to one of the survey questions. Over half (54.55 percent) of you never talk with your girlfriends about your desert vagina, and again, presumably, you don’t talk with them about other sexual menopausal issues, either.


I understand that it’s embarrassing to talk about vaginal dryness, but I’m sure you discuss other embarrassing menopausal topics with your BFFs, right? Maybe you joke about hot flashes and weight gain and mood swings and insomnia. Why avoid very common yet troubling sexual problems?

After all, who else (besides Mom) would really understand what you’re going through? Much as your spouse may want to be loving and supportive, it’s hard to really walk a mile in your menopausal shoes without being on the same biological journey.

Menopause is a topic fraught with myth and hearsay.

So, why aren’t we talking? Why do we continue to soldier on in silence? Isn’t it time to reach out to the sisterhood? “Create a support network to sustain you through the experience,” writes Ellen Dolgen, author ofMenopause Mondays: the Girlfriends’ Guide to Surviving and Thriving During Perimenopause and Menopause. “From my experience the menopause support I received from close friends has been invaluable.”


Amen to that, Sister!

I don’t mean complaining (although some griping is in order), or a revisiting of old wives’ tales and menopausal home remedies. I mean creating an emotional space in which we feel safe to talk about what we’re experiencing, whether it’s a bone-dry vagina or hair-trigger emotions, either of which may be wreaking havoc on our intimate relationships. And then to share credible information and to seek solutions.

In the interest of jump-starting some good BFF conversation, here are a few ideas:

  • Start a small group. It could be a Grumpy Girlfriends Club, a “book” club (lots of good menopausal books out there; my own offers plenty of food for thought), or just a plain-vanilla support group. (Author Ellen Dolgen promotes Menopause Mondays parties)  The idea is to invite a few compatible souls to share, discuss, and offer solutions to menopausal issues in a comfortable, safe environment.
  • Gather resources. Menopause is a topic fraught with myth and hearsay. But treatment options are changing fast! The advantage of a group is that you have more brainpower and eyeballs to cut through the nonsense and find solid, credible information.
  • Lay the groundwork. Obviously, you have to decide on the where and when as well as the format of the gatherings, but the nature of the discussion also dictates a need for privacy, sensitivity, and discretion.
  • No topic too touchy. The point of this support group is to air menopausal issues, such as sexual changes, that women don’t normally talk about. This demands a level of trust, acceptance, and confidentiality within the group. What’s said in the group should stay in the group. Critical or judgmental comments not allowed!
  • Not a gripe session. Gather a clutch of menopausal women, and the group could devolve into a litany of symptoms and complaints. While an honest exchange of the menopausal experience is critical, the point is to share information and seek solutions, not just to gripe. How can you cope with crippling hot flashes? What are the treatment options for vaginal dryness? For loss of libido?
  • Schedule something active occasionally. Good health habits are more important than ever at this time of life. Maybe schedule an occasional meeting that involves a walk in a park or a Sunday bike ride. You’ll get to know each other in a different way, and you’ll all experience the benefits of being outdoors and moving your bodies.

Breaking the shroud of silence surrounding the sexual issues of menopause empowers us to seek and share solutions. Along the way, we discover that a lot of other women are in the same boat. The message is the same, isn’t it? You are not alone.


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This is the fourth post in our occasional series inspired by the results of a survey we co-sponsored withPrevaLeaf, makers of natural products for intimate wellness. You can read our first post here and the rest by scrolling through our blog: You spoke. We’re listening.

Most of you who responded to our survey about vaginal dryness can skip this post. Take the dog for a walk. Give yourself a pedicure. And congratulate yourselves because the majority of you (78 percent) have spoken with your partner at least sometimes about the vaginal dryness you’re experiencing.

The rest of you, listen up.

What used to work in the past may not now.After all those years together (even if the partner is new and there haven’t been so many years), your partner probably has some sense of your monthly rhythms. Some vague idea about when you’re feeling hormonal or when you might be more approachable—or when to tread very lightly. Your mate may not be able to articulate it, exactly, but I’ll bet there’s a subliminal red light/green light awareness going on.

So, even if you don’t talk about it, you probably can’t completely cover up the more distressing menopausal symptoms that have begun to throw you for a loop. It could be the vaginal dryness that has become painful and distressing; it could be lack of interest in sex. It could be embarrassing bodily changes—sags, bags, and weight gain.

You can try to carry on; you can try to hide. Some women simply give up on sex, often to the detriment of their relationships and their own well-being, not to mention that of their partner. But those issues simply become the elephant in the room that you may ignore but that will never go away.

I understand that it’s embarrassing to gradually (or suddenly) become too dry for sex. Not getting wet is the female equivalent of erectile dysfunction, and it’s just as common. It makes you feel inadequate and less feminine. And, heaven forbid, old.

Vaginal dryness is easy to fix, but fixes take time and the patience to experiment. You need your partner on board, since your sexual issues are, by default, your partner’s as well. And that’s the trick—working together to address issues that affect you both. Ideally with a sense of playfulness and humor.

Here are some conversation-starters:

  • Beginning the dialog. Choose a relaxed, private time to talk about the changes you’re experiencing in a way that invites dialog. Beyond complaining about your symptoms, you want to explore various approaches and solutions. Maybe you should focus on intimacy as a couple and take it easy on vaginal penetration for a while. Maybe you want to try new lubes during sex, and you want your partner’s opinion on how they feel to him. Maybe you need more or different foreplay. Or a vibrator. Or a different position. We all get into sexual ruts, but what used to work in the past may not now. Can you talk about it together?
  • Doctor says. Schedule a visit to your ob/gyn and include your partner in the planning or in the actual visit. Our partners’ objective opinions about the changes they observe could be really helpful. Do they have questions or concerns? What do you both need? Then, a discussion of the visit may be in order—what did the doctor say about your options and how might things progress?
  • Their turn. We aren’t the only ones experiencing change, sexual or otherwise. Our partners may be struggling with age-related issues, too. Opening the door to dialog might allow you both to talk more frankly—and understand each other better.
  • Charting a path forward. The conversation isn’t over. Everything isn’t resolved, but maybe the door to difficult communication about midlife change is open a crack. Do you have some idea about what to try next? How to keep the intimacy and tenderness alive? Do our partners know how you feel and maybe what you need? Do you? Do they know that they’re still attractive to you and that you’ve been avoiding pain, not sex?

While vaginal dryness, among other menopausal issues, can be relieved despite your age, it’s a lot more effective to begin treatment early, according to Dr. James Simon, professor of ob/gyn at George Washington School of Medicine.  “It’s easier to fix something if it hasn’t been broken too long, so it’s typically easier to prevent serious atrophy by starting [estrogen therapy] early.”

“Relationships go bad for a whole bunch of reasons, but why not take vaginal atrophy out of the equation,” he said in this article.

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This is the third post in our occasional series inspired by the results of a survey we co-sponsored withPrevaLeaf, makers of natural products for intimate wellness. You can read our first post and the second, too: You spoke. We’re listening.

Those of you who responded to our survey are a chatty bunch! I’m thinking that, if you’re visiting the Prevaleaf and MiddlesexMD websites, you’re probably looking for information about sex and menopause. Ergo, you’re probably informed and willing to talk about it.

In our survey, we asked four questions about who you talk to regarding sexual problems, such as vaginal dryness: Do you talk to your doctor? To your friends? To your significant other? And how comfortable are you about discussing the issue, seeing as it’s not dinner-party banter?

In our sample of just over 100 women:

  • 64 percent have spoken with their doctors, at least “sometimes.”
  • 78 percent have spoken with their partner, at least “sometimes.”
  • 45 percent talk about vaginal dryness with their friends
  • 67 percent are either “very” or “somewhat” comfortable talking to anyone about the topic

Compared to national surveys, you guys knock it out of the park!

Normally, women just don’t talk about problems like vaginal dryness, even when it seriously impacts their sex lives. In a recent study of 3,000 women ages 45 to 75, Dr. Sheryl Kingsberg, chief of behavioral medicine at University Hospitals Case Medical Center in Cleveland, reports that although 60 percent suffer from vaginal dryness, only 44 percent mentioned it to their doctors.

The same study found that, while half the women expected their doctors to broach the topic, only 13 percent of them did. “There is a tremendous lack of communication around vaginal dryness,” says Kingsberg in a recentAARP article. It’s “underdiagnosed and undertreated.”

That lack of communication may result from embarrassment and timidity on both sides about bringing up a sensitive personal issue, but Kingsberg speculates that it comes from ignorance as well.

In Kingsberg’s study, 24 percent of women didn’t know that their vaginal symptoms were related to menopause. We all do a lot of girlfriend talk about hot flashes, night sweats, and mood swings. Vaginal dryness? Not so much. Fair enough, then, that it comes as a surprise and that we don’t automatically associate it with menopausal changes.

All of which sometimes leads women to home remedies and desperation measures for relief.

In a small study last year of 141 women by the University of California at Los Angeles, 17 percent used petroleum jelly and 13 percent used various oils as a vaginal lubricant, resulting in far higher levels of yeast and bacterial infections than for women who used lubricants made for vaginal use.

That’s because the microbial environment in the vagina is finely balanced to fight infection. Mess with that by using products that upset that balance (vinegar douches, saliva, oils), and you’ve got trouble.

We talk about hot flashes, night sweats, mood swings. Vaginal dryness? Not so much.“I have always been fascinated by the vast array of commercially available over-the-counter products marketed to women to modify their vaginal environment,” Joelle Brown, lead researcher in the UCLA study told Reuters Health by email. “In most pharmacies you can find entire aisles dedicated to vaginal douches, suppositories, and gels that are meant to make your vagina smell like a tropical splash or a cookie.” Here in my small Midwestern city, there are 15 moisturizers or lubricants on the shelf at Rite-Aid, 38 at Walgreens. Are we willing to stand there long enough to figure out which are healthy and helpful for us at midlife?

I may be preaching to the choir here, ladies, given your amazing survey result, but we need to start talking about our bottoms. To our doctors. To our partners. And to our friends.

I’m thinking that some good, informed conversation among girlfriends might help to shed light on this common yet misunderstood problem. And if you have any questions or unresolved issues, don’t wait for your doctor to bring it up. You may have to start the conversation yourself.

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