Archive for June, 2016

HPV After 50? It’s No Joke

You’ve come a long way, baby. You survived the sexual revolution of the 1960s and 1970s. You raised your family. You have a rewarding career. And you’re conquering menopause.

Now it’s time to face facts about human papillomavirus (HPV), the most common sexually transmitted infection.

It’s also the most common cause of abnormal pap smears, although a new abnormal pap result doesn’t mean you’ve been re-infected.

HPV 101

There are roughly 100 different types of HPV, and the most dangerous ones don’t have any symptoms.

And, just like other viruses, it can’t be treated with antibiotics.

Think you’re not at risk? Think again, because 8 of 10 sexually active people are infected at some point in their lives. And, according to a 2013 study, you can develop HPV after age 50 when a virus that was dormant for years “reactivates” decades later.

Kinda like getting chicken pox as a kid and then fighting shingles years later. Except worse, because some high-risk types of HPV (e.g., type 16, 18, 13) could lead to cervical cancer as well as head and neck, cervical, vulvar, vaginal, penile, and anal cancer.

Think you're not at risk? Think again.HPV infections occur when the virus enters your body, primarily by skin-to-skin contact. In some cases you may develop genital warts, which look like flat lesions, small cauliflower-like bumps or tiny stem-like protrusion. They can show up on your vulva, cervix, vagina or near your anus. (Warts can be treated with creams or, in some cases, removed.)

You can also get HPV infections in your throat, tongue, tonsils, larynx and nose.

Safety first

Women are twice as likely to develop STIs, especially after menopause when our genitals have aged and we’re more likely to develop small tears and cuts. (By the way, moisturizers and lubricants can help with that.)

Keep these tips in mind:

  • Don’t put off pap smears – especially if you’ve had multiple partners. At ages 30-65, you should have a Pap test every three years (or every five years if your health care provider does dual testing). Talk to your health care provider about the right plan for you, given their specific options. And, if you get an abnormal result, be sure to follow doctors’ orders.
  • If you’re in a newer or non-monogamous relationship, use protection to avoid getting and spreading HPV.
  • If you’ve been with the same partner for 20 years, you can’t be re-infected by the same HPV type. So no worries. You can relax and enjoy sex without a condom.

The bottom line: Although most HPV types are harmless, you’re always smart to be on guard.


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The times just might be a-changin’. At least that’s what I think we’re seeing with the results of our new MiddlesexMD survey.

The times just might be a-changin'.We asked for readers of our website and newsletter to respond to several questions about whether and how you use a vibrator, and we’ve been compiling and pondering those results for a while now.  Granted, our sample size is small and not exactly random, since it’s comprised of MiddlesexMD readers. Given the nature of
our mission, it’s skewed toward women in those peri- and post-menopausal middle years between 50 and 70.

That said, there’s a lot to be gleaned from the stats and especially from your comments about how you use vibrators and what you’d like to know about using them. We’ll continue to address those questions in future posts.

An interesting place to begin the discussion might be in what I interpret as a generational and cultural shift in attitudes and comfort level toward using a vibrator. Those are the cracks within which I think the times might be changing.

There’s a lot of anecdotal and scientific evidence that vibrators have gone mainstream in the past decade or so. In a 2011 study co-authored by Debby Herbenick, PhD., director of the Center for Sexual Health Promotion at Indiana University, over half of the 2000 women between the ages of 18 and 60 who were surveyed have used a vibrator and felt positively about both sex and their vibe.

In our survey, about 80 percent of the respondents under 60 have used a vibrator alone at least “rarely” and over half have used one with a partner. Of the respondents over 60, about 68 percent have used a vibrator alone and 37 percent with a partner.

About twice as many women over 60 have never used a vibrator alone compared to women under 60. In our much smaller subset of women under 50, all report using a vibrator at least rarely.

Granted, these numbers may be less revealing since our respondents cluster around the menopausal years and are women who are interested in their sex lives. But I think they do reinforce a sense of the cultural shift that has occurred.

Those of us who came of age during the rollicking 1960s and 70s may have partaken of, um, many things, including the sexual freedom of birth control options and evolving cultural morés. At that time, however, vibrators weren’t really on the radar. Heck, we were still striving for the elusive simultaneous orgasm(vaginally and without help). And what the heck was wrong with us if we couldn’t manage it?

“…by the 1970s, scientific publications stated that vibrators were harmful and never to be used by ‘normal’ women,” writes Lauren Streicher, MD., associate clinical professor at Northwestern University’s medical school in this blog post.

Well, guess what? The times have certainly changed since then. By the time Charlotte fell in love with her “rabbit” (a vibrator for both clitoral and vaginal stimulation) on the first season of Sex in the City in 1998, vibrator use had gone mainstream. Now, guys use them; partners use them; same sex couples use them. Far from being stigmatized, vibrators are associated with a whole bunch of good things, including a more robust sex life.

Some of us older gals may have missed the memo, but we’re catching up. That’s what our survey suggests: younger women use vibrators more, but our over-60 cohort is coming of age, so to speak. That’s a good thing, because vibrators are most critical during those drier, less sensitive, post-menopausal years.

So don’t be surprised if your doctor prescribes a vibrator just to keep your downtown tissues healthy, as Streicher did for one of her 70-year-old patients, who had to adjust her hearing aid to make sure she understood correctly.


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As the old saying goes, If Mama ain’t happy, ain’t nobody happy. The same thing could be said of Daddy—especially if Mama ain’t getting any. While my practice is focused on women, I know that my patients’ partners’ health is a critical component of intimacy and satisfaction. And one reason Mama may not be happy is Daddy’s erectile dysfunction (ED).

Working together to keep the flame alive is in your best interest.Erectile dysfunction can happen at any age, but it often becomes more consistent and problematic as a man grows older—just like the changes we’re experiencing with menopause. If your man is having trouble maintaining an erection, you might consider lovingly addressing the issue head-on. After all, both of you are going through changes that impact intimacy. So working together to keep the flame alive is in your collective best interest. And denial will definitely not make the problem go away.

Lots of interventions exist for ED, from surgery to the well-known pharmaceutical options, but as you may know, I’m a big fan of laying a solid foundation of good health habits before leaping on the pharma train.

The big advantage of good health habits, of course, is that they address a host of issues, from cardiovascular health to weight maintenance, which are critical to good sexual function but also to overall well-being.

So, in the interest of a vigorous sex life for both of you, here’s my short list of natural cures for ED.

  1. Exercise. According to Zachary Mucher, MD, a urologist in Sugar Land, Texas, of all the interventions for ED, “Exercise works on several fronts to combat the development of ED and help reverse it once it has become a problem,” says Dr. Mucher in this article. Moderate daily exercise improves cardiovascular health, keeps weight in check, and it can help medication for ED work more effectively. It releases nitric oxide in the blood, which is how Viagra works, and it improves testosterone levels. Darned good bang for the buck, I’d say.
  2. Do kegels. Yes, you read this right. What’s good for the goose, and all that. A toned pelvic floor in menstrengthens the bulbocavernosus muscle, which is associated with sexual performance. Just think, you and your man could warm up for your daily two-mile walk with a couple sets of kegels. Squeeze and hold the muscles that stop the stream of urine for 5 seconds at least 10 times. That’s a set, and that’s also togetherness.
  3. Healthy diet. You know the drill: lots of fruits and veggies; whole grains; less red meat and more fish; way less sugar and fat. Maintaining a healthy weight is another critical element of sexual function.Obesity is a well-known contributor to ED and also a predictor of less sex. In one oft-cited study, men with 32-inch waists were half as likely to have ED as those with 42-inch waistlines. (I’m thinking they were also younger.)
  4. Stop smoking and drinking. These habits are strongly linked to ED. Smoking compromises the cardiovascular system and drinking suppresses neurological function. Both need to be in optimal order for good sexual function.
  5. Natural supplements. Any health food store will carry a dizzying array of treatments for ED. Before straying too far down this path (some herbal supplements come with their own side effects and drug interactions), let me suggest some safe and easy “natural” supplements that have some basis in science.
  • Stronvivo Nutritional Supplement is essentially vitamins for cardiovascular health, because, as I said, cardiovascular health is linked to sexual performance for both men and women. I like the reports I’ve read from clinical evaluations, which showed improvements after 90 days of Stronvivo use.
  • Vitamin B12. Deficiency in this vitamin is linked to ED. Take a supplement and eat foods rich in B12, such as fish and red meat. (Here’s your excuse for a steak.)
  • Watermelon juice. Dubbed “nature’s Viagra,” watermelon is high in citrulline, which improves blood flow to the penis. This is an easy, healthy way to ingest some vitamin C along with a good dose of sex supplement.
  • Red ginseng. A type of ginseng root that is steamed and dried. Several studies suggest that ginseng helps with ED. It is also safe.

Did you notice that every one of these interventions for erectile dysfunction are good for both of you? In fact, this regimen could be considered a powerful and fundamental aphrodisiac for everyone. So, rather than harping on him to exercise or stop smoking, you can lead by example.

Watermelon, anyone?

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