Archive for July, 2016

The United State of Women “Healthy Women. Healthy Families.” summit in Washington D.C. didn’t focus specifically on perimenopausal and menopausal women, yet my conversation with attendee Marta Hill Gray naturally circled around to the topic of women, aging, and sexuality.

Marta, a women’s health advocate, worked behind the scenes to promote “pink viagra,” and she continues to be an insightful observer of women’s issues.

What have you observed about society’s view of women beyond the childbearing years?

As women age, society says we are supposed to suck it up and get on with it, but that doesn’t mean we are healthy and actually taking care of ourselves. For so many women, when you get to menopause no one has taken time to tell us what to expect.

After attending the event, what advice do you have for my readers?

Talk to daughters, sisters, nieces, and friends about the changes that are coming.Younger women need to know the time will come to a time when their bodies are going to change. As older women, we need to talk to daughters, sisters, nieces, and friends about the changes that are coming. Let them know that once you have your babies, it’s not over. We should really mentor them in being diligent about their bodies, so they ask better questions and they’re smarter than we were.

Your mom may tell you about having their period but not about menopause… It is a big deal. And women need to know there are doctors like you, menopause providers, who can make it manageable, who can give you treatment options and care and guidance so you move through it gracefully.

Not all doctors are comfortable with women in menopause.

That’s true. And if you don’t have health care providers you can talk to you, you need to fire them and find one you can talk to. Yes, you can fire your doctor, it’s all right! Just because they wear a white lab coat doesn’t mean they know how to help. You should be able to comfortably discuss any topic including bowel movements, urine, sexuality … all of that is important.

There seems to be more openness to talking about sexuality and sexual health today than when I began my practice.

I agree. The fact is that we’re living longer, we look better, and we are more involved than previous generations of women our age.

We're living longer and are more involved than previous generations.It is such a life-affirming thing to be a sexual creature, yet so many women have painful intercourse, and then they shut down, which can hurt relationships. I think that women going through menopause should definitely be able to depend on their health care provider to give them information and tools to overcome the challenges. It is different for everybody and, just as it is when you’re younger, it is very personal. A lot of women don’t know they have options and choices.

Women’s health and women’s sexual health isn’t behind the curtain anymore. It is being forced out on the table partially by the fact that our world is smaller and we know so much about girls as slaves, genital cutting, sexually transmitted diseases… everything is discussed and it will continue to be so discussed because these are facts. It’s an open discussion now, and the word vagina can be said. Women make up 50 percent of the population, and we are full citizens.

Younger women are leading the charge and they will not be denied. They have no fear. I think it’s fantastic, and it’s going to get better and better.

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You can't talk about women's empowerment without talking about health.My good friend and women’s health advocate Marta Hill Gray recently attended the first summit of The United State of Women, a gender equality movement with high-profile support from Michelle Obama, Warren Buffet, Oprah, Meryl Streep, Amy Poehler and other well-known celebrities. (To learn more, watch this two-minute film.) Naturally I was interested (and very curious) to hear all about this event, which was convened by the White House in Washington D.C. Here are highlights of my recent conversation with Marta:

I understand the topic of this summit was ‘Healthy Women, Healthy Families.’

Yes, you can’t talk about women’s empowerment in any fashion without talking about their health—it’s one and the same, and it hasn’t been given enough attention and respect. It was exciting to see 5,000 women who took time to fly from around the world for this event.

It was a tsunami of attention around women’s issues.

What was your main take-away?

There was a lot of sizzle with big-name celebrities… but more importantly, it really put a spotlight on younger women who are dedicating their lives to women’s issues

Millennials are really stepping up and very much engaged in ways we may not have been at that age. The younger women are leading the charge and they will not be denied. They have no fear. I just think it’s fantastic, and I think it’s going to get better and better.

What kinds of speakers did you encounter?

I saw some wonderful health care professionals who are working with under served communities, helping women get the support and education they need, and helping them understand their rights are in terms of pregnancy, treatment options and even what insurance will (and will not) cover.

For example, The Women’s Law Center spends all of their time answering the phone and explaining to women what their rights are, like the right of all women to have breast reconstruction surgery after a mastectomy.

Those are the kinds of things that many of us take for granted, but not all women get the same information or the same treatment.

What surprised you?

I am seeing a real shift in the language and the public perception about women’s health. This isn’t just a women’s problem—it’s a problem for men, for boys, for sons. This impacts families and it impacts lives.

Why this special focus on women’s health?

Women's bodies need to be understood separatelyHere’s an epiphany: Women’s bodies are not like men’s bodies. They need to be respected and understood separately. Yet, women don’t know about their bodies, there is often shame about it and there many cultural nuances. The question is, ‘How can we support women who need this kind of care?’

But the good news is that things are changing. This summit was full of vibrant conversations instead of the shame of years ago.

I was encouraged by the young women. To them, it’s so important that there’s no thought of repercussions. It gave me great hope to see women who are so sharp and directed and capable.

My conversation with Marta went beyond the summit to the topic of women, aging, and sexuality. Watch for my next blog to learn more.

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Q&A on women's sexual healthI hear this question every now and then, especially from women who are experiencing a higher libido than before. This is entirely possible and “normal”: While hormone levels are, in general, declining, the specific levels of estrogen and progesterone are fluctuating erratically from day to day. Testosterone is typically more steady, with less fluctuation from day to day or month to month. That means that the mix of hormones changes. If testosterone is dominant, a woman may experience an enhanced libido (which is why testosterone is sometimes considered as a part of therapy to restore sexual function).

I got an enthusiastic message from a woman who’s experiencing this “upside” of perimenopause:

“I’m 46 years old, with some normal perimenopausal symptoms like inability to stay asleep, and irregular heavy periods.

“Unlike most, however, I’m quite thrilled with peri-menopause at the moment, because I feel incredibly energetic and my libido is other-worldly. I’m wet all the time. When my husband approaches within one foot of me, I start panting. Sometimes a moment of mental arousal hits me randomly during the day and the blood rushes downward so quickly that I get light-headed. It’s very fun and I just want to share with you that it’s possible to get some unexpected goodies from this hormonal chaos.

“Maybe you could give a bit of a shout-out to the diversity of experiences that are normal and valid and healthy.”

Yes, I can! Perimenopause and menopause play out differently for each of us individually, and there is a diversity of experiences. Embrace your own experience, feel confident in observing your own body and its responses, and be prepared for happy surprises along the way!

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One respondent to our survey about vaginal dryness mentioned that she had been looking forward to menopause because she expected to get fewer migraines. And then she experienced a sex headache, which she described as “sudden, excruciating, and scary as hell.”

Let’s connect some dots and get some facts about sex headaches.

Dr. Barb DePreeThere haven’t been a lot of studies done on sex headaches, which go by several unpronounceable medical monikers, such as coital cephalalgia, coital headache, or orgasmic migraine. (Just FYI: Sex headaches are NOT considered migraines.) They seem to affect about 1 percent of the adult population. Younger men are more likely to experience them, but so are people with a history of migraines. (There is simply no justice in this world.)

The dot to connect here is that women who get migraines tend to get more of them during the hormonal peaks and valleys of menopause. Our respondent was correct, however, in that once those hormonal swings are resolved, post-menopausal women can usually look forward to some relief. Except for a higher risk of experiencing sex headaches, which aren’t hormonally induced.

Neurologists have identified two sub-categories of sex headache: pre-orgasmic and orgasmic. This may sound like hair-splitting, but the two are very different. A pre-orgasmic headache is a dull ache that builds as sexual tension increases. It’s bilateral (on both sides of the head) and may involve muscular tension in the neck and jaw. Some people have reported that the headache eases if they slow down the sexual pace.

Not fun, to be sure, but also easily resolved by taking an anti-inflammatory, such as ibuprofen, 30 minutes before having sex.

The orgasmic headache—which is anything but—is described as explosive and excruciating. A “thunderclap headache” that occurs during orgasm. It can occur during any kind of orgasm, from masturbation, oral sex, what-have-you. Sufferers describe it as the worst headache of their lives. It usually lasts only minutes (but it sometimes lasts longer), but the experience of having your head explode is exceedingly scary the first time it happens and exceedingly painful at any time.

The important point is that orgasmic headaches are usually treatable and benign, and are thought to be caused by a rise in blood pressure or change in blood vessel diameter, but it’s very important to eliminate the possibility of other serious and life-threatening causes, such as aneurysm or tumor.

So, the first time you get the explosive-type of orgasmic headache, see your doctor pronto for an evaluation. You’re probably fine, but the slight chance of a serious underlying condition makes it imperative to get checked out.

Once the bad stuff has been eliminated, your health care provider may write a prescription (an anti-inflammatory or migraine med, for example) to help you manage any recurrence. About three-quarters of those who experience an orgasmic headache, never get one again. In rare cases, however, they can become chronic. For chronic headaches, a different medication may be necessary.

“The good news is that there are treatments available, and they work,” says Dr. Merle Diamond, associate director of the Diamond Headache Clinic in Chicago in this WebMD article. “You don’t have to swear off sex.”


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We’ve been talking about vibrators for a few posts now, spinning riffs off the MiddlesexMD survey in which some of our readers participated. This will be the last post on using a vibrator with your partner, so I want to delve into the details of how to choose a vibrator and then use it together.

When it comes to sex toys, the human imagination runs wild. You can find every permutation of color, size, and shape for every conceivable purpose. This is certainly true for vibrators. For our shop we’ve tried tonarrow the field to a few high-quality devices that are uniquely suited to the needs of “mature” women (think long-lasting, powerful, straight-forward to use, and safe). But there are also vibrating devices just for men (penis rings and prostate massagers, among others), and some more specifically for partnered use, such as theWe-vibe.

A few additional pointers before we begin:

  • Decide whether you’d like to get used to a new vibe alone or to share the initial awkward play with your partner. There are pros and cons to each approach. Doing it together can be a funny, fumbly foray into a new level of intimacy that has its own quirky, erotic quality. Acclimating to a new vibe alone allows you to really concentrate on what you like and what works without the distraction of another person. Probably, you’ll want both to practice together and alone at some point.
  • A vibe is a very personal gadget. You’ll discover a lot about yourselves and each other, sensually speaking, that might surprise you both. That’s the beauty and the challenge of using a vibe. Be patient and persistent. If something doesn’t feel good, try another approach or a different type of vibrator. Some moves may be nice together; others feel better alone. Be sure to share what works with your partner.

Writes one blogger: “The thing about couples’ vibrators (and the thing about couples) is that each individual will have a wildly different experience, and the success of the device (or the relationship) is your ability to make it work for you.”

  • New partner? Don’t forget the risk of STDs. During sex, the vibrator may travel from him to her and back again, carrying whatever fluids are present, including sperm. Be sure to clean it thoroughly with soap and hot water or put a condom on it. Never go from rectum to vagina without cleaning. Hard materials, like silicone, plastic, and glass, are easiest to clean.
  • Do not put a small vibrator in the rectum. The most common vibrator mishaps are those that occur when the device gets “lost” in the vagina (it’s not really lost), or more frequently, in the rectum.
  • You can’t use too much lube, but you can use too little. Buy a good quality lubricant, and use it Use only water-based lubes with silicone toys.

With that in mind, I’d suggest starting simple, small, and uncomplicated. You can program some vibes for different series of pulses, to vibrate to music, to use with your Smartphone or a remote. I’ll bet some vibes change color with your mood. But why make things more complicated than they need to be at first?

Maybe start with a small, clitoral vibe that looks unintimidating (is smaller than he is) and that is easy to use. Try the Kiri or the Mia2, both by Lelo, a manufacturer of high-quality sex toys. At some point, maybe you’ll want to try the We-Vibe. It’s very popular and made for couple play. (One part is inserted in the vagina, along with the penis—yes, this works, and the other rests on the clitoris.) The programming variables are staggering. This blogger offers an objective and entertaining tutorial.

Consider the type of power you’d prefer: rechargeable (no batteries to buy; most powerful), lithium ion batteries (more power), regular alkaline batteries (typically less power). Some vibes are waterproof (consider the possibilities…).

When your vibrator arrives, check it out either alone or with your partner; charge it up; read the manual; test-drive the features. To start, use it on your extremities at the lowest setting, even with your clothes on, to get used to the feeling. How does it feel on your leg? Arms? Move to the back of the knee. Inner thigh. Circle the nipple—his and yours if you’re test-driving together.

Take it slow. Continue to explore what works for you. Use it on the labia, around the vagina. Or let him do it. Don’t go for a direct hit on the clitoris; too abrupt just hurts. Oblique works better. Vary the speed, the intensity, the angle.

Take turns. Let him hold the vibe and guide his hand. Then switch and let him guide you. Once you’ve both figured out what feels good, you can communicate with, or show, your partner.

Turn up the speed and run it up one side of his shaft and down the other. Then use your mouth on his penis with the vibe held against your cheek to continue the vibration but with a change in temperature and texture. Circle the head of his penis with it. With the vibration set very low, use it on his scrotum and finally, his perineum (the space between his scrotum and anus). This region can be very sensitive and indirectly stimulates his prostate. If you’re on top, you can easily reach down with the vibe and gently buzz this area.

Take your cues from him. Experiment, and let him tell you what he likes. You might also try a vibrating penis ring—you get clitoral vibrations while he gets a buzz to his shaft. Good vibrations all around.

The whole process may feel strange at first. But as this blogger puts it, “And that’s kind of the point: adding a little bit of fun and awkward and weird to sex.”

Eventually, you should learn a lot about pleasuring yourself and your partner. Maybe you’ll like the vibe just for foreplay or maybe it will become an integral part of your sex play. Maybe you’ll just decide to use it alone or not at all. As sex and relationship counselor, Kate McCombs writes, “…if a toy doesn’t do it for you, it doesn’t mean you’re broken.”

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In the last post, I made the case (persuasively, I hope) for why you might want to introduce your partner to sex with a vibrator. Now, let’s look at some non-threatening, sensitive ways to do that.

First, let me remind you that he might not be as threatened as you fear. Vibrators are everywhere—he’s probably seen them in the drugstore, on TV, or on social media. Maybe he’s curious, too. He may also be aware that your libido and sexual responses have been changing. You need more stimulation, more time, and maybe a change of pace to keep the flame alive. Maybe he needs something different as well.

Create a sense of mutual exploration and play.A good beginning is with a conversation. Something like, Hey, I’ve been thinking…or, I read an article on… What do you think about…? Or, Maybe you’ve noticed I’m not as responsive as I used to be… Sex and relationship educator Kate McCombs suggests that “people really underestimate the sexy power of talking about what you’re going to do to each other later. For example: ‘…Should we try it? Hey. Why don’t we check it out online? Ooh. Let’s do it, and let’s get the expedited shipping.’ Then, by the time it arrives, you’ve basically been engaged in this four-day foreplay. I think that can be powerful for people.”

Shopping for your vibe together not only builds anticipation, but it feels like you’re sharing this new adventure—you’re on the same team, rather than either one of you being in charge or leading the charge.

You may need to reassure him early on that a vibrator never replaces sex with the living, breathing person you love. It’s a tool and a toy; it adds a new dimension; it can feel good; and you can learn a lot about what you both like. But it isn’t a replacement; you won’t become dependent on the vibrator; you won’t prefer it to him. In fact, studies show that women (and men) who use vibrators usually perform better and feel more positively about sex with their partners.

(There’s a physiological reason for this. Orgasm begets orgasm, because the muscle contractions, genital stimulation, and increased circulation makes it easier to orgasm next time. That’s why you never need to worry about the myth that a vibrator will make climaxing with your partner impossible; in fact, it’s just the opposite.)

A more oblique approach might be to introduce something new but less threatening, like massage or shower sex to your routine. Buy a new lube or massage oil. Expand your repertoire of sexy smells and touch. If you’re getting green lights, maybe you can, in time, gift him a “Happy Wednesday” vibrator.

Create a sense of mutual exploration and play while being sensitive to your partner’s comfort level as you go along. If he’s reticent, slow down and explore why. Fear is usually the underlying cause of anxiety or resistance. Bottom line: It’s worth trying something new, but if you both can’t play, it won’t be fun.

Bottom line #2: If you get a complete shutdown with no wiggle room? Completely fine. You don’t need toys for a loving sex life. Maybe you can shelve the conversation for another time. I believe, however, that you are free to use a vibrator by yourself. Using a personal vibrator will keep your tissues healthy and your interest in sex alive. That’s a good thing for you and your partner.

If you’re still with me, in the next post we’ll dig into vibes for beginners (and beyond) and how to use them with your partner.

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I may be taking off the training wheels, but I want to forge right ahead with the topic from the last post about using vibrators with your partner.

I know. I should probably take things slow and discuss why and how you should be using a vibrator. But we’ve done that a few times. HereHere (this one is a series). And here.

So without further ado, let’s talk about partner sex with a vibrator. First, we’ll lay some groundwork; then we’ll get into the nitty-gritty.

One thing I often hear from women is, “I don’t think my partner would like it.” In fact, that was the reason of 15 percent of respondents in our MiddlesexMD survey who don’t use a vibrator. Another 4 percent said “my partner disapproves.”

In the gentlest possible way, I’d like to ask if this response is based on assumption or actual conversation. Have you discussed introducing a vibrator into your sex play? Because in my experience and that of other sex therapists, most men aren’t threatened by vibrators, and some find them kind of hot.

My anecdotal evidence is backed by science. In the study of vibrator use by Dr. Debby Herbenick, of the 1,000 men who were asked, 45 percent reported having used a vibrator, usually during sex with a woman.

Boredom is a huge disincentive to sex.Another barrier mentioned by Kate McCombs, MPH, is the notion that an orgasm with a vibrator is a cheat, which harkens back to that misbegotten standard of our youth in which the only real orgasm was a vaginal orgasm. Well, now we know that 70 percent of women don’t orgasm with vaginal penetration alone. And at this stage of life, I’d like to suggest that all orgasms count. To paraphrase Woody Allen, “I’ve never had an orgasm that wasn’t right on the money.”

If one or both of you are shy about taking this particular plunge, here are some good reasons to nudge the boundaries of your comfort zone.

  • Oh, those elbow, hips, and knees. Sex can be acrobatic, requiring pressure on joints that don’t work so well and repetitive motions that can be hard to sustain. A vibrator is a little comfort measure that allows things to happen quickly (or not) and reliably without so much work or pressure on the joints.
  • Make it last or make it happen at all. Maybe it takes longer for you. Maybe you need more stimulation. Maybe he can’t quite last as long or get it up. A vibrator makes things more reliable and less frustrating for both of you. One respondent to our survey was surprised to find her libido flagging after menopause…“when necessary, the vibrator assures a pleasurable experience for both my husband and me.” Says another, “It removes any anxiety about how long it’s taking, or is it working…” It’s going to work, and it can take as long as you want.
  • Break the monotony. You know the moves by heart. You could (and maybe you have) done them in your sleep. Boredom, especially after decades with the same partner, is a huge disincentive to sex. That’s where a vibrator (and other sex toys) can spice things up and introduce some creativity and play into your ho-hum routine. In our survey, over 20 percent of you agreed that you use a vibrator “to supplement intimacy and playfulness with a partner.” That is a very loving and wonderful use for this gizmo.
  • Know thyself (and thy partner). How can you let your partner know what you like if you don’t know what you like? A vibrator is a great tool for self-discovery, for finding out where the nerve endings are and what pressure and speed works best. You can also experiment on him. You may discover some new sweet spots.

In the end, while vibrators can be a fun toy and a helpful assist for flagging libido and waning sensation in the nether regions, whether or not you incorporate them into either personal or couple use is totally up to you.

In the realm of sexual intimacy, while I think it’s good to explore boundaries and maintain an open, questing spirit, if an experiment becomes too uncomfortable or anxiety-provoking, then a loving partner will back away. A vibrator for personal use is your decision (“It’s your orgasm,” writes one blogger), but introducing it into sex with your partner is a tango that requires a little more sensitivity.

More about that in a future post.


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