Feeds:
Posts
Comments

Archive for May, 2018

Re-engaging in intimacy is a bit different for each individual, just as everyone’s first experience of intercourse is unique. Some of the “preparation” can depend on the partner, the scenario, the amount of foreplay, and so on, so it’s a bit tough to know exactly when “you are ready.” I hope you can move into this slowly and gently to determine your readiness as you move forward.

An exam by your provider can tell a great deal. How comfortable was your last pelvic exam with speculum placement? I tell women that when I do a pelvic exam and place two fingertips into the vagina comfortably, it is quite likely they will be comfortable with intercourse. Because there are variations in male size and female elasticity, that may not always be 100 percent accurate.

Vaginal lubricantsYou say you’re taking vaginal estrogen, and that should be very helpful to your tissue health. This is a time using an intravaginal vibrator (like the Liv2 or Celesse) may be helpful. Can you insert and use these without discomfort? Having a good lubricant is very important as well. Most menopausal women benefit from a silicone or hybrid lubricant (and this article describes the variety of lubes and how you might select and use one). Some women need to use vaginal dilators to do some stretching of the vagina in advance of intercourse.

I’m so glad to hear you have found someone special to share intimacy!

Read Full Post »

Walk into any drug store and confront the aisles of skincare products: cosmetics, conditioners, lubricants, lotions, potions, and creams. If you’re looking for the safest, least allergenic product for your particular skin—good luck.

You walk up to a counter and how do you begin? How do you interpret the labels; how do you cross-reference which products might have been the irritant? It’s an impossible task to do as an individual.

You could read the teensy print on dozens of bottles and attempt to identify which unpronounceable ingredient might be causing your itchy rash. You could try to find products without parabens or Methyldibromo Glutaronitrile (yeah, that’s a thing). You could buy something expensive because the label says it’s “dermatologist tested” or “hypoallergenic.”

Or, you could go to the SkinSAFE website where that analysis has already been done on tens of thousands of products that touch your skin, from shampoo to cosmetics to sexual lubricants. There you can find products with the “TOP Allergen Free” designation, meaning that they contain none of the ingredients that have been identified as highly allergenic. You could also scan your favorite product into the SkinSAFE app on your smartphone to find out how that product ranks on the TOP Free scale and what allergens it might contain. Both the app and the website are intuitive, easy to use, and give you information that was impossible to find before.

 

You just need to know. Information is power.

This gargantuan effort is the result of decades of patient data painstakingly collected by dermatologists at Mayo Clinic and compiled in a user-friendly internet platform by Michelle Robson, creator of EmpowHER, a website dedicated to providing credible health information for women. (Michelle describes her journey in my podcast series, Fullness of Midlife.)

According to its clinicians, the number one complaint that brings patients to Mayo Clinic is skin conditions. Research also suggests that up to 45 percent of contact skin allergies could be avoided by using allergen-free products like those with the TOP Free designation on the SkinSAFE website. This kind of scientifically sound, third-party ranking of everyday products according to their allergenic properties is a huge public service, not to mention one that could avoid many trips to the dermatologist.

Top Free Uberlube LubricantSkinSAFE is a significant tool empowering consumers to make informed buying choices in an industry that’s been confusing at best and misleading at worst. It creates a meaningful designation—Top Allergen Free— based on science rather than marketing hype; it eliminates price from the equation. Neither price nor labels like “organic” or “hypoallergenic” are indicators of a product’s allergenic properties. Maybelline products, for example, are just as likely to receive the TOP Free designation as more exclusive brands. (And Uberlube is among the TOP Free products you’ll find in our shop.)

“There are a lot of myths about skin-care products,” says Dr. James Yiannias, a dermatologist at Mayo Clinic and co-developer of SkinSAFE, “so if you choose a product that says ‘hypoallergenic’ or ‘dermatologist-tested’, unfortunately, it doesn’t really mean a whole lot.”

For example, we often think of botanical ingredients as “natural” and thus harmless. We’d rather put something natural on our skin than a product laced with unpronounceable chemicals, right? But botanicals can be just as allergenic as synthetic ingredients. One of the major allergy-causing ingredients in skin-care products is fragrance. And “fragrance” can include natural botanicals, such as balsam of Peru, which is highly allergenic.

For most of us, this information just helps us make better choices in skincare products. But for those of us who truly suffer from skin sensitivities or allergies (which often only become more severe with age), it’s critically important information. The SkinSAFE website has a special section for those with very sensitive skin that allows you, presumably along with your doctor, to create a “personal allergy code” (PAC) that filters out products with your specific allergens and only shows you products that are safe for you to use based on your individual profile.

The SkinSAFE app and website are a tremendous resource intended to empower consumers and clinicians alike with current, credible, and badly needed information. And we’re adding SkinSAFE ratings to our product pages and submitting not-yet-rated products for SkinSAFE review. Because as Michelle Robson says, “You just need to know. Information is power.”

 

Read Full Post »

You describe two issues, one of which is painful sex and the other is embarrassing sound effects when your partner withdraws. You’re wondering why that happens and whether you can change it.

Vaginal DilatorsI don’t have an absolute solution for your dilemma, but I do have a suggestion that I hope will be helpful. We consider the vagina to be a “potential space”; in other words, the walls of the vagina are usually collapsed but can create “space” when needed – when you insert a tampon, for example, or during intercourse. When the space is created, air can, as you describe, enter and be trapped; the entering object (a penis, during intercourse) forces the air out. If the space is tight, there’s likely to be that sound effect you’ve noticed.

You may consider using vaginal dilators, which gently stretch the vagina, giving it greater capacity in both width and depth. This should both reduce the painful sensation of tightness you experience and the likelihood that air escaping will cause the embarrassing sounds.

I think this is definitely worth trying. Good luck! And in the meantime, remember that sex for everyone includes at least some messiness or awkwardness – and one of the joys of midlife intimacy can be the playfulness of laughing together.

Read Full Post »

You say you’ve tested negative for herpes 1 and 2 antibodies, while your partner has tested positive for the herpes 2 virus, though he has not shown symptoms. I don’t find your situation unusual, and it does pose a bit of a conundrum. The reality is that using condoms is the most reliable way to prevent transmission, but in a long-term relationship, I understand that it’s not desirable.

I find that the most up to date and reliable information regarding HSV (and other STIs) is the Centers for Disease Control and Prevention (CDC), which is what I use to counsel patients:

  • HSV can be transmitted when lesions are not present.
  • Anyone with a HSV diagnosis is encouraged to inform current and future intimate partners, and to abstain from sex when lesions or their precursor symptoms are present.
  • Correct and consistent use of latex condoms might reduce the risk of transmission.
  • “Daily treatment with valacyclovir 500 mg decreases the rate of HSV-2 transmission in discordant, heterosexual couples in which the source partner has a history of genital HSV-2 infection. Such couples should be encouraged to consider suppressive antiviral therapy as part of a strategy to prevent transmission, in addition to consistent condom use and avoidance of sexual activity during recurrences. Episodic therapy does not reduce the risk for transmission and its use should be discouraged for this purpose among persons whose partners might be at risk for HSV-2 acquisition.”

What that last point means is that ongoing daily treatment with a prescription for an antiviral therapy by the affected partner can be effective protection to reduce the chances of transmission; “episodic therapy,” meaning the antiviral is taken only in cases of an outbreak of lesions, will not provide that protection.

I hope this is clear! You can have intimacy confidently, and I’m glad you’re researching the steps to take!

Read Full Post »

You say you’re not sexually active, you’re approaching that menopause milestone, and your last pelvic exam was painful. You’re wondering about how to maintain your vaginal health – and wanting to keep your options open should you meet that “special someone.”

Because of the progressive nature of vulvovaginal atrophy in perimenopause and menopause, time is definitely going to work against you – against all of us, for that matter. With with less circulating estrogen, the changes to the genitals will continue to lead to more discomfort and dryness, and over time there is more narrowing and shortening of the vagina.

Vaginal moisturizers

At a minimum, using vaginal moisturizers should be part of your now plan. This may help preserve some of the moisture. Over time, moisturizers tend not to work as well, and then prescription therapies may be necessary to restore integrity and comfort to the tissues.

Using a vibrator or dilators keeps the tissues “in use,” so to speak; that “use it or lose it phenomenon” that we see is definitely a factor for the genitals. I understand that time is a limiting factor. Less time is required for maintenance than for reversing significant atrophic changes, which is to say, the longer you wait to devote the time, the harder it is to restore what is lost. Most women are grateful for having invested the time – especially if they do find themselves in a new relationship.

It is, of course, entirely up to you to decide how to invest your time, money, and energy. As with so many areas of life, the more you commit to focusing attention, the more successful the outcome!

Read Full Post »

You say you’ve spent some time reading about “the recipe for sexual health,” and are looking for the “how to implement” – and are struggling with HSDD (hypoactive sexual desire disorder). I’m sorry to say that there isn’t a single “how to” or formula for implementing the recipe, because solutions are likely to be as variable as each individual seeking information. The silver lining is that we are, each one of us, wonderfully made!

If your specific issue is centered on low libido, consider that we think of low desire as a biopsychosocial issue: It has to do with bio-hormones and neurotransmitters, psychology (your relationship, your emotional connection, your sexual history, culture, and norms), and social factors (other commitments, stressors, kids, aging parents, fatigue, work issues, and so on).

You can enter “libido” or “desire” in the search bar on MiddlesexMD to find the abundance of discussion on the issue of low libido and understanding desire. I especially like to talk through the Basson model for female sexual response with women who have challenges with desire, because it exposes the complexities of addressing those challenges.

Stronvivo

The two products that come to mind are Stronvivo and the Fiera. They’re two entirely different products, but they’ve both been shown in clinical trials to improve desire. Stronvivo is a nutritional supplement for cardiovascular health, while the Fiera is a device designed to increase genital circulation.

And sometimes the answer is further understanding of the condition, and then engaging in mindfulness and intention.

Read Full Post »

%d bloggers like this: