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Archive for the ‘Under the Covers’ Category

In previous posts, we discussed why menopausal weight gain is such a game-changer, and we explored how to limit the damage through dietary changes. Now, we’ll talk about the second critical key for maintaining—or regaining—a healthy weight after menopause.

You know what I’m gonna say.

Exercise. Not only does a regular exercise regimen help you burn more calories, which is what weight loss is all about, but it can also give you a higher quality of life and actually stave off illness.

Longitudinal studies have found that people who are more fit at midlife have lower levels of chronic illnesses, such as heart failure, diabetes, Alzheimer’s disease, colon and lung cancers, as they age. Although other factors, such as heredity, play a role, in general, higher fitness levels were strongly linked with lower rates of major chronic illnesses. “Compression of morbidity” is when debilitating illness doesn’t happen until close to the end of life—and people with healthy, active lifestyles tend to have compression of morbidity.

How’s that for paybacks?

I can tell you from personal experience that a regular, moderately challenging exercise regimen relieves stress, helps you sleep better, reduces the “aches and pains” associated with aging, and helps you to keep up with normal activities of daily life. It regulates your bowels and your moods. And simply feeling stronger and more capable physically helps you to feel more capable and in control of your life generally.

However, I will also say that maintaining a serious (and by serious, I mean regular and moderately challenging) exercise regimen is not easy. It takes time and self-discipline. It makes you sweat. It makes you breathless and it might make you sore.

Not only that, you have to approach exercise differently in your golden years than you did before. You won’t be able to just take off running without a serious warm up; you’ll have to watch your form more carefully; you’ll want to opt for low-impact exercise. Your postmenopausal exercise regimen should contain four elements:

  • Cardio. This is the aerobic stuff that gets your heart rate up, like walking fast enough that you can talk, but not sing (about 3.5 mph, which I find I can do with practice and conditioning), biking, swimming, dancing. Unless you know your joints can take it, stick with low-impact aerobics. The Centers for Disease Control and Prevention (CDC) recommends two-and-a-half hours of moderately strenuous aerobic exercise per week.

Lately, high intensity interval training (HIIT) is recommended to increase the effectiveness of an aerobic workout. In this regimen you alternate bursts of higher activity, such as jogging, with a less active period, such as walking. This gives you an “afterburner” effect in which your muscles continue to burn oxygen after the period of high activity. This AARP article has a good explanation of the benefits of HIIT.

  • Strength (resistance) training. This helps you maintain muscle strength. (Remember that you lose at least 20 percent of muscle mass as you age.) You can use weights or resistance bands, body weight or exercise machines. The CDC recommends weight training 2 days per week.
  • Flexibility. Stretching and toning exercises maintain your range-of-motion and keep your tendons healthy and your joints juicy. Don’t bounce or jerk while stretching. Hold positions for at least 30 seconds and don’t stretch to the point of pain. It’s a good practice to stretch after your regular workout. Here’s a simple stretching routine from the Mayo Clinic. Yoga is fabulous for maintaining flexibility and relieving stress. (Listen to our podcast on this topic here.) It also counts as strength training, so consider joining a class once or twice a week.
  • Balance. Balance is another capacity that diminishes with age, but it’s important to maintain because injury from falls is common and serious. Tai chi is a great discipline to improve balance, but so are simple exercises, such as standing on one foot, unassisted, for 10 seconds or standing first on tiptoe and then heels—simple exercises you can do every day.

Arguably, the hardest part about exercise is getting started. If you have any health conditions that might limit your activity, such as high blood pressure or arthritis, you need to talk with your doctor about what exercises you should and shouldn’t do.

Ideally, you should find a gym with classes or a trainer to get you started—to make sure you’re using correct form, and to show you how to use the machines. Yoga or Tai chi classes with experienced teachers are fantastic and motivational for establishing an exercise regimen.

Get on your mat every day.If this isn’t practical or possible for you, you might turn to the internet for videos and programs. You want substance, knowledgeable leaders, and safety, not razzle-dazzle. Try Fitness Blender (free workout videos and programs for all levels of fitness), Daily Burn, ($15/month; variety of workouts, including yoga, tailored to age and fitness level) or Yoga Today ($15/month with a discount for yearly membership; many workouts tailored to fitness level).

The next hardest part of an exercise regimen is continuing. You will miss days; you will have days in which you don’t work as hard as you should. After a few missed sessions, starting again is hard. That’s just how it goes. You start over; you don’t quit.

Part of the battle is finding a program that works for you—one that is varied, challenging (you are progressively lifting heavier, going longer and faster), but that isn’t killing you. Soreness is good; pain is bad. Move carefully without overextending or snapping joints. Always warm up and cool down.

This is your new normal: a clean diet, a daily exercise regimen that alternates weight training and aerobic exercise and incorporates stretching and balance segments.

I promise you that every ounce of effort invested in a healthy diet and regular exercise will return to you many-fold in a much higher quality of life now and in lower risk of chronic illness down the road. Let me know how it goes and send me any questions you may have. This stuff is too important to overlook.

 

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Okay. We’ve talked about sexual lubricants before. Many times. And for good reason. Vaginal dryness and the associated pain with sex, penetration, and sometimes daily life is possibly the #1 issue I deal with in my practice.

Insufficient lubrication during sex isn’t just a problem of menopause—many women experience it at various times of life—during pregnancy, with insufficient foreplay, or while on certain medications, for example. Or just because.

Fortunately, the sexual lubricants are an easy, safe way to make sex more comfortable and fun.

Vaginal lubricantsOne critical distinction: Lubricants are for use during sex to increase comfort and reduce friction. They coat whatever surface they’re applied to (including the penis and sex toys) but they aren’t absorbed by the skin, thus, they have to be (or naturally are) washed off. Moisturizers, on the other hand, are specially formulated to soften and moisten vaginal tissue. Like any lotion, they should be used regularly and are absorbed into vaginal and vulvar tissue. Moisturizers are for maintenance; lubricants are for sexual comfort.

Basically, there are three types of sexual lubricants: water-based, silicone, and a newer hybrid formulation. Each has unique characteristics and limitations. Water-based lubes are thick, feel natural, don’t stain, and don’t damage silicone toys. They rinse off easily with water. However, they tend to dry out more quickly (although they can be re-activated with water), and don’t provide long-lasting lubrication. Water-based lubricants may contain glycerin, which tastes sweet, but can exacerbate yeast infections.

Some lubes contain “warming” ingredients, such as capsaicin, the ingredient that gives chili peppers their heat, or minty, or menthol-y oils. They’re intended to enhance sensation, increase blood flow to the genitals, and create a “tingly-warm” feeling. As such, they’re good for foreplay and use on vulva, clitoris, penis, nipples, external vaginal tissue, but not internally if they contain essential oil.

Use warming oils and lubricants with caution, however, since delicate or dry vulvar-vaginal tissue may respond with a fiery-hot rather than pleasantly warm sensation.

Silicone lubes are the powerhouse of personal lubricants. They tend to feel slick and last three times as long as the water-based option. They’re hypoallergenic, odorless, and tasteless. They may stain and they will destroy silicone surfaces on other equipment, so you can’t use silicone lubes anywhere near your expensive silicone vibrator. They wash away with soap and water.

At this life stage, you can put away your coupons and dispense with frugality. Your vagina deserves the best! Not only have those tissues become more delicate, your vagina also has a finely balanced pH level that (usually) protects against yeast and bacterial infections. Cheap or homemade lubricants can seriously mess with tender tissue and that natural acidity.

Use only products recommended for vaginal lubrication—not baby oil, vegetable or essential oils, petroleum jelly, or saliva. (Note: Oil destroys the latex in condoms and leaves behind a film that is a bacteria magnet.) Look for organic, natural, and high-quality ingredients (we look for these for our shop).

Each individual (and couple) ends up with one or more faves when it comes to lubricants. So make this a fun exploration for the products that work best, both for solo and couple play. If you don’t like one lube, a different type or brand might be just the ticket; don’t give up on lubes altogether.

Because the options for various lubricants are legion, we’ve tried to narrow the field in search of only the most effective and safest products for our shop. We examine the ingredients and opt for the most natural and organic brands possible. We also look at the philosophy of the company that makes them. We’ve been known to do quite a bit of research “in the field,” as well.

In the spirit of experimentation, we’ve put together a selection of seven sachets of water, hybrid, and silicone-based lubes in a handy sample kit. You can give them a whirl without the investment in a full bottle of lube that ends up in your sock drawer.

New lubricant options appear with some regularity, and we evaluate and add them periodically. If you’ve found something you love, let us know; other women may be happy to learn about the option!

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Getting old ain’t for sissies, and neither is menopause. For all you guys out there with menopausal partners, maybe you’ve noticed her, um, lack of patience. Maybe you’ve been caught in the cross-hairs of her mood swings. Maybe you’ve been awoken at night to her tossing and night-sweat-induced turning.

And maybe she just isn’t interested in sex anymore.

With some work, you'll weather the storm and emerge stronger than before.In my practice, I usually hear the woman’s side, but I know you’re an uncomfortably intimate co-pilot on this journey. You may be feeling confused, hurt, rejected, and helpless. This person you thought you knew is changing before your eyes. You don’t know how to help; you don’t know what this means—and it seems to be going on forever.

You miss the sex, the intimacy, the person you used to know. You miss the way things used to be, and you don’t know if or when any of these things will ever come back.

You aren’t alone. Says 70-year-old Larry in this article: “When she got to about 65 it started to change. Intercourse became painful for her and she developed an allergy to semen. Now intercourse is out of the question and she has no desire for anything other than hugs.”

Life—and sex—does change during menopause, but that doesn’t mean you’re doomed to a relationship without intimacy forever. Shifting ground is treacherous, but with some work on both your parts, you’ll weather the storm, and emerge stronger than before.

Here’s what you can do:

Walk a mile in her shoes. Depending on the intensity of her symptoms, your partner is going through moods that may swing wildly without rhyme or reason, and over which she has no control. She may experience uncomfortable and embarrassing hot flashes frequently and unpredictably. She may toss and turn at night, waking soaked with sweat.

She may gain weight, lose her hair, and generally grow old before her own eyes. This can be particularly galling in a culture that is completely besotted with youth and beauty. “A woman’s self-esteem influences her sexuality, and low self-esteem is associated with sexual dysfunction,” according to this article.

What you can do: Educate yourself on menopause. Understand the trajectory and the tortuous path it takes. Read this blog. Learn about comfort measures and possible treatment options. There are many. She may be too embarrassed or miserable to do her own research or even to bring it up.

Armed with understanding, you can reassure and support. You can say, “You seem pretty down [or angry, or forgetful]. Are you okay? What can I do to help?” That alone may make an intimate connection, but this isn’t about sex right now. This is about reaching out to your lover who’s going through one of the most significant transitions in her life.

Now that you’ve asked, listen. And keep listening. Be an ally and a partner in this journey. Check in frequently to see how she’s feeling. Don’t advise unless you’re asked. Just listen. If she talks with her girlfriends, fine. But let her know you’re in her court.

Most important—reassure her that she’s still beautiful to you. Girlfriends can’t do that.

Nothing says love like taking out the garbage.Follow up with actions. Don’t sit on the couch while your partner makes dinner and then watch the game while she cleans up. Nothing says love like taking out the garbage or doing the dishes so she can take a bath.

Once in a while, go out of your way. Cook a special, romantic meal. (You can order from one of those home-delivered meal plans, like Blue Apron or HelloFresh.) Send her flowers or plan a surprise getaway weekend. No expectations; no pressure—just an expression of your love and caring.

Get healthy. I harp on this all the time, but both you and she will feel a whole lot better (and feel more like sex) if you’re eating healthfully, maintaining a good weight, and exercising. You can gently encourage walks together, healthy eating, and good sleep habits. Don’t be a drill sergeant, but your good example and attempt to make it a couple’s thing can’t hurt.

Shake things up. Boredom is a slow leak in the sex balloon. I’m not talking about having sex on the kitchen table. But just exploring the array of tools and props that can add sizzle and simple comfort to the routine. Since your partner is probably experiencing the common menopausal complaints of dry vaginal tissue, painful sex, loss of libido, you’ll have to shake up the routine anyway.

You’ll need lots of foreplay, lots of lube, and some toys. Try reading an erotic story or watching a sexy movie together to get your heads in the game. Don’t downplay the effect of a romantic ambiance—candles, incense, music. Use pillows to cushion joints and prop up the bits that matter. Try positions that might relieve pressure, offer a different kind of contact, or just be more comfortable.

Take your time and maybe forgo the literal act if the timing’s off. You can kiss, cuddle, spoon. You can use your tongue and mouth. You can masturbate together. Take the pressure off the performance and focus on trust and intimacy.

Don’t take it personally if she just doesn’t respond the way she used to. It isn’t about you, and it isn’t personal.

Once in a while, go out of your way.Find a counselor, if necessary. Generally, celibacy isn’t a healthy state in a marriage. If you’ve reached an impasse, and there’s no way out, you may have to get some help. This isn’t an admission of defeat; it’s a sign of maturity and wisdom to look for help when you need it. If your wife won’t go, you need to find a therapist for yourself to acquire the emotional tools to navigate your relationship.

I’ll leave you with the beautiful and encouraging counsel from the perspective of a 40-year marriage: “…we have found ways to enjoy sex with each other that do not need penetration. Mutual masturbation and oral and always with some nice foreplay, we still enjoy each other.

“I miss intercourse…but we make it work, and it’s usually fun! I hope some men will read this and decide there’s a way to stay happy with the woman of your youth.”

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Lots of attention has focused on the finicky female orgasm in recent years, from Dr. Rosemary Basson’s model of the female sexual response cycle to the helpful finding of just how female anatomy influences the probability of vaginal orgasm.

A new study from Chapman University, Indiana University, and the Kinsey Institute colored in some details of female sexual response, in part by rounding up a wide net of participants. Over 52,000 men and women between the ages of 18 and 65 responded to an online survey, including a more robust sample of those who identify as gay, lesbian, and bisexual.

There's significant misunderstanding between Venus and Mars.The take-away from all this analysis was the jaw-dropping finding (tongue in cheek) that men (95 percent) orgasm dependably, while women, not so much (65 percent). About 44 percent of women said they rarely or never reach orgasm with vaginal intercourse alone, a number that is quite low compared to other studies suggesting that fully 70 percent of women don’t orgasm with vaginal penetration. These numbers point (again) to some very significant differences in sexual response, which in turn, lead to significant misunderstanding between Venus and Mars.

“About 30 percent of men actually think that intercourse is the best way for women to have orgasm, and that is sort of a tragic figure because it couldn’t be more incorrect,” said Dr. Elisabeth Lloyd, a professor of biology at Indiana University and author of The Case of the Female Orgasm in this article.

Additionally, while 41 percent of men think their partner orgasms frequently, far fewer women (33 percent) say they actually do orgasm. The researchers note that this difference could be due to women faking orgasm for several reasons: “to protect their partner’s self-esteem, intoxication, or to bring the sexual encounter to an end.”

The researchers were particularly interested in the disparity between how dependably lesbian women orgasm (89 percent) versus heterosexual women (that 65 percent figure). They theorize that this is due, in part, to women having a better anatomical understanding of each other’s needs.

The headliner result of all those survey is a “Golden Trio” of sexual moves that the researchers say are almost guaranteed to induce the Meg Ryan-style “Yes! Yes! Yes!” in women: clitoral stimulation, deep kissing, and oral sex. Even without vaginal penetration, 80 percent of heterosexual woman and 91 percent of lesbian women were able to orgasm dependably with this magic trio. (Although deep kissing and oral sex seem either mutually exclusive or tremendously acrobatic.)

The research noted that women who orgasm more frequently also have sex more frequently and are more likely to be satisfied with their relationships. Whether satisfying sex is the chicken or the egg—a contributor to a satisfying relationship or an effect of a good relationship, it’s safe to say that the two go hand-in-hand. Good sex and good relationships are both enhanced when partners communicate about what works and include a healthy dollop of fun and flirtation.

“I would like [women] to take that home and think about it, and to think about it with their partners and talk about it with their partners,” said Lloyd. “If they are not fully experiencing their fullest sexual expression to the maximum of their ability, then I think our paper has something to contribute to their wellbeing.”

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You asked. Dr. Barb answered.The sexual arousal creams and gels are effective, and beneficial to most women who use them. Like our category of “warming lubricants and oils,” they typically use an ingredient like menthol, mint, or pepper to stimulate circulation, which increases responsiveness during intimacy. Read the instructions for the product you intend to use, to be sure you understand whether it’s for internal or only external use; lubricants are generally safe for internal tissues.

Arousal and warming products have the potential to cause some irritation for those women with significant atrophy, or thinning of the vulvovaginal tissues. I recommend applying a small amount to the genitals in advance of sex to make sure it’s comfortable and pleasurable.

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You say you reached menopause (one year without a period) six years ago. Sex has become painful, and you want to “get it back.”

You asked. Dr. Barb answered.It’s never too late! Using a vaginal moisturizer may be of some benefit, but if you’ve had pain for several years, you may need a prescription treatment option to restore comfort. There are localized estrogens and Osphena (a non-hormonal option) that are very effective at restoring vaginal health. I have a patient who had not had intercourse in over 25 years. Within 3 months of treatment she was able to resume–and enjoy–intercourse! It is absolutely possible.

I would recommend going to a physician/provider who can do a careful exam and confirm the cause of the pain. Atrophy is the most common reason for painful intercourse after menopause, but there can be other causes as well; identifying the right cause makes all the difference to effective treatment.

With effort and follow-through it is nearly always possible to successfully restore the ability to have intercourse.

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You describe having been on bioidentical hormones for a number of years, as well as having had a complete hysterectomy. There are a number of variables that contribute to this mystery.

You asked. Dr. Barb answered.A couple of thoughts: Are you using testosterone with your hormone therapy? The ability to arouse and orgasm, as well as drive, is influenced by testosterone for some women. Not all women get an improvement in sexual function with the use of testosterone. If you aren’t using testosterone, you may want to have a conversation with your provider about adding it. Virtually all women over 50 have low testosterone, and having ovaries removed is a big factor in low testosterone.

Second, are you using compounded hormone therapy (HT)? I see so much variation in the dosing and absorption of compounded HT that I almost always recommend a pharmaceutical bioidentical HT. I just see so much more consistency in symptom relief.

There is also a relatively new supplement, called Stronvivo, that I have had some great successes with women. They’ve used it–and it’s been tested–for improved sex drive, lubrication, and more. A neuropsychiatrist in my community is recommending Stronvivo for improved memory, too!)

And there’s one more newer product, the Fiera arouser, that’s been very helpful for many women with arousal (and orgasm). It’s promoted as helpful for “before play,” increasing circulation and lubrication.

I hope some combination of these suggestions solves your mystery!

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