Feeds:
Posts
Comments

Archive for the ‘Under the Covers’ Category

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.”

Read Full Post »

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.”

Read Full Post »

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.

Read Full Post »

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.

Read Full Post »

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!

Read Full Post »

You’re concerned that your penis is short, and that since it sometimes slips out during intercourse, you may not be satisfying your wife. The good news for you is that most women–about 70 percent–can’t achieve orgasm only with intercourse. That means it’s unlikely that your size is at fault or you’re doing something “wrong.”

Penetration is not required stimulation for most women; instead, what they need is direct clitoral touch and stimulation, whether by hand, tongue, or vibrator. I’d recommend that you ask your wife what she prefers to feel pleasure and experience orgasm.

You asked. Dr. Barb answered.She may very well already know! The sooner you talk about it, the sooner you’ll both be more satisfied. If she’s not sure herself, she can do some exploration herself–or you can explore as a couple. And you can participate fully, knowing that your size doesn’t need to be an issue for either of you.

Read Full Post »

You say you haven’t been able to have sex with my husband for about a year. You’ve seen a couple of health care providers: One prescribed an estrogen cream, which wasn’t effective, and the other saw nothing “physically wrong” and, since you’re not yet menopausal, recommended lubricants.
You asked. Dr. Barb answered.What you describe–a feeling of “tearing” or “burning” at penetration–sounds to me like the condition of vulvodynia (also know as vestibulodynia, provoked vulvodynia/vestibulodynia). The classic description is “burning and tearing” pain with penetration; other descriptors are razor blades or sandpaper-rubbing with penetration. Often, sex leaves women with this condition sore or uncomfortable. Vestibulodynia is an under-recognized cause of painful intercourse, and you’re not alone in receiving ineffective advice.

You express reservations about going to another doctor to talk about this issue. I know it’s difficult to bring up, and it doesn’t feel worth the effort if you don’t get solutions for intimacy. But you do need a provider who is familiar with vestibulodynia and knows the treatment options–because it is treatable and you can be intimate with your husband again.

I recommend finding a provider in your area through the North American Menopause Society (link to their practitioner locator here) or through the International Society of Women’s Sexual Health (ISSWSH) (link to their provider search here). If you choose to use the ISSWSH directory, note that the listing includes therapists as well, so be sure to select a physician who does clinical care and can provide the proper examination and treatment.

Please do follow through to find someone qualified to provide treatment. You don’t have to leave this part of intimacy with your husband behind.

 

Read Full Post »

Older Posts »

%d bloggers like this: