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I’m so sorry to hear of your childhood experience. Women—and men—can definitely move forward successfully from this history, but not without a good therapist. I recommend that you find a therapist as soon as possible specifically to address your molestation history, and a sex therapist would be best.

Your health care provider may be able to refer you to a specialized therapist in your community, or you can go to ASSECT’s (American Association of Sexuality Educators, Counselors, and Therapists) website, where they have a referral directory that lets you specify your location.

You deserve fulfillment in this area of your life, and seeking a professional to help you navigate could be life-changing. I urge you to seek this professional assistance!

Humankind has been trying to cover up its natural odor ever since we crawled out of the cave. Maybe this made sense when bathing was considered dangerous and soap was made from animal fat and wood ash. But in our obsessively hygienic and more enlightened time, why all the fuss about odor, specifically that of our nether regions? And why all the products meant to make our bottoms smell like a spring breeze, whatever that means? (Watch this Saturday Night Live clip for a hilarious take on the topic.)

As far as I can tell, these products follow a long, inglorious line of more or less successfully convincing women that they stink. In a 1930s ad, the “Love Quiz” asks why her man is avoiding his lovely wife’s embrace. The answer is that he’s no longer happy in the marriage because she’s neglected “proper feminine hygiene.”

The solution? “Every wife can hold her lovable charm simply by using ‘Lysol’ disinfectant as an effective douche.” Yeah, that Lysol.

You can’t make this stuff up.

Eighty-odd years later, have we really come such a long way? We may not be squirting floor cleaner up our yoni, but there are no lack of products on the market to camouflage our natural odor. Now, just as back in the day, the intent is to make us feel self-conscious and embarrassed about ourselves. To shame us into buying products we don’t need and that sometimes aren’t good for us.

Dr. Barb's book, Yes You Can: "Sound, reassuring, medically approved advice."Our vaginas don’t smell like a spring breeze, nor should they. Our vaginal smell comes from a delicate balance of certain bacteria called lactobacill—the same bacteria found in yogurt. When you think about it, a natural vaginal odor has that same slight pungency. In the vagina, lactobacilli produce lactic acid and hydrogen peroxide, to give us a slightly acidic garden that works with our bodily ecosystem to keep out bad bacteria and the fungi (yeast) that produce the really smelly stuff, sometimes accompanied by a ferocious, burning itch.

While our vaginas are quite resilient, if enough lactobacilli are killed off by medication, those nice-smelling douches, excessive sugar in our diet (encouraging sugar-loving yeast), trapped moisture in our crotch, or even blood or semen, which are fairly alkaline, the resulting bacterial mash-up can cause both odor (fishy or foul) and itch.

In that case, your doctor may advise treating the bacterial or fungal infection or using an over-the-counter product, like Balance Moisturizing Personal Wash, to restore the natural pH balance in your vagina.

Vaginal smell can also be affected by:

  • Sweat glands. We have a lot of them in the crotch area—the same kind as those in our armpits. Just so you know, sweat is basically odorless, but the bacteria living on our skin like our sweaty selves and produce yet another substance that gives sweat its distinctive odor. Wear cotton panties, take a shower, and change underwear after a workout. Let your crotch breathe—don’t wear tight clothes or pantyhose; go pantless when you can.
  • Medications. Obviously, antibiotics can change vaginal flora. If you take antibiotics, ask your doctor about replacing vaginal (and gut) flora with probiotics, yogurt, or RepHresh. Antihistamines can dry the vagina. Some herbal therapies can change vaginal odor.
  • Foods. If certain foods, such as asparagus, garlic, or curry, make your urine smell, they could also affect vaginal smell. No reason not to eat them, they just create a temporary odor.
  • Hormonal changes. The vagina is exceptionally sensitive to hormonal changes, as you probably know all too well. Menstruation, hormone therapies, birth control, even sex can change the bacterial garden. Loss of estrogen during menopause makes vaginal tissue thin and dry, thus more susceptible to bacterial and yeast infection. With menopause, we may have to adjust our vaginal housekeeping somewhat with regular use of vaginal moisturizerstopical estrogen, and sexual lubricants.

Left to its own devices, our vaginas are hardy and self-sufficient. They wash away dead cells and grow new ones. They don’t require special hygienic measures—just the normal shower wash of the external parts with warm water and a gentle soap. Just make sure the soap is fragrance-free and not antibacterial.

I’m betting that by now most of us have grown comfortable enough in our own skins and with our own natural smells not to be overly influenced by commercial messaging. Not that it is any less relentless, nor is there any lack of products and procedures to alter our appearance. By and large, we’ve just become wiser and less susceptible to the barrage. So maybe pass along the message to our younger sisters that they are beautiful and smell fine just the way they are.

Recently I had the privilege of interviewing Dr. Joan Vernikos for my podcast series “Fullness of Midlife,” which are conversations with interesting people about health, love, life, and meaning. Dr. Joan was director of Life Sciences at NASA until 2000 when she “retired” to write and speak (some retirement!) about some of the groundbreaking research she had conducted from her special perch at NASA.

You can listen to the entire interview here, but I wanted to also distill the pertinent bits for MiddlesexMD readers.

As you might imagine, the effect of gravity, or lack thereof, is a fundamental concern for scientists at NASA. Astronauts are exposed to low-gravity environments, sometimes for months at a time, which has wide-ranging and deleterious effects on bones and organs, blood and cardiovascular systems. During her time at NASA, Dr. Joan specialized in the effects of gravity on the human system.

But here’s the thing: Dr. Joan came to understand that gravity operates on earthbound humans in similar ways! When we are upright and moving around, we are subject to the full effects of gravity pulling us to the center of the earth vertically. But when we are horizontal, lying in bed, for example, gravity’s pull is spread evenly throughout our bodies and is much less intense—similar to the experience of astronauts. “…The changes that accompanied lying in bed… 24 hours a day… are very similar to those we see in astronauts. Granted, maybe a little less intense,” said Dr. Joan.

Interestingly, these metabolic changes don’t happen when we sleep at night. Normal sleep appears to have a restorative, “detoxing” effect on the body and the brain, which is also important to good health.

The body is designed to move all day long...Since the few astronauts who actually spent time living in micro-gravity were harder to find than subjects willing to lie in bed, Dr. Joan began studying the effects of long stretches of time spent horizontally. She found, for example, that after about four days “very significant changes” began to happen in the way her subjects metabolized fluids, in the cardiovascular system, and in stress responses. Of course, as with astronauts, these changes mostly were reversed when the test subjects got up and walked around or the astronauts came back to earth, and gravity took over.

Then, Dr. Joan visited a friend’s elderly mother who was bedridden, and she realized the low-gravity changes she’d been studying looked a lot like aging. Was there a link between our increasingly sedentary culture and the symptoms of early aging? Dr. Joan feels that the chronic diseases of the elderly—diabetes, cardiovascular problems, obesity, bone loss and muscle wasting—are happening at younger ages, even in childhood, because we no longer allow gravity to do its work. We sit too much and move too little.

Dr. Joan hypothesized that the body is meant to move all day long, and in the not-so-distant past, that happened pretty naturally. Our grandparents “…bent over and reached up and made beds and cleaned and washed and gardened. And went and bought groceries and walked home or rode a bicycle, or whatever.”

Following several studies, Dr. Joan feels that simply standing up is “fundamental” to countering the effects of inactivity. Simply standing up and then moving around reverses the micro-gravity effects of lying in bed—or of aging. Trouble is, we don’t live like our grandparents. More likely, we sit for hours in front of one screen or another in the office and at home. Then, if we’re disciplined, we might exercise a few times a week.

Exercising, while good in itself, isn’t enough to counteract the effect of sitting around for hours every day. Our bodies are designed to move, to work against gravity. That, not sitting, is our normal state, the result of eons of evolution.

After her 2011 book, “Sitting Kills, Moving Heals,” was published, a slew of new research supported the hypothesis she’d developed from her work at NASA: Long periods of inactivity have deleterious health effects. “…sitting makes worse absolutely everything. Whether you’re talking about cancer—prostate, breast cancer, cardiovascular conditions, stroke, metabolic conditions, diabetes, obesity—you name it, it makes it worse,” said Dr. Joan. (Here, for example, is NPR’s report on recent studies of aging subjects. The conclusion? If you don’t walk now, you might not be able to later.)

So, what should we do, especially if we’re still working and chained to a desk all day—but even if we’re retired and reading or knitting? Fortunately, the solution is simple. “Stand up!” says Dr. Joan. Go to the water-cooler, the bathroom, just take a break every 30 minutes or so. You don’t need to hop on a treadmill or take a 30-minute walk, just stand up and move for a few minutes. You won’t lose weight or tone your muscles with this regimen; it isn’t meant to take the place of exercise and a healthy diet, but it’s a good habit to develop if you regularly sit for hours every day.

Gravity is your friend, says Dr. Joan. Embrace it!

In a sense, the most “natural” replacement for lost estrogen is estrogen, which is a prescription product (like Premarin or Estrace vaginal cream, Estring, Vagifem, or the non-estrogen Osphena).

You asked. Dr. Barb answered.If, for a number of reasons, you prefer not to take that path, the next-best option is to maintain vaginal tissues by using a moisturizer regularly, two to three times a week. Moisturizers are designed to bring more moisture–no surprise–into the vagina to prevent the progressive dryness that occurs in menopause with the absence of estrogen.

Both Emerita and Prevaleaf Oasis are natural vaginal moisturizers.

One more option might be an oral nutritional supplement, Stronvivo, which some research shows improves vaginal moisture. It does this by improving blood flow, and that circulation also supports tissue health.

Oh, I feel for you. You say you have pain (and no doubt other symptoms—like fatigue and depression) from lupus, fibromyalgia, and Sjogren’s syndrome. You see your lack of interest in sex becoming a larger problem in your marriage as the difference between your sex drive and your husband’s increases.

The first order of business is to find a health care provider with whom you can discuss this aspect of your health. The pain you mention may be generalized pain from the autoimmune conditions you have, or it may be pain with intercourse. Painful intercourse is nearly always a treatable condition, so addressing that if you experience it is critical.

You asked. Dr. Barb answered.The harder issue is the “desire discrepancy” you describe in your marriage. While the situation is not uncommon, your additional health issues add a degree of difficulty. Assuming any issues with painful sex have been addressed, there are some medications that can be helpful for low libido: Addyitestosterone, and Wellbutrin, to name a few. Your health care provider can help you understand if any of these can be an option for you depending on your health history and other medications you’re taking.

For more about low libido, you can read this blog post on the emotional component and this one that includes an overview of the condition and common causes. It could be helpful to read these to have some terminology in mind when you meet with your health care provider.

The situation you describe might best be addressed with a (sex) therapist—perhaps not a dedicated sex therapist but one who has expertise in health-related relationship concerns. (Here are two blog posts on sex therapy: one I hoped would demystify it and one that explains how it works.) Your health care provider is likely to be able to direct you to someone with experience to assist you and your husband as you navigate this significant challenge.

Best of luck in reaching some common ground!

 

You say that your wife suffers from lichen sclerosus, a condition that creates skin tissue that is thinner than usual (and is a higher risk for postmenopausal women). Warming oils and lubricants, unfortunately, create discomfort rather than arousal for her. I’m not aware of an option in that category that would work for her, since the ingredients that make them effective–usually something minty or peppery–will almost certainly cause an adverse reaction.

Plain lubricants won’t cause that reaction; those we include in our product collection should be well-tolerated by lichen sclerosus patients.

There are a couple of other options you and your wife could explore for arousal. The use of testosterone has been beneficial for 50 to 60 percent of the women in my practice who’ve tried it. Testosterone is by prescription and off-label for women, which means a discussion with her health care provider is required.

Other prescription options include localized estrogenOsphena, or Intrarosa (a recently available FDA-approved choice). Any of these would increase blood supply by “estrogenizing” the genitals, which can improve arousal and orgasm as well.

Congratulations on undertaking this exploration together! Good communication and mutual support are so important to shared intimacy.

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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