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Here’s an idea to spice up a holiday evening: Gather your coffee klatch girlfriends, or your BFFs, or even your sisters and/or daughters, make popcorn and margaritas, and watch “Love, Sweat, and Tears,” the new documentary about menopause.

Even better, snuggle up and watch it with your partner, because the red thread running through all the information about hot flashes and mood swings is that our sex lives don’t have to be disrupted or put on the shelf forever because of menopause. We can still be sexual beings; we can still be attractive; we darned well can still have sex.

Sound familiar?

The movie was a labor of love for Dr. Pam Gaudry, an ob/gyn who specializes in treating older women. After years of consulting with patients in the throes of menopause, Dr. Pam came to realize that of all the difficulties accompanying menopause, the most disturbing to many of her patients was the disruption of their sex lives. Losing this deep and intimate connection with loved partners was the most distressing part of menopause. And she knew that losing sexual intimacy is completely unnecessary.

Dr. Pam wants to educate women about menopause, about how to stay vital, healthy, and sexually fulfilled. She wants to blow up the social stigma surrounding menopause (that we’re dried-up old crones). “Women should look forward to this transition,” she says. “I want them to know what to do to protect their vaginas so they can have exciting, comfortable, and worry free sexual intercourse for the rest of their lives.”

In the film, Dr. Pam travels across America interviewing actors, comedians, clergy, medical professionals, as well as ordinary men and women about love and menopause. Joan Rivers is the headliner, in what turned out to be her last interview before her death in 2014. “I’m on a mission,” says Dr. Pam in her interview with Rivers, “to save menopausal vaginas in America.”

“Well, sign me up,” says Rivers.

In the course of the film, Dr. Pam interviews several colleagues that MiddlesexMD readers have met—Mary Jo Rapini and Dr. Michael Krychman. I make a cameo appearance, too.

Basically, Dr. Pam covers the same ground that we do here at MiddlesexMD because we have the same mission and message. She does it holistically, with humor and a lot of sage advice. “I want women to know why they must protect their vaginas,” she says. “I want estrogen in their vaginas when they’re going into the ground. And no woman should die without using a vibrator.”

You can rent the movie on YouTubeNetflix, or Amazon. (Run time about an hour and twenty minutes)

Do not hesitate to gather selected friends and family and watch this movie together. For you and your honey, it’s required viewing. A pop quiz will follow.

 

You ask whether there’s effect on your pH level from swimming several times a week in a chlorinated pool and whether inserting a tampon would provide some protection. The vagina is, in its natural state, not an open space but collapsed, that is, the walls are lying next to each other. Imagine a balloon before it is blown up. We refer to the vagina as a “potential space,” because space is made there only when needed—for a tampon, childbirth, or sex.

The vaginal pH isn’t disrupted with a relatively brief swim or tub bath. Inserting a tampon actually would be more likely to act as a wick, introducing more chlorinated water because of its absorbency.

Chlorinated water certainly can affect the vulva and surrounding skin; I do hear that from a number of patients. In that case, be sure to rinse thoroughly after swimming, and then apply a product like Lubrigyn Lotion (available in wipes, which you can put in your bag to take to the pool) to soothe by moisturizing.

 

Among other things, sex is a nice aerobic workout. You breathe hard; your heart rate goes up, as does your metabolic rate. You burn calories. (Yay!)

Therein lies the rub for us older folks.

Isn’t the stress on the cardiovascular system dangerous for anyone with a heart condition? Especially if he or she doesn’t know about it? Or, even when the doctor gives you the green light to have sex, the specter of a sudden attack always looms in the background.

“I think it’s important to healthy relationships to have this anxiety lifted,” said Dr. Michael Ackerman, professor of medicine at Mayo Clinic. “[People] always ask about exercise and how active they can become,” he said in this article. “They almost never ask directly about sex,” but, once it’s mentioned, he said, ”the floodgates open.”

Now, a large and robust study provides the most detailed picture we’ve even had of the actual numbers of people who suffered a fatal heart attack during sex. Researchers examined lifetime medical records from 4,557 people in Portland, Oregon, who died of a sudden cardiac arrest from 2002 to 2015.

Of the 4557, the number of people who died of a heart attack during sex or within an hour after?

34.

That’s it. Thirty-four people ranging in age from 37 to 83. Of that number, 32 were men. Thus, the risk of having a heart attack during sex in men is 1 percent, while for women, it’s .1 percent. While doctors always knew the risk of heart attack was slim, now that the risk is quantified, even researchers were taken aback. “I’m a little surprised at the really tiny number,” said Dr. Sumeet Chugh, senior author of the study and a professor of medicine at Cedars-Sinai Heart Institute in Los Angeles.

It goes without saying to follow your own doctor’s instructions for activity if you have a heart condition. But if you’re given the “all clear” for sexual activity, I hope these numbers put your mind at ease. No need to abstain from one of life’s sweetest pleasures.

“[This is] a wonderful answer for those who love sex,” said Dr. Ackerman. And, I might add, for those who recognize the link between sexual health and overall good health.

 

 

For nigh onto 30 years, the North American Menopause Society has encouraged research into and disseminated information about all things menopause. It’s the hub of the wheel for healthcare professionals and individuals alike seeking the latest scientific information and objective advice about “the change.”

One presentation at this year’s annual meeting in October struck me as particularly apropos for MiddlesexMD readers—part refresher course; part new information. So I’d like to pass it along.

In a wide-ranging talk, Dr. Nick Panay, a gynecologist from Great Britain, explored current understanding of that most common and persistent problem of menopause: painful sex due to vaginal dryness. He reminded us that lots of women will suffer from it (about half of women at some point in life), and that many won’t mention it to their doctors. He encouraged healthcare workers to ask: “If you don’t ask, women often won’t volunteer the information.”

So far, so good, but ground that’s been covered.

Everyone likes sex better with good lubrication, he said, and women often expect their bodies to lubricate adequately, just like they did “before,” so when they inevitably don’t, it’s a real buzzkill for sex.

This state of affairs can be tackled in many ways—topical estrogenOsphenaIntrarosa, and the good old stand-by, moisturizers and lubricants. According to Dr. Panay, moisturizers and lubes can provide relief from vaginal dryness, but they don’t address the underlying cause, which is loss of estrogen. Only estrogen can do that.

Turns out, however, that a couple additional considerations might affect how your body reacts to a specific moisturizer and/or lubricant, depending on its ingredients. In this report, Dr. Panay mentions three physical characteristics of the vagina that might be altered by components in what we put there.

  • pH balance. A healthy vagina is slightly acidic with a pH value between 3.8 and 4.5. Ideally, whatever lubricant or moisturizer you use should be close to those values to retain the vagina’s protective bacterial balance.
  • Osmolality. This is a fancy concept that refers to the amount of particles dissolved in a liquid. High osmolality has a lot of “stuff;” low osmolality doesn’t. The way this works in the vagina is that, ideally, equilibrium is reached between vaginal cells and the moisturizer or lube, depending on its osmolality. When the osmolality is off-kilter, it either draws water from vaginal cells or over-moisturizes them, either of which could cause changes in the vagina. In a test of several products on slugs, for example (yes, like you see pictured below), which as we know are all about moisture and mucus, products that were hyper-osmolalic (high levels of particles) irritated the slugs a lot.
  • Additives. Ingredients like glycols, parabens, and preservatives, which are found in some products can also irritate the vaginal lining, kill good bacteria, and increase susceptibility to infection.

Ideally, says Dr. Panay, the lube/moisturizer you use should be as close to vaginal mucosa as possible—a product that is “optimally balanced in terms of both osmolality and pH and is physiologically most similar to natural vaginal secretions.”

slug like those used for testingTrouble is that the ingredients in a moisturizer or lubricant aren’t always listed on the label and identifying those with correct osmolality and pH levels is fairly impossible for the average user, especially since a product with a good pH level might have bad osmolality numbers. Dr. Panay shared the results for several dozen products available worldwide, and we were happy to see that YES VM, a moisturizer, and YES WB, a lubricant, both scored very well in the testing (we shouldn’t be too surprised, since they’re both very popular in our shop).

So what’s the practical application for all of this new data? For us at MiddlesexMD, we’ve got some new criteria for vetting and recommending products from our shop (sadly, Dr. Panay’s tests couldn’t include every product currently available). We hope that makers of moisturizers and lubricants will take these new findings into account in their formulations, and we can now ask for data on osmolality in addition to pH levels when we evaluate products.

For you, keep in mind that lubes and moisturizers are the first line of attack in making sex comfortable (or possible) and in keeping vaginal tissue flexible and moisturized. According to Dr. Panay, this is true even if you use topical estrogen or another drug, such as Osphena or Intrarosa. Choose your products carefully, looking for high-quality products that are free of glycol, parabens, and other additives.

Pay attention to any increase in vaginal irritation or infections. Your lubricant or moisturizer could be contributing. Don’t give up on lubes or moisturizers, though: Try another product or formulation that’s a better match for your pH and is providing the right amount of moisture to your tissues.

 

There are many reasons women may have pain with sex, so I can’t be certain of the specific cause for your wife. A pelvic examination by her health care provider is needed to determine the cause and therefore the proper treatment.

That being said, the most common cause of painful intercourse in perimenopause (the phase before menopause) or post-menopause (beyond the year after the last menstrual period that marks menopause) is due to the reduction or loss of estrogen and the atrophy or dryness that result.

You asked. Dr. Barb answered.Using a vaginal moisturizer regularly, two to three times a week, is a great place to start; if the atrophy is not advanced, restoring moisture to the tissues may help. Using a silicone lubricant with sex may help, too. I recommend Pink, which is very slippery and, because it has Vitamin E and aloe, it’s soothing, too. If there’s been some vaginal narrowing in the process of atrophy, vaginal dilators can be helpful, too, by gently stretching the vaginal tissues.

I hope this is helpful, and encourage you and your wife to pursue a medical evaluation to enhance her chances of regaining comfort! There may be a physical issue that needs addressing, and there are also prescription-only products available to address her symptoms. For a practitioner focusing on menopause care, I recommend the North American Menopause Society’s practitioner finder.

Six weeks before Christmas, and we all know the drill. We muddle; we fret; we scour, until… we find that perfect, thoughtful, useful, attractive gift for those special people in our lives who just happen to have everything. Does it feel like an exercise in futility

While you’re scrounging around the Internet labyrinth, you might include a quick spin through our MiddlesexMD shop. We’ve already done the searching and the testing to suss out the highest-quality products that you (and we) can trust. And you won’t find a selection remotely similar in the mall. Guaranteed.

While you might not want to give your mother a vibrator for Christmas, other products might tick all the boxes for a thoughtful, attractive, useful gift.

For the special women in your life—mother, daughters, friends: Knowledge. Navigating the rocky shoals of menopause is no picnic. Simply understanding why and how our bodies are changing and knowing what to expect can sometimes make a huge difference in how we weather the storm (listen to our recent podcast on this subject here). For example, understanding why we could suddenly gain weight and have so much trouble losing it can be an epiphany. And that’s not to mention the challenges of maintaining a vital sex life.

You might consider these books for a nearly menopausal friend, sister, or daughter:

If you like our website and find this blog helpful, you might like Yes, You Can: Dr. Barb’s Recipe for Lifelong Intimacy. It’s a collection of the common-sense explanations and explorations of health and sexuality that’s made MiddlesexMD one of the most popular blogs for the over-50 crowd. I share my decades of experience in treating women’s menopausal and sexual issues in, I hope, a sisterly style.

The practice of mindfulness can be an important factor in stress relief, overall well-being, and tangentially, a vital sex life. We think it’s so important that we’re happy to include The Miracle of Mindfulness, by Thich Nhat Hanh. This is a classic in the canon of books on meditation, spirituality, and mindfulness. It might be a thoughtful counterpoint to the feeding frenzy of the holidays.

Better Than I Ever Expected by Joan Price. We’re a fan of Joan’s straightforward yet lighthearted style. The book is a good overview of the multi-hued issues that accompanies menopause, especially as it relates to sexuality. This may be a good choice for women who want to warm a tepid relationship or for those embarking on a new romance.

We’ll step out on a limb here and recommend She Comes First: The Thinking Man’s Guide to Pleasuring a Woman by Ian Kerner as a gift for a receptive lover. Dr. Kerner is a clinical sexologist who explores the anatomy and psychology of sex. In this book, he does not overlook his personal struggle with sexual dysfunction. Described as “straightforward, intimate, and exuberant,” this book is highly recommended by many experts and doctors.
Everyone loves a good cookbook, and The New Intercourses: An Aphrodisiacs Cookbook is one we love. This book covers it all, exploring the history of aphrodisiacs, pairing recipes for decadent foods with the time of day, the season, and the stage of a relationship, all presented with lush photography. It even includes recipes for massage oils and bath salts and oils. This book is a delight for all the senses.

Speaking of sensual delights. Feeding the mind is fine, but a gift that pleasures the senses is what the holidays are all about. Any of these would be lovely choices for a romantic partner or a female friend.

The Lelo massage candle is a unique gift for your intimate partner or a sweet encouragement for your menopausal bestie. Made with a rich soy, almond kernel oil, and shea butter, the candle melts into a silky massage oil. It also comes in alluring, grownup scents, such as black pepper and pomegranate or snow pear and cedarwood.

High quality massage oils with natural ingredients and subtle scents are a pleasure with or without a partner. Check out our Kama Sutra or Just Love oils for the best of both.

The Sliquid O Gel is a racier gift for your Sex In the City girlfriend. Both lube and warming oil, O gel takes stimulation to the next level. With peppermint oil and menthol, O gel soothes and warms. Not for everyone, but exactly right for a more experimental someone.

For your romantic partner. We’ve gathered some unique products to share with your one-and-only. Slip them in the stocking or on the pillow along with a rose, a bottle of bubbly, your favorite sound track or all of the above.

Our Stocking Stuffer kit may be as much about you as it is about him, but we’re thinking he’ll be happy that you’re into making sex good for both of you. The kit contains the Jolie vibrator—a small but perky little number that you can both play with, a bottle of Yes water-based lubricant, and a small box of romantic, magnetic poetry. With any magnetic surface, you could create your own Shakespeare in Love boudoir. Express sentiments that take you beyond the day-to-day.

Romantic Vows for Affectionate Lovers gives you a playful way to express your feelings. Choose from 72 cards that seduce, promise, and describe. Hide them in his sock drawer or take turns surprising each other. It’s a low-pressure, flirtatious way to keep the flame alive.

One of our newest offerings, the Fin vibrator is a powerhouse in a teensy package. Made “by women for women” at Dame Products, Fin is comfy, unobtrusive, and intuitive. It’s also good for couple play. All Dame Products, including this one, come with an engaging instruction manual to get the most out of your toy.

Color him chocolate? And why not? You can do just that with our Lover’s Body Paint. A 2-ounce bottle of rich chocolate or caramel (or both?) and a soft brush and your lover becomes your own edible canvas. Or vice versa. Messy, silly, and surprising. The perfect stocking stuffer.

You say you’re four years past menopause, and in addition to hot flashes and other symptoms, you have dryness and have had vaginal atrophy—a decrease in the size of your vaginal opening. This is a classic symptom of genitourinary syndrome of menopause (GSM, earlier called vulvovaginal atrophy). Without estrogen, the vaginal tissues become thin and fragile, and the vagina can shorten and narrow.

Vaginal moisturizers, which you say you’re using, are of some benefit. They’re better at prevention, though, started during perimenopause or early in menopause; once atrophy is advanced, they’re less helpful and may be irritating, as you’ve experienced.

You asked. Dr. Barb answered.The most likely effective treatment is localized estrogens (cream, ring, or tablet) or something like Osphena (oral and non-estrogen) or Intrarosa. You say you like to avoid chemicals, and I understand that; estrogen is a natural chemical, and the local application is to replace what your body used to produce naturally in the way that has the fewest side effects. Osphena and Intrarosa work like a hormone, even though they aren’t one. These are all prescription therapies, and a necessary component of your plan to counter the effects of vulvovaginal atrophy, which is chronic and progressive.

Once the tissues are healthier, you may need to use vaginal dilators to regain increased “capacity” (patency, in medical terms) of the vagina.

Whenever there is pain involved, that problem needs to be addressed first; once you’ve achieved physical comfort, you may find a sex therapist helpful if issues remain, as your gynecologist suggested. In the meantime, no one should blame you for not wanting to have painful sex!

A number of the things you say are very familiar to me: you’ve had plenty of natural lubrication and you’ve never had issues with intercourse. The unfortunate reality is that menopause changes the game, more dramatically for some of us than others. What was true for the younger you is no longer the case (ask me about menopausal weight gain!). But! I know how important intimacy is to relationships, and if you’re willing to make the effort, it’s almost always possible to regain function and comfort again.

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