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Sounds like you’ve been doing a number of the right things: You’ve been using dilators, a vibrator, lubricant, and vaginal moisturizer. It sounds like you’re at a point where localized estrogenOsphena,  or Intrarosawould be helpful for you to achieve your desired outcome.

You asked. Dr. Barb answered.Any of these prescription drugs will provide elasticity, a critical factor for getting the “stretch” needed with the dilators. Take your dilators in to your health care provider and have this conversation, too. He or she can help you determine whether you can get further capacity with the methods you’re using or whether, as I suspect, you need to take the next step and add a prescription to your routine to restore health to the vaginal tissues.

It’s hard to get to the final goal without that option–and that final goal is definitely one worth working for! Good luck.

You asked. Dr. Barb Answered.The loss of hormones (estrogen and testosterone) with a hysterectomy and bilateral salpigoophorectomy (removal of ovaries) is definitely a “hit” to sexual function for women (I assume based on your message that your ovaries were removed). The genitals are, as we say in medicine, abundant with hormone receptors. In other words, hormones play a big role in the health and function—both urinary and sexual—of the genitals. So now, moving on without those hormones, what to do?

For most women, it’s direct stimulation of the clitoris that leads to experiencing orgasm. In the absence of estrogen, there is less blood supply, and, in turn, loss of sensation and ability to arouse or orgasm.

  • You can use a device to counter this trend. The Fiera Arouser is a small device you use before intimacy. It uses vacuum to increase circulation—and therefore sensation—in your clitoris.
  • There are also warming lubricants that can accelerate your response by increasing, again, circulation.
  • If your orgasms are weak, you might use the Intensity regularly on your own to build your pelvic floor muscles, which are what enable us to experience orgasm.
  • Probably the most reliable tool to help in achieving an orgasm will be a vibrator. The genitals need more direct and intense stimulation now, and a vibrator is usually a great solution. There are many great options to consider on the website.

This can also be a time to consider treating the genitals with prescription treatments such as localized estrogen or the non-estrogen options, Osphena or IntrarosaUsing testosterone off-label can help women with arousal and orgasm as well.

I’d encourage a conversation with your healthcare provider to see if there are options that may be helpful for you.

Good luck! I’m glad to hear that your husband is supportive in addressing this frustration for both of you!

I’m so sorry that you’re experiencing this loss in your relationship. Both depression and the medications used to treat it can be culprits in a loss of desire, and given the relatively short time frame in which you noted the change (one or two weeks), the antidepressant is the likely explanation for your husband.

The situation that you describe is probably best addressed with the help of a therapist; someone who does sex therapy would be most helpful (you can find one certified by the American Association of Sexuality Educators, Counselors, and Therapists through their website).

You asked. Dr. Barb answered.As you’ve begun to experience, the longer this dynamic goes on, the more anger and resentment builds. Having a therapist to help you navigate the conversations is extremely helpful. And your suggestion of a therapist sends your partner the clear message that intimacy is really, really important for you and your relationship.

There’s some evidence that Stronvivo, a nutritional supplement for cardiovascular health, can improve both libido and function in both men and women; that could be a consideration as well.

Good luck!

How We Get Turned On

The Female Sexual Response Cycle

As we’ve said (many times) before, our sexual responses are complicated and unpredictable. And this becomes especially true once we’ve embarked upon this menopausal transition. That doesn’t mean we can’t respond sexually anymore, just that we respond differently from men and differently even from the way we did before.

Way back in the 1960s, Masters and Johnson, the groundbreaking sexologists, developed a graph of the sexual response cycle. It was a simple, linear depiction that purported to track both men and women from arousal to afterglow in four stages—arousal, plateau, orgasm, and resolution. Sort of like a visual depiction of the wham-bam-thank-you-ma’am version of sex that women used to think was normal.

It did not contain a lot of room for nuance.

Fortunately, concepts about how we respond sexually have evolved over the years. Lately, Rosemary Basson, professor of psychiatry at the University of British Columbia, proposed another model of how women, specifically, experience sex. Guess what? It’s different from men. Her graph is circular. It includes elements that previously weren’t linked to sex, like relationship satisfaction and self-image, and our previous sexual experiences. It leaves room for skipped steps and a non-linear response to sex. This woman gets us.

Take feeling desire, for example. Basson’s model doesn’t get all hung up on desire. You may not feel spontaneous desire—the old “horny” thing—the way you used to. Or maybe you’ve never felt horny. According to a 1999 study from the University of Chicago, fully one-third of women never feel desire. “[Women] may move from sexual arousal to orgasm and satisfaction without experiencing sexual desire, or they can experience desire, arousal, and satisfaction but not orgasm,” according to this article.

You may not feel desire until you’ve begun to have sex; you might not feel desire even then. You might not feel desire even if you orgasm.

Likewise, for a lot of us, sexual satisfaction doesn’t even depend on having an orgasm, necessarily. We may have lovely, satisfying sex because it satisfies our partner and affirms the relationship and enhances our feeling of intimacy. Or, we may engage in sex for negative reasons, such as not wanting to lose a partner or avoiding the unpleasantness of turning him down.

Basically, Basson’s work tells us that however we experience sex that works for us and our partner is good sex. We may not “feel like” sex (experience desire), but once we get into it, desire might come tripping along like a puppy on a leash. Or, it might not, but the sex might be good anyway.

According to the literature, the sex that seems to work best for most couples is light-hearted, flirty, playful sex. It isn’t rushed. It has nothing to prove. It’s a mature, evolved celebration of the fact we’re still here, still loving each other. It’s the kind of sex worth working for.

Couple in kitchenSo, let’s give ourselves a break. If we’ve been honest with ourselves, our sexual response very often depends on stimuli that has little to do with sex—how safe and happy we are in our relationship; how long we’ve been in the relationship; how we feel about ourselves (confident, sexy, desirable; or fatigued, stressed, distracted); whether sex has been painful (it’s hard to look forward to an experience that’s associated with pain).

The most important thing that’s necessary for sexual satisfaction in your relationship is the willingness to pursue it in whatever way works for you.

Oh, and the more sex you have, the more you want it. There are lots of ways to make sex comfortable after menopause: That’s what this website is all about; lube up and laissez le bons temps rouler.

 

What you describe—pain during intercourse and tissues that your doctor says are thinning and pale—sounds like vulvovaginal atrophy, also called genitourinary syndrome of menopause (GSM). Since your hysterectomy (if it included your ovaries) or whenever your ovaries stopped producing estrogen, your vaginal tissues have become more fragile and can actually tear. GSM is what we call chronic and progressive, meaning it will continue to get worse over time as a natural consequence of the loss of hormones. If you want to have comfortable intercourse, you’ll need to maintain a treatment plan.

The most likely effective treatment is localized estrogen (in creams, ring, or tablet) or Osphena, a non-estrogen oral medication, or Intrarosa, a non-estrogen vaginal insert. Those are all prescription therapies. If you don’t have access to prescription medications, or in addition to them, vaginal moisturizers can be of some benefit; I’d recommend PrevaLeaf Oasis.

PrevaLeaf Oasis MoisturizerYou say that your partner is sometimes away from home for weeks or months at a time for military service. That can also pose some challenges for you. At this point in our lives, we face a “use it or lose it” challenge with our vaginal tissues, circulation, and muscle tone. That means treating your GSM can’t be an off-and-on pattern; you need continuous maintenance. I published an article shortly after MiddlesexMD launched called “Vaginal Patency for Single Women.” While you’re not single, you might follow some of its advice, including the use of a vibrator during those “dry spells” when you’re home alone.

Best of luck in regaining not only comfort but pleasure! Intimacy is an important part of our relationships and our lives.

In the last post, we examined where we are right now in life in order to identify where we might want to be in the future: the health of our bodies, our spirits, and our relationships as well as the dreams or passions we have not yet pursued (or maybe even identified).

With this in hand, let’s move on:

Step #2. Same drill. Quiet place; journal in hand. Read through your initial entry. Anything to add or edit? Does it still feel honest?

What leaps out at you from your work? Do you notice any patterns—boredom and overeating; stress and impatience; lack of self-assertion and a feeling of victimhood?

Did you identify something you always wanted to pursue or to learn? Are there disappointments you uncovered? Are some elements of your life story simply incomprehensible to you—how did you end up here, you ask?

Sit with these for a minute. What tugs at your heart? What calls to you? What sounds absolutely awful or completely thrilling? What needs a closer look?

Also read over your assessment of your primary relationships. Any action plan needed here? Fences that need mending or habits that need adjusting?

You aren’t writing anything, necessarily. You’re just noticing habits, patterns, ways of thinking, and how yesterday’s work makes you feel today.

Now. Begin creating your reinvention plan. This is the eulogy moment. What do you want people to say about you after you die? How do you want to feel about your one and only life? Begin to articulate the big, sine qua non items. The ones you cannot die without having accomplished. Make a list of them. Not an overwhelming list—the top three or four. The big ones.

Choose one. This is your project for this year. And maybe for next year. If it’s that important, you may work on it for the rest of your life. Break this goal down into manageable steps that you can start doing tomorrow. What’s the first step, then the second? Travel to Africa? You’ll start by researching your options with the goal of having a plan in place this year. Lose 35 pounds permanently? Research your options with a goal of having identified a realistic, lifelong approach this week that you can begin practicing next week. Learn how to play the flute? You’ll need to find an instrument and a teacher…

Next, review those primary relationships—kids, extended family, spouse. Have you identified tendencies to work on? Habits to develop or break? Relationships that need attention? Relationships that need special nourishment or a new approach?

Don’t overlook the one relationship that is most critical to your longevity and quality of life. “If you’re in a happy marriage, you will tend to live longer. That’s perhaps as important as not smoking, which is to say: huge,” says Lyle Ungar, one of the researchers of that data-driven longevity calculator I mentioned in the first post. Knowing that someone in the world knows you intimately, loves you, and has your back adds measurably to quality of life. It makes sense, then, to focus especially on this relationship in your life review—to test its soundness and ponder how it might be strengthened.

List one or two specific steps you can take immediately that will make any of these relationships stronger. Also write down one or two habits or personality traits that impede them—that you should work to change.

With a path identified (for the year, at least) and the initial steps delineated, you’re ready to begin. Let me just add the wisdom of a few professionals and life-reinventers who have walked this path before.

Practice gratitude. Every day.  “…allow yourself to be grateful for the things you…have. Anger is never inspirational but gratitude is,” writes the best-selling albeit hyperactive author, James Altucher.

Goals, such as those you just articulated are important because “if you don’t have long-term goals, you run the risk of doing lots of little things every day—cleaning the house, sending emails, catching up on TV—without ever making a contribution to your future,” says Art Markman, psychology professor and author in this article.

Stay flexible. Change is never static. Reinvention is an ongoing process. You’ll have to rinse and repeat again next year (or next month) to make sure the goals you set today are still relevant and important and that your progress is unfolding according to plan. “Too often, we give up just when we need to push harder, and persist when we actually should quit,” writes one author.

Change is never easy. Expect setbacks; anticipate resistance. Anything really challenging and worthwhile will take time to accomplish, so if it’s really important, don’t shortchange yourself. Persevere through the tough spots. “The most successful self-reinventors are those who understand that they have time and are willing to use it to invest in their own skills and education,” writes this author.

Declutter. Yes, you read that right. Downsizing, clearing out, cleaning up can feel both psychologically freeing and is also metaphorically linked to ridding your life of things that hold you back—mental clutter, too many commitments and obligations, relationships that are buzz-kills or worse, according to Margaret Manning, blogger and creator of sixtyandme.

There. You did it. I hope you feel empowered or at least optimistic. You should now have a roadmap for the months ahead. I’d love to hear how the project is working for you and if you have suggestions to refine it.

Good luck.

The Fullness of MidlifeNeed inspiration? Some of our “The Fullness of Midlife” podcasts are on topic: Lesley Jane Seymour on reinventionKate Convissor on overcoming fearsDeborah Robinson on appreciating our own bodies and treating them wellI, Joan Vernikos on how movement keeps us capable.   

I had a shock the other day.

In an unguarded moment, I ran across one of those life expectancy calculators. You know, the kind that will tell you how many years you have left on earth after 10 minutes of softball questions.

Basically, I believe that predicting how long you’ll live is a fool’s errand—any of us could get hit by alien laser rays or a schoolbus tomorrow. But my data-driven heart was sucked in by this calculator, which was developed by professors at the University of Pennsylvania Wharton School and based on 400,000 data samples collected by the National Institutes of Health and the AARP.

Now, I know that I fall in a healthy category for weight, activity level, and absence of chronic disease. But, still, the results shocked me.

Ninety-six. My estimated life expectancy is 96.

This is enough time to live a second adult life. This is enough time to start another career or follow a dream or pursue a passion. This is not enough time to waste.

So, that’s the challenge I put before you (and myself) this January: the macro view; the life-reinvention perspective. Because no matter how much time we have (or think we have), why squander it in self-defeating, fearful ways? Or simply by drifting through a handful of years without direction?

Reinvention isn’t a quick-fix project; it isn’t a lose-five-pounds resolution. It’s a project we could (and should) work on for the rest of our lives, periodically reviewing and adjusting our goals to see if they still fit.

Now—today—is a good time to start.  So I put before you the proprietary MiddlesexMD Reinvention Project. Ready?

Step #1. Take stock. No shortcuts here. Sit yourself down somewhere quiet. Open to the first page of the Reinvention journal that you bought for this occasion. (You did get one, didn’t you?) Today’s task is to examine the important aspects of your life. As realistically and objectively as possible. You can’t envision a new you without a solid understanding of who you are now, right?

How’s your health? (Obviously my first question.) Are you content with how you feel? How do you feel about your eating/exercising habits? Your weight? Your overall mobility? Your blood pressure and cholesterol levels? Your mental acuity? Do not indulge in guilt or leap to quick, feel-good resolutions, just assess your physical self realistically.

How’s your spirit? Do you feel lonely? Optimistic? Afraid? Content? Discontent? Restless? Do a full-spirit wellness scan. Are the physical and spiritual linked in some way—being overweight and depressed, for example? Are you handicapped by free-floating fears or anxieties? Does stress nibble at the corners of your life—or maybe devour the whole enchilada? Do you feel unsettled and discontent or grateful and happy?

What is the source of your greatest joy or satisfaction? What are you good at? What are you happiest doing? Where does your passion—or your pleasure or your interest—lie? What have you always wanted to attempt? Do you have dreams that you decided had passed you by or that you are too afraid to try? Is there anything you would regret not having done before you die?

Examine the health of your most important relationships. Our closest relationships are the sources of our greatest joy and satisfaction as well as our greatest heartbreak and frustration. We expend a lot of  energy repressing, denying, or making excuses for broken relationships, whether with family, lovers, or friends. Does this sound true for you?

Are you keeping up with friends and loved ones, or have you let important relationship wither on the vine? We also sometimes endure relationships that kill our spirits, that are toxic to our psyche and sometimes our bodies. Resolve now to examine them with a clear eye. You don’t have to do anything today except be honest with yourself.

Write it all down in the journal. This is the first day of your new you.

Okay. Take a deep breath. You’re done for today.

The Fullness of MidlifeNeed inspiration? Some of our “The Fullness of Midlife” podcasts are on topic: Lesley Jane Seymour on reinventionAmy Eller on intentional life designDruscilla French on understanding ourselves.

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