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“Midlife: when the Universe grabs your shoulders and tells you “I’m not f-ing around, use the gifts you were given.” —Brene Brown

I don’t know about you, but I love seeing old people in love. The way they hold hands toddling down the street. The way they go about their daily tasks having made peace with the past. I think it’s a miracle when love lasts this long and ages this gracefully.

Relationships encounter lots of challenges in the course of a lifetime, but from my own observations, which are supported by the data, the midlife transition, that somewhat fraught passage, is nothing to sneeze at. Menopause aside, the awareness of time passing often arrives unexpectedly and with surprising intensity, leading both men and women to make decisions that belie common sense, compared to which the red Corvette might be among the most benign. For example, the highest divorce rates from 1990 to 2010 occurred among couples over 50, according to this study. Concurrently, co-habitation rates among over-50s tripled from 2000 to 2013.

Whatever the cause—longer lifespan, greater economic freedom for women especially, cultural change—the fact is that something shifts when folks approach that midlife marker, and it’s often the woman who agitates for change.

This isn’t necessarily a bad thing. Periodic reevaluation and readjustment is healthy. So is honestly confronting ingrained habits and responses that ultimately stifle intimacy and deflect communication. Like a vintage car, most lengthy relationships require a major or minor tune-up now and then.

Still, midlife often opens a Pandora’s box of restlessness and dissatisfaction—the perennial is this all there is? What happened to the passion? Am I missing out? Do I really have to endure the quirks and habits of this individual for the rest of my life? What is really important? What dreams have I buried?

Those existential questions herald an important crossroad—the frontier between youth and maturity. With regard to your most intimate relationship, you can:

  1. Invest in what you have. Work on ways to reinvigorate and reignite the flame. This won’t be the passion of your youth, but something burnished by time and familiarity. A golden glow rather than red-hot embers. If your relationship is solid and things have just cooled off with time and neglect, it’s worth investing for the future.
  2. Reinvent it. Sometimes a creative change eases the chronic irritations that can erode a longterm relationship. Some couples successfully stay together but give themselves extra space with separate households, for example, or planned time apart, or splitting the daily finances and decision-making that cause problems. Rejiggering the quotidian foundation might ease the annoyances enough to allow a couple to value and appreciate the familiarity and intimacy that has developed over many years.
  3. Scrap it. This is a very tough judgment call, but some relationships have never worked well; some matches are misses; and sacrificing the years you have left may not be worth it for one or both of you. Dismantling a lifetime is a heartbreaker (or—maybe a release), but you may end up in a better place when the dust settles.

Major life transitions should never be done in haste. They deserve a considerable degree of mature reflection. We all know people who make fast and sometimes rash decisions in the throes of passion or as a desperate attempt to seize a day that appears to be slipping away. Amid the landmines of midlife, the baby is sometimes thrown out with the bathwater.

Here’s a little reality check.

However irresistible the urge, don’t blow up your life. Wait. Reflect. Seek counsel. The demand to create something more authentic, to realize cherished dreams is real and should be honored. But the best path forward probably isn’t over the shattered pieces of your present life.

You still have time. You can still seek your bliss, optimize potential, maybe with more freedom and effectiveness now that the kids are grown and you’re more self-confident. Start a business. Learn Chinese. Travel. The world is your oyster—just in a different shell than when you were younger.

Romantic passion is a landmine. Passion is powerful, blinding, and temporary. You can’t make good decisions in its throes. And even the most incredibly passionate relationship will inevitably fade with the demands of daily life. White-hot passion doesn’t last; it’s not meant to. And when reality checks in, the dirty socks on the floor look the same. Trust me on this one.

Talk to someone if you need to. A therapist. A friend. You can’t see things clearly (even if you think you can). Trust the counsel of someone wise and objective.

Don’t freeze out your partner. However restless and unsettled you may feel, your partner is probably not the enemy. You want to elicit support, not resistance. Anyone would feel threatened when cracks appear in the foundation of a secure life. Anyone would feel uncomprehending and maybe hurt. If, however, you are able to communicate what you’re feeling, even if it’s confused and incoherent, at least there’s a bridge rather than a canyon.

“This too shall pass,” writes blogger Deb Blum in this article. “It will pass more gracefully and completely if everyone is gentle and loving and gives the space necessary to get through this time.”

And that study about over-50 divorce rate also found that the longer a marriage lasts, the less likely it is to end in divorce. So those old folks holding hands in the park? The real deal.

You can’t really tighten your vagina. What you can do is tighten your pelvic floor muscles, which surround the vagina. We offer a variety of products designed to help you improve pelvic floor tone, as well as instructions on how to do Kegel exercises.

There are some laser treatments that have been offered to tighten the vagina. They’re relatively new treatment options, and the outcomes seem quite variable.

Strengthen your floor!I hope this helps! (And I’ll note that strengthening your pelvic floor is also good for preventing incontinence, so there’s lots of reason to develop the Kegel habit!)

 

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.

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!

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.

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.

 

We blather on regularly at MiddlesexMD about the importance of good health—staying active, eating well, exercising, maintaining a healthy body weight. Given the many exercise fads that come and go (remember Jazzercize?), maybe it’s time to get specific about ways a mature woman can stay in shape.

Yoga is one of the best. Hardly a fad, yoga’s been around for at least 5,000 years; the earliest mention is in sacred Ayervedic texts in northern India. In the US, it’s now a $10 billion-a-year industry with 20 million practitioners.

As you can imagine, many styles of yoga have developed over the millennia, but the main forms you might encounter are:

  • Hatha. The most familiar style that focuses on the breath while holding various poses.
  • Vinyasa. Series of poses that flow smoothly into one another.
  • Bikram. You might have heard of this “hot” yoga style that involves a specific series of challenging poses done in a very hot room.
  • Iyengar. This type uses props, such as foam blocks, straps, or blankets to maintain comfort and good form during poses.

What all these flavors have in common is a focus on the breath as a meditation and on moving at various speeds through a series of poses, which are sometimes very challenging. As such, it combines the calming effect of meditation with bodyweight strength-training of held poses.

The benefits of a regular yoga practice are impressive. Yoga clearly increases flexibility and strength, and improves balance. According to a slew of studies, the mind-body effect of yoga may also relieve stress and depression, lower blood pressure and heart rate, stabilize blood sugar levels, relieve chronic neck and back pain, and even improve brain function.

Referring to a 2015 study published in The European Review of Preventive Cardiology, an article in the Harvard Heart Letter reports, “over all, people who took yoga classes saw improvements in a number of factors that affect heart disease risk. They lost an average of five pounds, shaved five points off their blood pressure, and lowered their levels of harmful LDL cholesterol by 12 points.”

Despite the fact that some of these studies are small and not terribly rigorous, the consistent result is that, while yoga isn’t a cure-all, it helps to relieve some surprising conditions.

One of those small studies published in the Journal of Sexual Medicine reported that yoga can even improve sexual function. In this study, 40 women practiced yoga for an hour every day for 12 weeks. At the end of the study, 75 percent of them reported improvement in sexual satisfaction on several assessment areas, such as lubrication, desire, arousal, and pain. Women over 45 showed the most significant improvement in lubrication, arousal, and pain.

The good thing about yoga is that you can jump in and feel challenged at any fitness level, from couch potato to workout devotee. It’s low-impact, so it’s easy on the joints. It isn’t competitive, so you shouldn’t be looking over your shoulder (or between your legs) at the next person. It doesn’t require any equipment other than a mat, so don’t stress the gym wardrobe.

You can find yoga workouts online or on DVDs, but classes are offered everywhere as well. The glut of choice actually makes teasing out the best choice for you more challenging. It took hours of online searching to find a workout that fits my ability but that also avoids an annoyingly smarmy monologue or off-the-wall comments about hairstyle or the leader’s latest manicure. (Not kidding.)  I ended up sampling the beginner clips from this list.

Taking a bricks-and-mortar class may be the best option for maintaining motivation, but also for feedback and advice on proper form and avoiding injury. Check out the background of the person leading the class. Barriers to entry are low, so anyone can teach yoga with a few hours of training. You’ll want someone with experience and many years of practice in the discipline.

“To my mind, a good teacher always asks, ‘Are there any injuries or conditions I should know about before we get started?’” writes Julie Corliss, editor of the Harvard Health Letter.  She also advises checking out a few different classes to find a good fit.

 

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