Feeds:
Posts
Comments

Posts Tagged ‘sexual health’

The American Cancer Society has released new guidelines for Mammogram Screenings. We know you’ve likely read a lot about it. I thought I’d hand it over to our old friend and writer Julie, a longtime MiddlesexMD blogging pal, who has breasts of her own and some thoughts to share on what to do when new guidelines hit the airwaves.

Guideline Headlines!!! Okay girls! Grab them and run! But which way! When? Where? But wait!!! No!

No! These guidelines are saying to maybe squish less often? For some of us? Really? To not start so soon? Who are these people?

I’m confused.

With the latest release of Breast Cancer screening guidelines from the American Cancer Society, it’s easy to feel a little—entangled—in questions of when and whether to handle our screenings. And no wonder. The discussions are very much in the air, and the experts are agreeing to disagree. Very politely.

It wasn’t the intention of the committee to create this confusion, of course.

They truly wanted to offer up more leeway in guidelines, particularly for women with average risk of developing breast cancer—and that’s most of us. But leeway is very hard for most of us to interpret. Most of us just want very clear direction. We want safety and assurance. We want to avoid unnecessary exposure to radiation and unnecessary medical procedures. That’s not too much to ask, is it?

Well, we can’t have absolute assurances from medical guidelines. It would be so nice if we could. We can only get the best advice from smart committees working from what data they have to keep the greatest number of us safe most of the time.

So the new guidelines ease up on the youngest women, aged 40-45, saying they don’t need to start screening if they have average to low risk of breast cancer. Of course we women in menopause are already screening our breasts, have already been at it for years by now. Now we are wondering what to tell our daughters. And we will be getting different advice from at least three of the six breast-cancer-guideline-writing organizations in the US alone.

In fact all of those concurrent guidelines exist out there already, in our doctors’ heads. And online. And in our restless heads and hearts. So what do we do with all of this various information?

First… We breathe.

Then…  We remember, that we are each in charge of our own bodies. Guidelines are there just as a framework of reference. In practice, we each are working on our particular realities, which must be dealt with in the particular, with a plan that takes in all of the unique, unusual, specific aspects of our own bodies, or our daughter’s, their daughter’s.

So, I’ll take me, for example.

Those guidelines would suggest, since my breasts have been around for 55 years (well, one of them. The other seems much, much older), and in my family there is no history of breast cancer at all, and I have no current cancer markers, good and good. But… I’ve had so many surgeries and lung problems my chest as been radiated enough in my lifetime to light up Tokyo on a moonless night, which is not so good, and I’ve had to have a few lumps biopsied here and there, which have markers they like to peek at now and again, so….. Yeah I’m signed up for annual scans. Am I worried? Not really. But I’m committed. My sister, with the same family history, may logically choose to scan less often. Because she’s been much healthier throughout her life.

A young relative in my family? Just turned 40. Did she need to go for her first exam? Not really, but she and her friends made a party of it at the local breast exam clinic. Wine and bites and breast squashing in paper robes. She could have put it off another 5 years, but she prefers to get this ball rolling. Preference plays a roll here. She is being cautious.

You see how this rolls. Family history + conference with your physician over your own medical history + your own ideas and feelings about medical tests at this time in your life, taken together with a careful review of the recommendations = your best plan for screening. That plan for screening? It changes year over year as you age. That’s how you do this. Review your plan each year for you. Discuss it with the women in your family. And your friends. Like. Discuss it. Out loud. Over coffee or tea.  Like, “What’s your breast scan plan, Mom?”

Like that.

It’s not rude.

No. It’s not.

Happy deciding, everyone.

Read Full Post »

We have a new product in the house, and our team is pretty excited about it. I’m asking some of my patients to work with it as well as trying it myself, and I’m hoping to see exactly the same success with us as the manufacturer has been seeing in their studies. The studies you can see here, in the Journal of Sexual Medicine.

This product, called Stronvivo, is a supplement for women and men.

And, before you worry about a doctor pushing Supplements, please hold on a minute. Good science backs this supplement up.

Stronvivo contains a stack of amino acids and minerals that are all essential to human life, but particularly helpful for supporting endothelial health—that is, strong blood vessels. These are amino acids and minerals that at our age we might not be easily getting or producing through our diets, metabolisms, or normal organ function.

And what are healthy blood vessels good for? They are great for the happy working of sexual organs. They are what make those organs go. Hers and his and theirs.

But, bonus! These same elements in these supplements are great for helping support the circulation of sexual hormones! Win-win! And especially a win for women who, because of cancer risk or preference, want to support what hormonal production their bodies can manage post-menopause without the aid of hormone replacement. This is a great offering for me as a physician. I love having a non-hormonal alternative I can present to my post-menopausal patients, and their partners!

And it plays out in the research of this formulation. The company tested their Informed-Choice, all-natural, US-manufactured product with women and men over 40 who have arousal issues. The results showed clinical improvement of the health of the endothelium, stimulation of nitric oxide production, reduction of platelet aggregation and adhesion, improved circulation, improved hormone production in the test subjects.

Clinical evaluations used the FSFI (Female Sexual Function Index), the PHQ-9 (Patient Health Questionnaire), the IIEF (International Index of Erectile Function, and the ADAM (Androgen Deficiency in the Aging Male) to measure female and male patients over 90 days. The women showed improvement in desire, arousal, lubrication, orgasm, satisfaction, and pain. The men improved in androgen levels and overall satisfaction.

And both women and men had improvement in mood, with less depression.

To understand the full potential, 90 days’ use is recommended for women; men may see full benefit after as little as 30 days.

Personally, I like the idea of a nutritional supplement that couples take together. It represents a kind of shared commitment to lovemaking and holding on to one another.

Also, from a purely medical point of view, keeping the smaller blood vessels of our sexual organs happy will keep your larger vessels happy. And that will keep your whole body working better through time.

And that makes this doctor very happy. If we’ve convinced you to give Stronvivo a try, you can order it here.

Read Full Post »

I’ve got much to catch up on, study up on, and share with you from my trip to the North American Menopause Society (NAMS) annual meeting a couple of weeks ago. It was a whirlwind of great talks, and such a marvelous time to catch up with colleagues who are doing wonderful work.

One of my all-time favorite people, Dr. Susan Kellogg-Spadt, who’s been a medical advisor here at MiddlesexMD, spoke at the conference! She was fantastic, of course.

She’s a nationally recognized expert in pelvic and vulvar pain and the Director of Female Medicine at the Bryn Mawr office of Academic Urology at the Center for Pelvic Medicine, in Rosemont, Pennsylvania. She treats patients throughout the United States as a vulvar specialist, sexual dysfunction clinician and therapist.

At her NAMS talk, Susan talked specifically about the sexual needs of menopausal women, and in some detail. We gain so much from having her in our field! But without further, um… gushing? Here are Susan’s top clinical pearls for our sexual health and happiness:

Add moisture daily. If we use a water-based, bio-adhesive lubricant several times a week, regardless of sexual frequency, we can get a lot more comfort and satisfaction with sex and just make it easier to have an orgasm whenever we want to.

Nourish yourself. A Mediterranean diet has been shown to promote sexual function, (and, we just learned, perhaps lower breast cancer risk). And regular exercise improves mood and overall health, both of which contribute to better sex.

Talk it out. When we use “I” language to talk with our partners about sex honestly and in a non-accusatory way, we increase the chances of sexual success. Your NAMS doctor or therapist can help provide the vocabulary and communication tips.

Prioritize pleasure. Don’t wait for intimate time to just happen. Even a 20-minute block of time, scheduled weekly, for touching and intimate conversation can clear the way to better sex. Putting it on your checklist may seem like a cold thing to do, but trust us, it gets hotter with practice.

Mindfulness matters. Reading or watching even the softest erotica, being mindful of erotic thoughts as they occur, and focusing on sensation rather than distractions during arousal are all important. All mindfulness training can contribute to your ability to stay in the moment during your most intimate moments.

Intensity, baby. After menopause, many women need more intense stimulation to reach orgasm. Consider introducing vibrators into sex play. The term, “Doctor’s orders!” can be very useful here. You have our permission to use it.

Do try. Just opening up and talking about sex problems, and finding what can still be sexual successes, shows that a woman is committed to her partner, and taking action shows her level of care and concern for the relationship. Mutual affection, honest attempts at exploring what is possible, comfortable, what still feels good, does amazing things for a relationship.

Read Full Post »

My car’s license plate reads “HOTFLAS.” I take it for granted, until someone rolls down his window to talk to me at a stop sign.

“Hey, I like your license plate,” he says. “You must be about 50. Wow, my wife is going through that. It’s really tough. It’s been a real challenge.”

Only a few days later, I was meeting with a colleague from a nonprofit for whom I volunteer. “Remind me what you do,” he said. It took about half a sentence from me (“I’m a doctor specializing in menopause care…”) to strike a nerve with him. “It’s like a stranger is living in my house,” he said, of his wife’s journey through menopause.

It’s Menopause Awareness Month. These men—among so many others who regularly cross my path—are aware of menopause. Now. I think it’s safe to say that the experience has taken them—and their wives—somewhat by surprise. I can’t think of another medical condition that affects so many of us—directly and indirectly—yet about which we have so little advance education.

Six thousand American women become menopausal every day (defined as not having menstruated for a year). In the U.S., the average age of menopause is 51; that’s the age the youngest of the Baby Boomers are now. We have the highest proportion of menopausal women in our population we’ve ever had—and may ever have again.

And yet, women I meet in all areas of my life—and the men who are living with them—are surprised by the range of effects from the change in estrogen in their systems. While lots of jokes (and T-shirts) circulate about hot flashes, women don’t realize that they may also have

  • Difficulty with memory and cognition
  • Increased joint pain
  • Urinary urgency and frequency, including susceptibility to bladder infections

About half of women have pain with intercourse five years after menopause. For whatever reason, many women don’t associate that symptom with menopause. Too many of us think it’s just “what happens.” Too many of our doctors don’t ask about our sex lives, so women don’t tell about their experiences. While there are a range of treatments—both over the counter and prescription—that would help, too many of us are unaware of them.

Avoiding the topic doesn’t make menopause go away. I’ll keep talking—to patients, to colleagues, to men and women on the street. I encourage you to learn everything you can, pay attention to your own health, and to join the conversation! We midlife women are indispensible resources to our families, our companies, our communities. We deserve to have this natural phase of our lives understood!

Read Full Post »

We’re always trying to give you food for thought; this time we want to encourage you to think about the relationship between food and sex. It’s pretty straightforward: Eating healthy foods leads to feeling healthy and feeling healthy both increases the likelihood that you’ll be interested in sex—not to mention that you’ll enjoy it.

There’s no easier time to eat healthfully that than harvest season, when fresh fruits and vegetables are plentiful. If you plan ahead, you can turn your quest for healthy eating into a fun activity that brings the two of you closer.

Take some time to choose a menu together, or, if your partner isn’t interested in that step, at least get buy-in for the menu that you’ve chosen. As you and your beloved stroll through the farmer’s market (or grocery store), talk about the associations you each have with fresh foods. In learning why your partner hates blueberries or loves Brussels sprouts, you might hear a childhood story that gives you new insight.

While any fresh fruit or vegetable is good for you, you may want to seek out specific ones. The folic acid in asparagus, for example, increases histamines, which are important to sex drive. Meanwhile, watermelon contains L-citrulline, an amino acid that increases blood flow to sex organs. Peaches do the same thing. And cold-water fish like salmon, anchovies, and oysters are high in omega-3, which improves everything from mood to memory. The avocado has two things going for it: its suggestive shape and the folic acid it contains.

When you have all the ingredients and have found your way home, the real fun begins: You cook together—in more ways than one.

Read Full Post »

Whether in person in my office or by email from the MiddlesexMD website, I hear variations on this story more often than you might think: A woman who’s been without a partner for years—often as many as 10—has found someone new. While she’s happy to have found a partner with whom to be intimate, she finds that sex is uncomfortable or even painful.

I celebrate the new relationship with each woman! While it’s perfectly possible to be happy on our own, it’s also lovely when we find a “right person” with whom we can share our lives and experiences—and intimacy, too.

When we find that right person after menopause, sometimes physical changes take us by surprise. Pain with intercourse is typically associated with vulvovaginal atrophy, which is the effect of the loss of estrogen. Women notice that they have less natural lubrication, and vaginal dryness makes friction painful. And the vaginal tissues are less elastic; the vaginal actually can shrink.

Both dryness and loss of elasticity can be addressed most simply with a lubricant. Silicone lubricants (our most popular is Pink) provide the most glide and last longest. Vaginal dilators can be helpful if, after a period of sexual inactivity, tissues need some gentle stretching.

Providing estrogen to the tissues is another option. There are prescription products that supply estrogen only to the vaginal tissues: Estrace cream, Premarin vaginal cream, Estring, and Vagifem are all localized options. Osphena is a non-hormonal option for treatment of vaginal and vulvar pain.

Some women describe a burning sensation on penetration, which may be caused by vulvodynia. Estrogen is part of the solution then, too, and a thorough medical exam would be helpful to determine exactly what treatment is needed.

Women who are sexually active after a hiatus also sometimes report the first urinary tract infections of their lives! There’s a movement to replace the term “vulvovaginal atrophy” with “genitourinary syndrome of menopause.” Both terms are a little clumsy, but the latter more accurately represents the reality of the effects of menopause: that there is a urinary as well as a genital component. Again, anything that improves vaginal health is a plus for the urinary tract; adding localized estrogen may be necessary. If bladder infections are recurring, using an antibiotic each time you have sex can be helpful to preventing them.

And! If you’re not in a relationship right now, whether or not you’re looking for one, be mindful of your body’s changes. If you’d like to keep your options open for the future, create your own maintenance plan; with some ongoing care, you can avoid the need to undo the effects of time.

Read Full Post »

It’s March 1: Do you know where your New Year’s resolution is? You may be thinking, “It’s here, somewhere.”

I have a guess about where it is—collecting dust in a corner, where you left it when you “failed.” I’ve left a few there, myself.

Making a resolution is a positive step that makes it more likely we’ll change a behavior. But when we don’t follow through in the way we envisioned, that resolution becomes something that makes us feel worse about ourselves. When we don’t meet whatever goal we’ve set—whether it’s doing Kegels every day, ramping up a moisturizer habit, or setting aside time for intimacy—the easiest thing to do is give up altogether. “I don’t know why I even bother to make a resolution,” you might say. “I never keep them.”

I’d like to suggest that that’s a story you tell yourself. And the great thing about stories is that you can change them. In fact, research shows that telling yourself a different story has a lasting effect on performance. The researcher had students who thought of themselves as “bad at school” do a story editing exercise that included the idea “everyone fails at first.” Those students went on to get better grades and were more likely to stay in college.

So if you’re telling yourself that old story about your lack of self-discipline or your complete inability to follow through, stop. Retire that old story. Get yourself a new one. Tell yourself you’re learning how to integrate that new thing into your life, and learning takes time. Congratulate yourself on the effort. Look to the past for a time when you did follow through and change something about yourself or your life, and draw inspiration from it.

Then dust off that resolution—yes now!—and try again. Haven’t you heard? March is the new New Year.

Read Full Post »

Older Posts »

%d bloggers like this: