Category Archives: Menopause

The nitty-gritty of middle-age sex

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‘It’s good to experiment’

By Alana Kirk

If you are drinking your morning coffee while reading this, then perhaps this article should come with a warning. There are going to be phrases that we tend not to discuss much in public such as vaginal dryness, loss of libido and erectile dysfunction. However, they are a natural part of life, and if we want to continue to be active sexual people well into middle age and beyond, then we have to acknowledge and then address them, because turning the trials and tribulations of middle-age sex into the joy of sex is not difficult.

Sex is important to all of us, regardless of age. Not only is it excellent for getting the blood pumping and putting a youthful spring in your step, it has a number of other benefits too, such as reducing stress, strengthening your immune system, boosting self-esteem, and relieving depression.

The famous manual, The Joy of Sex, still has some salient advice for middle- aged and older people even though it was written nearly 50 years ago. It’s author Alex Comfort wrote: “The things that stop you enjoying sex in an old age are the same things that stop you from riding a bicycle – bad health, thinking it’s silly and no bicycle”.

Well, we can pump up a flat tyre, add some lubricating oil, and still be having sexual enjoyment with no partner. As recent research has shown, and despite an ageist societal view on the topic, our sexuality doesn’t die with middle and growing age. Our sexual needs and levels evolve and change over the years, and the particular issues that might arise from menopause, for example, do not mean we should give up on it. We just need to learn to adapt.

Emily Power Smith may be Ireland’s only clinical sexologist, and talks to large numbers of middle-aged women in her clinics and at talks around the country. “I’ve spoken and written more on this topic than any other related to sex, and the main driver for women coming to me with an issue is poor education. Generally women are very misinformed about what they should be expecting and are very quick to blame themselves.”

If we look at sexual activity as a life-long issue, there can be plenty of interruptions to the normal flow, including illness, childbirth and child rearing, loss of confidence, menopause, and hormonal fluctuations. Low libido, erectile dysfunction, and vaginal dryness are all just normal challenges that can affect our sexual lives, but importantly, ones that can be easily addressed.

“We do specific menopause consultations and counselling for women who start experiencing changes and want to know that they are a normal part of the ageing process,” says Dr Shirley McQuade, medical director of the Dublin Well Woman Centre. “Many women come in with a specific symptom thinking it’s all over, but in fact nearly all issues can be addressed. You just need to realise that your, and your partner’s body changes.”

So what are the main issues and what can be done about them?

Peri-menopausal symptoms

Menopause can effect every aspect of your being, and symptoms including hot flushes, not sleeping, and poor concentration levels, can affect how you feel about yourself.

“Hormonal changes can mean your libido and sex drive go, as well and the emotional havoc they can play,” explains Dr McQuaid. Mood swings, empty nest syndrome, trying teenagers, or work/life balance can weigh in to make us feel less than energetic about sex.

“It is really important to take the time for yourself when you are peri-menopausal, to take stock and adjust to the changes that are happening. I see lots of women who have reached senior career level or have lots of people depend on them and it can be difficult because they feel overwhelmed and aren’t giving enough time to themselves to deal with how they feel.”

The advice is to take pressure off yourself, and try and cull some of the responsibilities. Exercise, eat and sleep well and acknowledge that you can seek help if you need it. “I’ve seen women go to cardiologists because they think they have heart problems when they wake up sweating in the night, or go to rheumatologists with joint pain, when in fact they are just the symptoms of hormonal change.”

Hormone Replacement Therapy

HRT is a common treatment for women who are suffering from continued and difficult symptoms, and it only takes two or three weeks to find out if it will work for you. According to the National Institute for Health and Care Excellence (NicE) in their 2015 recommendations, the benefits of HRT, available in tablet form, gels, and patches far outweigh any risks.

According to Dr McQuaid, it is a positive option to take. “About 15 years ago there were scares about risks relating to heart disease and cancer, but the studies were seriously flawed. For women who take it through their 50s, the benefits are significant.”

HRT is available for as long as your symptoms last, with the average duration being eight years. Despite scaremongering to the contrary, there are no withdrawal symptoms or problems when you stop taking the drug, as long as you leave it long enough for your natural menopause to conclude. HRT masks the symptoms, so if you stop before they have fully receded, they will return.

Not all women experience menopausal symptoms, and for women who do, they do eventually pass.

Vaginal dryness

It is completely normal for most women in menopause to experience dryness. The drop in your body’s oestrogen levels means the vaginal membranes become thinner and drier which can makes for uncomfortable dryness. As a result, thrush and Urinary Tract Infections (UTI) are also more common. Lubrication is widely available and will transform your sexual experience if dryness is a problem. Dr McQuaid also recommends treating the underlying issue rather than just the symptom. A prescription product, licensed in Ireland as Vagifem, provides low levels of oestrogen to the local area, and if taken over the longer term can alleviate all symptoms of dryness. Regular sexual activity or stimulation from masturbation also promotes vaginal health and blood flow.

Erectile dysfunction

For men who may identify their every maleness with work and sexual ability, a lowering of libido or erectile dysfunction can be catastrophic. However, accepting that this will happen occasionally, and seeing it a normal part of the ageing process and hormonal changes may encourage them to seek help. The advice is to go to your GP to get checked out to make sure erectile dysfunction is not related to vascular changes and bold pressure / diabetes, and then again there is a simple medication solution.

Painful intercourse

Again this can be a common change in sexual experience, usually due to vaginal dryness. However, other reasons could be a prolapse of the uterus or front wall of vagina which can cause discomfort, so the first port of call for any pain is to get examined by your GP or at the Well Women clinics. All issues can be addressed with medication or procedures.

Heavy periods

A common complaint for women entering peri-menopause is very heavy periods, which are caused by the womb being uncomfortable and bulky. Some women from the age of 40 develop fibroids which make the womb heavier and along with hormonal fluctuations, combine to make structural and hormonal changes that affect the flow of periods. Some women have low iron levels, because heavy periods are the main reason for low iron which makes you tired, so it’s important to keep a medical check on your body while going through the menopause.

Traditionally this was often treated by a hysterectomy, whereas today women can access the pill or coil. All countries where the coil has been introduced have seen a significant reduction in hysterectomy operations.

Change of mind

Addressing specific symptoms is only one way of evolving our sexual lives. Changing the way we have sex is another. “I meet women who have only ever used one position, and now that that proves painful they are at a loss,” explains Dr McQuaid. “It’s useful to experiment and change. It’s more interesting too!”

What we need to remember is that sex is not just about intercourse. There is a variety of sensual, loving, exciting activities that can bring joy and satisfaction. For women experiencing menopause especially, they might need and want more touching and foreplay than before, but after years of marriage, it can be more difficult to change. Asking for what you need is important. Tantric sex – slightly ridiculed in the press after Sting and Trudie Styler admitted to it – is encouraged by many counsellors as it focuses on the sensual intimacy rather than an orgasmic goal.

Whatever the issue with sex may be, Dr McQuaid advises you start with a medical to check to make sure everything is okay. Once that is done, it’s just about dealing with specific issues. “I’ve had a 78-year-old woman come to me recently having a little bit of trouble because her partner has been given Viagra. So she went on Vagifem and has no more problems,” says McQuaid. “I have lots of women come to us for help and they’re happy and healthy and they certainly don’t stop having a sex life. Nor should they.”

Psychologically however, it is also important to rise above the social conditioning that we lose our sexiness as we get older. “There is just no scientific evidence to back this up,” explains Power Smith. “Irish women are very quick to blame themselves and feel guilty for not being better, not feeling enough or good enough. In part we are brought up to feel this way with magazines and media, and then when middle age hits, physical things happen to compound that.” She has three golden rules for women in their middle age with regards to keeping their sex lives healthy and functioning: masturbation, lubrication and communication.

So while the number of potential causes of sexual changes and challenges during menopause and middle ageing can seem overwhelming, there are just as many strategies and treatments for overcoming them.

You can go back to drinking your coffee now.

Complete Article HERE!

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Better Sleep Could Mean Better Sex for Older Women

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By Robert Preidt

A more satisfying sex life may be only a good night’s sleep away for women over 50, new research finds.

Researchers led by Dr. Juliana Kling of the Mayo Clinic in Scottsdale, Ariz., tracked data from nearly 94,000 women aged 50 to 79.

The investigators found that 31 percent had insomnia, and a little more than half (56 percent) said they were somewhat or very satisfied with their sex life.

But too little sleep — fewer than seven to eight hours a night — was linked with a lower likelihood of sexual satisfaction, the findings showed.

“This is a very important study since it examines a question which has tremendous potential impact on women’s lives,” said Dr. Jill Rabin, who reviewed the findings. She’s co-chief of the Women’s Health Program at Northwell Health in New Hyde Park, N.Y.

Age played a key role in outcomes. For example, the study found that older women were less likely than younger women to be sexually active if they slept fewer than seven to eight hours per night.

Among women older than 70, those who slept fewer than five hours a night were 30 percent less likely to be sexually active than women sleeping seven to eight hours, Kling’s team found.

The findings highlight how crucial sleep is to many aspects of women’s health, medical experts said.

“Seven hours of sleep per night will improve sexual satisfaction and has been shown to increase sexual responsiveness,” said Dr. JoAnn Pinkerton, executive director of The North American Menopause Society.

Besides putting a damper on sex lives, she said, poor sleep is also tied to an array of health issues, such as “sleep apnea, restless legs syndrome, stress and anxiety.” Other health problems linked to insomnia include “heart disease, hypertension [high blood pressure], arthritis, fibromyalgia, diabetes, depression and neurological disorders,” Pinkerton added.

Dr. Steven Feinsilver directs sleep medicine at Lenox Hill Hospital in New York City. He reviewed the new findings and stressed that they can’t prove cause and effect. “It certainly could be possible that many underlying problems — for example, illness, depression — could be causing both worsened sleep and worsened sex,” he noted.

Rabin agreed, but said there’s been “a paucity of studies” looking into links between sleep and sexual health, especially during menopause.

“We know that obstructive sleep apnea and sexual dysfunction are positively correlated,” she said. “Other factors which may lead to a decreased sleep quality include: a woman’s general health; various life events, which may contribute to her stress; chronic disease; medication; and degree and presence of social supports, just to name a few,” Rabin explained.

And, “in menopause, and due to the hormonal transition, women may experience various symptoms which may impact the duration and quality of their sleep patterns,” Rabin added.

We and our patients need to know that quality sleep is necessary for overall optimum functioning and health, including sexual satisfaction, and that there are effective treatment options — including hormone therapy — which are available for symptomatic women,” she said.

The study was published online Feb. 1 in the journal Menopause.

Complete Article HERE!

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What getting intimate at 60 really means

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Most people assume getting saucy under the sheets it just for the young, but what about the young at heart?

By Ashley Macleod and Marita McCabe

Sexuality encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction and what we think, feel and believe about them. It has been a research focus for over a hundred years, and highlighted as an important part of the human experience. Since the first studies on human sexuality in the 1940s, research has consistently demonstrated that sexual interest and activity are sustained well into old age. However, only a fraction of the research has explored sexuality in the later years of life.

Most of the early research on sexuality and ageing looked at the sexual behaviours and biology of older adults, generally ignoring the wider concept of sexuality. When researchers did discuss sexuality more broadly, many referred to sexuality as the domain of the young, and emphasised this was a major barrier to the study of sexuality in older adults.

Sexuality in later life ignored

Towards the end of the 20th century, research expanded to include attitudes towards sexual expression in older adults, and the biological aspects of sexuality and ageing. Consistently, the research showed sexual expression is possible for older adults, and sustained sexual activity into old age is more likely for those who had active sex lives earlier in life.

By the late 1980s, there was a strong focus on the biological aspects of ageing. This expanded to include the reasons behind sexual decline. The research found these were highly varied and many older adults remain sexually active well into later life.

But despite evidence adults continue to desire and pursue sexual expression well into later life, both society in general and many health professionals have inadvertently helped perpetuate the myth of the asexual older person. This can happen through an unintentional lack of recognition, or an avoidance of a topic that makes some people uncomfortable.

Why does this matter?

These ageist attitudes can have an impact on older adults not only in their personal lives, but also in relation to their health needs. Examples include the failure of medical personnel to test for sexually transmissible infections in older populations, or the refusal of patients to take prescribed medications because of adverse impacts on erection rigidity. We need more health practitioners to be conscious of and incorporate later life sexuality into the regular health care of older adults. We still have a long way to go.

By ignoring the importance of sexuality for many older adults, we fail to acknowledge the role that sexuality plays in many people’s relationships, health, well-being and quality of life. Failure to address sexual issues with older patients may lead to or exacerbate marital problems and result in the withdrawal of one or both partners from other forms of intimacy. Failure to discuss sexual health needs with patients can also lead to incorrect medical diagnoses, such as the misdiagnosis of dementia in an older patient with HIV.

It’s not about ‘the deed’ itself

In a recent survey examining sexuality in older people, adults aged between 51 and 89 were asked a series of open-ended questions about sexuality, intimacy and desire, and changes to their experiences in mid-life and later life. This information was then used to create a series of statements that participants were asked to group together in ways they felt made sense, and to rank the importance of each statement.

The most important themes that emerged from the research encompassed things such as partner compatibility, intimacy and pleasure, and factors that influence the experience of desire or the way people express themselves sexually. Although people still considered sexual expression and sexual urges to be important, they were not the focus for many people over 45.

Affectionate and intimate behaviours, trust, respect and compatibility were more important aspects of sexuality than intercourse for most people. Overall, the message was one about the quality of the experience and the desire for connection with a partner, and not about the frequency of sexual activities.

People did discuss barriers to sexual expression and intimacy such as illness, mood or lack of opportunity or a suitable partner, but many felt these were not something they focused on in their own lives. This is in line with the data that shows participants place a greater importance on intimacy and affectionate behaviours such as touching, hugging and kissing, rather than intercourse.

These results help us challenge the existing stereotype of the “asexual older person” and the idea intercourse is necessary to be considered sexually active. They also make it clear researchers and health practitioners need to focus on a greater variety of ways we can improve the experience and expressions of sexuality and intimacy for adults from mid-life onwards beyond medical interventions (like Viagra) that focus on prolonging or enhancing intercourse.

Complete Article HERE!

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10 Reasons Why Women Lose Their Libido

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Ladies, libido means sexual desire. Women having decreased libido is one of the most common complaints I hear in the office, especially for those stressed out supermoms. Trust me – you’re not alone, ladies. It is estimated that more than 40% of women experience some sort of sexual dysfunction in their lifetime. Here’s why, and what you can do about it.

Dried Rose On Old Vintage Wood Plates

Female sexual dysfunction can include problems with desire, arousal, achieving orgasm and sexual pain that causes significant distress in your life. More specifically, decreased libido is when you don’t want to engage in any type of sexual activity, including masturbation, and you don’t want to have any sexual thoughts or fantasies. Sound like someone you know? Let’s review some reasons why you may not want to have sex with your significant other:

1. Bad Relationship.

Fighting with your partner is an easy way to kill your sex drive. When you are angry or hurt, sex is the last thing on your mind. Fix your relationship — go to couples’ therapy.

2. Stress.

It doesn’t matter where the stress comes from, all of it can cause your libido to drop. It doesn’t matter if you’re stressed out from financial problems, from trying to get pregnant, or from worrying about your job – it all negatively impacts your libido. Stress can also lead to you being fatigued, which worsens the problem. Find ways to chill out ladies – I mediate daily to deal with stress, and that might work for you, too.

3. Alcohol and Smoking.

Both of these drugs have been shown to decrease sexual desire and satisfaction. While alcohol in moderation is okay, when you binge drink, sexual dysfunction starts to occur. On the other hand, any kind of smoking is bad – just quit!

Easier said than done, right? You have to know why you are smoking. Substitute that why with something else. For example, if you smoke because you are bored, instead of lighting up go to the gym.

4. Mental Illness.

Mental conditions such as depression and anxiety can also cause your libido to drop. Talk to your doctor and get treated. Sometimes medications used to treat these conditions can also cause a drop in libido – but not every medication does, so talk to your doctor.

crying girl

5. Birth Control.

Hormonal birth has been shown to decrease testosterone in your body, which could lead to a lowered libido. This is because testosterone is one of the hormones that makes you horny.

Other medications such as antidepressants, anti-seizure meds, opioids, medical marijuana, antihistamines, and hypertensive medications can also decrease your sexual desire. Talk to your doctor about switching your medications if you think any are giving you a problem. Your healthcare provider can also potentially switch you to a non-hormonal birth control option, like the Paragard IUD.

6. Trauma in your Past.

Negative sexual experiences in the past can cause issues with decreased libido. Women who were raped or have been victims of domestic violence may, understandably, have issues here. Going to therapy to work through your pain can help.

7. Poor Body Image.

In a world full of fake butts and boobs, it isn’t hard to image women struggling with their body image. Not thinking you are sexy enough can cause your sex drive to plummet. If you don’t like something about yourself, change it – in a healthy way, of course. Eat clean, drink water and exercise – though, keep in mind that a lot of times this is something that you have to work out in therapy.

8. Medical Conditions.

Medical illnesses such as diabetes, hypertension, thyroid disease, congestive heart failure, or cancer can all affect libido. They can alter hormones that have an impact on your sex drive. Proper treatment of the underlying disease can often improve libido.

9. Pregnancy and Breastfeeding.

Hormones fluctuate during pregnancy and breastfeeding, which can decrease your sex drive. Being pregnant can cause you to be tired and not feel sexy, which certainly doesn’t help your libido! Do your best to focus on intimacy with your partner — also, when you have the baby, get help. Let those grandparents help out with babysitting!

10. Aging.

In menopause, estrogen levels drop drastically because the ovaries aren’t working anymore. Low estrogen causes, among other things, a dry vagina, which makes sex painful. This can lead to decreased sexual desire. Arthritis in the aging population can make having sex less fun. When vaginal dryness makes sex uncomfortable, use lubricants (try a free sample of Astroglide Liquid or Astroglide Gel, which temporarily relieve dryness during intercourse). Some women find using vaginal estrogen also helps.

Complete Article HERE!

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Sex Therapy—What Is It and Who Needs It? – Part 2

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(Look for Part 1 of this series HERE!)

Of course, there are plenty of individuals—and couples—who haven’t waited until the last minute to seek help. These people want to be proactive about their concerns. Some people simply need some clear, unambiguous information about human sexuality. A surprising number of people are trying to piece together their sexual lives, but are hampered by misconceptions and misinformation.

Sometimes a momentous event motivates a person to address arising sexual or intimacy issues. The birth of a child, a disease process, a death in the family, or an accident can fundamentally alter the power dynamic of a relationship, which will require a rethinking of the entire relationship.

Or perhaps someone comes to a new realization about him or herself: Perhaps they are finally able to acknowledge their bisexuality, or that he’s gay, or she’s a lesbian. Maybe they are finally able to acknowledge a fetish—he’s a crossdresser, or she’s into another kink. Things like this obviously impact the individual, but if that person is in a relationship, the relationship is also affected. People in these self-revelatory situations are often unsure how to talk about their discoveries with a partner, which is another reason they seek counseling.

Some couples don’t fret when the sex vanishes from the relationship; other couples are devastated. What does one do when one partner still has sexual needs, but the other doesn’t? Often, there are unexplored options that can hold the relationship together, but will address the disparity in sexual interest and desire.

In this case, I can help the couple make compromises without losing their moral compass. Some couples navigate this with ease; others not so much. It can be extremely challenging, but there are ways to preserve what’s sacred about a primary relationship, while contemplating opening the relationship to include others. I can help a couple establish guidelines and ground rules for making the necessary adjustments.

Sometimes the relationship is really wonderful and fun. The couple really loves each other, but they’ve noticed their sex life together is pretty boring and stale. I’m often approached to simply help a couple spice things up. In this instance, my work is sheer joy. Mostly, I just give them permission to experiment and have fun.

You’ve probably noticed that a good portion of the work that I do as a sex therapist is merely giving permission. That may not sound like therapy at all, but when you consider that our sex-negative culture is so full of prohibitions; permission giving is often the front line of sexual rehabilitation. Most of the permissions I give are for an individual to educate him or herself about his or her body and his or her sexual response cycle. Personal exploration, such as masturbation, is the very best means to that education. I’m a huge proponent of partners masturbating together.

Happily, our need to reacquaint and reeducate ourselves about our bodies and our sexual response cycle is a life-long process. There is always something new to explore. As we age, our bodies change, and if we don’t keep up with those changes, we can become frustrated and disoriented. Older people, menopausal women and andropausal men, take longer to build up “a head of sexual steam,” so to speak. If they’re not attuned to the changes they’re going through, they can easily miss the important cues their body is sending to slow down and enjoy the sensuality.

Of course, I could go on and on, but now I want to leave you with what is the distillation of years my thinking about the role sexuality plays in our life:

I believe that sex is like food. We can enjoy it alone, or with others. We can be abstemious, or gluttonous. We can nosh or nibble; dine or devour. And we can be certain there will be both times of feast and famine.

Sex is like food. It can nourish and sustain us, or it can make us sick. We can consume all the available bounty, or restrict our diet. It can completely satisfy, or leave us devastatingly empty. We can employ it to express our highest aspirations, or allow it to rob us of our soul. We can give it as a gift, or use it as a weapon. It can be both bacchanal and sacrament.

One thing is for sure, whether purely physical or transcendentally spiritual, no one can live without food…or sex.

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