Can You Have a Sex Life After Breast Cancer?

— Experts Say Yes.

With patience and treatment, you and your partner can rekindle your sexual spark.

You may find yourself facing physical changes and emotional challenges, but you can overcome them.

By Abby McCoy, RN

If you’ve recently gone through lifesaving breast cancer treatment, you may be looking forward to better days ahead. But as you try to get back to “normal life,” you might notice a change in your libido.

“Cancer treatment across the board can take a significant toll on the body, and breast cancer is no different,” says Gabriel Cartagena, PhD, a clinical psychologist at Smilow Cancer Hospital at Yale New Haven and an assistant professor at Yale School of Medicine in New Haven, Connecticut.

About 60 to 70 percent of breast cancer survivors report sexuality issues after treatment, according to a study published in 2019 in Breast Cancer, so if you’re having that experience, know that many other women are, too. We asked the experts and have some treatments and tips to help you fire up your sex life after breast cancer.

How Breast Cancer Affects Your Libido

So you can understand how to combat a low libido after breast cancer treatment and take back your sexuality, let’s look at the causes.

Premature Menopause

Several cancer therapies can lead to premature menopause, according to a study published in 2022 in the Journal of Clinical Medicine. Chemotherapy and radiation therapy, for example, can decrease hormone levels in your body and make your menstrual cycle slow down or stop altogether, says Mary Jane Minkin, MD, a codirector of the sexuality, intimacy, and menopause program for cancer survivors at Yale Cancer Center and Smilow Cancer Hospital. For women whose breast cancer is fueled by estrogen, treatment may include medication to block the production of estrogen, or surgical removal of the ovaries. These measures, too, can bring on premature menopause. With menopause symptoms like hot flashes, insomnia, and dry mouth, sex may be the last thing on your mind.

Emotional Distress

A breast cancer diagnosis comes with a lot of emotions. Women diagnosed with breast cancer can be at a higher risk for mental health issues like depression and anxiety, neither of which are conducive to a high libido, according to a study published in 2021.

Vaginal Dryness

When your estrogen takes a nosedive during and after treatment, your vagina can become very dry, says Dr. Minkin. Lack of lubrication in this area can make sex uncomfortable or even painful, according to the American Cancer Society (ACS).

Painful Sex

Painful sex can also arise from pelvic floor dysfunction, which means the muscles in and around your pelvis can be too tight or too loose. That’s according to the research published in the Journal of Clinical Medicine, which also found that women may experience chronic pelvic pain syndrome (unexplained pain in your pelvis) after breast cancer treatment.

Body Changes

If you have had surgery or other body changes during treatment, such as removal or reconstruction of one or both breasts, you may not feel like revealing the new you in a sexual encounter, and new or missing sensations can make it hard to get in the mood. “Many women who have lost breast tissue, particularly if they have lost nipples, may feel [less] sensation in their breasts, and many women find breast stimulation important for sex,” says Minkin.

How to Get Your Groove Back

This list may feel discouraging to read, but you shouldn’t lose hope. “The important thing is that we can help with most of these issues,” says Minkin.

Medications Minkin recommends nonhormonal (estrogen-free) medications to help with symptoms of early menopause. “An over-the-counter herbal product called Ristela can help improve pelvic blood flow and enhance libido,” Minkin says. One meta-analysis published in 2021 found that women who took Ristela and similar products that contain the amino acid L-arginine experienced more sexual arousal, better lubrication, more frequent orgasms, and less discomfort or pain. Many participants reported no side effects at all, but a few experienced an upset stomach, heavier menstrual bleeding, and headache.

“Women can also consult with their providers about using prescription nonhormonal medications called flibanserin (Addyi) or bremelanotide (Vyleesi),” Minkin says. Addyi may be less effective than other options, and can cause fatigue and drowsiness, according to a meta-analysis published in 2022 in Sexual Medicine. Vyleesi, on the other hand, has shown more promise, according to a study published in 2019, with uncommon mild side effects like nausea, flushing, and headaches.

If your low libido stems from feelings of depression or anxiety, medications, often in combination with psychotherapy, are an option you can discuss with your healthcare provider.

Vaginal moisturizers For vaginal dryness, Minkin often suggests over-the-counter nonhormonal vaginal moisturizers, like Replens and Revaree, which are inserted into the vagina with an applicator a few times a week. “[These] work very nicely for many women,” Minkin says.

Toys A vibrator or similar device could be a worthwhile investment. They can boost sensation and increase blood flow to your pelvis, says Minkin, both of which can amplify desire.

Therapy One or more sessions with a counselor can be helpful, says Minkin. Sexual health counselors often use cognitive behavioral techniques to discover the “why” behind your low libido, and help you unlock thought patterns that may be blocking your sexual drive, according to a study published in 2020. Therapy is also an effective treatment for depression and anxiety.

Vaginal hormones Hormone replacement therapy is often used to treat menopause symptoms. But if you’ve had breast cancer, it may increase the risk that it will come back, especially if your cancer is sensitive to hormones. With vaginal hormonal treatments, a cream, tablet, or ring containing low-dose estrogen is placed directly in your vagina to aid lubrication and strengthen the vaginal lining. Because much less estrogen gets into your bloodstream, this option is generally considered safe, according to the North American Menopause Society. Your healthcare provider can help you decide if hormone treatments are right for you.

Get Reacquainted With Your Body

Breast cancer treatment can leave you feeling like you’re living in a stranger’s body. “A stark change like a mastectomy can leave women feeling separated from themselves,” says Dr. Cartagena. But every woman can get to know and accept her new body.

Reintroduce Yourself Gradually

“The process to reknow your body takes time and begins in small steps,” says Cartagena, who suggests a first step could be to get dressed in the morning with the lights on. After a few days or weeks of this, you might try spending 10 seconds observing your body in the mirror.

“Exposing yourself to your body little by little can allow you to gradually grieve what is different and take notice of what is new that is still important to you,” explains Cartagena.

Reframe Your Sexual Desires

Sex after cancer may look different, and mourning lost sensations is very important, says Cartagena. Looking forward, he encourages breast cancer survivors to study what sex means to them by asking questions like, “What feels good now?”

“If penetrative sex still evokes pain, a patient can explore foreplay, different forms of stimulation, or other forms of intimacy to induce different, fulfilling sensations,” says Cartegena. Sex doesn’t have to mean one thing — it can be whatever you need or want it to be.

Complete Article HERE!

Sex and the Aging Male

I’m receiving a startling number of correspondences lately from older men and their partners, highlighting the sexual difficulties of the aging process. It’s not surprising that these people are noticing the changes in their sexual response cycle as they age, but it is astonishing that they haven’t attributed the changes to andropause.

A Little Frustrated

Dr Dick,
I’m a 54-year-old man, who three years ago managed to finally come out and live the life I so desperately longed for all my life. My question: Is there a biological clock in men like women have to deal with in menopause? During the last years of my marriage, there was no sex life—other than with myself. Now I’m living a fantastic life, with a great man whom I love very much. I know there is more to life than sex, but now that I’m finally able to express myself physically with a ma, I am unable to perform—and not for lack of trying!

I tried Viagra a few years ago. It used to work maintaining an erection, but it was just by myself, and I always had fun. But the side effects—headaches and discomfort—made me wonder, “Do I really want to take this stuff?” But now, even the meds don’t help, and as for my libido, it suffers due to my lack of ability.

I’ve been tested for testosterone levels, and they say I’m right where I should be at for my age. I’ve seen two doctors about the issue, and when they find out my partner’s sex, they don’t want to deal with it, and seem to just pass it off as an age thing. (BTW: I’m in fairly decent shape; I exercise three to four days a week at the gym.) Can you send me any advice on a path to take?
—A Little Frustrated

A little frustrated? Holy cow, darlin’, you sound a lot frustrated—and rightfully so! You finally find what’s been missing your whole life, only to discover that your plumbing is now giving out on you. Ain’t that a bitch!

And before I continue, I want to tell you and all the other alternative lifestyle people in my audience: Don’t settle for a sex-negative physician—no matter what. Find yourself a sex-positive doctor who will look beyond your choice of partner; someone who will give you the respect you deserve!

Andropause

You raise an interesting question about the aging process when you ask if men experience something similar to menopause in women. The short answer is—you betcha! In fact, it even has a name: andropause. It’s only been recently that the medical industry has started to pay attention to the impact that changing hormonal levels have on the male mind and body. Most often andropause is misdiagnosed as depression and treated with an antidepressant. WRONG!

All men experience a decrease in testosterone, the “male” hormone, as they age. This decline is gradual, often spanning 10 to 15 years. While the gradual decrease of testosterone does not display the profound effects that menopause does, the end results are similar.

And listen: When a physician says that your testosterone level falls within “an acceptable range,” he/she isn’t telling you much. Let’s just say you had an elevated level of testosterone all your life, ’til now. Let’s say that you now register on the lower end of “acceptable.” That would mean that you’ve had a significant loss in testosterone. But your doctor wouldn’t know that, because he/she has no baseline for your normal testosterone level.

There is no doubt that a man’s sexual response changes with advancing age and the decrease of testosterone. Sexual urges diminish, erections are harder to come by, they’re not as rigid, there’s less jizz shot with less oomph. And our refractory period (or interval) between erections is more elongated, too.

Andropausal men might want to consider Testosterone Replacement Therapy (TRT). Just know that most medical professionals resist testosterone therapy. Some mistakenly link Testosterone Replacement Therapy with prostate cancer, even though recent evidence shows prostatic disease is estrogen-dependent rather than testosterone-dependent. I encourage you to be fully informed about TRT before you approach your new sex-positive doctor, because the best medicine is practiced collaboratively—by you and your doctor.

Finally, getting the lead back in your pencil, so to speak, may simply be an issue of taking more time with arousal play. Don’t expect to go from zero to 60 in a matter of seconds like you once did. Also, I suggest that you use a cock ring. But most of all, fuckin’ relax, why don’tcha already? Your anxiety is short-circuiting your wood, my friend. And only you can stop that.

Here’s Gwen, who reports on her husband’s condition:

Dr Dick, My husband and I have been married for 33 years. Our relationship is hell when it comes to sex. My husband is overweight, and he’s stressed out about his elderly parents. Sex is non-existent. He never was the instigator in our relationship. And he is the kind of guy who thinks having sex on the couch as opposed to the bedroom is adventuresome. He has become so boring. I don’t believe the man feels sex should be that important at our ages. (I’m 57 and he’s 62) I, on the other hand, am more sexually aroused and creative than ever now that I am more mature and the kids are out of the house. Menopause and all the sex on the Internet helps too. 😉 Is there anything I can do to make my man return to being a healthy sexual being once again? Thank you.

No—thank you, Gwen. Your complaint is a familiar one. So familiar, in fact, that I regularly offer therapy groups for couples in long-term relationships, like you and your old man, who have, for one reason or another, hit a wall when it comes to their sex lives.

I’m sad to say there’s not much you can do to beef up your sex life if there’s no interest on the part of your husband to do so. I mean, you can lead the horse to water, but you can’t make him drink. You confide that you husband is overweight and stressed; not a happy combination when it comes to his sexual response cycle, even if we don’t factor in his age. In fact, your husband sounds like a heart attack waiting to happen. Perhaps if your challenged him about his general health—encourage weight loss and stress reduction—you might find that it might also reignite his sex drive. It’s worth a try.

And thank you for mentioning menopause. So many women find the changes that take place in midlife confusing and disorientating. It’s so good to hear from someone eager to explore and enjoy her sexuality post-menopause.

It’s clear that as we age, both women and men need more time and stimulation to get aroused. The slower, more sensuous foreplay that often results is a welcome change for most women and even some men. Increased focus on sensuality, intimacy, and communication can help a sexual relationship remain rewarding even well into our most senior years. If your husband is avoiding intercourse, there still many ways of expressing your love and staying connected:

Hugging, cuddling, kissing
Touching, stroking, massage, sensual baths
Mutual masturbation and oral sex

However, if your husband is more wedded to food and to stress than he is to you, and if he continues to refuse to join you in finding an appropriate outlet for your sexual frustration, then it’s up to you to make this happen on your own. Age 57 is way too soon to say goodbye to your sex life.

May I suggest joining a women’s group? Not a therapy group, but more of a support group or activities group. Getting out of the house, involving yourself with other self-actualized mature women, may uncover the secret solutions other women have put in place to find sexual satisfaction when they are without a partner or have a partner who’s no longer interested in them. I think you will be surprised by how creative your sisters can be. Make it happen, Gwen. Don’t sink to the lowest common denominator of living a sexless life.

Good luck!

Don’t feel pressured, learn to ‘simmer’ and keep experimenting

— How to have great sex at every stage of life

Expert tips on a fun, fulfilling sex life – for teenagers, octogenarians and anyone in between

By

Age 16-25

Don’t worry if your first time isn’t perfect
“It’s not helpful to think of sex as having one big ‘first time’. You’ll probably have lots of first times,” says Milly Evans, author of Honest: Everything They Don’t Tell You About Sex, Relationships and Bodies Instead, she advises breaking it down into all the individual firsts you might have – “your first time having oral sex, penetrative sex, using hands or using toys”. Even if you experience all of these with one person, there will be a whole new set of firsts to explore with a different partner.

Communication is the thing that matters most
This holds true whatever age you are, according to Clover Stroud, author of My Wild and Sleepless Nights “Communicating clearly about desire, or how you like to be touched or treated, isn’t easy. I wish I’d known how much sex improves as you get older and become more confident about what you like and how to communicate those needs.”

Being ready to have sex is more than just a feeling
“It’s about lots of practical and emotional things too,” says Evans. “Does the idea of having sex make you excited or anxious? Do you know enough about contraception, STIs and consent? Do you know where to access support if something doesn’t go to plan? Would you have to drink alcohol in order to feel confident enough to have sex? Is there a safe place for you to have sex? Safety, comfort and wellbeing are essential.” If you can’t answer all of these questions positively, you probably aren’t ready.

Think about what you want ahead of time
“Reflecting can help you feel more prepared and in control,” says Evans. “Take a look at boundaries around things like touch, communication and time. Ask yourself if the relationships or sex depicted on TV, in books or on social media are what you’d like from your own. And remember that sex is something that happens with you, not to you – speak up about what you want, and encourage partners to do the same.”

Switch off negativity
“As you’re looking at movies or television or porn, or magazines or music videos or social media, ask yourself, ‘After I see this, am I going to feel better about my body as it is today, or worse?’” says sex educator Emily Nagoski, in her book Come As You Are. “If the answer is ‘worse’, stop buying or watching those things.” This is especially important where porn is concerned.

As the recent report from the children’s commissioner for England, Rachel de Souza, has highlighted, the increasingly abusive, aggressive behaviour depicted on many mainstream porn sites is normalising sexual violence and exploitation among teenagers, affecting their mental health and undermining their ability to develop healthy sexual relationships.

You have the right to change your mind
“Don’t feel pressure to do something sexually that you’re not comfortable with,” advises psychotherapist Silva Neves, author of Sexology: The Basics. “You can always say ‘no’ or ‘pause’, or say ‘no’ after you’ve said ‘yes’.”

Age 25-35

It’s good to simmer
“The happiest erotic couples make a point of enjoying feeling aroused together for its own sake – even on days when sex isn’t on the menu,” says US sex therapist Stephen Snyder, author of Love Worth Making: How to Have Ridiculously Great Sex in a Long-Lasting Relationship. “In sex therapy we call this simmering. It’s what teenage couples do whenever they get a moment’s privacy. Quick, intimate bodily contact, fully clothed – just enough to get you slightly buzzed.”

Penetrative sex isn’t the gold standard (nor, for that matter, is simultaneous orgasm)
Many of what we have come to perceive as cultural markers of sexual excellence are spurious ideas that are now being refuted by science – and more honest, open debate around the subject. Such ingrained cultural beliefs are worth challenging. Do what works for you rather than what society tells you ought to work for you. For example, says Neves: “Many gay men don’t have anal sex at all, but prefer oral sex and intimate touching. Similarly, many women have very good sex without penis-in-vagina sex.”

You need to set the right conditions for sex
Context is everything, explains Nagoski. If you’re feeling relaxed, loved and fully present (as opposed to, say, worrying about an email you need to send, an argument you’ve just had, or whether the children might walk in on you) you’re likely to have better sex. If you’re not, it doesn’t matter how sexy your partner is, how much you love them, how fancy your underwear is or how many candles you light – almost nothing will activate that desire. Nor is it about what you do with your partner, which body parts go where, or how often, or for how long. It’s about sharing sensation in the context of profound trust and connection, and recognising the difference between what great sex is really like and what most of us expect great sex to be like.

You don’t have to have sex at all
“Gen Z are having less sex than millennials, who have less sex than older generations. This is often treated as a bad thing, but it might reflect more self-awareness in a hypersexual society,” says Aimée Lutkin, author of The Lonely Hunter: How Our Search for Love Is Broken. “Think about what you want out of sex and be honest about whether it is the thing you are really seeking. Is it intimacy? Community? Distraction? If it is sex, that’s great. The more in touch you are with your needs, the more likely it is you’ll make the connections you want to.”

Commitment and monogamy can be exciting
“In my teens and 20s, I thought good sex was about physical desire,” says Stroud, “but in my 30s I realised that feeling psychologically ‘seen’ by another, and trusting them implicitly, is where good sex starts. Then you learn to take huge risks with them too. At that point, commitment and monogamy get really exciting.”

Age 35-45

It’s normal for sex to drop off the list of priorities
“When you have a new baby or you’re caring for an elderly parent, overwhelmed with work or coping with some other form of stress, sex won’t be top of the agenda (though for some it will be a useful stress reliever),” writes Nagoski. “Don’t panic about it. It’s a phase you’ll pass through when you’ve managed the stress, and you’ll find your way back to the other side.”

Have a six-second kiss
“Greet one another at the end of the day with a kiss that lasts at least six seconds, or a hug that lasts at least 20 seconds. That guarantees you will both produce the hormone of emotional bonding, oxytocin,” says relationships expert John Gottman, co-author of The Seven-Day Love Prescription.

Make sex a priority
“Don’t make lovemaking the very last item on a long to-do list,” says Gottman. “Make it a real priority. Go on an overnight romantic date at a local B&B, or farther afield, at least four times a year.”

Don’t try to second-guess what your partner will enjoy
Whether you’re trying to sustain sexual satisfaction in a long-term relationship or wondering why a new partner isn’t responding to your usual moves the way a previous one did, the key is to be really honest about what works (or doesn’t) for you, instead of expecting your partner to guess. “About a quarter of women orgasm reliably with intercourse,” writes Nagoski. “The other 75% sometimes, rarely or never do, but might orgasm through manual sex, oral sex, vibrators, breast stimulation, toe sucking or pretty much any way you can imagine. They’re all healthy and normal. Similarly, a woman can be perfectly normal and experience arousal nonconcordance, where the behaviour of her genitals (being wet or dry) may not match her mental experience (feeling turned on or not).”

Have sex with yourself
Whatever age you are, “masturbation can be a great way to explore your body and fantasies”, says Evans. “Spend time creating your own storylines and find out what turns you on. You can also explore a whole world of visual, written and audio erotic content – but make sure it’s ethical (ie it is consensual, treats performers with respect, and pays performers and makers fairly). Audio erotica, in particular, has become more mainstream, especially among those who aren’t into visual porn, enjoy bringing their imagination into solo sex or want to try something new.” Two of the best-known platforms are Quinn and Dipsea, but it’s a fast-growing market.

Mothers are allowed to enjoy sex, too
“It is a complicated balance, being both a mother and a sexual being,” says Lucy Roeber, editor of the Erotic Review, which relaunches later this year. “In our society, we sometimes expect women who give birth to pass through a door into an idealised state of maternal preoccupation without a backward glance. Yet they have the same messy lusts and cravings. My advice is: don’t strive to be too perfect a mother and don’t deny yourself pleasure. It is surprisingly easy for women to accidentally put their sexual being to one side while they work on motherhood. Yet the two can and should work together. After all, in most cases, it was sex that started the process of parenthood in the first place.”

Age 45-55

To cuddle or not to cuddle?
Snyder says that “cuddling tends to deplete a couple’s erotic energy. If you like to cuddle together while watching TV, then be sure to ‘simmer’ [see above] during the ad breaks.” Gottman, however, advises “a daily cuddling ritual for watching films and TV shows at home where you actually stay physically in touch with one another. On one of these nights offer to give your partner a 15-minute massage.”

Don’t wait for desire to strike – practise creating it
“Too many couples only have sex when they feel desire,” says Snyder. “That’s fine when you’re 20. But by 50 most people are more interested in a good night’s sleep. What to do? Have sex anyway.” Nagoski agrees that pleasure matters more than desire. She says: “Create a context that allows your brain to interpret the world as a safe, fun, sexy, pleasurable place. It’s called responsive desire and it asks that your partner help you in creating good reasons for you to be turned on. While some people have a spontaneous desire style (they want sex out of the blue); others have a responsive desire style (they want sex only when something pleasurable is already happening). The rest, about half of women, experience some combination of the two.”

Embrace body confidence
“I’ve found that being in my 40s is entirely liberating. We get better as we shed the self-consciousness of youth, the desire to please, the emotional pliability. I love my body. It is the map of the years I’ve lived,” says Roeber. Nagoski questions wider sex-negative culture. “If you’ve learned to associate sexual arousal with stress, shame, disgust and guilt, you won’t have as good a sex life as someone who associates it with pleasure, confidence, joy and satisfaction,” she says. “Begin to recognise when your learned disgust response is interfering with your sexual pleasure. Your genitals and your partners’, your genital fluids and your partners’, your skin and sweat, and the fragrances of your body – these are all healthy elements of human sexual experience.”

Manage the menopause
Hormonal changes during the menopause and perimenopause can trigger a host of symptoms (low libido, fatigue, low mood, vaginal inflammation or dryness) that do not make a recipe for romance, according to Dr Louise Newson, GP, menopause specialist and founder of the Balance app. “If you notice any of these changes, see a healthcare professional for a proper diagnosis and to discuss treatment options.” Don’t assume these issues will only start in your late 40s, either. “Though the average age of menopause is 51, one in 100 women will go through menopause before the age of 40. Even if you have an ‘average’ menopause, the perimenopause often starts in your early 40s.”

Have a sex date
“Set a date to meet naked in bed to do absolutely nothing at all,” advises Snyder. “Talk, if you like, but this isn’t the time for deep conversation. Instead, focus on experiencing what’s going on in your body at that moment. Time is an endless string of such moments. Pay attention to a few of them. That’s often the best preparation for good lovemaking afterwards.”

Learn how to reconnect
“It can be hard to connect to someone intimately if you don’t feel connected to them emotionally. Launching into ‘You don’t make me come any more’ or ‘You never want sex and I feel rejected’ will put your partner on the defence,” says Ammanda Major, head of service quality and clinical practice at Relate. “Saying, ‘I’ve noticed we seem to have drifted a bit on this and I’m really hoping we might talk about it’ is gentler. You’re not making assumptions about what your partner might be feeling, but you are showing that you’re interested in what they have to say about it. Once you’ve got those things in place, you can have a conversation about how to deal with it.”

You’re never too old to experiment
“We have one body, but it can experience so many different forms of pleasure, especially when we open our minds. The more we accept the lie that our lives are over at 40, the more we are just cutting ourselves off from possibility,” says Lutkin. Newson agrees: “Your 50s and 60s can be a time of sexual liberation when your children may have flown the nest or you may be back on the dating scene after the end of a relationship. Many of my patients tell me that HRT and testosterone have given them a new lease of life. Make sure you are using lubricants [see below] and toys that are safe. These can ease discomfort and make sex more enjoyable, but many brands of lubricant contain irritants like glycerine and parabens, and should be avoided.”

Age 55-65

Focusing on sex drive is a wrong turn
So often we use the catch-all phrase “sex drive” to describe our enthusiasm for, or lack of interest in, sexual activity. In reality the process is more complicated than whether you’re feeling in the mood or not. “Your brain has a sexual ‘accelerator’ that responds to ‘sex-related’ stimulation: anything your brain has learned to associate with sexual arousal,” says Nagoski. “It also has sexual ‘brakes’ that respond to anything your brain interprets as a reason not to be turned on. Constantly monitoring for footsteps in the hallway? Have sex when no one else is home. Tired? Have a nap. Icked out by grit on the sheets? Change them. Cold feet? Put on socks. Sometimes it really is this simple.”

Follow the recipe for romance
While everyone’s particular sexual preferences may differ, studies suggest there are some commonalities among couples who claim to have great sex lives. “From the largest study ever done on what makes for great sex, the Normal Bar study, as well as our own studies, there are a baker’s dozen suggestions that set apart people who say they have a great sex life from people who complain that their sex life is awful,” says Gottman. “Things that work include kissing passionately, giving each other surprise romantic gifts, talking comfortably about their sex life and having weekly romantic dates.”

Manage dryness
“One symptom affecting a healthy sex life that should be on every woman’s radar is vaginal dryness,” says Newson. “You might also experience soreness, itching, irritation, painful sex, vulval changes and UTIs. It can be hugely distressing – I’ve treated women who have been in so much discomfort they can’t put on a pair of trousers or even sit down, let alone have intercourse. But it can be managed by using vaginal oestrogen or HRT and avoiding tight-fitting clothing. You should also avoid perfumed soaps and shower gels or intimate-hygiene washes.”

Find out what you like as a couple and make it happen
Monogamy is sometimes framed as the death knell of erotic connection, but, says Nagoski, this is a red herring. “Passion doesn’t happen automatically in a long-term, monogamous relationship. But it does happen if the couple takes deliberate control of the context,” she says. So find out what is pleasurable for you as a couple and spend time creating the context that leads to it. Often, but not always, we fall into one of two categories – those who need space from a partner in order to create spontaneous desire and those for whom great sex tends to happen when it’s preceded by affection and intimacy.

Don’t take things for granted
People often get stuck in familiar routines in the bedroom but, whether you’re with a long-term partner or starting a new relationship, it’s important to check in now and then and ask whether your usual approach is working. “If something doesn’t feel quite right, it’s important to be able to talk about it honestly and caringly,” says Major.

Age 65-plus

Don’t rush things
“If you’ve been in a partnership for many years that has now ended, you may want to get out there and meet people,” says Major. “But if something doesn’t feel right, it isn’t. Whether you’re 18 or 58, having sex is something to do when you feel confident that there is a degree of trust. New partners may have different expectations from you and different experiences. That’s potentially two very different sets of boundaries.”

Make the wellness connection
Older generations sometimes see sex as a taboo subject. If that’s the case for you, try reframing sexual wellbeing as one component of your wider physical and mental wellbeing. Whether you’re eager to discover positions that are easier on arthritic joints or prefer the closeness of a cuddle, maintaining intimacy can significantly boost overall wellness. Conversely, good health habits can improve our sexual wellbeing, particularly as the effects of ageing start to kick in. “Not drinking too much, eating sensibly and exercising regularly can all have a beneficial impact on our sex lives,” says Major.

Seek medical help when needed
Many older couples say erectile dysfunction medications make sex less anxiety-provoking, says Snyder, just as a lubricant can help some women. “Sex and worrying don’t go well together. As a sex therapist, I’m always happy when a couple has one less thing to worry about.” Major agrees: “Issues like erectile capacity and vaginal dryness need not rule out a satisfying sexual connection. But seeking medical help where needed is important – lumps, bumps, weird bleeding and poor erectile capacity can be symptomatic of health issues. And with the number of STIs in the over-65s having significantly increased as people move out of long-term relationships and start new ones, it’s important to get checked out.”

Strive for connection
“Being able to share intimacy with a partner, as opposed to just wanting intimacy for yourself, is vital,” says Major. “Your level of energy or physical connection might be quite constrained, but it’s very possible through gentle touch, words or kindness to maintain that core intimacy. For some couples, the physicality of sex becomes unimportant in later life, but what they have is a deep emotional connection – an ability to talk honestly and openly and caringly with one another.”

Welcome your sexuality
“The most important thing you can do to have a great sex life is to welcome your sexuality as it is, right now,” says Nagoski, “even if it’s not what you wanted or expected it to be.”

Complete Article HERE!

Sex after menopause doesn’t need to hurt

— Comprehensive review offers roadmap for doctors to evaluate, treat overlooked condition

  • Between 13% and 84% of postmenopausal women experience vaginal pain during sex
  • Causes of pain other than vaginal dryness are often undiagnosed and untreated
  • Pain during sex can harm relationships, self-esteem and contribute to depression, anxiety
  • Safe, effective therapies exist but condition is rarely evaluated or treated

Between 13% and 84% of postmenopausal women experience dyspareunia—vaginal pain during sex—but the condition is rarely evaluated or treated despite the availability of safe and effective therapies. With life expectancy increasing and the functional health of older adults improving, the identification and treatment of painful penetrative sex represents a great unmet need.

A new Northwestern University Feinberg School of Medicine comprehensive review of medical studies involving painful sex in post-menopausal women provides a roadmap for doctors to evaluate and treat the typically overlooked condition.

It is the only comprehensive review of its kind because it examines multiple reasons for the condition beyond just vaginal dryness due to lack of estrogen, such as post-hysterectomy problems, arthritis, cancer treatments and more.

“Post-menopausal women shouldn’t accept painful sex as their new norm,” said Dr. Lauren Streicher, clinical professor of obstetrics and gynecology at Feinberg. “Many women try over-the-counter lubricants but continue to have pain. They, and sometimes their health care professionals, are unaware that there are other, more effective treatments.

“In addition, women are increasingly treated by telemedicine and not examined. The cause of pain with penetration is assumed to be due to vaginal dryness when they may have another condition that has been undetected.”

The review was published last week in Menopause: The Journal of The North American Menopause Society.

Aside from the obvious negative aspects of enduring pain and the inability to have penetrative sex, the consequences of dyspareunia include negatively impacting relationships and self-esteem and can contribute to depression and anxiety. In addition, other sexual dysfunctions such as hypoactive desire disorder and orgasmic dysfunction are often consequences of pain with penetrative sex.

Causes of vaginal pain during sex

Post-menopausal vaginal pain is often specifically due to lack of estrogen, but there are other, usually undetected and untreated causes for inability to have penetrative sex, Streicher said. These include post-hysterectomy problems; cancer treatments (chemotherapy, radiation, surgery); lichen sclerosus (patchy, discolored, thin skin) and other vulvar conditions; pelvic-floor tension; arthritis and other musculoskeletal problems; pelvic organ prolapse; and sexually transmitted infections.

More than 30% of women over the age of 50 are single and potentially will have a new sexual partner, Streicher added.

“Sexuality in women after the age of 50 years is marginalized, and gynecologic care is not prioritized, valued or even recommended,” Streicher said.

Why aren’t women being evaluated, treated for the condition?

Despite available treatments, dyspareunia often goes undetected for a variety of reasons. First, most American women no longer see a gynecologist after going through menopause, Streicher said. Secondly, women often don’t discuss painful sex with their primary health care clinicians, and, when they do, most clinicians are not equipped to treat these problems because they haven’t been trained to properly evaluate or treat dyspareunia in this population. Third, sexual function is often a low priority in women with other serious medical problems.

In a 2004 survey of more than 1,000 midlife women, 98% had at least one sexual concern, but only 18% of physicians broached the topic. This is particularly true in postmenopausal women who are unaware that solutions are available and rarely seek care for this complaint.

It’s also difficult to pinpoint the exact prevalence of dyspareunia in post-menopausal women because studies on dyspareunia require women to have at least one sexual encounter the month before enrollment, and women with dyspareunia avoid sexual activity because of pain.

What can be done?

Doctors should broach the topic of dyspareunia with their patients using oral or written questionnaires, Streicher said. In addition to a thorough medical history and physical examination, various tools can be used as further assessments, including vaginal pH, vaginal dilators, imaging, vulvar biopsy, vulvoscopy and photography, the cotton swab test, sexually transmitted infection screening and vaginitis testing.

Some of the treatments discussed in the review include silicone lubricants, moisturizers, vaginal estrogen, ospemifene, dehydroepiandrosterone, local testosterone therapy, cannabidiol and fractional CO2 laser treatments. In some cases, dyspareunia may need to be specifically addressed by pelvic floor physical or sex therapists.

Complete Article HERE!

10 Top Sex Ed Tips for Those 50 and Older

Making love is about more than intimacy. It’s good for your health, too

By Robin Westen

How sexy are your 50s?

If you think sex is the province of the young, you’re wrong. People in their 20s are having less sex now than ever before, studies show, so it’s possible that you’re as active, or more so, as the average millennial. About a third of us are getting busy several times a week, one survey found.

And most of us are still in the game: 91 percent of men and 86 percent of women in their 50s report being sexually active, although activity levels vary widely. So, there’s no “normal” amount of sex for people our age. What matters more is that you and your partner are happy with your sex life. Men and women age differently, and some studies indicate that sexual interest wanes differently as well. Combine that with emotional and physical issues, and it’s possible that you and your partner aren’t on the same wavelength when it comes to making waves.

The upsides, however, go way beyond our cravings for intimacy, pleasure and connection. Sex boosts our immune systems, improves self-esteem, decreases depression and anxiety, relieves pain, encourages sleep, reduces stress and increases heart health. (In one study, men who had sex at least twice a week were 50 percent less likely to die of heart disease than their less active peers were.) Another bonus: You burn more calories making love than by watching The Great British Baking Show.

Not only is there a lot of science around the subject of later-life lovemaking; there’s also a range of products and medicines that can help. Take these steps to revitalize your sex life.

1. Connect emotionally

Women are twice as likely as men to lose their enthusiasm for sex in long-term relationships, research shows. The problem isn’t always reduced estrogen; it could be an absence of emotional closeness. In these cases, try listening more, praising more and showing more kindness. Individual, couples and/or sex therapy can help as well. Look for a sex therapist certified by the American Association of Sexuality Educators, Counselors and Therapists.

2. Address vaginal dryness

It’s one of the top impediments to sex among older women: 34 percent of women ages 57 to 59 experience dryness and discomfort during intercourse, one study found. For help, try over-the-counter remedies before and during sex, such as water-based lubricants (K-Y Jelly and Astroglide), oil-based lubes (olive, coconut and baby oils) and OTC moisturizers (Replens and Revaree). Use these a few times a week, even if you’re not having sex.

3. Emphasize foreplay

“Regardless of the level of dryness, every woman needs to be primed with foreplay before intercourse,” says Elizabeth Kavaler, M.D., a urologist-urogynecologist at Total Urology Care of New York. Another tip: Encourage a woman to orgasm first, which provides more moisture for intercourse and other penetration.

4. Don’t let ED keep you down

Half of men who are in their 50s experience erectile dysfunction (ED), and the gold standard for treatment is prescription meds. Safe, effective options include Viagra (which lasts for four to six hours), Levitra (four hours), Cialis (up to 18 hours) and Stendra (up to six hours).

For the minority of men who can’t rely on a pill, other choices include alprostadil (a drug that’s self-injected into the penis) and Muse (a suppository that slides into the penis). Vacuum pumps use suction to coax erections, and new treatments include platelet-rich plasma (PRP) therapy, which may regenerate nerves and improve blood circulation.

5. Don’t ignore other conditions

Any problem that affects overall health can interfere with sexual pleasure. “Cardiovascular issues such as high blood pressure, as well as diabetes, can negatively impact blood flow,” which isn’t good for sexual arousal, notes New York ob-gyn Alyssa Dweck, M.D., coauthor of The Complete A to Z for Your V. “And depression or anxiety can reduce the desire or ability to have sex.” The problem? Medicines that treat these conditions may also affect sexual desire and response. Speak with your health care provider about side effects and possibly switching meds or adjusting the dosage or timing.

6. Consider estrogen

Women, if over-the-counter lubricants aren’t doing the trick, consider estrogen replacement therapy (ERT), which treats hot flashes and vaginal dryness. The most common delivery methods are creams and pills (you can self-apply Estrace and Premarin with an applicator or take these in pill form), insertable tablets (with Vagifem, you use an applicator to slide a tiny tablet into the vagina) and a ring (Estring, which your doctor inserts, or you can do this yourself; it needs to be replaced every three months). ERT is not recommended for anyone who has or had breast cancer, or for those who have recurrent or active endometrial cancer, abnormal vaginal bleeding, recurrent or active blood clots, or a history of stroke.

7. Think about lasers

A treatment called fractional laser therapy can help reduce vaginal dryness without estrogen. It works like this: A laser creates tiny superficial burns in the vaginal canal. As the area heals, this leads to fresher collagen development and increased blood supply, which makes the area more elastic and responsive, Kavaler explains. (She cautions against vaginal rejuvenation surgery, which is a cosmetic procedure: “It can reduce sensitivity in the area and can make orgasms even more difficult to achieve or, in some cases, sexual intercourse permanently painful.”)

8. Confront incontinence issues

In a national poll of more than 1,000 women, nearly half of those over age 50 reported bladder leakage during sex. The primary reason: Sexual stimulation puts pressure on the bladder and urethra. If you’re hoping to get lucky in the hours ahead, avoid consuming beverages or foods with caffeine, such as coffee and chocolate; caffeine stimulates the bladder and acts as a diuretic (citrus fruits and juices are diuretics, too). Men whose prostates have been removed can also experience incontinence during sex. This condition, known as climacturia, can be treated in a number of surgical and nonsurgical ways. Plus, medications such as Ditropan and Vesicare can decrease urination frequency.

9. Turn down testosterone

In late 2020, the American College of Physicians stated that testosterone replacement should no longer be administered to treat a lagging libido (testosterone can have serious side effects, including an increased risk of prostate abnormalities). Denver urologist David Sobel, M.D., offers three easy alternatives: “sleep, reducing stress, and — the big one — exercise.” Even better: Work out with your lover. Seventy-one percent of runners say that running as a couple plays a healthy role in their sex life, according to a 2021 survey according to a 2021 survey.

10. Overcome arthritis aches

About 58 million Americans have arthritis, and over half are younger than 65, reports the Centers for Disease Control and Prevention. Arthritis can limit your ability to engage in sex. In addition, an empathetic partner may resist sex to avoid creating discomfort. An option: Ask your partner to experiment with more comfortable positions. Also, time sex for when you feel best (rheumatoid arthritis pain is usually more acute in the morning), the Arthritis Foundation advises. Taking a warm bath, alone or together, can help relax joints before making love. If the pain is severe, try an OTC medicine such as ibuprofen before having sex, or speak with your doctor about prescription medications.

Complete Article HERE!

Menopause symptoms may interfere with sexual activity

In a recent survey, more than one-quarter of women ages 50 to 80 said menopause symptoms were interfering with their sex lives — including one-third of those ages 50 to 64.

By Amy Norton

Many women remain sexually active into their 70s, but for others, menopause symptoms and chronic health issues get in the way.

That’s among the findings from the latest University of Michigan Poll on Healthy Aging, which surveyed more than 1,200 U.S. women ages 50 to 80.

Overall, 43% said they were sexually active, be that intercourse, foreplay and caressing, or masturbation. A similar proportion, however, were limited by health issues.

More than one-quarter of women said menopause symptoms were interfering with their sex lives — including one-third of those ages 50 to 64. Meanwhile, 17% said other health conditions were the problem.

It’s not clear what specific issues were the biggest obstacles. But experts said menopause can affect a woman’s sexual function in a number of ways.

Sometimes it’s relatively straightforward, said Dr. Daniel Morgan, a professor of obstetrics and gynecology at Michigan Medicine.

He pointed to a prime example: The hormonal changes of menopause can cause dryness and irritation of the vagina or the vulvar skin — which can make sex painful.

Fortunately, there are good treatments, Morgan said. For vaginal dryness, women can try over-the-counter lubricants, or get a prescription for vaginal products that contain low doses of estrogen. Steroid ointments can help soothe vulvar skin conditions, Morgan said.

In other cases, sexual dysfunction is more complex.

Declining estrogen levels can directly affect a woman’s libido, said Dr. Stephanie Faubion, medical director of the North American Menopause Society and director of the Mayo Clinic’s Center for Women’s Health.

As a result, women may find their desires are dialed down, and they feel less motivated to initiate sex — though, Faubion said, they may still respond to their partner’s romantic overtures.

At the same time, some women feel exhausted during this time of life, whether that’s related to menopausal night sweats keeping them awake, chronic health conditions, or having a hectic life. Women in their 50s may be caring for kids and aging parents, while balancing that with work.

“If a woman is exhausted, sex drops down the list,” Faubion said.

Mental well-being is also a big factor. Depression can interfere with sexual activity for some women, Faubion said. In the survey, of women who indicated their mental health was poor to fair, only 36% said they were “very satisfied” with their sex lives, versus 65% of women who reported good mental health — though it’s not clear whether the mental health issues caused problems with sexual activity.

When sexual desire and activities do change as a woman ages, that’s not necessarily distressing, both Faubion and Morgan emphasized. It’s only a problem if she is bothered by it, or it’s causing issues in her relationship.

And in cases where a couple is having difficulties they can’t work out, Faubion said, counseling might be the right option.

Menopause-related symptoms were highly prevalent among poll respondents, with half saying they’d suffered one to three in the past year. problems and weight gain were most common, followed by diminished libido, hot flashes/night sweats and mood swings.

Overall, 28% said those symptoms were interfering with their sex lives.

Yet, of all women reporting menopause symptoms, only 44% had spoken with a healthcare provider about treatment options.

“Some women may not be aware there are treatments,” Faubion said. “Or they may think the symptoms will be temporary and are waiting them out.”

And, both she and Morgan said, healthcare providers may not be asking about menopause symptoms, or any issues with sexual activity.

But Faubion said it’s important for doctors of all specialties to have sexual health on their radar: Patients with conditions ranging from heart disease to hip replacements are going to have questions about sexual activity, she pointed out.

It is fine for women to let sexual activity go, if that’s what they want: In the poll, 52% of women who were not sexually active said they were satisfied with their sex lives. That was lower, however, than the figure among women who were sexually active, at 74%.

And women who are concerned about their sexual health, or menopause symptoms in general, should feel free to broach the topic with a healthcare provider, Morgan said. Your primary care doctor is a good place to start, he noted.

The poll was conducted online and by phone between January and March and has a margin of error between 2 and 4 percentage points.

More information

The North American Menopause Society has more on sexual health.

Complete Article HERE!

Sex in the Senior Years: Why It’s Key to Overall Health

Lovemaking isn’t just for the young — older people gain a lot of satisfaction from amorous relations as well.

But things get complicated as people age, and many folks let this important part of life drift away rather than talk about sexual problems with either their partner or their doctor, experts told HealthDay Now.

“Not many people talk about sex with their doctors, especially as we age,” said Alexis Bender, an assistant professor of geriatrics with the Emory University School of Medicine, in Atlanta. “So many people do report sexual dysfunction on surveys, but they don’t when they’re talking to their doctors. And so it’s important to have those conversations with primary care physicians.”

It’s worth discussing. A healthy sex life brings many benefits to seniors, experts say.

Sex has been linked to heart health, as well as overall mental and physical health. “It’s definitely an association, and it’s positive,” Bender said.

For example, lots of beneficial biochemicals are released by the body during sex, said HealthDay medical correspondent Dr. Robin Miller. These include DHEA, a hormone that helps with cognitive function, and oxytocin, another hormone that plays a role in social bonding, affection and intimacy.

“Having sex is a really important part of overall health and happiness, and people that have it, they live longer,” said Miller, a practicing physician with Triune Integrative Medicine in Medford, Ore.

Sex can actually get better as you get older, Miller added.

“For instance, for men, they can control their ejaculation better as they get older,” Miller said. “Women aren’t worried about pregnancy once they go through menopause, so they’re freer.”

Unfortunately, aging does complicate matters a bit when it comes to sex, Bender noted.

“For both men and women, we see changes in physical health such as diabetes or cardiac conditions that might limit desire or ability to have sex,” Bender said. “Activity decreases with age, but interest and desire does not, for both men and women.”

The changes wrought by menopause and andropause also can affect the sex lives of older men and women, Miller said.

Continued

“For women, vaginal dryness is a big issue. With men, it’s erectile dysfunction,” Miller told HealthDay Now.

Luckily, modern medicine has made advances that can help with these problems. Hormone replacement therapy can help women with the physical symptoms of menopause that interfere with sex, Miller said, and men have Viagra and other erectile dysfunction drugs.

“The story of Viagra is very interesting, actually,” Miller said. “In 1998, they were experimenting using it as an antihypertensive. What they noticed was when they were experimenting with these men, when the nurses arrived to check on them they were all on their stomachs, because they were embarrassed since they had erections.”

“That’s when they realized this was a much better medicine for erectile dysfunction than high blood pressure, and that’s made a big difference for men,” Miller continued.

Women can take Viagra as well, “but women don’t like the side effects. Men don’t really like them, either, but they’re willing to put up with them,” Miller said.

“What I found is for women that you can use Viagra as a cream on the clitoral area,” Miller said. “I call it ‘scream cream.’ You can get it made up at a compound pharmacy. It works like a charm. You still have to wait 40 minutes like men do, but there’s no side effects, and it works, especially for women who are on antidepressants, who have trouble reaching orgasm. It really is very helpful.”

So help is out there, but seniors will have to get over their hang-ups and talk to their doctor to take advantage of these options, the experts said.

“Sex and sexuality are taboo in our society,” Bender said. “Especially for women, sex is highly regulated and talked about at an early age, and we’re really socialized to not be sexual beings.”

Miller said, “I think it’s generational. Some Baby Boomers have a hard time talking about sex. My kids don’t have any trouble talking about it. I bet yours don’t either.”

Women also face practical problems when it comes to finding a sex partner, particularly if they’re looking for a man, Bender said. Women outlive men, so the dating pool shrinks as time goes on, and men tend to choose younger partners.

Continued

Through her research, Miller was surprised to learn that many women just give up on the search.

“Even though I think it’s important to have a healthy sex life and healthy partnership, a lot of women don’t want to reengage in partnership as they get older,” Miller said. “They’ve been married. They’ve taken care of people for a very long time. They’ve taken care of their husbands and their children. And they just say, I don’t want that anymore. I’m happy to sit and hold hands with someone, but I don’t want to get into a relationship again. And so that kind of challenged some of my generational thinking about what relationships mean over time.”

More information

The Mayo Clinic has more about good sex and aging.

Complete Article HERE!

How the vagina changes over time and what to do if sex becomes less enjoyable

The vagina can stretch to twice its normal size during childbirth.

By

  • The average vagina is about 9.6 centimeters (3.8 inches) deep but can stretch to twice that amount.
  • Childbirth and menopause can change the depth of a vagina, which may change how sex feels.
  • If your vagina feels loose, try Kegel exercises or other exercises to strengthen your pelvic floor.

The average vagina measures seven to ten centimeters (about two to four inches). However, the vaginal canal is impressively flexible and how deep a vagina is at any given time often depends on the person as well as circumstances like sexual arousal, pregnancy, childbirth, and menopause.

How deep is a vagina?

According to a small 2005 study, the average depth of a vagina is 9.6 centimeters (or 3.78 inches). However, it has the ability to stretch when sexually aroused to accommodate a penis.

The vagina can also stretch six inches or wider during childbirth to accommodate the baby’s head and shoulders, says Maureen Whelihan, MD, FACOG, a gynecologist at the Elite GYN Care of the Palm Beaches and section chair of American College of Obstetricians and Gynecologists (ACOG) District XII.

Does vaginal depth affect sexual pleasure?

Some people may think that having a deeper vagina is more pleasurable because there will be more nerve endings to heighten the sensation.

However, “the current evidence suggests that vaginal length is not associated with sexual satisfaction. Most women are aroused from the clitoris which is independent from vaginal length,” says Oz Harmanli, MD, chief of Yale Medicine Urogynecology & Reconstructive Pelvic Surgery and professor at the Yale School of Medicine.

Additionally, a 2010 study involving more than 500 heterosexual women found that the length of the vagina did not seem to affect how sexually active they were.

How does the vagina change over time?

Age and lifestyle has a big impact on how the vagina changes over time. In particular, giving birth and going through menopause are perhaps the two primary events in a person’s life that will significantly change their vagina.

Childbirth

Childbirth can affect vaginal depth because the pelvic floor muscles, which support the pelvic organs such as the uterus, bladder, and bowels, get stretched out to support the weight of the baby.

In fact, a 2009 study found that the pelvic floor muscles stretch more than three times their normal size during labor.

The vagina can remain lax after childbirth for up to a year, depending on the size of the baby or the number of babies that were born, says Whelihan.

“The main reason for [feeling loose] could be pelvic floor relaxation and tears as a result of pregnancies, and especially vaginal deliveries,” says Harmanli.

Experts say Kegel exercises and pelvic floor exercises can help regain muscle strength in the pelvic floor, which increases sexual arousal and vaginal lubrication.

Menopause

During menopause, estrogen levels drop, which makes the vaginal canal shorter and narrower, says Harmanli.

Postmenopausal individuals may feel like there is less room inside the vagina for intercourse if they don’t have penetrative sex for a long time, he adds. However, having regular vaginal sexual activity even after menopause helps maintain the vagina’s length and width and reduces dryness.

What if a vagina feels loose during sex?

When it comes to penetrative sex, there is a pervasive myth that having more sex will make the vagina feel “loose” and lead to less pleasurable sex. However, this is not true and is most likely used to shame people for their sexual activity.

A vagina that is perceived as loose might point to a lack of arousal or be reflective of their partner’s small penis or inability to maintain a firm erection, says Whelihan.

Therefore, if the quality of your sexual experience has diminished, it’s important to communicate with your partner(s) about each other’s wants, needs, and openness to try new things.

Insider’s takeaway

The vaginal canal is usually about seven to ten centimeters deep. But it can stretch and become deeper during sex or childbirth.

The vagina may also get shorter during menopause, but having regular sexual activity helps maintain its length.

Finally, there’s no evidence that having a lot of sex will make the vagina loose. But a vagina may feel loose after childbirth in which case pelvic floor exercises may help restore vaginal lubrication and improve sexual satisfaction.

Complete Article HERE!

As menopause hit, my libido waned, my brain felt dull.

So I gave testosterone a try.

By Tara Ellison

As menopause hit, I found I wasn’t as interested in intimacy as I used to be. Sex started to feel like a box that needed to be checked a couple of times a week, and that was causing problems in my marriage.

But it wasn’t just sex. I felt was slowing down in many areas. After hot flashes in my 40s had sent me running to the gynecologist for help, I’d been using bioidentical creams to balance my declining hormones.

When, at 51, I confided to a friend that I’d had limited success with what my doctor prescribed, she said that she was thriving on something called hormonal “pellets.” I grilled her about them and then made an appointment with her practitioner, an internal medicine doctor.

He ordered extensive lab work, which showed that my testosterone levels were very low, which can happen with aging. The doctor said I had two options: do nothing, which he said would eventually likely lead to loss of muscle, decreased bone density and a host of other health complications. Or up my testosterone.

Testosterone therapy for women is a hotly debated subject. Studies suggest that testosterone can heighten libido in women with hypoactive sexual desire disorder (HSDD), at least in the short term. A recent statement by a group of international medical societies involved with women’s health endorsed the use of testosterone therapy in women for HSDD, and specifically excluded pellets and injectables as “not recommended.” It also cautioned there was not enough data to support the use of testosterone therapy for cognitive performance.

Women make between four to 10 times as much testosterone as estrogen, which the body can convert to estrogen. Despite its significance, no testosterone products designed for women are on the market and approved by the Food and Drug Administration. (Two non-testosterone, libido-focused drugs are available for premenopausal women.)

For men, the benefits of testosterone are well-documented — improved mood, sexual function and stronger bones — and more than 30 FDA-approved products are available, according to the agency. But long-term studies in women are lacking, including the effects on those who have a history of breast or uterine cancers and liver or cardiovascular disease. Although studies say testosterone is widely used in women, its use is considered off-label.

The pellets my doctor proposed are unregulated, and not recommended by the North American Menopause Society (NAMS) because of their high doses of testosterone and unpredictable absorption.

“There are a lot of misconceptions for the potential benefits of testosterone,” said Cynthia A. Stuenkel, clinical professor of medicine at the University of California at San Diego’s School of Medicine and past president of NAMS. “You’re going to lose fat mass. You’re going to gain muscle mass. You’re going to think more clearly. You’re going to reduce your risk of breast cancer. You’re going to improve your mood, and I think the global consensus pretty much dispels those proposed benefits.”

But I was desperate to feel better and at the time wasn’t deterred by some possible side effects, which included acne, facial hair growth and a lowered voice. And my friend was clearly convinced testosterone had helped her. The tiny dissolvable pellets, containing estrogen and testosterone, were inserted beneath the skin on my mid-buttock and would last between three to five months. If I developed any side effect, on the next re-up date we could adjust the dose or discontinue, my doctor said.

The insertion process took less than 10 minutes and about five days to kick in. I didn’t have to wait long to see improvement.

Within weeks, I was feeling good — my brain felt clearer — and my libido was in full swing again. It was hard to pass my husband in the kitchen without reaching over to touch him.

I can’t rule out a placebo effect of course, but having a jolt of testosterone seemed to make me more focused — I got things done. One morning in the magnifying mirror, however, I noticed a definite uptick in facial hair.< My husband liked the increased sexual activity and joked that he didn’t have to endure discussions about my feelings anymore since I had gotten more direct in my conversations with him. I also found I was more driven to work. Just generally, I felt more confident and it seemed like people responded to me differently because of that. And rather than being finely attuned to my spouse’s desires, I was pursuing my own. Was all this biochemical or, again, could it have been a placebo effect? “There are strong placebo effects for sexuality in research on aids for sexuality and research on testosterone,” she said. “Our culture has long painted women’s sexuality as a problem; when women have lower desire than men, the women’s desire is seen as too low or ‘hypoactive’ and, when their desire is higher than male partners, the women’s desire is seen as too high or ‘out of control.’ As a result, medical and other interventions for women’s sexuality, especially desire, are best viewed with a healthy skepticism: Are these interventions addressing a problem within the women or a problem created by gendered norms? Should the solution address women and their bodies or gendered prescriptions?” Women and the waxing and waning of sexual desire is a complex and tricky subject. But I was starting to wonder why there seemed to be fewer options available for women and less research about those options. Was the gender disparity slowing down progress for women’s sexual health? There seems to be an attitude of, “You’re past menopause, you’re not making babies anymore, what does it matter?” said Sharon J. Parish, a professor of medicine in clinical psychiatry and of clinical medicine at Weill Cornell Medical College. James Simon, clinical professor at George Washington University and a past-president of both the International Society for the Study of Women’s Sexual Health and NAMS, said “a lot more money” is available for research into men’s sexual health and “where there’s money, you have direct-to-consumer advertising. You have additional research and development. You have glitzy ads and promotions, et cetera., this is not a new subject for men or men’s sexual health.” Viagra, he said, which men can take for their sexual performance issues, just had its 23rd birthday. He added, “I think women’s sexual health has been largely neglected or put aside or denigrated or minimized because it took more time, was harder to measure, had less money and cachet involved, and it was easy for many in the medical community to do that, and women did not, and still to some degree, do not demand more, and that allows this to perpetuate.” Six months later, when I saw my gynecologist and said that I was using pellets, she looked alarmed and advised me to get off them as soon as possible. “They’re scary,” she told me and referred me to a recent article and study about worrisome side effects, among them mood swings, abnormal uterine bleeding and also greater likelihood of having to undergo hysterectomy when on the hormonal therapy.

Where you get into trouble is when women are given super high doses of testosterone.

“Keeping the total testosterone in the physiologic range, closer to where women were pre-menopause, without exceeding that level and giving excess testosterone, is the goal,” Parish said. “Pellets are extremely problematic; we don’t support those, because they result in what’s called super-physiologic ranges and can result in toxicity, and we don’t have safety data supporting that.”

Susan R. Davis, an endocrinologist and director of the Women’s Health Research Program in the School of Public Health and Preventive Medicine at Monash University in Melbourne, Australia, said instead of pellets women seeking help “would be better off using a testosterone gel or equivalent that’s approved for men and using a micro dose or a fraction of the dose. . . .

“You can do a blood test to make sure [a woman] is not going over the female limit,” she added. “You can vary the dose, and you can cut back the dose if she starts getting side effects” — unlike pellets, which stop working only after they’ve slowly disintegrated. Once a pellet has been inserted, it’s very hard to get it out if an issue develops.

“I think testosterone is important for women,” Davis said, “but we’ve got to be very cautious how we administer it and we need products approved for women. That’s what we need. It’s a bit like Goldilocks: there’s too much, too little, and just right, and if you use too much it’s bad. Higher doses are actually worse for sexual function. Women start to feel agitated, irritable, negative mood, so too much is bad. So, there is a ‘just right’ dose.”

Stuenkel, past president of NAMS, added: “If you’re going to do it, I think the transdermal preparations [patches that stick on the skin] make sense [since they] are FDA approved” — although for men’s dosing. “And so that’s not great, but I think in many ways it’s safer.”

Yet, for many women, dissatisfied with gels and the like, pellets can seem worth the risk — at least for a trial run.

In my case, I had gone from having no interest in sex to wanting lots of sex. But it hadn’t been the salve that I had imagined.

My relationship with my husband was undergoing a systems update. While I was feeling much better and my behavior reflected that, there were some things about the old operating system that my husband missed. Our relationship had always been a bit “old school” — my world revolved around keeping my man happy. I could take his emotional temperature at a glance. I tried to match his hectic pace, even when I knew I needed rest, and I had always been willing to put his needs before my own. But that wasn’t sustainable over the course of a marriage.

I wondered what if my lack of sexual interest before pellets wasn’t just physiological but reflected the result of needing something different from my relationship to fuel and sustain our intimacy?

Low testosterone didn’t create the problems in my relationship but it made us more aware of them. We had long standing dynamics that needed to shift and change. We needed to have some difficult conversations to help us develop a deeper connection. A more satisfying emotional intimacy that could then naturally lead to increased sexual desire.

Testosterone may make you feel like having sex again but I discovered it’s not a magic bullet to solve everything.

It has been two years and given the long-term safety concerns about the pellets, I’ve decided to give them up when the current batch melts away — but I’m not giving up testosterone entirely. I’m considering using a patch or gel next.

The absorption might not be as effective, but at least I’d have more control over the dosage.

It may not fix everything, but finding the right balance between estrogen and testosterone — one that feels right in both my body and my marriage — seems worth it.

Complete Article HERE!

Can Marijuana Ease Your Hot Flashes?

Advice from a Menopause Expert

If you’re considering trying pot to escape hot flash hell, here’s guidance on the best way to do that, and the science of why it might help.

By

If you’ve heard a friend mention that she’s easing hot flashes and other annoying side effects of menopause with marijuana, she’s not alone: In a 2020 study, 27% of menopausal women reported that they used some form of cannabis—the scientific name of the marijuana plant—to alleviate hot flashes, insomnia, vaginal dryness, mood swings, and brain fog. That’s more than 1 in 4 women—compare that to the mere 7% of women who take systemic estrogen to alleviate symptoms. Women are smoking pot, drinking cannabis-laced beverages, and infusing marijuana in oil and putting it not only on their avocado toast but also on their vulva and in their vagina.

Join Dr. Streicher and other experts for a conversation about menopause on October 18. Sign up for free today!

Turning to cannabis to ease menopausal symptoms isn’t new either: According to historian Ethan Russ, cannabis was used as far back as the 7th century for myriad women’s ailments. It even pops up as a treatment of meno­pause in the 1899 edition of the Merck Manual, a popu­lar medical textbook. At the turn of that century, all the major pharmaceutical companies—Eli Lilly, Parke-Davis (now Pfizer), and Squibb—sold cannabis as a powder, tablet, and tincture.

So what’s the story—can smoking a joint or imbibing cannabis in some other way really cool the heat and soothe other menopause symptoms? (Before you jump in, remember: Marijuana isn’t legal everywhere. Check out this map to find out the status of legalization in your state.)

Are there studies on marijuana and hot flashes?

Though there are some wildly enthusiastic anecdotal reports about the effectiveness of pot to ease hot flashes, there have been inadequate scientific studies—meaning studies done on large groups of women over an extended period of time, with a control group using fake pot as a comparison. In other words, when it comes to cannabinoids (the compounds found in cannabis), there aren’t the kinds of studies that are required for pharmaceutical agents to become FDA-approved. In addition, most studies on the effect of cannabinoids include only men—and women are not little men.

Aside from being expensive, studies on the impact of cannabis on menopause symptoms would be difficult to conduct. The pharmacology is complex: There are well over 100 cannabinoids, and all have different physical and psychological effects. The dosage and type of cannabis are difficult to standardize and are also dramatically altered by variables, such as the other medications someone might be taking.

Don’t get me wrong: I think the use of cannabinoids to relieve menopause symptoms is very promising, and based on the known properties of cannabinoids, there is good reason that they would be beneficial in alleviating many symptoms of menopause. It just would be nice to have more research as to what kind of cannabis and what dosage works best, so that I and other physicians can make informed recommendations to our patients. But having said that, here is what is known based on the science of cannabinoids as well as observational, anecdotal data.

The impact of cannabis on our bodies

First, an interesting fact: The human body makes its own cannabi­noids. The human endocannabinoid system is a complex, nerve-signaling system composed of neurotransmitters that bind to cannabinoid receptors. It’s responsible for regulating multiple body functions, including appetite, metabolism, pain, mood, learning, memory, sleep, stress, bone health, and cardiovascular health—pretty much ev­erything that keeps humans functional and balanced.

And it turns out that hormones, specifically estrogen, play a critical role in the endocannabinoid system, and some experts propose that the disruption in that system when estrogen is low is responsible for menopause symptoms—and they say it’s also why using cannabis can decrease hot flashes.

The marijuana plant and hot flashes

There are two cannabinoids extracted from the flow­er of the marijuana plant that have potential roles in managing menopause symp­toms: tetrahydrocannabinol (THC) and cannabidiol (CBD). And, no surprise, only the female flower contains these elements.

THC is the psychoactive component of cannabis (that’s the component that brings on the high). It mimics some aspects of the natural endocannabinoid in our bodies that helps regulate body temperature, which is theoretically why THC is the key to reducing hot flashes.

CBD is extracted from hemp flowers. It contains trace amounts of THC but doesn’t have psy­choactive properties, so it will not get you high. Although it may not reduce hot flashes specifically, it does decrease pain and inflam­mation, in addition to helping you get a good night’s sleep. (The anti-inflammatory properties of both cannabinoids also may help with bone loss and cardiovascular disease.)

So, does pot relieve hot flashes?

Since this hasn’t been scientifically studied, what I’m going to say is based on the known pharmacolo­gy of cannabinoids and anecdotal information from folks in this world. But yes, it does appear that cannabis can be effec­tive in decreasing the frequency and severity of hot flashes.

Again, the THC in cannabis mimics the endocannabinoid that helps regulate body temperature. This effect when using cannabis is dose dependent. Large amounts of THC cause your internal temperature to drop, while small amounts can cause your internal temperature to rise. In other words, THC can regulate your internal thermostat, but it is important to use the right amount.

How to use cannabis for hot flashes

Eat it? Smoke it? Rub it on? How you take cannabis is important—not only in terms of what it will do for you, but also when it comes to onset of action (meaning, how quickly it hits you) and potential side effects. The onset of action, peak levels, and total duration of ef­fect listed here are very approximate, but I’ve included them to give you an idea.

Smoking or vaping

Inhaling cannabis has the advantage of an immediate effect, but the disadvantage is potentially harming your re­spiratory tract. It’s also not an activity you can do discreetly.

Onset of action: Within minutes
Peak levels: About 15 to 30 minutes
Total duration: About two or more hours

Edibles

Edibles include foods infused with cannabis, such as gummies, chocolate, ice cream, smoothies, and cookies—the possibilities are endless. The effect is delayed, which sometimes leads to overdos­ing (more on that at the end). Edibles are not psychoactive unless they contain more than trace amounts of THC.

Onset of action: 30 to 90 minutes
Peak levels: Two to six hours
Total duration: At least four to eight hours

Sublinguals

Sublinguals are tinctures, sprays, or strips placed under the tongue that are quickly absorbed into the bloodstream through a plexus of blood vessels, rather than making the trip through the digestive system like edibles do. The advantage is a relatively quick onset of action, along with bypassing the gut and the lungs. Also, it appears that THC is absorbed better as a sublingual than as an edible.

Onset of action: Within minutes
Peak levels: About 10 minutes
Total duration: Hours or even days (highly variable)

What’s the right dose for cannabis?

I’ll give you some general dosing guidelines, but they are not based on scientific studies. I’m just telling you what’s being said by the experts I’ve talked to. The dosage is a free-for-all, and even the phar­macists who work in the industry and appear very knowl­edgeable are basing their recommendations on anecdotal reports and individual experience as opposed to scientific studies. Remember, most of the folks who work in dispen­saries are not medical practitioners, and they may not be aware of a potential drug interaction or other medical variables. Also, it’s a known fact that young women metabolize cannabis more slowly than men, and women who are post-menopause metabolize it more slowly than those who are pre-menopause. This makes sense, given that cannabis metabolism is fa­cilitated by estrogen, and women who are post-menopause don’t have any.

There is no one-size-fits-all dosing, and because cannabis is a botanical, you cannot count on the same level of con­sistency as you would with a commercial pharmaceutical. Keeping a journal is a good idea until you figure out what works best for you. Small, spaced-out doses (micro-dosing) is smart.

Here are guidelines for hot flash relief sup­plied by Luba Andrus, a registered pharmacist and cannabis pharma­cologist with whom I consulted; she routinely works with menopausal women.

Guidelines for THC

  • Sublingual is preferred
  • Start at 1.25 mg once or twice daily
  • Titrate up (increase the dose) every five to seven days
  • 2 mg to 4 mg works for most women

Guidelines for CBD

  • Sublingual is preferred
  • Use an indica-dominant product (a dispensary can guide you)
  • Start at 2.5 mg twice daily
  • Titrate up (increase the dose) every four to seven days
  • Continue until 20 mg is reached
  • Keep in mind that it can take upwards of 30 days to feel the full effect, so be patient.

Guidelines for THC/CBD-combined products

  • Sublingual is preferred
  • CBD/THC ratio should be 20:1 or higher (22% to 26% THC and 0.76% CBD is a common combo)
  • Products with a high THC:CBD ratio are best taken in the evening or at bedtime.

Heed these warnings

Cannabinoids have the potential to interact with cer­tain medicines, such as blood thinners and antiseizure drugs. In some cases, they can potentially make other medications less effective. Talk to your doctor!

Cannabis is generally felt to be safe, but the side effects may include brain fog, dry mouth, unsteady gait, diar­rhea, and drowsiness. A glass of water at the bedside is a good idea since you may wake up thirsty in the middle of the night. Some other important advice:

Don’t drive while under the influence!

Cannabis users need up to twice the sedation for med­ical procedures. If you partake, be sure to tell the an­esthesiologist.

The effects of cannabinoids are dose related. Low to moderate doses appear to have positive effects on sex­ual function and responsiveness (loss of inhibition, in­creased sensitivity). High doses can be a problem and are associated with an increase in paranoia and anxiety. There is such a thing as too much of a good thing.

• Again, menopausal women are more vulnerable than men to an overdose. So especially when it comes to edibles, start at a low dose and make sure you wait 90 minutes before taking any more, because it can take that long for it to kick in. And keep in mind that many edibles are sold in individual servings of 10 mg of THC, which is way more than most menopausal women should be ingesting.

Complete Article HERE!

New ways to think about sex

An enjoyable sexual relationship can happen without traditional intercourse.

By Matthew Solan

People’s bodies change over time. Probably nowhere is this most telling than with their sex lives.

For men, sexual drive can slow as hormone production naturally drops, and it’s common to experience erectile dysfunction or health issues that can interfere with sexual performance.

Women can have their own physical barriers to sex, such as vaginal dryness and lower libido after menopause. All of these issues can make conventional sex problematic and stressful for both parties.

“Even though older adults go through physical changes, they often expect their sex life to stay the way it was decades earlier, and that is just not always realistic,” says Dr. Sharon Bober, director of the Sexual Health Program at Harvard-affiliated Dana-Farber Cancer Institute. “Still, there are many ways to continue a strong, healthy sexual relationship without always relying on regular intercourse. Couples should see this new phase of their sex lives as an opportunity to explore different and exciting ways to satisfy each other.”

Redefining sex

The first step older couples should take is to re-examine their definition of “sex.” “Don’t give in to the idea of a so-called normal sex life being narrowly defined,” says Dr. Bober. “Sex refers to a broad spectrum, and there are many places you can land.”

Examine what sex now means to you and your partner. This could mean changing how you pleasure each other, routines you follow, and frequency — as well as making compromises about expectations. “Don’t assume there is only one way to have a sexual relationship,” says Dr. Bober. “It doesn’t have to be all or nothing.”

Your relationship status also can shape this new idea of sex. For instance, some couples may enjoy a connection based more on companionship, where the emphasis is on emotional bonding and spending quality time together and less on the physical side.

Language of love

As with most aspects of a strong relationship, communication is vital. “The more you avoid talking about your sex lives, the bigger the issues become,” says Dr. Bober.

Of course, talking about sex isn’t always easy, but most partners are open and willing to discuss and share if given a chance. “Often partners aren’t sure how to begin the conversation, so it never happens,” she says. There are many ways to initiate a sex dialogue. Here are some suggestions:

Seek permission. Begin the conversation positively. For instance, say something like “I want to find ways to reconnect that feel good for both of us” or “Our sex life has been on my mind and I have been wondering if I could share some of my thoughts. Is it okay to talk about it?”

By asking for permission, you can broach the topic without intimidating your partner. “This initial conversation is not about making demands, but about finding ways to explore mutual goals,” says Dr. Bober.

Invite a response. Make it clear you want to hear your partner’s feelings too. For example, say, “I’ve been wondering how you feel about our sex life. What has sex been like for you?” Inviting partners to participate can prevent them from feeling defensive and shows you care about their experience and input, says Dr. Bober.

Express what you both want. Talk about what you both hope to gain from this new sexual relationship, such as more excitement, greater closeness, or even reconnection. “Sharing your needs and expectations helps your partner express theirs, so you both can come to some kind of mutual understanding,” says Dr. Bober.

Different ways to satisfy

Once you’ve had these talks, then you both can look for different ways to approach your new sex life.

Dr. Bober says a good place to begin is with “outercourse.” Here, the attention and energy are directed toward foreplay and manual stimulation with your partner, like massages, hugging, petting, kissing, or just snuggling naked in bed.

“The emphasis is on intimacy and closeness without any big expectations of intercourse,” says Dr. Bober. “This can take the pressure off both partners and eliminate some of the stress and anxiety of having regular sex. It also shows that you can interact with your partner in various satisfying ways.”

Penetration is not always needed to achieve pleasure or orgasm for both people. Instead, try sexual aids like vibrators as well as manual stimulation, masturbation, and oral sex.

As you explore ways to stay intimate, be mindful that every couple is unique.

“A sexual relationship is defined by the two people in it and nobody else,” says Dr. Bober. “Focus on what matters to you and your partner. Your sex lives may have changed, but together you can discover what’s best for each other and your relationship.”

Complete Article HERE!

Why does sex hurt?

14 common reasons why intercourse is painful, plus how to prevent it

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So, why does sex hurt? Good question – and, sadly, not one that there’s a straightforward answer too.

Getting intimate and then feeling a stabbing, burning or, well, any kind of pain down there can be a bit of a mood killer, can’t it? Not to mention a worry.

Sex can hurt for a number of reasons, from underlying infections to hidden health conditions. That highlighted, it’s definitely better to deal with it sooner rather than later – no point gritting your teeth and hoping it will go away.

Known medically as dyspareunia, as obstetrician, gynaecologist and ambassador for Wellbeing Sisters doctor Larisa Corda explains, painful sex affects one in ten British women, as per an International Journal of Obstetrics and Gynaecology study.

And, according to doctor Shree Datta, gynaecologist for intimate wellbeing brand INTIMINA, there are two main types. Superficial dyspareunia – pain at the entrance to the vagina or within it at the point of penetration – or deep dyspareunia – which occurs deep in the pelvis. “Remember that pain can range from a mild irritation to debilitating pain, meaning sex can’t be tolerated, and it may be temporary, intermittent or a long term problem,” she explains.

Both female experts stress that it’s important to discover it sooner rather than later why you may be suffering from pain during sex. Keep reading to decode why does sex hurt, once and for all.

1. Too little lubrication

FYI, one of the most common reasons you’re having to Google, ‘why does sex hurt?’, is because you have too little vaginal lubrication during sex. This is totally normal – a lot of women experience vaginal dryness.

Your vagina lacking moisture can be down to the amount of foreplay before penetration, or even a lack of hormones such as oestrogen around the time of menopause, explains Datta. “If you suffer from medical conditions such as diabetes or depression, this can also affect your sexual libido and enjoyment,” she shares.

Bottom line: many women simply do not produce enough vaginal lubrication, including younger women, adds Samantha Evans, sexual health expert, former nurse and co founder of luxury sex toy retailer Jo Divine.

Try this: Rather than keep Googling why does sex hurt, Evans shares that the use of lubricants can really help. Often GPs will prescribe a hormonal cream or pessary, but many gynaecologists advocate using vaginal lubricants to help nourish the delicate tissues of the vagina. Read out guide to the best lubes to buy over the counter, while you’re here.

2. You may be suffering from a skin condition

Did you know? Underlying skin conditions can actually cause irritation during sex, and condoms may also cause discomfort or burning, particularly if you have an allergy, explains Datta. If your vagina burns after sex, you may have eczema and other genital skin conditions, such as lichen sclerosis.

Try this: Make sure you visit your GP to get your skin condition defined, if you think you may be suffering. From there, they can help you decide the best course of action, explains Corda.

3. You may have vaginismus

Ever heard of vaginismus? If you haven’t, it’s the tightening of your vaginal muscles automatically at the time of penetration, explains Datta. But why does this happen? “It can be caused by a combination of physical and psychological issues,” explains Corda. “Physical causes can include urinary tract infections, sexually transmitted diseases, vulvodynia, skin conditions such as psoriasis or eczema, menopause, and birth trauma.”

Psychological problems, on the other hand, can be caused by emotional or sexual trauma. “A previous painful experience with sex might make it harder to feel aroused and enjoy touch,” explains a spokesperson from Brook Advisory. “It can also make the muscles around the vagina and anus clench (to protect you from the pain you’re worried about) and make penetration difficult and more painful.”

Try this: With the appropriate medical intervention and counselling, the experts share that the problem can be alleviated to enable penetrative sex. Treatment usually involves specialist counselling, pelvic floor exercises, biofeedback training with a women’s health physiotherapist and use of medical dilators or a vibrator or dildo to slowly encourage the vagina to relax and open.

4. You may have an STD

Pain during or after sex can also be a sign of a sexually transmitted disease (STI) or vaginal infection, like a urinary tract infection like cystitis.

“Stinging or burning during sex may be as a result of a sexually transmitted infection, especially if you also experience an unusual vaginal discharge, or an unusual odour,” says Professor Ellis Downes, consultant obstetrician and gynaecologist and spokesperson for vSculpt. “If you have a new sexual partner and have had unprotected sex with him, and are experiencing these symptoms it would be a good idea to have it diagnosed and treated by your GP or at a sexual health clinic.”

Try this: STIs such as Chlamydia or gonorrhoea can have little to no symptoms but vaginal itching or burning, as well as painful sex, might be a sign that you are infected. Visit your GP or GUM clinic for a test. Treatments usually involve antibiotics but your doctor can recommend the next course of action.

5. You might have thrush

Three out of four women will suffer with thrush at some point in their lives, although it’s other infections, such as bacterial vaginosis. As above, UTI’s are also a common reason as to why sex is likely to hurt. Vaginal thrush, in particular, is a common yeast infection, and the main symptoms include painful sex, itching, soreness, stinging, burning when peeing and an odourless discharge.

Try this: You can pick up a DIY test in most pharmacies to determine whether you have thrush or BV, and your pharmacist will be able to recommend the best course of action. It’s usually treated with anti-fungal cream, pessaries, pills or a combination.

6. You could be going through the menopause

According to Corda, during the menopause, women experience a reduction in sex hormones which can lead to both vaginal dryness and sexual pain.

Do note here: Don’t feel embarrassed about this or suffer in silence – as Datta points out, lots of people experience sexual problems at different stages of life. “There is a lot of help out there, so there is no need to deal with this difficulty alone,” she shares. Do book an appointment with your GP if you think your painful sex may be because of menopausal symptoms.

7. Your vagina may be irritated

You’ll likely know that genital irritation can be caused by spermicides, latex or vaginal douching. Some women are allergic to certain products or even their partner’s sperm. Latex products, such as condoms or sex toys, can also cause an allergic reaction, so if you’ve ever experienced an itching or burning sensation when trying new products, then you might’ve had an irritation or allergic reaction which can, in turn, lead to painful sex.

Try this: do be aware of what you are applying to the delicate skin of your genitals. Glycerin – which is often found in flavoured lubes – as well as parabens and aspartame, can cause irritation. Similarly, alkali or acidic lubes can mess with the pH balance of your vagina and cause dryness and itching. Instead, switch to a water-based (not silicon-based) lube, such as Pjur. Another alternative is Sliquid, which is also glycerin- and paraben-free.

Similarly, opt for latex-free condoms and, when using a sex toy, make sure you clean if after use (read how to clean your sex toys, here), recommends Downes. “Some cleaning substances can irritate the vaginal lining, though, so do note that it’s best just to use hot water and natural soap.”

8. You may just not be aroused

“If you’re not physically aroused, touch of any kind can be uncomfortable, especially if it’s somewhere sensitive, like your clitoris or the tip of your penis,” says a spokesperson from the Brook Advisory Clinic. “Being well-lubricated, relaxed and with lots of blood flow in the area (you want either an erect penis or a vulva swell) helps with this, so put plenty of focus on foreplay,” they recommend.

FYI, women especially need warming up before penetrative sex, both physically and emotionally. “If you’re not feeling turned on – that is, if you’re not mentally aroused – touch can be unpleasant. For example, being tickled when you’re feeling playful and silly is usually more fun than when you’re tired or angry,” adds the Brook spokesperson.

Try this: The sexpert suggests spending time enjoying foreplay to significantly improve your sexual pleasure. “There may be times when penetrative sex is not possible, but you can still have great sex without intercourse,” they share.

Corda also adds that, if you’re worried about your lack of libido, counselling could be key to treating these factors and reviving the pain associated with sex. But in the first instance, it’s important to see your doctor to rule out medical causes first and provide the correct treatment.

9. You may be injured

Did you know? “Painful sex can be a sign of damage from previous sex, such as tearing or soreness,” explains a spokesperson from the Brook Advisory Clinic.

Think about it – you wouldn’t go running if you’d twisted your ankle, so try not to have sex super quickly after a particularly enthusiastic session, as it may have resulted in friction that has left you sore.

10. He may be too big

“Even if you’re well lubricated and fully aroused, you may experience pain if a man inserts his penis too quickly or deeply,” says Evans. “The vagina relaxes as you warm up to having sex, and will open more comfortably if the penis enters slowly. Guiding your partner in at your own pace can really help avoid any pain.”

Try this: She explains that often, having sex doggy style can be painful, so try backing onto the penis at your own pace. The same can be said when going on top. Don’t let your partner to pull you down onto their penis if you suffer from painful sex: instead, she recommends slowly lower yourself, controlling the speed and depth of insertion that is comfortable. Got it?

11. You may have a female health condition like endometriosis

Painful sex is a common symptom for women with endometriosis symptoms, which affect two million women in the UK, making many avoid sex altogether. Up to 50% of women with endometriosis have cited painful intercourse, ranging from sharp, stabbing, needle-like pain to a deep ache. It can feel mild to intense, either during sexual intercourse or up to 24 to 48 hours post-coitally, or both.

As well as endometriosis (when the lining of the uterus grows outside the uterus or is thicker than normal), painful sex can also be caused by fibroids (growths of muscle and tissue inside the uterus) growing close to your vagina or cervix, irritable bowel syndrome and constipation.

Try this: Endometriosis – and its flare ups – are unpredictable, so often it feels like there’s no knowing when they may occur. Some women experience pain throughout the month whereas others only experience it at certain times, likely – but not definitely – related to their menstrual cycle. There is no cure for endometriosis but there are treatments that can help with the pain – do visit your doctor if you fear you may have it.

12. If you’ve just given birth, your vagina may be recovering

Wondering why does sex hurt after just giving birth? FYI, giving birth is a beautiful and emotional thing – but also an emotional and physical challenge, too, and you’ll need to take time to recover afterwards. “Childbirth is a formative experience for any woman, and for some it can be traumatic,” says Dr Becky Spelman, psychologist and We-Vibe‘s relationship expert. “Insensitive care practitioners or a difficult or dangerous birth can give rise to a heightened fear of birth, pregnancy, and even sexuality itself. Women who have experienced a traumatic birth often struggle to re-engage with their sexual selves, even when they have recovered physically, and can experience pain with no obvious physical cause,” she explains.

So why exactly is sex painful after giving birth? A number of reasons, from bruising to the vaginal wall is a common reason, explains Downes. “You may also have experienced a tear which will need time to heal completely before you have sex again – doctors recommend at least six weeks but it often takes longer,” she shares.

Why is sex painful? Woman with Legs Raised wearing white shorts lying on bed

13. Your relationship might be under strain

Arguing a lot or working through a stressful patch in your relationship? Ill feeling can actually totally cause painful sex, FYI – it’s a vicious cycle.

“Experiencing emotional pain as a result of conflict within your relationship could lead to painful sex,” says Evans. “Many couples go through an emotional disconnect if one of them is unable to have sex, which in turn can increase the pain levels, thus creating a vicious circle.”

Try this: The sexpert advises that consulting a couples’ counsellor or sex therapist may help – and remember, you are not alone.

14. You could have a hidden health condition

Often painful sex is a sign of a more unusual, difficult to diagnose health issue, explains Evans. Some of the lesser known conditions that could be causing you discomfort during sex include:

  • Lichen Schlerosus – a common condition generally affecting postmenopausal women thought to be linked to an overactive immune system.
  • Vestibulodynia – a condition that makes you feel a burning pain thought to affect 12-15% of women.
  • Vulvodynia – spontaneous burning without an itching sensation.

If you’re worried you have any of the above, do see a doctor.

Is painful sex normal?

Now you’ve read the expert answer to why does sex hurt, we’re sure you’re keen to know if pain during intercourse is actually common. Short answer: yes, but it’s important to see your doctor if sex is painful repeatedly. “It can stop you from enjoying sex or lead to you avoiding sex altogether,” shares Datta – which is not good.

“This can be isolating, affect your mood and cause distress,” she shares. “It could also cause problems in your relationship over time. You may be referred to see a Gynaecologist and we may need to examine and exclude both physical and psychological problems.

Bottom line: pain during sex can be down to a number of different causes. “That’s why sometimes a multi-disciplinary approach is needed to reach an adequate diagnosis and to offer appropriate support,” explains Corda. “This may include psychologists, urologists, gynaecologists, and even dermatologists.”

They’ll be able to allow you to explore the various issues affecting your ability to have or enjoy sex, and your relationship with your partner.

Complete Article HERE!

Sexual activity linked to higher cognitive function in older age

A joint study by two England universities explores the link between sex and cognitive function with some surprising differences in male and female outcomes in old age.

By

  • A joint study by the universities of Coventry and Oxford in England has linked sexual activity with higher cognitive abilities in older age.
  • The results of this study suggest there are significant associations between sexual activity and number sequencing/word recall in men. In women, however, there was a significant association between sexual activity in word recall alone – number sequencing was not impacted.
  • The differences in testosterone (the male sex hormone) and oxytocin (a predominantly female hormone) may factor into why the male cognitive level changes much more during sexual activity in older age.

Countless studies have been done on the health benefits of sex – from an orgasm giving you clearer skin and a boosted immune system, to the physical activity keeping your blood pressure at a healthy level. A lowered risk of heart disease, the ability to block pain, a lowered risk of prostate cancer, less stress which leads to improved sleeping patterns…all of these are proven benefits of sexual activity.

The health benefits of sex have been studied again and again, and yet, there are still new things we’re learning about the benefits on the human body and brain.

Study links sexual activity to higher cognitive function in old age

The results of this study suggest there are significant associations between sexual activity and number sequencing/word recall in men and a significant association between sexual activity in word recall in women.

Cognitive function has been associated with various physical, psychological, and emotional patterns in older adults – from lifestyle to quality of life, loneliness, and mood changes as well as physical activity levels.

A 2016 joint study by the universities of Coventry and Oxford in England has linked sexual activity with higher/better cognitive abilities in older age.

This longitudinal study used a newly available wave of data from the English Longitudinal Study of Ageing to explore the connections between sexual activity in the older population (50+) with cognitive function.

The study consisted of 6,833 participants between the ages of 50-89 years old.

Two different cognitive function tests were analyzed:

  • Number sequencing, which broadly relates to the brain’s executive functions.
  • Word recall, which relates to the brain’s memory functions.

The results of these tests were then adjusted to account for each person’s gender, age, education level, wealth, physical activity, and mental health. The reason for this is that the researchers noticed there are often biases in other studies that examine the links between sexual activity and overall health.

For example, in this scenario, without taking those things into account, healthy older Italian men with a continued interest in sex would score higher on these tests. Women, who are more likely to become widowed and lose their sexual partner, would score lower.

The results…

While studying the impact of sexual activity on overall health, there are not many studies that focus on the link between sexual activity and cognitive function, and no other study that focuses on sexual activity and cognitive function in older adults.

The results of this one-of-a-kind study suggest there are significant associations between sexual activity and number sequencing/word recall in men. In women, however, there was a significant association between sexual activity in word recall alone – number sequencing was not impacted.

You can see the breakdown of this information here.

Why were the results for males and females so different?

One of the highlights of this study was exploring the differences sexual activity has in cognitive function in older males and older females.

Exploring the differences when it comes to the improved cognitive ability between the older males and the older females in this study was one of the highlights of the research.

Testosterone versus oxytocin

Testosterone, which is the male sex hormone, reacts very differently to the brain than oxytocin, which is released in females during sexual activity.

Testosterone plays a key role in many different areas such as muscle mass, facial and pubic hair development, and mood changes. It also impacts your sex drive and your verbal memory and thinking ability.

Testosterone belongs to a class of male hormones, and although the ovaries of a woman do produce minimal amounts of testosterone, it’s not enough to compare the impacts on the male and female bodies.

Oxytocin, on the other hand, is produced in the male and female bodies quite similarly, but ultimately the hormone reacts differently in the female body, triggering the portion of the brain responsible for emotion, motivation, and reward.

These differences in testosterone and oxytocin may factor into why the male cognitive level changes much more during sexual activity in older age.

Women’s ability for memory recall remains a mystery…

Another study, this time back in 1997, looked at the relationship between gender and episodic memory. The results of this study proved that women have a higher level of performance on episodic memory tasks (for example, recalling childhood memories) than men. The reason for this was not further explored in this study and has remained something of a mystery, even now.

The female brain deteriorates during menopause.

Women very commonly struggle with memory-related problems during and post-menopause. This could be the reason why the original study proved older men had a higher cognitive ability in number sequencing than older women.

Along with menopause-related cognitive decline, women are also at a higher risk for memory impairment and dementia compared to men.

Lead researcher of the original 2016 study, Dr. Hayley Wright, from Coventry University, explains:

“Every time we do another piece of research we are getting a little bit closer to understanding why this association exists at all, what the underlying mechanisms are and whether there is a ’cause and effect’ relationship between sexual activity and cognitive function in older people.”

Complete Article HERE!

Dealing with the symptoms of menopause

It’s a good idea to talk to your doctor about treatment options

by Maggie Ireland

As women approach the end of their childbearing years, they may experience symptoms of menopause but may not realize all of the treatments now available.

“Menopause is the lack of menses in a woman. Typically, this happens in her early 50s. The current diagnosis for menopause is that a woman has no periods for 12 months,” said Dr. Lindsy Alons, a physician at Cedar Rapids OB/GYN Specialists. “It’s different for every woman.”

In menopause, a woman’s body adjusts to changing levels of ovarian hormones — estrogen — as her cycles phase out. The uneven levels of estrogen can cause a wide variety of symptoms, with hot flashes and night sweats the most common.

“A lot of patients have night sweats, hot flashes, changes in libido, vaginal dryness, mood changes and other symptoms,” Alons said.

Quality of life

Eugenia Mazur, a physician in the Menopause and Sexual Health Clinic at University of Iowa Hospitals and Clinics in Iowa City, treats many woman for the effects of menopause, some more serious than others.

“Every woman goes through menopause without exclusion,” Mazur said. “Some of us have very mild or no symptoms and don’t require any intervention. Another group of women experience quite significant symptoms.”

Some women experience sleep disruption. Often, they experience fatigue, a lack of concentration or a “brain funk” the next day, Mazur said. Many gain weight.

Another common symptom is vaginal dryness, which “can lead to pain with intercourse,” Mazur said. “I’ve learned to always ask about this — if I don’t ask, a patient may be too embarrassed to bring it up herself.”

The combination of symptoms can drastically alter a woman’s quality of life, she said.

“On average, menopause symptoms will last seven years,” Mazur said. “So, if you have symptoms that are affecting your daily life, you should absolutely talk to your doctor.”

Estrogen or aging?

While more serious health concerns can develop during menopause, both physicians acknowledged it can be difficult to distinguish what is caused by changes in estrogen levels and what is brought on by aging.

For example, women tend to develop cardiovascular abnormalities more commonly in their 50s and 60s, whereas men tend to develop those issues sooner.

“It’s hard to say if it’s hormonal or aging,” Alons said.

In menopause, a woman’s cholesterol may jump, sometimes drastically, so it is important they get their cholesterol levels checked and talk to their doctor about heart health.

Bone health is another concern.

“Once the ovaries stop making estrogen, we see a lot more thinning of bones as women become postmenopausal,” Alons said.

Osteopenia and osteoporosis are both diseases of progressive bone loss that become more common in women after menopause. Prevention, including bone density tests, is key.

Treatment options

The good news is that the treatment options available are as diverse as the types and severity of symptoms accompanying menopause.

“We, of course, make lifestyle, health, diet and exercise recommendations when they are appropriate,” Mazur said.

The most common treatment for the symptoms of menopause is hormone replacement therapy — regulating the level of estrogen.

“There are lots of over-the-counter options out there, but they don’t usually have a ton of effect,” Alons said. “With hormone replacement therapy, there are many different formulations — pills, patches, topical lotions, vaginal preparations, laser therapy and more. So treatment can really be tailored to the needs of each woman and the severity of her symptoms.”

Adding estrogen back into a woman’s body carries the bonus of helping combat bone loss.

“There is nothing close to estrogen in prevention of bone loss,” Mazur said. “We do not prescribe estrogen for osteoporosis specifically — but if we start it for other symptoms, you also will get the added benefits of prevention.”

Many women, she said, “are scared of using estrogen due to possible side effects. But we will always assess a woman’s risk factors and health history before making a recommendation for hormone replacement. If you’re a good candidate for estrogen replacement, it can really improve your quality of life.”

Doctors also may prescribe antidepressants or sleep aids if a woman’s mood or sleep are drastically affected by menopause.

Do some research

When it comes to doing your own research on menopause symptoms and treatment, Mazur has some advice.

“Dr. Google is not always helpful and can be overwhelming,” she said.

But a “great” source of information, she said, can be found at the North American Menopausal Society website at menopause.org.

“Even if you are only approaching the age of menopause, it’s good to do some research,” Mazur said. “You can talk to your doctor about any questions you have.”

If concerns arise about treatment options, talk to your doctor for tailored, specific advice, she said.

Alons agreed — there’s no reason to go into menopause with unanswered questions or uncontrolled symptoms.

“More and more women are coming in with their concerns,” she said. “For a long time, menopause wasn’t talked about, so women suffered in silence. Now, there are lots of options for treatments available so you can live a healthy, comfortable lifestyle.”

Complete Article HERE!

What Women Over 40 With Amazing Sex Lives Have In Common

by Susan Hardwick-Smith, MD

When it comes to midlife and sexuality, what are the stories that need to be challenged if we want to be among the sexually woke? Inasmuch as these stories are causing harm or are not true, what might be a healthier way to view the same situation?

As an example, let me tell you how this worked for me. In my early-40s, life felt like I was on a conveyor belt going in one direction and largely out of my control. I was driven by a list of things I was supposed to do. Financial planners told me how much money I needed to earn and save to live to 95, to send my kids to an average of six years of private college, and to keep my invented life looking perfect from the outside. We predicted the rise and fall of the stock market for the next 50 years. Every morning, I got up and did what I was supposed to do. I made lots of money, won lots of awards, and made things seem amazing on Facebook.

My then-husband and I had complex wills, life insurance policies, disability policies, and every other imaginable tool to create the illusion that we had this life figured out and under control. I knew the precise date I was going to retire, as well as the date we were going to sell our home. I knew the dates our kids would get married, how much their weddings would cost, when I would become a grandparent, and the date each of us would probably die. Nothing was unknown.

If the goal of all this planning and attempting to manipulate the future was to provide a sense of safety and security, why did the idea of getting old fill me with dread? Why did following this nicely mapped-out path feel like I was being buried in an early grave? The fact was I had nothing to look forward to. There was nothing exciting or surprising to anticipate. Life had been wrapped carefully and stuffed into a box. Looking into the future felt like looking down a long, dark, narrowing tunnel. It was a death march.

At that same time, I was struggling with getting older. I was getting crow’s feet. Gray hairs became too many to pluck out. My sex drive was nonexistent. Women much younger than me were enjoying leadership roles and accolades and were prominently featured in the media. I could feel myself slowly being pushed out of the picture of what matters.

The real reason women’s sex lives decline over time.

After hearing Ben Zander talk about his book The Art of Possibility in 2010, the wall of that tunnel started to be a little more opaque. A little light started to come in. If there was light on the other side of those tunnel walls, what was out there? I read Zander’s book, and my curiosity started to rise. Within a few months, I was devouring a book every week and attending every seminar I could find on the subject of personal growth and spirituality. As my self-invented tunnel started to crumble, the future began to look quite different: an open field of possibility, openness, emptiness—a blank canvas ready for me to paint.

The degree to which this changed my life cannot be overstated, and all I did was change my perspective. Nothing “out there” changed. The only thing that changed was my ability to see it. I woke up.

Here’s an observation from 20 years as a gynecologist and 52 years as a woman. When you feel trapped in a box, you don’t want to have sex. Truly making love is generative, free, expressive, and creative. It’s a dance that takes place in an open field, not a dark tunnel. Love cannot be confined within walls. Trying to do so makes it die.

This observation points to one of the key findings of my research and perhaps the most important “secret.” It’s not aging that causes our sex lives to decline. It’s the feeling, conscious or subconscious, that we are trapped.

This is why women of all ages invariably have a spike in libido when they start a new relationship and why having a deep spiritual understanding (of something bigger than ourselves) is associated with a better sex life. The truth is we are not and never were trapped. We put ourselves in a prison but forget we hold the key. Outside those walls is a world of infinite possibility.

The sexual freedom that can come with age.

As I talked with the sexually woke, this theme came up over and over again. These women did not complain about aging; rather, they appreciated their newfound wisdom and freedom and universally described this as the best time of their lives. Surprisingly to me, many women shared similar images and metaphors to describe their own awakening. In Robin’s words:

“The idea of the fullness in life when we are younger is paradoxical because we tend to think of fullness related to success, achievement, money, and status. Then we find the futility when we get to menopause—the futility of trying to hold it all together. The first half of my life, I felt like I was building a very solid structure. That gave me some comfort. But then we literally start to see our bodies fall apart and realize that it’s all falling apart really. That solid structure was not based on anything real. My new house got old, my perfect kids grew up and didn’t do what the plan dictated, and my marriage fell apart. For me, the acceptance of that and letting go of the fantasy of solidity really let me enter the fullness of life. With the solidity of the walls I had created, I had no access to other possibilities. I was pretty delusional that life was solid. After my divorce, I was free—finally free to have that fullness of life and be available to meet someone I could be my full self with as my full sexual being. I’m 55, and life has never been better. As for sex, I’m only just beginning to find out where I can go with that. There’s no road map, no walls. I can go wherever I want. It’s beautiful.”

All of a sudden you have some space. You can finally ask those questions like, “What am I really here to do?” With that space to reflect, you can integrate yourself, pull all those pieces together, and really show up. People might call it a midlife crisis, saying, “Oh, she went nuts, left her husband, and moved to France.” But I don’t think that’s what it is. It’s an awakening. More like, “Oh, I’ve only been half here all this time.” When you’ve cut off your sexual being and then find it, it’s like you’ve been walking around without one arm then realizing that you have both. “Wow! Look at all these things I can do now with two arms!” Alexa shares another beautiful metaphor:

“I think of my sexuality as a sea snail, the kind with the coiled shell. For most of my life, my sexuality had lived inside a shell. For one thing, it’s not safe to be gay, so I hid. But now when I feel safe and happy, the snail will venture out of her shell and start to venture across the ocean floor and explore this unknown new world. I used to think the shell was a prison, but it’s really just a place to be safe if there’s real harm around. When I feel safe, there’s a door that I can venture out of and go as far as I want.

I’m 61, and I was thinking about women my age whose sexuality has gone out like the tide or at least they think it has. Then I started thinking about spaciousness, to live in the spaciousness of the unknown, of possibility. Inside the shell can feel safer, but I think an existence with spaciousness is what we are hopefully evolving into. There’s this ‘letting go of certainty’ aspect in sexuality that mirrors letting go into the spiritual life. For me, I think that’s how those two come together. There’s a huge element of letting go around the time of menopause. The reality of our finite life can be very freeing. There’s a letting go of needing to be a certain way, the way that conforms to being young. Instead of framing that as loss, to me it’s letting go of a whole lot of baggage and realizing your shell has a door. It’s freedom.”

I was amazed at how frequently words like freedom and liberation were used by the sexually woke in relation to midlife. This certainly wasn’t what I was taught! Freedom came in many forms: freedom from limiting beliefs, freedom from fear of pregnancy, and even freedom to make more noise or be more spontaneous without family in the house. Christine adds:

“Sex is so liberating now. I am past the baby stage. There’s no more waiting for a period to either get here or not and no more worrying about getting pregnant. I know what I like, and we are comfortable with each other. His body knows my body; it ‘listens,’ and it’s learned when to move left or right, keep going, stop, or try something else. Although we talk openly about sex, sometimes he just knows exactly what to do by the way my body is responding. It’s like we are in our 20s again but better because we’ve both learned so much and look forward to just being together.”

“It seems to me there are two possibilities. One is that you are still in a fog of years of youthful, idiotic, and delusional thinking, not really understanding things. On the other hand, now with some years and experience under your belt, you have a certain strength, clarity, and wisdom. I am starting to understand things. In the old days, they would have called me a crone. The wise old woman that the village would go to for advice. But maybe I can be a sexy crone. I feel better than ever. I don’t care so much what other people think. I am free to be myself. I can make love with my husband, and I am all here.”

Complete Article HERE!