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New treatments restoring sexual pleasure for older women


By Tara Bahrampour

When the FDA approved Viagra in 1998 to treat erectile dysfunction, it changed the sexual landscape for older men, adding decades to their vitality. Meanwhile, older women with sexual problems brought on by aging were left out in the cold with few places to turn besides hormone therapy, which isn’t suitable for many or always recommended as a long-term treatment.

Now, propelled by a growing market of women demanding solutions, new treatments are helping women who suffer from one of the most pervasive age-related sexual problems.

Genitourinary syndrome, brought on by a decrease in sex hormones and a change in vaginal pH after menopause, is characterized by vaginal dryness, shrinking of tissues, itching and burning, which can make intercourse painful. GSM affects up to half of post-menopausal women and can also contribute to bladder and urinary tract infections and incontinence. Yet only 7 percent of post-menopausal women use a prescription treatment for it, according to a recent study.

The new remedies range from pills to inserts to a five-minute laser treatment that some doctors and patients are hailing as a miracle cure.

The lag inaddressing GSM has been due in part to a longstanding reluctance among doctors to see post-menopausal women as sexual beings, said Leah Millheiser, director of the Female Sexual Medicine Program at Stanford University.

“Unfortunately, many clinicians have their own biases and they assume these women are not sexually active, and that couldn’t be farther from the truth, because research shows that women continue to be sexually active throughout their lifetime,” she said.

With today’s increased life expectancy, that can be a long stretch – another 30 or 40 years, for a typical woman who begins menopause in her early 50s. “It’s time for clinicians to understand that they have to bring up sexual function with their patients whether they’re in their 50s or they’re in their 80s or 90s,” Dr. Millheiser said.

By contrast, doctors routinely ask middle-aged men about their sexual function and are quick to offer prescriptions for Viagra, said Lauren Streicher, medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause.

“If every guy, on his 50th birthday, his penis shriveled up and he was told he could never have sex again, he would not be told, ‘That’s just part of aging,’” Dr. Streicher said.

Iona Harding of Princeton, New Jersey, had come to regard GSM, also known as vulvovaginal atrophy, as just that.

For much of their marriage, she and her husband had a “normal, active sex life.” But after menopause sex became so painful that they eventually stopped trying.

“I talked openly about this with my gynecologist every year,” said Mrs. Harding, 66, a human resources consultant. “There was never any discussion of any solution other than using estrogen cream, which wasn’t enough. So we had resigned ourselves to this is how it’s going to be.”

It is perhaps no coincidence that the same generation who first benefited widely from the birth control pill in the 1960s are now demanding fresh solutions to keep enjoying sex.

“The Pill was the first acknowlegement that you can have sex for pleasure and not just for reproduction, so it really is an extension of what we saw with the Pill,” Dr. Streicher said. “These are the women who have the entitlement, who are saying ‘Wait a minute, sex is supposed to be for pleasure and don’t tell me that I don’t get to have pleasure.’”

The push for a “pink Viagra” to increase desire highlighted women’s growing demand for sexual equality. But the drug flibanserin, approved by the FDA in 2015, proved minimally effective.

For years, the array of medical remedies has been limited. Over-the-counter lubricants ease friction but don’t replenish vaginal tissue. Long-acting mosturizers help plump up tissue and increase lubrication, but sometimes not enough. Women are advised to “use it or lose it” – regular intercourse can keep the tissues more elastic – but not if it is too painful.

Systemic hormone therapy that increases the estrogen, progesterone, and testosterone throughout the body can be effective, but if used over many years it carries health risks, and it is not always safe for cancer survivors.

Local estrogen creams, suppositories or rings are safer since the hormone stays in the vaginal area. But they can be messy, and despite recent studies showing such therapy is not associated with cancer, some women are uncomfortable with its long-term use.

In recent years, two prescription drugs have expanded the array of options. Ospemifene, a daily oral tablet approved by the FDA in 2013,activates specific estrogen receptors in the vagina. Side effects include mild hot flashes in a small percentage of women.

Prasterone DHEA, a naturally occurring steroid that the FDA approved last year, is a daily vaginal insert that prompts a woman’s body to produce its own estrogen and testosterone. However, it is not clear how safe it is to use longterm.

And then there is fractional carbon dioxide laser therapy, developed in Italy and approved by the FDA in 2014 for use in the U.S. Similar to treatments long performed on the face, it uses lasers to make micro-abrasions in the vaginal wall, which stimulate growth of new blood vessels and collagen.

The treatment is nearly painless and takes about five minutes; it is repeated two more times at 6-week intervals. For many patients, the vaginal tissues almost immediately become thicker, more elastic, and more lubricated.

Mrs. Harding began using it in 2016, and after three treatments with MonaLisa Touch, the fractional CO2 laser device that has been most extensively studied, she and her husband were able to have intercourse for the first time in years.

Cheryl Edwards, 61, a teacher and writer in Pennington, New Jersey, started using estrogen in her early 50s, but sex with her husband was painful and she was plagued by urinary tract infections requiring antibiotics, along with severe dryness.

After her first treatment with MonaLisa Touch a year and a half ago, the difference was stark.

“I couldn’t believe it… and with each treatment it got better,” she said. “It was like I was in my 20s or 30s.”

While studies on MonaLisa Touch have so far been small, doctors who use it range from cautiously optimistic to heartily enthusiastic.

“I’ve been kind of blown away by it,” said Dr. Streicher, who, along with Dr. Millheiser, is participating in a larger study comparing it to topical estrogen. Using MonaLisa Touch alone or in combination with other therapies, she said, “I have not had anyone who’s come in and I’ve not had them able to have sex.”

Cheryl Iglesia, director of Female Pelvic Medicine & Reconstructive Surgery at MedStar Washington Hospital Center in Washington D.C., was more guarded. While she has treated hundreds of women with MonaLisa Touch and is also participating in the larger study, she noted that studies so far have looked only at short-term effects, and less is known about using it for years or decades.

“What we don’t know is is there a point at which the tissue is so thin that the treatment could be damaging it?” she said. “Is there priming needed?”

Dr. Millheiser echoed those concerns, saying she supports trying local vaginal estrogen first.

So far the main drawback seems to be price. An initial round of treatments can cost between $1,500 and $2,700, plus another $500 a year for the recommended annual touch-up. Unlike hormone therapy or Viagra, the treatment is not covered by insurance.

Some women continue to use local estrogen or lubricants to complement the laser. But unlike hormones, which are less effective if begun many years after menopause, the laser seems to do the trick at any age. Dr. Streicher described a patient in her 80s who had been widowed since her 60s and had recently begun seeing a man.

It had been twenty years since she was intimate with a man, Dr. Streicher said. “She came in and said, ‘I want to have sex.’” After combining MonaLisa Touch with dilators to gradually re-enlarge her vagina, the woman reported successful intercourse. “Not everything is reversible after a long time,” Dr. Streicher said. “This is.”

But Dr. Iglesia said she has seen a range of responses, from patients who report vast improvement to others who see little effect.

“I’m confident that in the next few years we will have better guidelines (but) at this point I’m afraid there is more marketing than there is science for us to guide patients,” she said. “Nobody wants sandpaper sex; it hurts. But at the same time, is this going to help?”

The laser therapy can also help younger women who have undergone early menopause due to cancer treatment, including the 250,000 a year diagnosed with breast cancer. Many cannot safely use hormones, and often they feel uncomfortable bringing up sexual concerns with doctors who are trying to save their lives.

“If you’re a 40-year-old and you get cancer, your vagina might look like it’s 70 and feel like it’s 70,” said Maria Sophocles, founding medical director of Women’s Healthcare of Princeton, who treated Mrs. Edwards and Mrs. Harding.

After performing the procedure on cancer survivors, she said, “Tears are rolling down from their eyes because they haven’t had sex in eight years and you’re restoring their femininity to them.”

The procedure also alleviates menopause-related symptoms in other parts of the pelvic floor, including the bladder, urinary tract, and urethra, reducing infections and incontinence.

Ardella House, a 67-year-old homemaker outside Denver, suffered from incontinence and recurring bladder infections as well as painful sex. After getting the MonaLisa Touch treatment last year, she became a proslyter.

“It was so successful that I started telling all my friends, and sure enough, it was something that was a problem for all of them but they didn’t talk about it either,” she said.

“I always used to think, you reach a certain age and you’re not as into sex as you were in your younger years. But that’s not the case, because if it’s enjoyable, you like to do it just as much as when you were younger.”

Complete Article HERE!


Better Sleep Could Mean Better Sex for Older Women


By Robert Preidt

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Complete Article HERE!


Low sexual desire, related distress not uncommon in older women


By Kathryn Doyle

senior intimacy

Just because social attitudes toward sex at older ages are more positive than in the past doesn’t mean all older women have positive feelings about sex, according to a new Australian study.

Researchers found that nearly 90 percent of women over 70 in the study had low sexual desire and a much smaller proportion were distressed about it. The combination of low desire and related distress is known as hypoactive sexual desire dysfunction (HSDD) and nearly 14 percent of women had it.

Older people are increasingly remaining sexually active and sexual wellbeing is important to them, said senior author Susan R. Davis of Monash University in Melbourne.

“This is probably because people for this age are healthier now than people of this age in past decades,” Davis told Reuters Health by email.

A random national sample of women ages 65 to 79 was contacted by phone and invited to take part in a women’s health study. Those who agreed received questionnaires asking about demographic data, partner status and health history, including menopausal symptoms, vaginal dryness, pelvic floor dysfunction, depression symptoms, sexual activity and sexual distress.

Of the 1,548 women who completed and returned the questionnaires, about half were married or partnered, 43 percent had pelvic surgery and 26 percent had cancer of some kind. About a third had menopausal symptoms and one in five had vaginal dryness during intercourse.

In the entire sample, 88 percent reported having low sexual desire, 15.5 percent had sex-related personal distress, and women with both, who qualified for HSDD, made up 13.6 percent of the group, as reported in Menopause.

That’s lower than has been reported for this age group in the past, and similar to how many women report HSDD at midlife, Davis noted.

“Considering how conservative women of this age are, we were surprised that over 85 percent of the women completed all the questions on desire and sexual distress so we could actually assess this on most of the study participants,” Davis said.

Vaginal dryness, pelvic floor dysfunction, moderate to severe depressive symptoms and having a partner were all associated with a higher likelihood of HSDD. Sexually active women, partnered or not, more often had HSDD than others.

“We would never label women with low/diminished sex drive as having HSDD,” Davis said. “In our study 88 percent had low desire and only 13.6 percent had HSDD, this is because low desire is not an issue if you are not bothered by it.”

Vaginal dryness, associated with HSDD in this study, can easily treated by low dose vaginal estrogen which is effective and safe, she said.

HSDD was also associated with urinary incontinence, depressive symptoms and hot flashes and sweats, she said.

“Even talking about the problem with a health care professional who is interested and sympathetic is a good start,” Davis said. “Conversely health care professionals need to realize that many older women remain sexually active and do care about this issue.”

Complete Article HERE!


For Queer Women, What Counts as Losing Your Virginity?


I wanted, desperately, to know if the sex I was having “counted.”

After I hooked up with someone, I snuck out of bed and into the darkness of my balcony, alone. A nervous wreck, I texted my friend, practically hyperventilating because of something I’d never expected to worry about at all.

Hoping for an answer, I texted: Am I still a virgin if I had sex with a girl?

My friend asked what I thought, but I really didn’t know. The woman I’d slept with defined sex as penetration, so by her definition, we hadn’t had sex. She, as the older, long-time queer in the hookup, had the upper hand. I didn’t think it was up to me. After all, what did I know about the rules of girl-on-girl sex, let alone what counts as losing your virginity? Could it be sex if only half of the people involved thought it was?

To me, it felt like it had to be sex, because if not sex, what was it?

It was a panic I never expected to feel. I was super open-minded. I was super feminist. I should have been beyond thrilled and empowered by the fact that I’d had a positive sexual encounter. But instead of cuddling the girl I was sleeping with and basking in our post-sex glow, or even vocalizing my worry over whether or not we’d just had sex, I was panicking in solitude.

My identity has always been a blur—I’m biracial, bisexual, and queer—and it’s something that makes me feel murky, unsure of who I am. Virginity was just the newest thing to freak out about. I stood in the dark alone and tried to figure out, once again, how to define myself.

I wanted, desperately, to know if the sex I was having “counted.” And I’m not the only one.

While many people have a strained relationship with the concept of virginity (and whether or not it exists to begin with), for queer women, the role of virginity is especially complicated.

“Virginity is a socially constructed idea that is fairly exclusive to the heterosexual population,” Kristen Mark, Ph.D. an associate professor of health promotion at University of Kentucky and director of the sexual health promotion lab, told SELF. “There is very little language in determining how virginity is ‘lost’ in non-heterosexual populations. Given the relatively large population of non-heterosexual populations, the validity of virginity is poor.”

As a result, many of us are stressed out by the concept, and left wondering if there’s just something other queer women know that we aren’t quite in on.

For Sam Roberts*, the lack of clarity surrounding expectations of queer women made them hesitant to come out in the first place. “I didn’t come out as queer until I was 25,” they tell SELF. “I felt vulnerable because of the lack of understanding around queer sexuality. Certainly it has gotten better, but not having a model for what queer sex ([specifically] for [cisgender]-women) looks like via health class, media, or pop culture can make it hard to know how to navigate that space.”

Alaina Leary, 24, expressed similar frustrations the first time they had sex. “My first sex partner and I had a lot of conversations around sex and sexuality,” Leary tells SELF. “We were essentially figuring it out on our own. Health class, for me, never taught me much about LGBTQ sex.”

When you’ve been socialized to view penetration as the hallmark of sexual intercourse, it’s hard to know what counts as losing your virginity—or having sex, for that matter.

“For many queer women, what they consider sex is not considered sex from a heteronormative perspective,” Karen Blair, Ph.D., professor of psychology at St. Francis Xavier University and director of the KLB Research Lab, tells SELF. “So this can complicate the question of when one lost their virginity, if ever.”

“Even if one expands the definition of having lost one’s virginity to some form of vaginal penetration, many queer women may never actually ‘lose’ their virginity—to the extent that it is something that can be considered ‘lost’ in the first place.”

To be clear, relying on penetration as a defining aspect of sex only serves to exclude all those who aren’t interested in or physically capable of engaging in penetrative sexual acts—regardless of their sexual orientation. Ultimately, requiring sex to be any one thing is inherently difficult because of the limitless differences among bodies and genitals, and the simple fact that what feels pleasurable to one body can be boring at best, and traumatizing at worst, to another.

The lack of a clear moment when one became sexually active can make us feel like the sex we have doesn’t count.

We live in a culture that overwhelmingly values virginity, with “losing your v-card” still seen as a step into adulthood. It’s something that, as a former straight girl, I’d never even thought about, but, as a queer girl, I became obsessive over: When was I really, truly, having sex?

It was especially frustrating considering that my straight friends seemed instantly thrust into this status of adults in real, legitimate sexual relationships, while my relationships were being thought of as “foreplay” by the mainstream, rather than valid sex acts.

Apparently, I wasn’t alone in feeling this way. “We had straight friends who were having sex and doing sexual things in very defined ways,” Leary says. “One of my friends was obsessed with the ‘bases’ and insisted that her oral sex with her boyfriend didn’t count as sex because it was ‘only third base.’”

So what does that mean for those of us who will only ever engage in “foreplay?”

Considering the larger structures and cultural expectations that make queer women feel invalid, virginity is just another way that we’re left feeling somehow less than our straight and cisgender counterparts.

“The primary impact of the concept of virginity on queer women is an—even if unconscious—feeling of inferiority or oppression,” Dr. Mark explains. “We as a society place so much emphasis on virginity loss, yet it is a concept that is only relevant to a portion of the population. Women in general, regardless of sexual orientation, know they are sexual objects before they are sexually active due to the existence of the concept of virginity.”

Consider the fact that most young women first learn about sex in the context of virginity, which often exists under the scope of “purity.” This, Dr. Mark says, can make women feel “defined by virginity status.”

As a result, when queer women do have sex, and it doesn’t “count” as their virginity being “taken,” they can be left confused about the encounter and unsure of how valid their sexual relationships are to begin with.

At the end of the day, it’s up to queer women to define what virginity—and sex—mean for ourselves.

“I would encourage queer women to define their sexual lives in ways that make sense for them,” Dr. Mark explains. “If they have created an idea around virginity that makes it important to them, I encourage them to think about alternate ways to define it that fits with their experience. But I also encourage the rejection of virginity for women who feel like it doesn’t fit for them.”

This lack of an expectation (beyond consent, of course) when it comes to how you have sex can actually be freeing, in a way, Dr. Blair says.

“One of the best things that queer women have going for them in their relationships is the freedom to write their own sexual scripts in a way that suits them and their partners best.”

Complete Article HERE!


Sex advice from a youngster is no use to older couples



“When we first fell in love, we really didn’t know what the future would hold. We were in awe of love’s mysterious forces. But if our relationship has endured, it will have been thoroughly worked through and mirror our maturity in life. Love’s forces will have created a bond between us that radiates a quiet warmth. There is a welcoming space to share common interests and the joy of living. We perceive our own true individuality and treat our partners with respect and honour.”

If this is the picture of your relationship then you probably don’t have any issues with sexuality. It is woven securely into the tapestry of your relationship. For some couples, it’s a subtle thread. For others, it’s more colourful and vibrant.

However, if you’re wondering what has happened because sex isn’t thriving in your relationship, there is a lot of advice out there that won’t help you in the long run.

Forget about learning new sexual techniques. They won’t save your sex life. By now, you should know what works for you and what doesn’t. Forget about trying to retrieve the stamina you had in your 20s, 30s or your 40s. It’s better to appreciate the resiliency you’ve gained through experience.

Forget about taking pole dancing classes or buying expensive lingerie unless you truly think you will enjoy it. Forget about taking advice given to you by someone younger than you who think they know the real secret to a good sex life. If they haven’t experienced sex in an older body or in a long-term relationship, they probably don’t know what they’re talking about.

While trying something new may shake things up and make you look and feel differently in the short-term, sexuality is a living experience. It is a response from inside of you, not a reaction to an idea taken on from the outside. Rearranging things on the outside may help a little, but the real shift takes place by aligning your interior life with your outer experience.

You can begin by asking yourself some questions.

What’s it like being in your older body?

As we age, the exaltation of touch and sensation softens. That fiery, electric current that passes between young lovers gives way to a slow burning flame that is deeper and longer. We take our time. We notice that sensations become less localised, leading to a profoundly satisfying whole body experience.

In older bodies libido tends to decrease. For women it’s a common aftermath of menopause. For men, sex drive lowers more gradually and is definitely noticeable by around the age 62 when most men begin to experience difficulty in achieving or maintaining an erection. It takes more time to warm up. But the silver lining is that by spending time touching, kissing, and caressing, you can crawl into your partner’s skin, melting body and soul.

Intimacy or sex?

Intimacy is at the heart of a strong relationship. It is the experience of emotional closeness when two people are able to reveal their true feelings, thoughts, fears and desires. They are completely free in each other’s presence. When sex comes from a place of love and connection, it is the physical embodiment of intimacy.

Although sex and intimacy isn’t the same thing, they are inextricably linked. Intimacy builds sex and sex builds intimacy. Intimate sex can be deeply fulfilling whereas sex without intimacy can be very unrewarding.

What if sex is no longer a part of your relationship?

While sex is an integral part of many relationships, some couples don’t have sex anymore. This may have happened through circumstance such as when one person became ill or simply because sex slowly disappeared in importance over the years.

If sex is a very subtle thread in the tapestry of your relationship, it’s important not to abstain from all physical contact. Hugging, kissing, holding hands and cuddling heighten awareness and awaken the senses. It’s a way of getting to know each other as if for the first time.

Complete Article HERE!