Knowledge

As we get older and our hormone levels drop, we experience changes in our tissues, our sensitivities, and our responsiveness. If we understand these normal changes, we can keep our bodies and minds in shape for continued sexuality, and we can compensate when we need to. At this stage in our lives, we may be "high maintenance," but it's worth the effort! Our recipe for continued sexual health starts with Knowledge and continues with the other tabs, above, across the page.

Start to learn by clicking on any of the statements at right that "sound like you." If you experience — or suspect you may have — any of the conditions listed below, click to understand it more fully and learn what to do about it. There are definitely actions you can take to stay healthy!

First published 02/16/2010 Last updated 06/27/2011

Any of these conditions may affect your sex life now:

It might be hernia repair, a hysterectomy and menopause,
Some women reach midlife without ever experiencing strong arousal or satisfying sex.
Most of us have worked all our lives to develop a good body image--what a complicated concept!
Sexual trauma is, unfortunately, a history too many of us share. Every two minutes, in the U.S. alone, a woman is raped.
Deep pain with penetration, especially with thrusting, is often caused by pelvic problems, and should be explored with your doctor if it is...
Is your relationship unsafe? For many of us, that's not an easy question to answer. We each have basic rights for physical and emotional safety.
The most common reason for declining interest in sex among women at any age?
Vaginal dryness, often the first signal of vaginal atrophy, is a common obstacle to comfortable sex for midlife women.
When is your libido too low? It’s low if your lack of desire causes stress or unhappiness for you.
"It's like hitting a wall," say our patients with vaginismus. This is a condition in which the involuntary muscles of the vagina go into vaginal...
What, if anything, should we do about our sexual health if we have no sexual relationships? Midlife women are often without sex partners.
A vaginal discharge that some people think is kind of smelly, itching that can be light or furious, and irritation or pain are the key symptoms of...
A common source of pelvic and vaginal discomfort attends the "prolapse" or shifting of our pelvic organs after childbirth, hysterectomy, or with...
Pain in any part of your vulva -- the mons, outer or inner labia, the clitoris or vestibule, that cannot be attributed to any other cause, is called...
Midlife comes with aches, pains, limitations. We don't bounce the way we used to. Some of us have lost strength in our limbs.
If you’ve never had an orgasm, or have stopped having them, you have lots of good company.
By midlife many of us have been in our relationships for decades, have endured ups and downs together.
At midlife many of us are dating, some of us starting to date again after many years with the same partner.

Recent blog posts

If you’re a regular reader of the MiddlesexMD blog, you might think I’m a broken record on the topic of the dearth of pharmaceutical tools to address hypoactive sexual desire disorder (HSDD). That...

We received this submission from UK-based kindred spirits, looking to maintain intimacy for women–and their partners–just as long as they choose. Erectile dysfunction affects millions of men in...

Sjogren’s is an immune system disorder most commonly identified by dry eyes and dry mouth, but vaginal dryness is among the additional symptoms. For a vaginal moisturizer, be sure you’re starting...

You describe hot flashes and night sweats that began after a hysterectomy to reduce breast cancer risk. You’re right that the symptoms can be prompted by your sudden entry into menopause (through...

I’m a gynecologist. I talk about sex and body parts all day long, and I have for 25 years. I guess I take a certain amount of openness for granted. I see intimacy as a cherished part of...

The pelvic floor is made up of multiple muscles and supporting tendons. They act like a hammock or trampoline to support a number of vital organs: the bladder and urethra, uterus and vagina, and...

You ask about vaginal pH (the abbreviation stands for ‘potential hydrogen,’ a measurement of acidity). The scale for measuring pH is from 0 to 14, with a lower number meaning more acidic and a...

While the cream you describe would be fine with the dilators themselves, we doctors recommend against using oils in the vagina. Oils tend to promote the growth of bacteria and break down or weaken...

Given all of the unpredictability of perimenopause, you’re wondering which symptoms carry over into menopause and which are resolved: Will you feel your best all the time? Or your worst? I so wish...

Many of the women I see in my office would like a black and white answer: Where, exactly, are they on the path to menopause? What, exactly, can they expect? Unfortunately, I can’t really give them...

As you suspected, the “vaginal cuff” is the healed incision at the top of the vagina after the surgical removal of the cervix and other pelvic organs. The vagina is just as functional as it was...

The dryness, discomfort, and frequent infections you describe are consistent with vulvovaginal atrophy (now sometimes called “genitourinary syndrome of menopause”) and, possibly, vulvodynia. The...

The MiddlesexMD team and I spend some time at medical conferences, so I know that vaginal dilators aren’t a mystery just to a lot of women: They’re also a mystery to some medical professionals!...

Perhaps you’ve seen reviews of a new book, called Sex After…: Women Share How Intimacy Changes as Life Changes. It’s definitely in my reading pile. The author, Iris Krasnow, interviewed 150 women...

Remember in middle school (we called it junior high in those days) when the boys and the girls were shepherded into separate rooms for those awkward films? It might have been presented by the gym...

Let’s first acknowledge that women—and men, too—come to sex with a host of different backgrounds, value sets, cultural expectations, emotional foundations, and experiences. It’s very difficult,...

What you ask about specifically is your clitoris, which, along with other genital tissues, does typically shrink with the loss of estrogen—whether through menopause or some other medical event....

That sounds like a bad riddle, right? Like one I heard on NPR last week: What goes up a hill and down a hill but doesn’t move? The answer to that one is a road. And the answer to what subtracts...

Itchy beyond words. Crotch of underwear rubs painfully against labia. Sensation of being on the receiving end of a vulvar wedgie. Feels like tiny razor blade nicks in my vagina during intercourse...

Surely this has happened to you: You read one article, and it leads you to another. From that second article, you’re pointed to another. Before you know it, you’ve spent an hour diving into a...

A couple of weeks ago, I talked about an article I’d seen about how sexual intimacy is linked to marital happiness. The research, by Adena M. Galinsky and Linda J. Waite, found that continued...

I referred a few weeks ago to the controversy surrounding recommendations for the frequency of mammograms. A conversation over the weekend reminds me that there’s a similar fog surrounding the...

I wish there were a “secret sauce” that worked for all of us to restore libido. Not surprisingly, it’s more complicated than that. It’s somewhat unusual to have an abrupt change to libido; for...

One of the motivations for my work with women both in my practice and through MiddlesexMD is the difference staying sexy makes for women in their relationships. I’ve heard anecdotes on both sides...

As a menopause care provider, I have lots of conversations with women about sex. I’ve heard confirmation that our motivations to have sex change with our situations. What motivates us when we’re...

I don’t always catch AARP The Magazine, I suspect because I’m still adjusting to thinking of myself as part of their demographic. But the most recent issue contained an article I’m glad I saw: “...

You may be among the 4 percent who won’t experience orgasm–who, for some reason, simply can’t, under any circumstances. It’s more likely that you’re among the 96 percent who can. When a woman...

The loss of estrogen that comes with menopause results in thinning of urogenital tissues, which include the vagina, vulva, and urethra. Because those tissues are thinner, they can be more fragile...

First, let me assure you that you’re not alone in feeling a loss of libido: It’s common for women to lose desire, even in great, emotionally supportive relationships. Low desire is challenging to...

We had a focus group a couple of weeks ago, a gathering of women to check in on what’s on women’s minds. One of the questions we asked was to whom women talked about sex—beyond their partners—and...

Women are not men. No surprise, right? In many parts of our lives, we know that. When it comes to sex, though, many of our expectations—and those of the experts who advise us—are still based on...

Breasts play a role in our sexual response, as I’ve described before. Our nipples are bundles of nerve endings that respond to touch. Some women (though not most) can reach orgasm through nipple...

It’s going on eight years since I transformed my medical practice. I studied and became certified by the North American Menopause Society as a menopause care provider, and while welcoming patients...

My last blog post, about thinking about sex as we think about exercise to encourage us to keep our sexuality alive, reminded me of another article I saw a while back. In “Men Don’t Think about Sex...

There are many benefits to being sexually active: It releases estrogen and increases oxytocin, serotonin, endorphins, and immunoglobulin A. This chemical and hormonal stew makes us both feel and...

What you describe—pain and a burning sensation around your clitoris—is most consistent with vulvovaginal atrophy. As we lose estrogen, the genital tissues thin, and the labia and clitoris actually...

For every reader of a study, there’s a different headline. That’s my conclusion after reading The Lancet’s publishing of the findings from the British National Surveys of Sexual Attitudes and...

You say that you’re both excited and anxious about being with your partner, but that you’re tense with him and haven’t experienced this before. Let me first say that there’s no magic pill that...

We’ve been following the development of Flibanserin, also called “pink Viagra,” since 2010, when its developer shelved it after hitting a bump in the road to FDA approval. Several years later, we...

I rarely recommend water pills unless a patient is in heart failure and we need to decrease the fluid load on her heart and kidneys. Bloating is usually related to gastrointestinal issues, and...

The more I work with women in my practice, the more I recognize that the science of human sexuality is young. For most of the last century, we assumed that men and women approach sex in roughly...

The best option for what you describe is a regular routine of vaginal moisturizer use; use it consistently at least two times a week. Add a lubricant at the time of intercourse to assure your...

You’re wondering whether your hormone therapy, designed to address your hot flashes, is having an unintended negative effect on your libido. The good news is that adding estrogen is better for sex...

Had you asked Charles Darwin why people have sex, he would say that it’s all about procreation. You know, survival of the fittest and fastest breeders and all that. Had you asked 1,500 students at...

There is really no definitive definition of “rough sex”; even resources devoted to BDSM (bondage, discipline, sadism, masochism) leave the field pretty open. Every individual has her own...

Great question! Unfortunately, there’s enough controversy about the answer to have warranted a whole blog post on the subject. The short answer, though, is that the G-spot (named for the German...

What you describe could well be vaginismus, which is the involuntary spasm of pelvic floor muscles of the outer (lower) third of the vagina. The resulting interference with intercourse is...

You mention a variety of things that play a role, all coinciding with the change in hormone levels that comes with menopause, which you’ll reach in a few more months (the milestone is one year...

It’s highly unlikely that Estring would cause liver damage, so no, you needn’t be concerned. Estring releases estrogen locally, in the vagina; this is not metabolized through the liver. We do know...

Few things affect quality of life like lack of sleep. Nothing kills the jazz or even dulls the everyday ho-hum routine like that head-in-a-fog, feet-in-the-mud feeling of too little sleep. And sex...

It sounds like you’ve done a great job with regular, sustained use of dilators to restore the vaginal opening. Be aware that the top of the vagina tapers a bit, so it’s possible that the largest-...

Chocolate/vanilla. Black/white. Either/or. By now we know that life is a lot more nuanced. It’s an infinity of shades of gray. (Also a lot more flavors of ice cream.) Recently, a quiet phenomenon...

Localized estrogen is not thought to be absorbed systemically, which means that blood estrogen levels remain in the menopausal range; if there is any absorption, it is scant. At that level, it...

In my practice, I typically ask to see a patient again three months after I’ve prescribed localized hormones. That’s so we can check in to see whether the therapy is addressing the symptoms as we...

Estrogen–and vaginal moisturizers–generally lower the pH level, making it a more healthy environment. The vagina is typically slightly acidic, like tomatoes or wine. The loss of estrogen with...

Recently, I was browsing through an online discussion board about the pros and cons of hormone replacement therapy. I ran across this comment from a participant: “I’m going to try bioidentical...

When women in my practice have vaginal dryness or atrophy, I typically start by recommending a vaginal moisturizer. The key is to be faithful, using the moisturizer at least two times each week....

You refer to hot flashes, weight gain, mood swings, and loss of libido as symptoms of menopause, and all of those happen for some women. Menopause doesn’t equate absolutely to those symptoms for...

This is the kind of question that makes me grateful to have Mary Jo Rapini, who specializes in relationship counseling, as an advisor to MiddlesexMD. When I shared some of your story with her, she...

Maybe you gathered from last week’s post that the clitoris is command central of the female orgasm. Perched atop the labia minora, its sole purpose and function is sexual pleasure. It has more...

I assume that your hormone therapy is oral or transdermal and systemic. There isn’t evidence that says hormone therapy contributes to weight gain. In fact, some of the research suggests that it...

Let’s start with anatomy and etymology, shall we? The clitoris is a small button-like protuberance located at the top of the labia minora (the “little lips” inside the vulva). Clitoris comes from...

What you describe—clear, odorless fluid released when the “right spot deep inside” is stimulated—is classic “female ejaculation.” The fluid comes from the Skenes glands located along the front (...

Here’s the scene. A “mature” couple is sitting companionably together in the living room, reading. He looks over the top of his paper. “Hey, Snookums, you look remarkably fetching tonight. Want to...

Autumn can be a tremendously busy time of year when work ramps up and social obligations resume. Or it can herald a return to peaceful calm after summer frenzy. Full disclosure: There’s nothing...

Many women go through menopause with little more than irritability and hot flashes. In our last blog post, we reviewed research that suggests, though, that if you’ve experienced postpartum...

We’ve talked about depression during menopause. It’s a common, joy-sapping beastie that rears its ugly head during this time of whacked-out hormones and middle-age adjustment. After all, what with...

Overall, estrogen is helpful to libido and sexual desire. Oral (systemic) estrogen can have the unintended effect of decreasing testosterone, which is linked to libido in women as well as men. The...

Pity the poor chimpanzee. She lives scarcely 40 years in the wild, bearing young the entire time. She is fertile throughout her lifespan, growing old and gray while birthing baby chimps to the end...

What you describe is a natural result of the loss of natural estrogen through menopause. There are a number of localized estrogen options, including Estrace and Premarin creams, Vagifem tablets...

Out of sight; out of mind. That’s how it is with the vagina. As long as it’s working and isn’t causing a fuss (which, granted, becomes more iffy at this stage of the game), we forget about it....

Life is scary after a heart attack. You’re not sure what to expect. You may be depressed. You’re probably on several medications. You may be confused about what you’re allowed to do and when. Like...

Yeast infections occur when there’s an overgrowth of yeast that inhabits the vagina normally. Yeast isn’t transmitted from men to women. A healthy vagina is slightly acidic, measured by pH level....

I suspect you’ve been reading the fine print on an advertisement or packaging for one of the estrogen products—for which I congratulate you! It’s good to learn as much as you can about your...

For years, the dominant theory among anthropologists and evolutionary biologists has been that men are lusty, sexual creatures, primed by eons of evolution to spread their seed far and wide,...

It all began when entrepreneur Peter Ehrlich took a stroll through a vegan food fair in Toronto. If your livelihood depends on generating ideas, I guess that part of your brain never sleeps....

Can’t remember the name of the new work colleague? Forgot the city your best friend lives in? Can’t recall the movie you saw last week? Join the club. A little-known fact about loss of estrogen is...

I had never thought of bringing together these two very personal and powerful actions until I read this post by psychotherapist and MiddlesexMD advisor Mary Jo Rapini. She writes, “One method not...

Estring, a vaginal ring, is one method for delivering localized hormones—in this case estradiol. The ring itself includes silicone polymers, so I recommend to my patients that they use a water-...

A definition first: The endometrium is the mucous membrane that lines the uterus. For women who have had hysterectomies, the endometrium is not an issue in planning hormone therapy (HT). For...

An older couple walked into the therapist’s office. The marriage had been a bit rocky from the get-go, but now the woman had completely lost interest in sex. The therapist recommended that the...

In my line of work, I’ve looked at a lot of lady-bottoms, and I can tell you that “normal” female anatomy is extremely diverse. We are each as unique “down there” as we are in every other body...

This is a common question; unfortunately, it’s complicated to answer. First let me say that while I know weight gain affects many women’s sense of being desirable, what I read and my own informal...

Ever since Flibanserin was shelved after FDA rejection, the search for the next drug to treat lack of libido in women has been mighty low-key. To be sure, there were legitimate concerns about...

So glad you’ve been successful with the dilators you ordered from MiddlesexMD! Vaginal dilators can help to restore capacity and comfort for intercourse. Our website has instructions for how to...

As we grow older or experience physical changes, our sexual abilities may change. Oral sex is one alternative, as is anal sex, although that has some drawbacks. There are also variations called “...

In my last post, I talked about how we construct our body image from childhood experience, media messages, and social definitions of beauty. Body image is the result of our own internal dialog,...

O wad some Power the giftie gie us To see oursels as others see us…          —Robert Burns As Mary Jo Rapini discussed in her excellent post about body image, the way we view our bodies—our body...

I don’t know about you, but celebrating New Year’s Eve has become as exciting as a dirty sock under the bed. What happened to the crazy parties with friends? What happened to Auld Lang Syne and...

A young woman I know went to the hospital to have a baby. She packed all the things she thought she needed to keep her comfortable during labor—a big ball to sit on; small balls for back pain,...

In a previous post, we began exploring ways to engage all our senses when we make love. Today, we pick up where we left off. Sight. Of all the senses, we humans rely heavily on eyesight. So why do...

The pain that you describe sounds like vulvovaginal atrophy, and possibly vulvodynia (vestibulodynia). These conditions can both be treated, but need the attention of a physician for an accurate...

Sex is all about the senses. That’s why “sex” is the fraternal twin of “sensual,” which broadly refers to “voluptuous gratification of the senses.” Now, I ask you, what is more voluptuously...

Diabetes has slightly more impact, statistically, on men’s sexual function than on women’s, but about half of both are affected. There are multiple reasons, most likely, which include neuropathy (...

Perimenopause, also called menopause transition, starts with variation in menstrual cycle length. Cycles can go from every 28 to 30 days to every 21 to 24 days—or 21-40 days. Cycles that are...

Breast cancer doesn’t really have much in common with sex. But I know it’s hard to be very interested in sex when you have cancer or are recovering from cancer treatments or are working to feel...

Hypothyroidism, which is a low-functioning thyroid gland, is quite common in women; about one in eight will have thyroid disease in her lifetime. Interestingly, there’s been little research in...

Feeling gratitude and not expressing it is like wrapping a present and not giving it. —William Arthur Ward The good thing about holidays is that they give us an opportunity to reflect (if we’re...

We know about muscles. We use them; maybe we tone them; maybe we watch them get saggy over the years. But the vagina? Yep. That too. Our pelvic floor is encased in muscle. And just like all the...

I once knew a crusty old farmer who refused to acknowledge the existence of daylight savings time. Ask him the time during spring or summer, and he’d respond, “Do you want the real time?” To...

The North American Menopause Society (NAMS) has just published its seventh position statement about hormone therapy in the ten years since the Women’s Health Initiative (WHI) linked a whole bunch...

Did you know that the whole idea behind MiddlesexMD is based on a recipe? You could call it the MiddlesexMD formula for really juicy sex. Officially, we call it “our recipe for women’s sexual...

One of the advantages of having an advisory board is the different perspectives we bring to the same set of problems. In our last conversation with Mary Jo Rapini, the issue of body image came up...

Sometimes we medical people get to hear about medications and treatments before they hit the doctor’s offices and pharmacies. Recently, MiddlesexMD advisor Dr. Michael Krychman interviewed Dr....

The MiddlesexMD team and I have just come back from representing what we do at two conferences in Orlando. The first was the gathering of the North American Menopause Society; the second was the...

As we saw in the last post, vibrators were developed by doctors in the late 1800s to replace the “pelvic finger massage” they routinely administered to female patients. The massage was intended to...

Just released on September 21, Hysteria is a light comedy about a dark and silly time. So touchy is its topic, in fact, that it took the producer, who is a woman, about ten years to find a studio...

I hear from a number of women that although they’re in long-term relationships, they’re feeling alone. Sometimes this becomes apparent as part of adjusting to other changes—like sending the last...

Last week I wrote about the STRAW guidelines and STRAW + 10, an update based on the review of research done in the 10 years since the original guidelines were published. Because not all of us have...

About ten years ago, a group of medical professionals put their heads together to create a set of guidelines that would chart the course of normal menopause in a more systematic way. They came up...

The changes that come at midlife sometimes mean that we need to recognize that we’ve fallen in a rut—whether in our health habits, relationships, or sex lives. Mary Jo Rapini, a MiddlesexMD...

The American Association of Retired Persons (AARP), the venerable group that’s always looking out for our best interests, has completed three major surveys of the sexual behavior of midlife (and...

Sexual health always follows general health, so it’s hard to enjoy sexual health with other chronic conditions. Obesity is a known risk factor for heart disease, stroke, sleep apnea and other...

Our culture sends lots of messages about sex, through TV shows and movies, articles, girlfriend talk, and “wisdom” from our mothers (some of it really was wise!). Some of these messages become...

Before Sex and the City, before Gloria Steinem, before Jane Fonda, there was Helen Gurley Brown. She was the creator of the iconic Cosmo Girl, wearer of organza and décolletage, and advocate of a...

The editor of the MiddlesexMD newsletter, who somehow knows these things, tells me that August is Romance Awareness Month. Who knew? According to an online poll by Zoosk, which calls itself a “...

We talk a lot here at MiddlesexMD about female side of sex, how to keep your libido alive and your sexual experience comfortable and pleasurable. But we often take the male orgasm for granted (or...

According to a recent New York Times article, women now have available a plethora of products meant to boost “feminine arousal.” And they’re appearing not behind the pharmacist’s counter, but in...

Recently, I was interviewed by Dr. Michael Krychman, a gynecologist and MiddlesexMD adviser, about the 50 Shades of Grey series. In case you’ve been, um, visiting another galaxy for the past few...

From what you describe, you sound like a typical patient of mine! About 4 percent of women never can have an orgasm. “Orgasmic dysfunction,” or difficulty with orgasm, is reported in 9 to 27...

Lichen Slerosis is a skin disorder that most often appears in the genital area. Early on, there are small white spots, which grow and become thin and brittle over time. We’re not quite sure of the...

Recently, I took a photo of my college-age daughter. I saw a beautiful young woman in a candid moment—smiling, long hair blowing in the breeze, everything youth should be. Her reaction? “Look how...

Let’s face it. When you get to this stage of the game, and especially if you’ve been with the same partner for years, you may be wondering whether sex is really worth all the bother. Is it really...

Humankind has relied on medicinal plants for thousands of years. From that perspective, treatments like estrogen therapy (ET) are a flash in the pan. And with insecurity about prescription oral ET...

Recently, Dr. Sheryl Kingsberg, chief of behavioral medicine at University Hospitals Case Medical Center, professor in Reproductive Biology and Psychiatry at Case Western Reserve University, and a...

In an earlier blog post, Dr. Susan Kellogg Spadt, PhD, CRNP, a MiddlesexMD advisor, referred to vulvar discomfort that may be caused by contact dermatitis. Because this is a common condition, I...

You say your physician is reluctant to prescribe any hormones because you had a pulmonary embolism 10 years ago. After a hysterectomy, you’re coping with physical issues reasonably well, but have...

Even if you’ve been an emotional Rock of Gibraltar throughout your life, menopause can brew up a perfect storm for jittery moods, anxiety, and depression. And in addition to its psychological...

First of all, know you’re not alone. By some estimates, as many as one in ten of us has never experienced orgasm, and among those of us who have, it happens in only about half of our sexual...

A woman I know was sitting in a café with her lover. Newly single after having been married for many years to her first and only sexual partner, she was babe in the sexual wilderness. She didn’t...

I often recommend that people try the North American Menopause Society’s (NAMS) website. NAMS has a rigorous process for certification, so the health care providers who are a part of it are likely...

About one in five women smoke. If you’re part of that 20 percent, I’m sure you’ve heard all the warnings and finger-wagging about the health hazards of smoking. Maybe you’re tired of hearing about...

One of the advantages of having a medical advisor team is that I can hear reports from events I can’t attend! Michael Krychman, part of the team and medical director of The Sexual Medicine Center...

You say you were diagnosed five years ago with fibroids, and you’ve reached menopause (one year without periods) quite recently. The good news is that fibroids tend to shrink in menopause, so they...

We’ve discussed when you might want to look for a new health care provider. MiddlesexMD advisor Dr. Sheryl Kingsberg minces no words on that point: If your health care provider isn’t addressing...

I get occasional questions about erotic use of various household objects. I am, after all, long trained as a physician, so safety and hygiene are among my first concerns. And, since starting...

Dr. Sheryl Kingsberg is a MiddlesexMD advisor and a psychologist specializing in women’s sexual health. She talks to physicians a lot about why it’s important to at least ask about a patient’s...

The provider-patient relationship is delicate and fraught with opportunity for misunderstanding. On one hand, you have a busy professional in a somewhat risky, stressful profession who is pressed...

When was the last time your doctor asked you how your sex life was going? I thought so. In a new study, a team from the University of Chicago surveyed over a thousand OB/GYNs about whether they...

Dear beloved partner of mine: If you read my last letter (you did, right?), then maybe you understand how I feel—and how to make me feel better—sexually speaking. So let’s stop beating about the...

You know that we always encourage you to exercise. Keeping fit is excellent for your overall health, and it keeps you sexually tuned up as well. You have more energy; you have a better self-image...

Tightening of the vaginal opening is one of the effects women can experience from the loss of estrogen. The type of lubricants that offer the most “slipperiness” and the least resistance is...

Dear beloved partner of mine: We’ve been together for a long time. We’ve weathered some storms; we’ve had our ups and downs. The kids are raised; the house is ours again. These should be our...

If you’re experiencing some irritation with clitoral stimulation, you might start with a hybrid (Liquid Silk or Sliquid Organics) or a silicone lubricant (Pink, Pjur, or JO). They provide more...

If one-third of women don’t fantasize and rarely feel sexual desire, does that mean they’re all sexually dysfunctional? (Actually, the term is “hypoactive sexual desire disorder.”) Or does it mean...

In our little roundup of sexually transmitted infections, maybe you’ve noticed that many of them have no symptoms, and others mimic common illnesses like the flu or a urinary tract infection. The...

In a post last week we established that folks over 50 are reentering the singles scene with seriously outdated information about the sexually transmitted infections (STIs) that have become...

There are a number of pieces to this puzzle–we women are complicated! First, because your hysterectomy was “complete,” you no longer have ovaries, which are a major source of testosterone (up to...

You say the skin is becoming lighter and sometimes is dry, sometimes moist or itchy. That sounds completely consistent with the changes of vulvovaginal atrophy (VVA), which results from the...

Sit down, Girlfriend. We need to talk. Remember those uncomfortable discussions you had with your kids back in the day? You know, the birds-and-bees and how-not-to-get-pregnant talks? Well, now it...

We’ve discussed the research: Older women “do it,” and like it, a lot! Beneath the sheets, we’re a lusty bunch, but get out on the streets, and we become invisible. No checking-you-out eye action...

You’re right to be concerned, since the vulva and opening to the vagina can be easily irritated–and more so after menopause without estrogen therapy. Vitamin E oil can be used both for massage and...

What makes sex feel so good? What ignites passion and sustains attachment? What is it that makes your heart flutter? And how can you keep those feelings alive, especially in the bedroom, after 10—...

Last month MiddlesexMD advisor and psychotherapist Mary Jo Rapini shared some advice about how to restore your sense of sexual self after divorce. That conversation led to another, about some of...

When “intimate massagers” are placed between the flannel pajamas and the birdhouses in the Vermont Country Store catalog you know that vibrators have gone mainstream! The ad rightly points out...

HPV is an unlikely cause for pain with or after intercourse. It’s associated with abnormal pap tests, which may require further investigation—like the biopsy you say you had. Much less commonly,...

Remember the G-spot brouhaha? Yes, there is one. No, there isn’t. Is. Isn’t. If you were aware of that controversy you might wonder whatever happened to it. Was anything about the mysterious G-...

I’ve talked before about dyspareunia, or pain with sexual intercourse. It’s a common problem; up to half of us are affected at least once during our lifetimes. This issue is a special focus for...

In a post last week I talked about the very important pelvic floor muscles—that springy base that supports our pelvic organs and controls the orifices that pass through it. While it’s pretty...

An advisory board discussion turned to our experiences as professionals supporting women who find themselves newly single, often after a divorce. I asked Mary Jo Rapini, one of our medical...

The pelvic floor may be the most neglected and underrated part of our anatomy—on the level of the pinkie toe or the back of the knee. But for sheer impact on our quality of life, we neglect the...

It’s official. The American Heart Association (AHA) has just released its most comprehensive guidelines ever regarding sex for patients with heart disease. The bottom line: Sex is safe after a...

The stroller is in mothballs, along with the Little League jersey and the Cub Scouts uniform. Just when the kids can brush their own teeth and maybe drive themselves to hockey practice, just when...

A male reader wrote to me recently. He’s “turned on” at the thought of his wife using a vibrator and wants to incorporate it into their sex life. The problem is that his wife is “creeped out” at...

Hm. We could have told you that. Recently, we reported on the results of an international survey that explored how satisfied older couples are with their relationships and sex lives. Turns out...

That’s one of the questions MiddlesexMD medical advisor and sex therapist Sheryl Kingsberg often hears. I asked her to write about how she answers it. Each of us is unique, with varied interests,...

You’ve been through a lot. After surgery or chemo or radiation therapy, you may feel like you inhabit the body of a stranger—it doesn’t look, feel, or behave like the body you once knew so...

Estimates say that up to a fifth of heterosexual couples have anal intercourse at least intermittently, more rarely exclusively. The risk of sexually transmitted infections is the same or perhaps...

At MiddlesexMD, our approach to sex at midlife didn’t spring to life fully formed. In fact, it’s the result of a lot of thought and discussion about the kind of information women need during and...

I posed this question to Mary Jo Rapini, an advisor to MiddlesexMD and a therapist, writer, and speaker. Here’s her advice: You’re not alone in your feelings of being married to a man who cannot...

Until recently, no one has given much thought to the sex life and relationship satisfaction of middle-aged couples in long-term relationships. You know, ordinary people. So no one knows what keeps...

Suzanne Somers touts them in her bestselling book, Ageless: The Naked Truth about Bioidentical Hormones. Oprah promotes their use. On the other hand, the Harvard Medical School, the North American...

Absolutely you can, and I often recommend that women use both. Both vaginal estrogen creams–like Estrace–and vaginal moisturizers–like Replens–are typically used twice a week. Because each needs...

Estrogen is the queen of hormones. From our brains to our bones to our bottoms, estrogen keeps our systems regulated, lubricated, elastic, and running smoothly. Estrogen doesn’t just trigger...

You may not be able to leap up from a lotus position in a single bound. (Heck, you may not even be able to get into a lotus position.) You may find your back a little cranky when your two-year-old...

Breast discomfort, bloating, acne, and cramps are all symptoms associated with perimenopause, I’m afraid. If your periods are irregular but still happening, what’s going on is that your ovaries...

My conversations with patients, blog readers, and visitors to MiddlesexMD tell me that once a person’s gotten past her own discomfort with the idea of a vibrator, there can lurk another obstacle:...

In the course of our conversation about vibrators, I asked MiddlesexMD medical advisor Dr. Michael Krychman how he recommends that his patients begin to use a vibrator. Here’s what he says: “Get...

If you’ve followed this blog for a while, you know that I’m a fan of vibrators. From talking to my patients, I’m well aware that not everyone is as comfortable with the idea—and the reality—of...

Maybe you remember reading Our Bodies, Ourselves in the 1970s. Maybe for you, as for me, it demystified your own anatomy. Maybe that knowledge empowered you with a sense of self-determination. For...

Libido is, at best, complicated. Testosterone is the hormone that is linked to libido for women as well as men. After about age 25, our testosterone levels are slowly dropping. It’s estimated that...

Whether you were already menopausal or were abruptly deposited into menopause after treatment for your cancer, you’re probably familiar with what happens to your vagina when you lose estrogen. You...

I’m glad to hear that a vibrator has been helpful to you! Women our age often need extra stimulation for arousal and orgasm, and many find that a vibrator provides just what they need. If you’re...

“Women often shut down emotionally from their partners [after a cancer diagnosis] for a number of reasons,” says Maureen Ryan, sex therapist and nurse practitioner. “Maybe they’re scared; maybe...

Vagifem is a vaginal estrogen, applied locally. It is safe for someone with your medical history, posing no risk of thrombosis. Only oral estrogen, which enters the system rather than being...

“I cannot give you another regimen that has as many good health benefits as exercise. Hands down. Exercise improves life energy and sexual energy; your body image will improve. I can’t give you a...

This is such a tough question. I brought one of our advisors, Mary Jo Rapini into the conversation, since she’s a therapist who often deals with this issue. Two things we think it’s very important...

Here is the second part of our talk with Mary Jo Rapini, a therapist who specializes in intimacy counseling (the first part focused on the mind). She often receives referrals from oncologists who...

“Not everything that is faced can be changed, but nothing can be changed until it is faced.”     –James Baldwin We’ve been hearing from many women who are receiving treatments for various forms of...

It’s the third Friday of the month, and you know the script by heart—half-hearted foreplay, missionary position, a quick (or not-so-quick) denouement, and your partner’s already snoring while you’...

Maybe your last child left home, as mine just did this fall. Maybe you (or your partner) retired. Maybe your partner became ill. The catalyst could be one of many life events, or it could simply...

We all remember Maslow… don’t we? That noted psychologist who, in 1954, published his famous hierarchy of human needs that we all learned about in high school psychology? Maslow determined that we...

By the time women reach midlife, we’ve experienced all kinds of things in our relationships, some good, some bad. It’s great to think back on the positive experiences once in a while, maybe even...

Vaginal estrogen is the most effective treatment for vaginal atrophy and its symptoms: dryness, itching, irritation, pain with intercourse. There are three low-dose, localized (without systemic...

In 1968, she was Barbarella, the fresh-faced ingénue in shockingly sexy outfits. Then she was Hanoi Jane protesting against the Vietnam War. She was the prostitute in the movie Klute, for which...

There really are no special considerations specific to your diabetes. While I can’t confidently diagnose the cause of your pain with intercourse, I can’t think of a diagnosis or treatment option...

Remember back in the day, when good girls didn’t “hook up”? They “saved themselves” for marriage, and there were names for those who didn’t. If, God forbid, an unmarried girl happened to disgrace...

We have had a great time listening to and talking with Mary Jo Rapini, our pal+resource for helping us put our minds to our sexuality. We asked her about the advice we hear a lot: Making an...

If you follow us on Facebook or on Twitter, you’ve likely seen us posting stuff by and about Mary Jo Rapini, a psychotherapist who specializes in intimacy, sex and relationships. You may have “met...

If you came of age in the 1960s, you may have had two books on the nightstand: The Joy of Sex and the Kama Sutra. You may have even tried some of those melodic-sounding acrobatics: the “splitting...

A while ago, a comment from a reader on one of my blog posts gave me some food for thought, and I’ve been digesting ever since. “To me, sexuality = feeling strong and attractive and powerful and...

Some women do have sudden severe headaches precipitated by sexual activity, and often at the time of orgasm. They’re called benign orgasmic headaches, and they seem to be caused by a reversible...

Testosterone, of course, is the hormone that makes guys hairy, muscular, and sexual. But testosterone isn’t only for guys. Women produce it, too, but at much lower levels, and for us, the effects...

If you can comfortably insert any size tampon, you don’t need much more space to allow for intercourse. I use two fingertips as a rule of thumb; that is, if I can insert index and middle fingers...

Other than bemoaning wrinkles and slathering on moisturizers at night, who among us pays attention to our skin? Yet, that tough, resilient, and underappreciated mantle that covers our entire body...

A burning pain upon penetration is a classic symptom of vulvodynia (also known as vestibulodynia). The cause is not well understood, but it’s more common in low-estrogen states–like menopause. The...

Admit it, ladies. When it comes to menopause, we’ve sucked up all the oxygen in the room. We’ve cornered the market on attention, research, and therapies. So when men exhibit hormonal symptoms,...

“Your most powerful sex organ doesn’t lie between your legs,” the famous sex researcher Alfred Kinsey is reported to have said. “It lies between your ears.” (Or, of course, as Dumbledore said to...

Today, more and more women over age 50 are finding themselves sharing their households with parents and/or grown children. A recent article in the Atlantic magazine, “Grandma’s in the Attic,...

There are literally millions of women in the U.S. who have the genital herpes virus—including many of us at midlife. Not everyone is aware that outbreaks can increase during menopause, which...

Okay, so you’ve tried everything. You regularly use a good, natural moisturizer, plus a lubricant during sex. No soaps, sprays, scents, dyes, or synthetic underwear ever touch your bottom. You’re...

Dilators are not intended to fit all the way inside your vagina. The extra length gives you some space to hold on to and to apply gentle upward pressure. The pressure gently stretches the tissues...

As a medical doctor, I try to provide a place where uncomfortable or unfamiliar topics can be discussed in an open, honest way, without inhibitions or worries about “what people might think.” For...

We’ve talked before about mindfulness – making a conscious effort to become more fully aware of something and thinking more deeply about it – and how being more mindful of sex can help increase...

Orgasm. Such a complicated topic; so many questions, so few answers. But let’s focus on the most important point, which is, that for women, the biggest obstacle to experiencing orgasm is anxiety....

Sex and religion aren’t often mentioned in the same breath. One is fleshly; the other spiritual, right? Like oil and water. Yet, both are integral to our person and to our psyche. Both faith and...

In past posts we tried to identify books and movies that we thought were hot—the kind of stuff to turn on a more discriminating, mature woman. It wasn’t easy. In the normal course of things, women...

Squeezies. The year was 1986, maybe. Or 1987. I’m not exactly sure, and precision is not important to this story. It matters only that it was the last day of the year. My sister and I were young,...

Every now and then, a question from a patient or website visitor tells me that bladder function is interfering with a woman’s sexuality. Maybe their “urge to go” makes them lose focus during an...

A wonderful and unexpected benefit of starting MiddlesexMD has been meeting other women and men who are like-minded, who see the value in—have a passion for—supporting sexuality throughout our...

Long, long ago, when humankind first stood up on two feet, some bit of engineering seems to have gone missing. As a result, back pain is practically programmed into the human condition. The lucky...

Just when you thought you were home free—the kids are grown, and you’ve somehow gotten through multiple birds-and-bees talks. But now you find the shoe is on the other foot, and you’re the one...

Last month we talked about some of the disincentives to sex, and fatigue was one of the top three. As you may know from your own experience, getting a good night’s sleep during or after menopause...

The odor and discharge that you describe sounds most consistent with bacterial vaginosis; it’s not a result of your partner’s medications. This infection is not serious or particularly worrisome,...

We all know how powerful scents can be, from cinnamon rolls baking in the oven to the first lilacs of spring. Our sense of smell, which stimulates nerve endings behind the nose, can trigger many...

The popular TV show Modern Family has a running joke with Clare and Phil, a 40-something couple with three kids: They go to a hotel once in awhile pretending to be strangers who meet in the bar...

In the last post, we talked about how pH levels affect the vagina. The second part of good vaginal health has to do with moisture. As we say at MiddlesexMD, moist tissues are strong tissues....

When you think about it, the vagina is a pretty undemanding organ. It’s cooperated through childbirth and nights of passion; it’s soldiered on uncomplainingly throughout years of menses and the...

Yes, your vibrator or other toys are safe with estrogen creams, often prescribed for vaginal dryness. What you’ll want to be careful of is silicone-based lubricants. Whether they’re safe to use...

It’s been a long time since your partner’s been able to “get it up.” And truth be told, you’d grown accustomed to a platonic relationship. You haven’t missed the sex. Frankly, it was never all...

Estrace, or estradiol, is an estrogen that was circulating in your bloodstream, produced by your ovaries, for 40 years or so! Any allergy is likely to be to the “vehicle,” the substance that...

Without doubt, breast cancer is a game-changer, altering every area of life and relationships. At first, amid the flurry of medical decisions, surgery, chemo, and recovery, you don’t have the time...

(But you probably knew that, right?) I wanted to elaborate a bit more on the Wall Street Journal article I mentioned in a recent post. “The Joy of Researching the Health Benefits of Sex,” (a play...

I’m very happy to tell you about an article that appeared recently in the Wall Street Journal about… sex! It’s encouraging to me to see that a traditional business publication like the WSJ is...

Whenever there are neurologic implications to a disease process, sexual response can be affected; these are difficult issues. I did see an MS patient just recently who had not experienced orgasm...

As we’ve discussed before, experiencing pain during intercourse is not unusual for post-menopausal women. The general medical term for it, dyspareunia, is defined as “recurrent or persistent...

Vaginismus, a vaginal muscle spasm that prevents penetration, can be part of a vicious cycle of pain and response. If you experience painful intercourse, your natural desire to avoid the pain may...

You say that your husband had a tumor removed from his lip, and you’ve experienced some discomfort since then after oral sex. The only possibility I can imagine that’s specific to your situation...

Scary, huh? Being completely vulnerable to another human being can be scary, even if that person is our life partner. Yet, just as sex involves physical nudity, great sex demands a similar level...

A while ago, we began exploring the qualities of great sex that were identified in a study published in The Canadian Journal of Sexuality. These qualities were gleaned from interviews with 20 sex...

I’ve talked before about the benefits of touch and said that we’d give you some tips on how to give a “sexy” massage. Well, here they are! While professional massage therapists are trained to...

Yes, vaginal dilators will help gently and gradually to assure that your vaginal tissues are stretched. I recommend using them one or two times a day for 20- or 30-minute sessions. The more you...

The notion of body image has to do with how we feel emotionally about our appearance rather than how others view us or how we look objectively (height, weight, eye and hair color). It’s a complex...

“I can tell you the movements he’s going to make step-by-step. He can get me off, but it’s sex. It’s not making love.” –quoted by Marta Meana, Ph.D., University of Nevada, Las Vegas, “When Feeling...

This is the first of three blog posts on the three main reasons women might decide not to have sex, a series introduced last week. Maybe the kids have flown the coop—or maybe not. Maybe your...

We are complicated sexual creatures. For us, arousal isn’t just a matter of plumbing; rather, it’s intricately connected to how we feel about ourselves, our partners, and the rest of our lives....

The exercise balls slide out because the muscles of the pelvic floor are weak. Contracting and working the pelvic floor muscles will make them stronger, and they’ll keep the exercise balls in...

Our last post talked about the side effects of prostate cancer treatments for your partner, including loss of libido and erectile dysfunction, and the fact that both of you are affected. While...

Many women at this stage of life, as well as facing some changes of their own, are dealing with the very tough challenges that come when a husband has prostate cancer. Maybe you’re one of them or...

It sounds like you could benefit from a really good pelvic floor physical therapist. While many physical therapists have some training with the pelvic floor, there are only a few with that...

Remember that play that premiered a few years back called, “The Vagina Monologues”? Well, I wish someone would write one called, “The Vagina Dialogues” so that women would start to realize that it...

What you describe–feeling like your partner is “hitting a wall” when you attempt intercourse, sounds most consistent with vaginismus. A physical exam can look normal; with careful palpation of the...

Heart disease is a sobering reminder of mortality. After a heart attack or surgery, you live with a new reality. Maybe you’re faced with dietary restrictions or lifestyle changes or a new...

When you exercise, you need more oxygen. Sex is like a light exercise—you need more oxygen then, too. For people with chronic obstructive pulmonary disease (COPD), such as asthma, emphysema, or...

As we age, few of us escape periodic (or not-so-periodic) joint pain. While it may be possible to work around occasional pain and stiffness in a knee or elbow, when arthritis is constantly painful...

Of course, we’d all love to enjoy good health and great sex until the day we die peacefully in our sleep. While we can control many aspects of our health, sometimes we just draw the short straw....

Your description of pain with the vaginal opening makes me think a really careful exam is your next step. It sounds like vulvodynia (also called vestibulodynia) should be considered. This...

More and more research is being done these days about the powerful effects of human touch, with study subjects ranging from newborns to NBA basketball players to sexually dysfunctional couples....

Great question–without a simple, single great answer! Women who have lost their ovaries have lost not only their source of estrogen, but also a significant source of testosterone. I find many, but...

People often make jokes about snoring (the word itself is kind of funny), but if you’re losing sleep because your partner is a loud snorer, you know it’s anything but humorous. Not only are you...

HPV is the most common cause of abnormal pap smears. It is only fairly recently that we get more specific results with pap smears, telling us whether an ‘abnormal’ finding is related to a low-risk...

Good health and good sex? It’s that chicken and egg thing. Being sexually active improves health in some powerful ways, but good health is also an important foundation for good sex. Sex may...

It’s estimated that 60 to 85 percent of all adults have come in contact with HPV and are therefore carriers. Any HPV that you or he introduced to the relationship 20 years ago, you were both...

A few weeks ago I reminded you how beneficial sex can be for your health. Turns out, it might even help you live longer! Perhaps you’ve heard about a new book called, The Longevity Project, by...

As we age, along with everything else we lose (our keys, our glasses, our hearing), it’s common to lose sensation in our genitals. Less sensation makes it harder to achieve arousal, which can lead...

First, know you’re not alone! About 25 percent of us report difficulty achieving an orgasm. The most commonly used approach to treat ‘primary anorgasmia’ (the medical term for a woman who has...

This is the second part of our interview with sex therapist Sarah Young, who works with individuals and couples to help them rediscover–or perhaps discover for the first time–the joys of sex. Q:...

A few months ago we talked about couples therapy, which caused some discussion about a closely related field: sex therapy. The idea of going to a sex therapist may be so scary that you wouldn’t...

Dilators don’t treat vaginal atrophy, but they do help counter a consequence of vaginal atrophy: narrowing or shortening of the vaginal. Used over time in graduated sizes, dilators help to restore...

Who has time for sex any more? That’s a question I hear from women whose plates are full with working, caring for parents, caring for kids, even caring for grandchildren. With all of the demands...

This topic comes up more often with girlfriends than with patients. But it comes up often enough with girlfriends that I know it’s on my patients’ minds, too! The question is whether it’s...

This is a great question. Overall wellness is vital to sexual health; a woman who enjoys good health will usually have more sexual satisfaction, as well. There’s a clear tie, for example, between...

If you read this blog regularly, you know that I usually summarize questions I receive from visitors to the website when I think the answers will be helpful to more people. An e-mail I received...

There are two principle non-surgical options for birth control: hormonal and barrier methods. Sounds like you’ve already decided to steer clear of hormones, at least for a time. The most common...

Hot flashes. They’re the stereotypical symptom of menopause, the subject of T-shirts and mugs: “It’s not a hot flash, it’s a power surge.” But when you say to yourself or your partner, in an...

Both Replens and Yes, the vaginal moisturizers we offer at MiddlesexMD, are perfectly safe for oral sex. In fact, all of the products we offer are chosen with safety in mind. Your partner may have...

You say you don’t have issues with vaginal dryness, but you did feel discomfort–difficult to sit comfortably, spasms of pain–for at least a week after intercourse. It does sound as though you...

“I just want to want sex again.” I can’t tell you how many of my patients have expressed — in one way or another — this simple desire for the desire they experienced in their 20s and 30s, when...

Absolutely not! As we grow older, it takes more stimulation for us to arouse and lubricate, and that stimulation can come in many forms–physical or mental. If watching an erotic video provided...

When a patient tells me that she no longer enjoys sex, one of first things I ask her is to tell me about something that she does enjoy. If she isn’t able to come up with a fairly quick answer, in...

“There are many paths to heaven, and sex is one of them.” –Abraham Maslow Maslow, the humanist psychologist who invented the term “peak experience,” would know exactly what participants in the “...

I’m still thinking about the research that says lots of post-menopause women have sex even though it hurts. The study I read said many of them think there’s nothing that can be done—that painful...

I’ve talked about a couple of general topics prompted by reading the REVEAL research results: that lots of women aren’t aware of the effects of menopause on sexuality and that many of us aren’t...

A woman born in 1850 could expect to live just past her 40th birthday. A woman born in 1900 was likely to make it to 50—assuming she survived the flu epidemic of 1918 and other hazards. I looked...

Just be yourself, our mothers told us when we worried about what to wear and say and do on our first date with that special someone. Such hard advice to follow when we wanted to be cool and sexy...

I was struck by this sentence in a report on research with women aged 45 to 65 experiencing menopause: “As a generation, they have yet to develop a voice for this situation, and many remain silent...

When the results of a new AP-LifeGoesStrong.com poll of the boomer generation about sex and relationships were released last month, the news media highlighted two seemingly contradictory findings...

Vagifem will have some influence on tissues within four to six weeks; I hope it won’t be long before you note some benefit. Beyond tissue health and lubrication, having comfortable sex depends on...

I’m sure I’m not the only one who gets sentimental during the holidays. As my family gathers in a home that looks better than usual, preparing gifts and eating more-than-usually festive food, I...

HPV (Human Papilloma Virus) is so common that the lifetime cumulative risk of being an HPV carrier is 80 percent. In other words, we’re nearly all carriers of HPV. Fortunately, most people do not...

You may have heard about the Centers for Disease Control and Prevention’s prediction that by 2050, one in three Americans could have diabetes. One in ten already do, although many of them haven’t...

We’ve talked before about the fact that sex is different for women. Rosemary Basson, MB, FRCP, of the University of British Columbia, describes a couple of ways that women experience arousal...

We love hearing from our readers and our customers. We’re thrilled when we hear from someone who’s gotten unstuck in her sex life because of information or products we’ve been able to supply. Two...

When they listed “communication” as an essential component of “optimal sexuality,” participants in the groundbreaking study published last year in The Canadian Journal of Human Sexuality were...

Vaginal moisturizers can typically be applied in two ways: either with your fingertip in the vagina and externally as needed, or with an applicator in the vagina. Applicators often come pre-filled...

A magazine in my waiting room cites a study that suggests 40 ounces of caffeinated coffee a day to prevent memory loss. The downside, of course, is that you may not sleep at night—which would...

Most of a woman’s genital lubrication comes during arousal, not with orgasm (unless you’re wondering about female ejaculation; there isn’t agreement about whether this occurs for women, and if it...

An article in The New York Times last week reports that, come January, Playboy TV will begin “shifting from traditional pornography toward a higher-quality, female-friendly slate of of reality...

Critics of the quest for “pink viagra” — the elusive drug to increase female sex drive — often argue that depressed libido isn’t medical condition (like erectile dysfunction) that can be “fixed”...

Many of the women I see in my office would like a black and white answer: Where, exactly, are they on the path to menopause? Unfortunately, I can’t really give them a solid answer, and here’s why...

When we were assembling our product collection, the MiddlesexMD team spent a fair amount of time researching personal lubricants. Some of this research was straightforward: We knew safety came...

What’s the difference between “connection” (number two of the “eight components of optimal sexuality”) and “deep sexual and erotic intimacy” (number three)? That stumped me for a bit while I was...

A vaginectomy–surgical removal of part or all of the vagina–is most often done as part of cancer treatment. It’s rarely a doctor’s first choice, and some reconstruction is usually involved. Your...

Many of the women I see in my practice have been with the same partner for years. These couples have made homes together, raised children together, weathered hard times and enjoyed happy moments...

We had a flurry of questions about foreplay — or dealing with the lack of it — awhile back, which led to a number of conversations within the MiddlesexMD team, but also between team members and...

It’s interesting to me how many patients who come to me with concerns about diminishing libido are there because of their husbands or long-time partners. These lucky women have a great...

Vaginal dilators really do work to increase vaginal caliber–the size of the opening. If you’re having your first sexual encounters, have an exam by your healthcare provider to rule out other...

We’re learning. I was happy to see that confirmed by Indiana University’s Center for Sexual Health Promotion’s findings in the latest National Survey of Sexual Health and Behavior. I was glad to...

We’ve talked about how crucial mindfulness–being mentally and emotionally present in the moment–is to enjoying great sex, sex that is “better than good,” as reported in a study recently published...

Oooh! “Less painful” is a difficult goal; I’d like penetration to be pleasurable for you! I’d like you to start with a thorough exam by a gynecologist or someone who specializes in women’s health...

I saw a headline that irked me in Salon.com’s Broadsheet a week or two ago. I couldn’t quite put my finger on why it bothered me until I wrote a post about the cancelation of the flibanserin...

I’m a recreational runner, and before a run, I always spend a few minutes warming up. I’ll run in place and do some stretches, especially of my calves and ankles. Experts no longer say this is a...

It’s official. Boehringer Engelheim, the German pharmaceutical company, has shelved its plans to develop flibanserin. They’ve decided to focus on other drugs that “have better potential to make it...

In an earlier blog post we reported on a study published last year in The Canadian Journal of Human Sexuality called “The Components of Optimal Sexuality: A Portrait of ‘Great Sex.’” Analyzing...

Now that our new site has been up for a while, we’ve met and made friends with others in online communities serving midlife women and sharing information about sexual health. We’d love for you to...

There are many “natural” reasons women our age begin to lose interest in sex. Hormonal changes, diminished energy, lowered self-esteem as we mourn the loss of our youthful bodies — a complicated...

There is no doubt that the ability to achieve an orgasm becomes more difficult as we age, and the orgasm itself is often briefer and less intense. As we age, we need more time for every step of...

No, I’m afraid a moisturizer won’t help with bladder function. Moisturizers really only improve the tissue condition in the vagina where they’re applied. The vagina and the base of the bladder and...

Recently I treated a patient who’d had elective breast reduction surgery. Nerve damage during the procedure had caused her to lose all sensation in her nipples. She found herself unable to have an...

A declining interest in sex as we age is typical for women, but many face a couple of additional factors that are really big: 1) It is painful; and 2) the event itself may not be particularly...

I had a call the other day from a friend who’s been a widow for several years. “I’ve found someone!” she told me, with just the slightest quiver in her voice. “I’m so excited I can hardly...

Estrogen-containing vaginal preparations are prescription only. If you haven’t tried lubricants and moisturizers, which are available over the counter, you might try those first. Lubricants are...

Maybe I was naïve. We ran into some issues with the launch of MiddlesexMD.com earlier this year: We couldn’t advertise on a popular social networking site. An article we submitted was rejected...

I saw a patient this week who is in her early 60s, in great shape, and happily married to an attractive and generally healthy man also in his 60s. Recently retired from executive positions, they...

Are the medications you’re on behind your loss of interest in sex? Are they making it more difficult for you to reach orgasm? These are tough questions. On one hand, the answer is almost always “...

Isn’t it amazing how quickly things can change? You say you were tested as being mid-menopause. Blood work is accurate at assessing ovarian function on the day you’re tested, but it is miserable...

For the first 10 or 15 years that we knew her, we were not to call Elaine “Grandma.” At least and especially not in public. She was too busy attending to her coiffure and hosting wild parties for...

It’s a personal question, I know, but one I’m trying to be sure to ask my midlife and older patients who are newly single and sexually active. Among women our age, sexually transmitted infections...

This is an important issue. At 49 you are ‘subfertile,’ but not infertile. You also can’t rely on rhythm, as there is no rhythm! Barrier methods–condoms or a diaphragm–can work well, although they...

We’ve written before about our efforts to find erotica to recommend to our growing MiddlesexMD community (Hi there, community!). Our efforts are are purely pragmatic, you understand. By subjecting...

She’s 54 years old. She’s spent most of her adult life in a long-term monogamous relationship. She’s just been diagnosed with genital herpes. This happens more often than you might think. Even I...

Thyroid disorders are not typically a significant factor for libido or orgasm. A bigger issue is expectations: The majority (probably at least 80 percent) of women cannot have and never have had...

When you’re in perimenopause, we say that your hormone levels are, in general, declining. While they are declining “in general,” it’s likely that your levels of estrogen and progesterone are...

In menopause, in the absence of estrogen, the vagina narrows and becomes more thin and fragile. Even when you are lubricated enough, the tissues have likely lost elasticity and can’t comfortably...

The first thing I try to do with women who have both of these issues is to make sex comfortable. It is pretty hard to be interested in intercourse when you know it is going to lead to pain. You...

Fortunately, the vagina is self-cleansing; it requires very little attention. The cells on the surface of the vagina naturally regenerate or ‘turn over’ on an ongoing basis. After intercourse,...

I’m busy exploring the boundaries of a new phase of my life, brought on by an illness I’m managing. As illnesses will, it’s grabbed me by the collar, given me a big shake, and forced me to order...

Oh, where do I begin? Perimenopause can be a pretty tough transition for many women. It is not only possible but probable that those symptoms are related. Patients with these complaints get a one-...

My libido woke up. This week we shoveled out a room to make room for a new hobby. In the unearthing, my husband found my long-lost, autographed picture of Dean Martin: Oh, be still, foolish heart...

Last year researchers published their study defining "The Components of Optimal Sexuality: A Portrait of 'Great Sex.'"

Not long before launch time, we wrote about our movie night with girlfriends, exploring erotica, and talking about what sort of flicks worked to turn us on… The premise being that as we grow older...

If you have pain during intercourse, you need a good, thorough physical exam to start, to make sure there is no obvious cause for the pain with penetration (for example, vulvodynia/vestibulodynia...

The most important thing is usually to re-estrogenize the vagina—with localized, not systemic estrogen. I haven’t seen a single oncologist not agree to allow breast cancer patients to use this....

No!  It’s great that you recognize the value of remaining sexually active, despite your decreasing libido. As we get older, we have to learn some new techniques to continue to enjoy sex. You can...

If you’ve missed periods, you are perimenopausal. It’s likely that you are experiencing symptoms of less circulating estrogen. Hot flashes are the most common symptom from that, but the way we...

Urinary incontinence for women is usually classified as “stress incontinence” or “urge incontinence.” Losing bladder control during sexual stimulation is most likely urge incontinence: The...

Weights in hand, what I need is time and focus and coaching. And ladies, there is an App for that. That is, if you use an iPhone or iTouch, you can download Kegel coaching applications for...

I surely don't miss the troublesome little egg sacs. The havoc they played with my system when they were there made my life miserable, to say the least. The new freedoms I have without them are...

While we are on the subject of finding medications and supplements that can help us… a quick note about using herbal remedies to help alleviate the symptoms of menopause and/or to boost your...

Vagifem is a low-dose ‘localized’ estrogen. It is delivering estrogen to the vagina and adjacent tissues, but not to areas outside of this area (that’s why it’s called ‘localized’ vs. ‘systemic...

The real difference between a lubricant and a moisturizer is duration. Lubricants coat the vagina to ease penetration, which adds comfort during intercourse. They provide a benefit at the time of...

I have had women in my office, losing sleep, depressed, miserable, because the lack of intimacy where it is wanted can have a domino effect, destroying communication, trust, a couple, a family....

Studies consistently show that estrogen use is not associated with weight gain. The estrogen ring (you are probably referring to Estring, although there are other estrogen ring products) should...

Zoloft is an SSRI (selective serotonin reuptake inhibitor), which increases serotonin. That improves mood, but more serotonin is not good for women sexually. Sometimes changing meds within that...

Part 3 of 3 Shopping for vibrators can be fun, and really very interesting. These devices come in many configurations and with many options, because, well, we’re all different. What one woman or...

Part 2 of 3 Of course, I can explain why we need more vulvo-vaginal stimulation at our age to nearly any woman in my office, and she may understand and fully accept what I’m telling her. But her...

Part 1 of 3 “A Vibrator? Me? At my age?!” That’s a pretty common response when I recommend — actually prescribe — using a vibrator to the patients I see in my menopause practice. I live in a small...

It’s been great to hear from a number of you after the opening of our shop. You’ve validated my suspicion that, for lots of women, there just weren’t good sources for information and products they...

We are learning more and more about what motivates women to have sex — enough to know that we still don’t know that much. We do know that our motivations change with our situations. What motivates...

So you arrive home from a hectic day at the office, and there’s the box you’ve been waiting for, with your new lube, a vaginal moisturizer, and those dilators that have promised to return your sex...

Turning 50 is like walking through a doorway into another world. Suddenly we notice our bodies, primarily because they are not functioning as effortlessly as they used to. Welcome to the...

I hate to be the first to break it to you, but your Mom had sex. She did. And it’s possible she even enjoyed it.

It took a very long time for the medical community to to take the physical and psychological changes that come with the menopause seriously at all. And it took still longer before we began...

A story is necessary to bring about the appropriate emotion… When I was in my early 40s, I decided I needed to run a big race. Not so much a long race, but a big one, with crowds and a chip on my...

As a general rule, women over 40 need more stimulation to become aroused enough for good sex. When we were young, just thinking about making love with our partners may have been enough to arouse...

A lot of the patients in my menopause practice are single women. My patients who have no sexual partners can be quick to dismiss my questions about sexual symptoms, figuring that without a partner...

None of us get through our adult lives without some questions about sexual functioning. And we go lots of places for answers, consulting family, friends, texts, the Internet, piecing together a...

I live and practice in the Midwest, where open discussion about sex is just not part of the culture. Even among close-knit groups of girlfriends, it’s a rare discussion, at least not past a...

The post title is just tongue-in-cheek, folks. A little health writing humor, poking a stick at the whole idea of health “secrets.”
We don’t believe in keeping information about attaining...

MiddlesexMD began with a business plan I wrote for my Masters in Medical Management program at Carnegie Mellon University. Its essential proposition — offering women over 40 the information,...

Since launching MiddlesexMD, I have to say, my dinners have gotten a lot more spicy.
You know how it is when dining with buddies. It’s polite — required — for them to ask what you’ve been up...

Writing for my gynecologist friend has included a lot of Aha! moments. I admit some of this learning makes me blush. It’s not just because I blush when talking about sex — though, I do. It’s...

…and why you should care too!
It began when I partnered with the local hospital in my hometown to evaluate local women’s health services, looking for any gaps where additional services were...

Menopause brings a drop in circulating estrogen. And a drop in circulating estrogen often (but not always!) brings a drop in sexual response. So at midlife, for many of us, sexual satisfaction...

Hi everybody. My name is Julie. I’m a writer here at MiddlesexMD. My credentials for writing about sex at midlife are… Well… I have reached midlife. And I enjoy sex.
Still.
Despite...

The science of human sexuality is young. For most of the last century, we assumed that men and women approach sex in roughly the same way.
I know: Crazy. But as I said, the science is young...

A big bouquet of roses waited for me at the front desk of my clinic. It wasn’t my anniversary or my birthday. And doctors just don’t get a lot of flowers. When I saw who sent them, I smiled that...

Learn how your body's changes affect your sexuality.
Understanding what's changing can help you keep sex enjoyable.

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