The stars have aligned for our January resolutions series. Not only is January designated as Cervical Health Awareness Month, but I’d say that the cervix counts as an “often neglected body part” related to our sexual health or well-being, which was the criterion for this January resolutions series.
The good news about the cervix is that there really isn’t anything you have to do to improve its function—no exercise, no diet, no special creams or lotions. Basically, it’s four centimeters of tough muscle between the vagina and the uterus. It keeps a baby in safely tucked inside the uterus and then dilates when it’s time for the baby to be born. That dilation is what labor is all about, as though you could ever forget. It really has no sexual function, contrary to previous belief.
The deal with the cervix—and why we have this special month devoted to it—is that you can almost ignore it if it’s healthy, but if it acts up, as with cervical cancer, then you have a problem, Houston.
And that’s why you can’t completely ignore it. So let’s give the lowly cervix a little blog luv.
Times have changed with the sexual revolution and advent of cheap, easy, and effective birth control. There’s a whole lot more sex happening with more partners, for one thing. And with that has come a lot more sexually transmitted diseases. We talked about that at length, beginning here, but as it relates to the cervix, here’s the rub.
The precursor for cervical cancer is what we call SIL (squamous intraepithelial) change (or dysplasia in physicians’ lingo). That change is nearly always caused by human papillomavirus (HPV; there are rare occasions where cervical cancer isn’t HPV related), and HPV is pretty much ubiquitous among sexually active people (80 percent). Plus, it’s a virus, so once you have it, there’s no cure. Usually that’s no problem. In 70 to 90 percent of cases, a healthy immune system clears it up within two years—kind of like the common cold.
But as we know, viruses are wily, shape-shifting critters. There are about 100 strains of HPV, only a few of which are considered high risk for cervical cancer. About 12,000 women get cervical cancer every year in the US, and one-third of them die. This isn’t a huge number, but the tragic thing about cervical cancer is no one should die from it because cervical cancer is extremely easy to detect and treat. In women older than 65 with cervical cancer, 42 percent had never been screened.
Screening guidelines and testing procedures have changed in recent years, however, so it’s no wonder if you’re confused about what to do and how often to do it. There is now a test for HPV, which is recommended for any woman over 30. There is also the tried-and-true Pap test that tests the cervix for precancerous cellular change, or dysplasia. This test is recommended to start at age 21.
A woman with a history of negative results and no other complications only needs a Pap test every three years. Combined with a negative HPV test, the wait can be five years.
Obviously, if your cervix was removed during a hysterectomy (and you DO know whether or not it was removed, don’t you?), and if you don’t have a history of cancer or dysplasia, you are done with Pap tests forever. Even if your cervix is intact, until recently the guidelines advised that women over 65 with no history of positive Pap results no longer need screenings.
All that may be changing.
In a 2013 study of women between 35 and 60 found that some women who had been monogamous or celibate for decades began testing positive for HPV. The results suggested that these women had been carrying latent and undetectable levels of the HPV virus from sexual encounters in their youth that had spontaneously reactivated during menopause. This is akin to a childhood case of chicken pox returning later in life as shingles.
“As long as you are controlling these infections, your immediate risk of [cancer] is going to be low,” molecular biologist Dr. Patti Gravitt explains in this article from Johns Hopkins. “But if menopause, or just getting old, increases HPV reactivation, then we need to look at what this means for screening these older women who came of age during the sexual revolution and are much more likely to reach menopause with latent HPV than the postmenopausal women we have screened in the past.”
In the face of this surprising finding, the North America Menopause Society now recommends that “all women who have had multiple partners should not stray too far from their Pap smear or HPV test at menopause until we know more about the increased risk of HPV flare up at menopause.”
Even women who have had their cervix removed should be aware that rarely HPV also causes vaginal and vulvar cancers. So more than ever it pays to be aware of your cervical health—and your HPV status. Being postmenopausal doesn’t give us a pass anymore.
You say you’re hoping to enjoy intercourse again after a five-year hiatus, but that you experienced some discomfort with your last gynecological exam. The prescriptions offered to you (which I assume were localized estrogen) are not in your budget, so you’re wondering about other options.
A vaginal moisturizer, used regularly, can help you regain some tissue elasticity. Any of the moisturizers we offer might be an option for you; they’re intended to be used regularly, from daily to several times a week.
Along with thinner and fragile tissues, in menopause, without estrogen and without sexual activity, the vagina will become more narrow and shortened. You may need the gentle stretching of dilators to help restore vaginal capacity.
I’m hopeful that, with some effort and regular attention, you can restore vaginal health to resume pleasurable intercourse!
Resolutions are easy to make and hard to keep (most people don’t). However, as we mentioned before, certain psychological tricks can increase your chances for success, and sheer persistence is one of them.
In the spirit of successful resolutions, I propose devoting January (yes, the whole month) to specific health-related resolutions. In fact, each one focuses on an often neglected body part that is critical to good sex and/or well-being.
First up? The pelvic floor.
You might not think much about your pelvic floor, but it affects you every single day. That surprising leakage after your firstborn child? That need to pee every half hour now that you’re post-menopausal? The more frequent UTIs? The slack “vaginal embrace” during sex? That really annoying pelvic organ prolapse that’s causing all manner of issues?
All these annoyances (and more) are related to the muscles in your pelvic floor. That’s why we write about pelvic floor health and doing kegels so much on MiddlesexMD. That’s why a healthy pelvic floor is part of our recipe. That’s why we have products to help you do those kegels right. It’s all because a healthy pelvic floor is so darned critical to our quality of life, especially as we get older and lose muscle tone and elasticity.
While many lifestyle improvements—losing weight, not smoking—will coincidentally improve the pelvic floor, they aren’t the stuff of resolutions that are easy to keep. Kegels, on the other hand, are specific, countable, time-limited, and realistic—all the elements of a solid, successful program.
And now, they can be fun! (Another element of success.)
A new smartphone app combined with a high-tech vaginal tool was recently launched on the crowdfunding website Indiegogo. Perifit is an exercise tracker/trainer for your pelvic floor. It’s comprised of a flexible, bulbous, silicone tool that goes in your vagina and sends low-energy Bluetooth signals to an app that is downloaded onto your smartphone, tablet, or laptop.
If you’re successfully tightening your pelvic floor, a butterfly stays afloat on your device. The tighter you squeeze, the higher it flies. Not only will you know if you’re tightening correctly, but the tool also measures both deep and shallow muscles contractions as well as their effectiveness against four parameters: force, endurance, reflex, and agility. You also get to choose among several training programs targeted toward specific issues, such as different types of incontinence or post-childbirth trauma.
The program isn’t cheap, and it’s also new, but it’s a hugely fun concept and casts the notion of doing kegels in a refreshingly different light. If nothing else, watch the video with the adorable baby and draw comfort from the fact that women of all ages are working on their pelvic floor.
Like any workout, developing pelvic floor muscle takes time and consistency. Whether your success with this program depends on a butterfly video or vaginal weights or your own self-discipline, you have choices among several tools, one of which might align well with your personality.
The last element to a successful resolution is persistence. Of course you’ll forget or skip days or get lazy. The secret is to pick up where you left off and keep on going. Set up a realistic, measurable program. Healthline recommends holding a kegel for a 3 seconds; releasing for 3 seconds and working up to a 10-second hold. Three sets of 10 ten-second reps a day is a good goal.
Developing pelvic floor strength isn’t as obvious or satisfying as working on tanktop arms or a bikini belly (if that’s even possible anymore), but it is arguably more important. Avoiding or reducing incontinence, UTIs, and pelvic organ prolapse while increasing sensation and vaginal strength for better sex is nothing to sneeze at.
I’m afraid this is a complicated issue. A dozen different contributing factors are possible, and the challenge you and your wife face may be a combination of them. You’re not alone, which is, I recognize, both bad news and good news.
I’ve addressed low libido and many of the contributing factors in blog posts before. Here’s the introduction to the topic on our website; here’s a blog post with additional explanation. Here is a list of answers to specific questions readers have submitted, including certain health conditions or medications which can inhibit libido as a side effect.
You didn’t describe your wife’s overall health; I hope she’s had a recent evaluation from her health care provider and has mentioned her loss of interest in intimacy. He or she can help to determine the cause, which will then point to the best options for treatment. You may also find a couples therapist or a sex therapist to be helpful, since emotional as well as physical factors come into play in intimacy.
I do wish you the best with finding the cause and some ways to address it! Physical intimacy adds meaningful dimensions to our relationships.
This is my quiet moment—the pause between the years, the time of taking-stock. One thing I know for sure—I have a lot to be grateful for this year!
It’s been more than ten years already since I decided to specialize in the sexual needs of women in midlife—women like you and me. As I mention here, I wanted to provide clinically sound, research-driven information to women who are caught in the throes of the menopausal transition. I wanted to address our sexual issues head-on, without embarrassment or beating around the bush. I also wanted to provide a safe, tasteful environment in which you could actually buy the products I was recommending—vibrators, lubricants, moisturizers, dilators, vaginal weights.
That was the rationale behind MiddlesexMD. I envisioned a space in which to communicate with a lot more of you than I could see in my clinical practice. A place where you can ask questions or start a conversation and where I can discuss whatever’s on my mind—from research on new drugs and therapies to tips on maintaining sexual intimacy. And we did put together a shop, where you can find those safe, tested, high-quality products, and have them mailed to you in discreet packaging.
It’s been a journey, that’s for sure—rewarding, challenging, busy, and sometimes unexpected. In 2013, the North American Menopause Society awarded me the “Certified Menopause Practitioner of the Year.” Late last year, I published my book, Yes, You Can: Dr. Barb’s Recipe for Lifelong Intimacy. The book uses my recipe for sexual health and draws from the accumulated wisdom on MiddlesexMD—your questions, the blog posts, and my own thinking.
Response to the book has been wonderful. It was a banner year for interviews on various media outlets about the book and my work. I’m grateful for these opportunities to communicate to a broader circle of midlife women that they have options, that sex can still be rich and fulfilling, and more importantly, that they are not alone.
When I began this endeavor, I couldn’t have anticipated how gratifying it would be to meet such resilient, independent, inquisitive women who are tackling life’s challenges gracefully and well. I’ve been honored to share this journey with you and to provide some support and information that may make the experience easier and, I hope, more joyful for you.
So, my friends, here’s to good health and good sex. Thank you for sharing your journey with me.
What is it about that first, unblemished day of a new year? The first white page of a journal? The hush that follows merrymaking; the pause before the quotidian rushes in again?
I’ve always loved that moment of held breath after one year ends and before the next begins. For me, it’s a day (or, more realistically, an hour) of reflection when I remember, take stock and my own measure, of what the year has brought, and how I’ve responded to it.
Resolutions, however? Not so good.
Turns out, there’s a bit of art and science to resolution-making—a few principles that increase our odds of success. In the spirit of helping us all out to a solid start, let’s explore ways to make our resolutions stick. (Success is always affirming.)
And secondly, instead of resolutions focused on self-improvement, let’s explore resolutions that focus on relationship-improvement.
Far be it from me to diminish the value of losing weight (#1 on the list of New Year’s resolutions for 2015) or of “staying fit and healthy” (#5), but I would suggest that, in addition to these worthy goals, you get a lot of bang for the buck when you work on your sex life. According to relationship consultant Dr. Sheryl Kingsberg, a good sexual relationship adds significant value to a relationship (15-20 percent), whereas a poor one actually drains a relationship significantly and negatively (50-70 percent).
Since only 8 percent of the people who make resolutions actually achieve them, let’s look at ways to beat those dismal odds.
Even with something that’s supposed to be light-hearted, like improving your sex life, you should realistically assess what is likely to work for both you and your partner. Maybe planning a romantic evening at home would work better than a night out. If your partner isn’t entirely on board, maybe you’ll work on your own sexual health and subtly introduce changes
Don’t give in. Get up and start again. That’s the very essence of discipline—keeping on.
Next January 1, when you reflect on the year just passed, I hope you can derive some quiet pleasure in having moved the intimacy needle a bit and generally banked some points in your sexual wellbeing account.
I know it can seem like ob/gyn offices are full of pregnant women! And while general practitioners can be extremely helpful, sometimes you want the extra training and focus of a menopause care specialist.
I recommend finding a menopause provider in your area by going to the North American Menopause Society (NAMS) website, where you can enter your zip code and specify a mile radius to find a practitioner near you. Note that you can also check the box (NCMP) to limit the search results to NAMS-certified providers, who have completed additional focused training and receive ongoing updates on research and recommendations from the society.
Continuing with our series of tips for holiday sanity, and even enjoyment, this is the most fun suggestion of all: Schedule a quick, romantic getaway for after the holidays to re-connect with your honey and get some downtime in a sweetly unfamiliar place.
You want to keep the emphasis on the fun and not get carried away with anything elaborate and expensive. A weekend away with minimal planning increases the chance that you’ll actually do it—no good excuses, and it’s easy to find someone to check in on the cat.
A quickie in midwinter can be especially economical and especially delightful. You’ll encounter a laid-back and welcoming atmosphere that’s lacking in the midst of summer tourist season. You’ll also encounter off-season rates.
I fondly recall a midwinter weekend in a tourist town near my West Michigan home. Yes, some places were closed for the season, but the rest of the town was just as scenic and beautiful in winter. We eavesdropped on local chatter in the diner and neighborhood pub that had been crawling with tourists just a few months before.
So, here’s my down-and-dirty guide to a relaxed, relationship-rejuvenating weekend in the middle of the long winter night.
You are now approaching the crescendo of holiday preparation. Give yourself a treat to look forward to. A weekend getaway won’t break the bank but will ease both of you out of the post-holiday, wintertime blues. And maybe just knowing you have this special weekend on the calendar will remind you to be more gentle with each other during the holiday frenzy.
The symptoms you describe--moodiness, depression and anxiety, hot flashes, sleep interruptions, less sensitivity in nipples and clitoris--are all consistent with stopping the hormone therapy (HT). Sensitivity to the effects of hormones varies among women, and you’re definitely in the “responder” category!
You mention that you discontinued the HT because of concerns for long-term health. It’s important to consider the form of HT you’re using: The Combipatch that you were using is a transdermal estrogen (and progestin) delivery method, and that method has significantly less risk for stroke or thrombosis. If estrogen is taken orally, it is metabolized through the liver, which increases a blood clotting factor and puts women at a slightly greater risk for stroke and blood clots. Transdermal (through the skin) delivery doesn’t pose the same risk, because it bypasses the liver metabolism and enters the bloodstream directly.
You’re in your 50s, fit, and low risk: You’re a perfect person to consider continuation of HT for all the reasons you mention. It sounds like HT definitely improves your quality of life, which is to me a determinative factor. We don’t really have a clear time frame in which we know that HT starts to pose additional risk.
Yeah, I know. The last thing you need right now is another list of ways to avoid stress during the holidays. The mere thought of another list is stressful all by itself.
I don’t cotton to holiday de-stress lists, either. That’s why I combed through dozens of tips from experts and ordinary folks to winnow out what I think are the best, most truly helpful holiday reminders. I’m betting that something on this list will truly make your life easier and your spirit more joyous. Most of the suggestions even have some science behind them, which always makes me happy.