You say you’re using estrogen therapy, have sufficient lubrication, but are experiencing pelvic muscle spasms that cause you some discomfort during sex. You’re wondering whether being sedentary contributes to the problem, and whether a vibrator, which your doctor recommended, may help.
It’s unlikely that sitting too much would contribute to the muscle spasms (although as a doc, I need to recommend more physical activity). Unfortunately, most of the time we don’t have a good explanation as to the cause of muscle spasms. A vibrator works by increasing (through stimulation) blood supply to surrounding tissues, which, in turn, promotes vaginal health. If you choose a vibrator, make sure it’s one you can use internally, not just externally on the clitoris.
The other tool that’s often helpful with muscle spasms is a set of vaginal dilators. These are designed to provide a gentle stretch to pelvic floor muscles to reduce spasm.
I hope this is helpful! Part of the solution is to be confident you can address the issue.
One of the benefits of my work with MiddlesexMD is the networking that makes it more likely that I’ll run into medical information, over-the-counter products, articles and books that could be helpful to my patients, and, of course, the interesting conversations that turned into our podcast, The Fullness of Life.
I received an advance copy of Love Worth Making: How to Have Ridiculously Great Sex in a Long-Lasting Relationship, by Stephen Snyder, MD, a month or so ago. Steve is a couples therapist, psychiatrist, and writer, as well as associate clinical professor of Psychiatry at the Icahn School of Medicine at Mt. Sinai in New York City. While I’ve met him—so far—only via email and his written words, I know we share some perspectives: that intimacy remains important to us no matter what our age, that men and women do have some differences in their approaches to love-making, and that there’s nothing wrong—and lots that’s right—about seeking tools that help us!
I think it’s useful to hear men’s perspective on sexuality, too, so when Steve offered to contribute to this blog, I accepted! Read on for more from Stephen Snyder, “sex therapist in the ‘hood.”
Several years ago, a merchant in my neighborhood learned that I was both an MD and a sex therapist. The next time I was in his shop, he asked me if I could get him some Viagra.
“How long have you had erection problems?” I asked.
“I don’t,” he answered. “But my wife and I have been married for 30 years. To tell you the truth, sometimes I’m too tired or preoccupied to get hard without the Viagra.”
What was this man’s problem, exactly? He wanted to have sex with his wife, even though he wasn’t feeling that strongly turned on. Evidently there were other reasons he wanted to do it.
Sound familiar? Of course: He wanted to make love like a woman.
Women can have sex with their partners any time they want. They don’t have to be very excited. Sure, some lubricant might be required, especially over 50. But the absence of peak excitement isn’t necessarily a deal-breaker.
A woman can make love for other reasons besides strong desire. To feel close or emotionally connected to her partner. To promote loving feelings. Or just for the simple pleasure of the experience. Even occasionally to keep a partner happy, even though she might be too tired or preoccupied to be really into it. A useful book on the subject calls it “good-enough sex.”
One wouldn’t want all one’s sex experiences to be like this. But once in a while it’s okay. Especially if the alternative is not to make love at all. If there’s one thing that sex research repeatedly shows about successful long-term couples, it’s that they keep having sex even when if the sex isn’t always earth-shaking. The ritual itself is important.
Men traditionally haven’t been able to do sex very easily under conditions of lower arousal. Especially over 50, when it ordinarily takes more stimulation to stay hard than it did at 20. If a man, for whatever reason, hasn’t been strongly turned on, conventional sex hasn’t usually been an option for him.
Viagra changed all that. Since the blue pill came on the market in 1998, a man can take Viagra and have sex even if he’s tired or preoccupied and just wants some loving and affirmation but isn’t feeling peak excitement. In fact, just having a good erection can help a man feel more in the mood.
There is often strong partner resistance to a man’s boosting his erection through chemistry, though. Women especially are used to the affirmation that occurs when a man gets hard (as Mae West famously put it) simply because he’s “happy to see her.” It’s worth it for a man to communicate that he needs sex for closeness and affirmation and pleasure as well. Just like she does. And that worrying about his erection just gets in the way.
Some couples worry whether taking Viagra under such conditions is a wholesome or natural thing to do. If it just takes more sexual stimulation now to keep him hard, wouldn’t it be more natural to simply intensify the excitement?
Maybe, but not necessarily. Intensifying excitement sounds like a great idea. But in practice, having to do things to get the man hard enough can be a bit of a burden. And it can take time, sometimes so much time that the moment is lost.
Sound familiar? Of course. It’s the same predicament that women find themselves in when they can’t get lubricated or can’t climax. Deliberate efforts to manufacture excitement often backfire. They usually aren’t very erotic.
My advice? It depends on the couple and the situation. But sometimes Eros is best served by taking the Viagra. Then a man can stop worrying about his erection, and get back to making love.
Sometimes it’s best for a man once in awhile to make love like a woman.
Sounds like you’ve been doing a number of the right things: You’ve been using dilators, a vibrator, lubricant, and vaginal moisturizer. It sounds like you’re at a point where localized estrogen, Osphena, or Intrarosa would be helpful for you to achieve your desired outcome.
Any of these prescription drugs will provide elasticity, a critical factor for getting the “stretch” needed with the dilators. Take your dilators in to your health care provider and have this conversation, too. He or she can help you determine whether you can get further capacity with the methods you’re using or whether, as I suspect, you need to take the next step and add a prescription to your routine to restore health to the vaginal tissues.
It’s hard to get to the final goal without that option--and that final goal is definitely one worth working for! Good luck.
I’m so sorry that you’re experiencing this loss in your relationship. Both depression and the medications used to treat it can be culprits in a loss of desire, and given the relatively short time frame in which you noted the change (one or two weeks), the antidepressant is the likely explanation for your husband.
The situation that you describe is probably best addressed with the help of a therapist; someone who does sex therapy would be most helpful (you can find one certified by the American Association of Sexuality Educators, Counselors, and Therapists through their website).
As you’ve begun to experience, the longer this dynamic goes on, the more anger and resentment builds. Having a therapist to help you navigate the conversations is extremely helpful. And your suggestion of a therapist sends your partner the clear message that intimacy is really, really important for you and your relationship.
There’s some evidence that Stronvivo, a nutritional supplement for cardiovascular health, can improve both libido and function in both men and women; that could be a consideration as well.
In the last post, we examined where we are right now in life in order to identify where we might want to be in the future: the health of our bodies, our spirits, and our relationships as well as the dreams or passions we have not yet pursued (or maybe even identified).
With this in hand, let’s move on:
Step #2. Same drill. Quiet place; journal in hand. Read through your initial entry. Anything to add or edit? Does it still feel honest?
What leaps out at you from your work? Do you notice any patterns—boredom and overeating; stress and impatience; lack of self-assertion and a feeling of victimhood?
Did you identify something you always wanted to pursue or to learn? Are there disappointments you uncovered? Are some elements of your life story simply incomprehensible to you—how did you end up here, you ask?
Sit with these for a minute. What tugs at your heart? What calls to you? What sounds absolutely awful or completely thrilling? What needs a closer look?
Also read over your assessment of your primary relationships. Any action plan needed here? Fences that need mending or habits that need adjusting?
You aren’t writing anything, necessarily. You’re just noticing habits, patterns, ways of thinking, and how yesterday’s work makes you feel today.
Now. Begin creating your reinvention plan. This is the eulogy moment. What do you want people to say about you after you die? How do you want to feel about your one and only life? Begin to articulate the big, sine qua non items. The ones you cannot die without having accomplished. Make a list of them. Not an overwhelming list—the top three or four. The big ones.
Choose one. This is your project for this year. And maybe for next year. If it’s that important, you may work on it for the rest of your life. Break this goal down into manageable steps that you can start doing tomorrow. What’s the first step, then the second? Travel to Africa? You’ll start by researching your options with the goal of having a plan in place this year. Lose 35 pounds permanently? Research your options with a goal of having identified a realistic, lifelong approach this week that you can begin practicing next week. Learn how to play the flute? You’ll need to find an instrument and a teacher…
Next, review those primary relationships—kids, extended family, spouse. Have you identified tendencies to work on? Habits to develop or break? Relationships that need attention? Relationships that need special nourishment or a new approach?
Don’t overlook the one relationship that is most critical to your longevity and quality of life. “If you’re in a happy marriage, you will tend to live longer. That’s perhaps as important as not smoking, which is to say: huge,” says Lyle Ungar, one of the researchers of that data-driven longevity calculator I mentioned in the first post. Knowing that someone in the world knows you intimately, loves you, and has your back adds measurably to quality of life. It makes sense, then, to focus especially on this relationship in your life review—to test its soundness and ponder how it might be strengthened.
List one or two specific steps you can take immediately that will make any of these relationships stronger. Also write down one or two habits or personality traits that impede them—that you should work to change.
With a path identified (for the year, at least) and the initial steps delineated, you’re ready to begin. Let me just add the wisdom of a few professionals and life-reinventers who have walked this path before.
Practice gratitude. Every day. “…allow yourself to be grateful for the things you…have. Anger is never inspirational but gratitude is,” writes the best-selling albeit hyperactive author, James Altucher.
Goals, such as those you just articulated are important because “if you don't have long-term goals, you run the risk of doing lots of little things every day—cleaning the house, sending emails, catching up on TV—without ever making a contribution to your future,” says Art Markman, psychology professor and author in this article.
Stay flexible. Change is never static. Reinvention is an ongoing process. You’ll have to rinse and repeat again next year (or next month) to make sure the goals you set today are still relevant and important and that your progress is unfolding according to plan. “Too often, we give up just when we need to push harder, and persist when we actually should quit,” writes one author.
Change is never easy. Expect setbacks; anticipate resistance. Anything really challenging and worthwhile will take time to accomplish, so if it’s really important, don’t shortchange yourself. Persevere through the tough spots. “The most successful self-reinventors are those who understand that they have time and are willing to use it to invest in their own skills and education,” writes this author.
Declutter. Yes, you read that right. Downsizing, clearing out, cleaning up can feel both psychologically freeing and is also metaphorically linked to ridding your life of things that hold you back—mental clutter, too many commitments and obligations, relationships that are buzz-kills or worse, according to Margaret Manning, blogger and creator of sixtyandme.
There. You did it. I hope you feel empowered or at least optimistic. You should now have a roadmap for the months ahead. I’d love to hear how the project is working for you and if you have suggestions to refine it.
Need inspiration? Some of our “The Fullness of Midlife” podcasts are on topic: Lesley Jane Seymour on reinvention, Kate Convissor on overcoming fears, Deborah Robinson on appreciating our own bodies and treating them wellI, Joan Vernikos on how movement keeps us capable.
I had a shock the other day.
In an unguarded moment, I ran across one of those life expectancy calculators. You know, the kind that will tell you how many years you have left on earth after 10 minutes of softball questions.
Basically, I believe that predicting how long you’ll live is a fool’s errand—any of us could get hit by alien laser rays or a schoolbus tomorrow. But my data-driven heart was sucked in by this calculator, which was developed by professors at the University of Pennsylvania Wharton School and based on 400,000 data samples collected by the National Institutes of Health and the AARP.
Now, I know that I fall in a healthy category for weight, activity level, and absence of chronic disease. But, still, the results shocked me.
Ninety-six. My estimated life expectancy is 96.
This is enough time to live a second adult life. This is enough time to start another career or follow a dream or pursue a passion. This is not enough time to waste.
So, that’s the challenge I put before you (and myself) this January: the macro view; the life-reinvention perspective. Because no matter how much time we have (or think we have), why squander it in self-defeating, fearful ways? Or simply by drifting through a handful of years without direction?
Reinvention isn’t a quick-fix project; it isn’t a lose-five-pounds resolution. It’s a project we could (and should) work on for the rest of our lives, periodically reviewing and adjusting our goals to see if they still fit.
Now—today—is a good time to start. So I put before you the proprietary MiddlesexMD Reinvention Project. Ready?
Step #1. Take stock. No shortcuts here. Sit yourself down somewhere quiet. Open to the first page of the Reinvention journal that you bought for this occasion. (You did get one, didn’t you?) Today’s task is to examine the important aspects of your life. As realistically and objectively as possible. You can’t envision a new you without a solid understanding of who you are now, right?
How’s your health? (Obviously my first question.) Are you content with how you feel? How do you feel about your eating/exercising habits? Your weight? Your overall mobility? Your blood pressure and cholesterol levels? Your mental acuity? Do not indulge in guilt or leap to quick, feel-good resolutions, just assess your physical self realistically.
How’s your spirit? Do you feel lonely? Optimistic? Afraid? Content? Discontent? Restless? Do a full-spirit wellness scan. Are the physical and spiritual linked in some way—being overweight and depressed, for example? Are you handicapped by free-floating fears or anxieties? Does stress nibble at the corners of your life—or maybe devour the whole enchilada? Do you feel unsettled and discontent or grateful and happy?
What is the source of your greatest joy or satisfaction? What are you good at? What are you happiest doing? Where does your passion—or your pleasure or your interest—lie? What have you always wanted to attempt? Do you have dreams that you decided had passed you by or that you are too afraid to try? Is there anything you would regret not having done before you die?
Examine the health of your most important relationships. Our closest relationships are the sources of our greatest joy and satisfaction as well as our greatest heartbreak and frustration. We expend a lot of energy repressing, denying, or making excuses for broken relationships, whether with family, lovers, or friends. Does this sound true for you?
Are you keeping up with friends and loved ones, or have you let important relationship wither on the vine? We also sometimes endure relationships that kill our spirits, that are toxic to our psyche and sometimes our bodies. Resolve now to examine them with a clear eye. You don’t have to do anything today except be honest with yourself.
Write it all down in the journal. This is the first day of your new you.
Okay. Take a deep breath. You’re done for today.
Even though vaginal dilators have been around for decades, they still elicit lots of attention and a few quizzical looks even from healthcare professionals whenever we display our wares at medical conferences. My patients sometimes have questions, too, and we get phoned-in and emailed questions here at MiddlesexMD.
Dilators are one of the most straightforward medical devices you’ll run across. They are a set of tubes that gradually increase in diameter from about a half-inch to about an inch and a half. They are usually made of high-quality plastic, but may also be made of silicone, which gives them a softer, more flesh-like quality. Both types are washable with soap and water. Dilators are used to increase vaginal “patency,”—its capacity and ability to accommodate the things that vaginas are made to do, like a speculum, a baby, a penis—some pretty important stuff, in other words.
Dilators are used to:
Since some vaginal conditions might require additional treatment, such as localized estrogen or muscle relaxants, you should always discuss any vaginal pain or change in your ability to have sex with your doctor, as well as how you might benefit from using dilators. From there, if it’s simply a matter of conditioning or maintenance, our shop has a selection of high-quality plastic and silicone dilators.
I recommend any of these sets. Choose the features and sizes that appeal to you. The first set that we found and offered remains a favorite. It’s available with five or seven dilators, depending on your starting point, and the straight, solid cylinders are easy to handle and clean.
The silicone kit is firm yet flexible with a softer touch. (Bright colors don’t hurt, either.) Be aware that silicone lubes will degrade the surface of these dilators, so use them only with water-based lubricants.
The Amielle kit is our high-quality, good-value choice. This set of five dilators is made of medical-grade plastic and includes a detachable handle that might make insertion easier.
Increasing vaginal capacity takes patience—often several months. For maintenance, you may need to use dilators regularly until you’re having sex regularly. The goal is to accommodate your partner’s penis (or your doctor’s speculum) comfortably and without pain. It’s a worthy goal, so accept that you’re in it for the long haul.
To use dilators:
You may bleed a little at first. This is normal. But if you soak a sanitary napkin or experience frequent bleeding, this is not normal. Stop using the dilator and call your doctor.
I like dilators because they’re both simple and effective. Granted, taking a pill is easier, but there are no pills that treat vaginal patency as such. If you stick to the regimen, dilators are very effective in both reconditioning the vagina and in maintaining elasticity during fallow sexual periods.
The Intensity Pelvic Tone Vibrator works in two ways: It has electrodes that stimulate the muscles of the pelvic floor, causing them to contract and therefore strengthen. The vibration feature of the Intensity, which you can control separately, improves pelvic floor muscle tone the same way any vibrator does: They all help the user to experience orgasm, which is intense contractions of the pelvic floor. Those contractions, whether from the electric pulses or orgasm, improve muscle tone, just like flexing your bicep does. The contractions also increase blood supply to the pelvis, which improves function and sensation, too.
Yes, orgasm is good for muscle tone! And improved muscle tone can strengthen future orgasms, as well as holding organs in place and preventing or minimizing incontinence. I guess I’d call that a virtuous cycle.
Here’s an idea to spice up a holiday evening: Gather your coffee klatch girlfriends, or your BFFs, or even your sisters and/or daughters, make popcorn and margaritas, and watch “Love, Sweat, and Tears,” the new documentary about menopause.
Even better, snuggle up and watch it with your partner, because the red thread running through all the information about hot flashes and mood swings is that our sex lives don’t have to be disrupted or put on the shelf forever because of menopause. We can still be sexual beings; we can still be attractive; we darned well can still have sex.
The movie was a labor of love for Dr. Pam Gaudry, an ob/gyn who specializes in treating older women. After years of consulting with patients in the throes of menopause, Dr. Pam came to realize that of all the difficulties accompanying menopause, the most disturbing to many of her patients was the disruption of their sex lives. Losing this deep and intimate connection with loved partners was the most distressing part of menopause. And she knew that losing sexual intimacy is completely unnecessary.
Dr. Pam wants to educate women about menopause, about how to stay vital, healthy, and sexually fulfilled. She wants to blow up the social stigma surrounding menopause (that we’re dried-up old crones). “Women should look forward to this transition,” she says. “I want them to know what to do to protect their vaginas so they can have exciting, comfortable, and worry free sexual intercourse for the rest of their lives.”
In the film, Dr. Pam travels across America interviewing actors, comedians, clergy, medical professionals, as well as ordinary men and women about love and menopause. Joan Rivers is the headliner, in what turned out to be her last interview before her death in 2014. “I’m on a mission,” says Dr. Pam in her interview with Rivers, “to save menopausal vaginas in America.”
“Well, sign me up,” says Rivers.
In the course of the film, Dr. Pam interviews several colleagues that MiddlesexMD readers have met—Mary Jo Rapini and Dr. Michael Krychman. I make a cameo appearance, too.
Basically, Dr. Pam covers the same ground that we do here at MiddlesexMD because we have the same mission and message. She does it holistically, with humor and a lot of sage advice. “I want women to know why they must protect their vaginas,” she says. “I want estrogen in their vaginas when they’re going into the ground. And no woman should die without using a vibrator.”
Do not hesitate to gather selected friends and family and watch this movie together. For you and your honey, it’s required viewing. A pop quiz will follow.
Among other things, sex is a nice aerobic workout. You breathe hard; your heart rate goes up, as does your metabolic rate. You burn calories. (Yay!)
Therein lies the rub for us older folks.
Isn’t the stress on the cardiovascular system dangerous for anyone with a heart condition? Especially if he or she doesn’t know about it? Or, even when the doctor gives you the green light to have sex, the specter of a sudden attack always looms in the background.
"I think it's important to healthy relationships to have this anxiety lifted," said Dr. Michael Ackerman, professor of medicine at Mayo Clinic. “[People] always ask about exercise and how active they can become,” he said in this article. “They almost never ask directly about sex,” but, once it’s mentioned, he said, ”the floodgates open.”
Now, a large and robust study provides the most detailed picture we’ve even had of the actual numbers of people who suffered a fatal heart attack during sex. Researchers examined lifetime medical records from 4,557 people in Portland, Oregon, who died of a sudden cardiac arrest from 2002 to 2015.
Of the 4557, the number of people who died of a heart attack during sex or within an hour after?
That’s it. Thirty-four people ranging in age from 37 to 83. Of that number, 32 were men. Thus, the risk of having a heart attack during sex in men is 1 percent, while for women, it’s .1 percent. While doctors always knew the risk of heart attack was slim, now that the risk is quantified, even researchers were taken aback. “I’m a little surprised at the really tiny number,” said Dr. Sumeet Chugh, senior author of the study and a professor of medicine at Cedars-Sinai Heart Institute in Los Angeles.
It goes without saying to follow your own doctor’s instructions for activity if you have a heart condition. But if you’re given the “all clear” for sexual activity, I hope these numbers put your mind at ease. No need to abstain from one of life’s sweetest pleasures.
“[This is] a wonderful answer for those who love sex,” said Dr. Ackerman. And, I might add, for those who recognize the link between sexual health and overall good health.