The Progress We’re Making

Birthdays are a useful thing—although it’s increasingly easier to celebrate them for our children (or grandchildren) than for ourselves. Here at MiddlesexMD, we’re celebrating a milestone: It was five years ago this month that we launched our website. While I’ve been practicing medicine for much longer (did I say it’s not easy to celebrate every milestone?), this marks five years of encouraging women to learn about and take charge of their sexual health throughout their lives.There are a number of ways to measure how far we’ve come, like marking our children’s height on a chart. The first that comes to mind is the number of women who’ve been in touch.

We’ve been in contact with hundreds of thousands of women (and men who love them) from 209 countries. Many have thanked us for solving a specific problem, or for simply providing some hope and a path to follow.

We’ve talked to hundreds of women in person, too, at medical conferences. Nurse practitioners and other health care providers have said how grateful they are to have a resource for patients and, because many of them are women, have shared personal stories, too.

As a physician, I have more options available to me than I did five years ago. Osphena comes to mind as a treatment for vaginal and vulvar pain. And while localized estrogen products have been on the market for a while, I’ve noticed more advertisements for them. While too much advertising—especially of pharmaceuticals—can sometimes just be noise, I see the ads as an increase in conversation about women’s sexual health. And that’s a good thing.

I’m hopeful about increased conversation at the FDA, too. Last fall I attended meetings to discuss how the agency reviewed and set priorities for drugs to treat women’s sexual health challenges. It’s been rewarding to join with colleagues in Even the Score, a campaign for women’s sexual health equity. In March, eleven members of Congress signed a letter to the commissioner of the FDA, expressing the firm belief that “equitable access to health care should be a fundamental right” and noting the disparity between the number of FDA-approved drugs for male sexual dysfunction (26) and female sexual dysfunction (0).

Yes You Can by Dr. Barb DePreeIt will take some time for new treatments to make their way through development, testing, and FDA approval. In the meantime, I’m also happy to note more books (including my own) and websites offering information, encouragement, and community to women as they navigate midlife and beyond. 

I hope you’re talking, too—to your partner, your friends, your sisters, and your health care provider. When we share our experiences, we feel less alone. And we can also learn from each other about what’s happening and what works to keep us vital and engaged. Because we know that even at—especially at—midlife and beyond, we’ve still got it!

What Do You Think? Doctors and Shopping

I’d like to solicit your opinion.

As you know, (or… maybe you don’t) MiddlesexMD has an online store in which we sell all kinds of products geared toward the sexual needs and pleasures of older women—“for midlife women who want to enjoy sexuality for life,” as we say. And some products just for fun.

As I’ve explained before, I created this store for a generation of women who need more sexual stimulation, lubrication, and support, but who probably aren’t going to check out their local sex shop (assuming there is one) and who probably aren’t savvy or experienced shoppers when it comes to choosing items like vibrators or warming oils.

So my team and I did the shopping (when was the last time you went to an “adult” trade show?), testing, and selecting of products we thought would be helpful and safe for midlife women.

It wasn’t easy, let me tell you, but I’m proud of our selection, and I’m confident about the quality of their design and construction and the safety of their materials. Full disclosure: MiddlesexMD is a business, so there is some profit involved.

So what’s the problem?

Because I have this dual role—as a practicing physician and as MiddlesexMD, other health care providers ask my advice about product sales. I know that the doctor-patient relationship is a tender thing, and it’s based on trust. My patients trust me to use my skills on their behalf. They don’t want my commitment to their health and well-being diluted or divided by self-interest. Nor do I.

When doctors sell products, conflict of interest is always lurking. Can doctors be objective when they stand to make money by recommending this vitamin or that weight-loss aid? And wouldn’t patients feel some pressure to buy the product to please the doctor? Does the presence of the product in a doctor’s office imply that the doctor endorses it?

The fact that some doctors derive a significant portion of their income from selling these products in their offices reinforces that appearance of ethical shadow-boxing. A few “celebrity” doctors have become virtual mouthpieces for certain product lines, which often lack research as to their efficacy or even safety.

As you can imagine, the issue has engendered passionate discussion both pro and con within medical circles, and professional medical organization have yet to issue any guidance regarding the practice.

I can honestly say that my primary motivation for selling products that I’ve tested and sometimes use myself is to provide a tasteful, private, safe opportunity for women to buy intimate items that will help keep them sexually active and comfortable and that they’d have a hard time finding otherwise. I set prices comparable to other retail options.

I practiced medicine for years before bringing products into my office. My relationships with patients were well-established. And I’ve seen first-hand that women are more likely to follow through when I can show them what lubricants feel like or how a vibrator functions. When my patients can walk out with products they’re ready to use, rather than with one more research project for their to-do lists—well, I think that’s useful and convenient. I’m not sure I would still have an electric toothbrush if my dentist didn’t offer them for sale.

So I’d like to think I’m offering a valuable service to my patients, but can I truly be objective when I have something, however modest, to gain? Do my patients feel subtly obligated? Do I compromise my professional credibility?

What do you think? Service or self-serving? I’d really like to know.

“Exactly What I Need at This Point in My Life”

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 felt comfortable perusing. These are two of the comments that have made me smile in the month since we’ve opened:

"…Thank you so much! I happened upon your site and it is exactly what I need to see at this point in my life. I'm so happy! I'm finding all kinds of info that I haven't seen anywhere else and just in the nick of time. What a relief to find that I'm not alone, that someone understands, and what a wealth of useful information. Thank you, thank you, thank you! I'll be back often."

"…My entire experience was perfect. I was a little self-conscious reading and browsing at first, but soon I was so absorbed in the information/sexual aids that I had my Gigi vibrator and other items selected and bought before I knew it! When I opened the box and saw the card and tissue paper and all the care that went into making my first intimacy purchase special, I knew that I would not be disappointed. And I wasn't! And neither was my husband. I have no words to describe how much we've been enjoying each other! It's like we're on our honeymoon!!"

Like these women, many of you are exploring sexual aids for the first time. One of our most popular products has been a lubricant selection kit. Women who buy it get seven samples of different kinds of lubes—water-based, silicone, and hybrid. After they’ve experimented, they can tell us which they like best and receive a full-sized bottle of their favorite. If you have suggestions for other ways we can make it easier for you to figure out what works, let us know!

We’ve certainly been hearing from people who want to “Ask Dr. Barb,” as we invite you to do on our website. I’ve been answering the questions directly via e-mail, but I’m sure others of you are wondering about similar issues.

To expand the discussion, we’ll start posting the answers to common questions sent to “Ask Dr. Barb” here on our blog—of course, we’ll protect the privacy of the people who asked! And remember, there’s no substitute for talking to your own physician for specific advice for you. But we hope our exchanges here will help you feel comfortable knowing what questions to ask—and inspire you to sustain your sexuality just as long as you’d like.

Alive! Alive-O!

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 shoe and a finish line and a medal. A real race. At the time I was pretty heavy, but working on getting leaner, and putting a big race out in front of me seemed a good goal. Something to look forward to, and a kind of capstone to all the hard work of losing weight and getting fit.

As it happened, the perfect race would be run in Dublin at a time when I planned to be in Ireland anyway, riding in my husband’s bags as he went there to teach for one lovely month of May.

This race is an annual 8K, dubbed a mini-marathon, run entirely by women, and doubles as one of the biggest fund-raising events in Ireland every year. That day 40,000 women gathered in the center of the city to await the starting gun. Tradition dictates that  all these women together sing the first verse of the old Irish folk song, Molly Malone, just before the race starts...

In Dublin’s fair city
Where the girls are all pretty
I first set my eyes on Miss Molly Malone.
As she wheeled her wheel barrow,
Through streets broad and narrow,
Crying “Cockles! And Mussels! Alive! Alive-O!”
Alive! Alive-O! Alive! Alive-O!
Crying “Cockles! And Mussels! Alive! Alive-O”

This makes absolutely every woman in the field begin their run with tears streaming down their faces, and feeling the ghost of Molly in their hearts, and feeling very much alive. I haven’t quite felt so glad and proud to be alive and kicking as I was that day.

Until today. Because tomorrow, MiddlesexMD.com goes live. We’re all thrilled and a little terrified, waiting here, at the starting line. This blog has been a bit quiet for the past month as we’ve all been hurling ourselves into our final wind-sprints. This is an amazing group of experienced, wise, and funny midlife women who have worked hard for a year now to pull off Dr. Barb DePree’s dream of a smart, informative, trustworthy place for women in menopause to explore and sustain their sexuality for life.

And it has been a dream project. Important. Fascinating. We have learned so much, and look forward to learning so much more. Learning from you, for you, and making all the necessary connections that women our age need to keep feeling Alive! Alive-O!

Please take the time to take a peek soon, and tell us what you think!