Good Sex, Grandma?

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 from 20 to 90 about their sex lives.

The surprise—to Iris and some reviewers—was that the women in the later chapters were claiming some of the best sex of their lives. Among the comments:

We are so comfortable with each other that we will try anything to keep things hot.
When you’re younger, it’s all about the orgasm, then it’s over. I love this suspended feeling, the absolute intimacy we have been able to achieve.

Given my conversations with patients in my practice, I’m not surprised. There’s a whole lot of life after 50, and a whole lot of pleasure.

Two things typically get in our way: First, just as our kids never wanted to know we had sex (mine are adults and still don’t want to know!), we’re culturally just a little uneasy with grandparents having sex. Silly, but there it is.

And second, we could do a better job of sharing information about how to keep sex comfortable for just as long as we want it—and expanding our thinking about what “sex” means as intimacy beyond vaginal intercourse.

Most of the women I see are interested in being sexually active—I am, after all, a gynecologist. Every now and then, though, a woman will tell me, “We’re done with all that. And it’s okay.”

I think it’s awfully hard to tease out how we really feel about that “okay”: If it’s not cultural messages that we’re too old for sex, it's a cultural message that we need to keep at it to stay young. For many of us, the discomfort we may now experience with sex is enough to sway us toward that “too old” message.

But beyond the effect on relationships I’ve talked about before, what I hear from the women in this book echoes my own experience: Sex is part of feeling alive, powerful, energized, secure, blissed, refreshed. I’ll decide for myself when I’m ready to give that up.

And you can, too.

New Study: Docs Don’t Talk about Sex

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 talk with their patients about sex. The results may not surprise you, but they won’t reassure you, either.

  • 63 percent routinely ask whether their patient is sexually active. (Good, but fairly superficial.)
  • 40 percent routinely ask if the patient is having any problems regarding sex. (Which means that 60 percent don’t ask about sexual problems.)
  • 28.5 percent ask about sexual satisfaction. (Which means that two out of three doctors don’t ask.)
  • 28 percent ask about sexual orientation or identity. (Yikes! Two out of three don’t even know if their patient is gay or bisexual.)
  • 13.8 percent ask about sexual pleasure. (Which means that 86 percent don’t ask whether the patient enjoys having sex.)

Even more distressing was that 25 percent of OB/GYNs reported expressing disapproval of a patient’s sexual practices. Foreign doctors, older doctors, and very religious doctors were more likely either not to address the issue of sex or to express disapproval. Female doctors and those whose practice focuses on gynecology rather than on delivering babies were more likely to do some sexual assessment, although it was often insufficient.

Dr. Stacy Tessler Lindau, a practicing OB/GYN and lead researcher in the study, points out that OB/GYNs are the most appropriate health care provider to be asking these questions, and if they aren’t, it’s unlikely that anyone else is. Which means, as we have found repeatedly, that women tend not to mention sexual problems, to assume that a doctor can’t help anyway, and to suffer with or adapt to sexual problems on their own.

Doctors should be talking about sex with their patients because

  • Sex is an intimately linked to overall quality of life and the quality of one’s relationship.
  • One-third of younger women and one-half of older women report having some sexual issues, from lack of desire to painful intercourse
  • A change in sexual patterns can indicate an underlying health problem, such as depression or thyroid problems.
  • Women with ongoing sexual issues are more likely to feel self-conscious, isolated, embarrassed, ashamed, or guilty.
  • Assuming that a patient has a heterosexual orientation is alienating to patients who are lesbian or bisexual and can result in miscommunication and misdiagnosis.
  • Common medications, such as those for depression and breast cancer, for example, can cause sexual problems, such as low libido. Women are often not told about sexual side effects of medications and are therefore unprepared to cope with them.

The researchers hypothesize that doctors don’t talk about sex because, like everyone else, they’re embarrassed or they may worry about embarrassing their patients. Talking about sex isn’t part of their medical training, and although they may treat a woman’s sexual organs, they aren’t equipped to assess and treat her sexual problems. So what’s a frustrated patient to do?

Take the initiative, counsels Dr. Lindau. If you trust your doctor, but he or she hasn’t asked about your sex life, you can, and should, begin the conversation.

  • Formulate your questions ahead of time. What, exactly, do you want to ask your doctor about sex? Do you have specific issues, such as painful intercourse or low libido? Are you anxious about entering menopause and need information about what to expect? Write down your questions and be as specific as possible.
  • Acknowledge your discomfort, advises Dr. Michelle Curtis. It clears the air. “I know this is a little embarrassing, but I have some questions about sex I’d like to discuss.” Don’t worry about embarrassing the doctor, says Dr. Curtis. It’s his or her job to answer your questions.
  • Empower yourself. The medical profession will change as women take responsibility for their own sexual health and begin asking questions and expecting thoughtful answers. You can ground yourself in basic information with websites like this one or others backed by solid medical organizations, such as the Cleveland Clinic or Mayo Clinic. Then you can approach your doctor with good, informed questions.
And if your doctor doesn’t respond in kind, avoids your questions, or seems uninformed, you can consider finding another doctor. We’ll discuss that process in a future post.

Sexual Desire. Still Trying to Figure Us Out.

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 that the medical community needs a better understanding of how women get turned on, why we want to have sex, and why we might not want to have sex?

The research is clear and consistent: A lot of us simply don’t feel much sexual desire. We don’t think about sex much “in between,” and we aren’t particularly motivated to initiate sex. We do, however, enjoy it once the ball gets rolling, and we feel pretty good about our sex lives overall. “Research confirms that women report sexually satisfying lives despite rarely or never sensing desire,” writes Dr. Rosemary Basson in an editorial in Menopause: the Journal of the North American Menopause Society.

Basson is a champion for less labeling and a more open-minded understanding of female sexual arousal and response. (That’s why we love Rosemary!) She and others hypothesize that women have a different arousal mechanism than men, less straightforward and linear, more subtle and complex. Maybe desire and arousal overlap and reinforce each other in women. Maybe we need to light the kindling—a little nibble on the earlobe, a little stroke along the thigh—before desire and arousal begin to smolder. And sometimes life experiences affect our sexual appetite and responses. Longstanding personal issues, like childhood abuse or problems with our partner, for example, or recent developments, such as illness or depression.

Basson advocates careful consideration of all the variables when it comes to labeling one-third of women as sexually dysfunctional because sexual desire in women is subtle and many-faceted. Is a physical illness the impediment, or is it the financial worry that accompanies the illness? Or is it depression brought on by the medication for the illness?

Basson encourages a more “detailed, careful interview” to establish causation. And she is hesitant about blaming hormonal or neurochemical imbalances, which she says there is lack of evidence for.

When women are carefully examined, she feels that only a “theoretical sub-fraction… would merit a diagnosis of intrinsic sexual disorder.”

The bottom line, ladies? Lots of us don’t think about sex much in the course of daily life, but light the match, and we warm up nicely. For most of us, this isn’t a problem. So why consider it a sexual disorder?

And if it is a problem in our relationship, try to find a medical professional who’s willing to perform  the kind of “detailed, careful” examination that Basson recommends.

Study Confirms Older Women Like Sex

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 sex continues to be important to older women, and it’s an important element in overall satisfaction with their relationships—and sometimes it’s even more important to the women than to the men.

Now, another survey adds a little more texture and depth to that glimpse behind the bedroom curtain. Gals, we’re sexier than we thought.

Since 1972, researchers from the University of California San Diego School of Medicine have regularly surveyed a group of residents of a southern California community to track various characteristics of health and aging.

Recently, the results of a new survey of this group were published in the January 2012 issue of the American Journal of Medicine. Several hundred older women in the community were questioned about their sexual activity. In a mail-in survey, they were asked about how often they’d had sex in the past four weeks, about hormone use, lubrication, orgasm, and level of satisfaction.

“Sex” was broadly defined as “caressing, foreplay, masturbation, and intercourse” (of the penis-in-vagina variety). The women didn’t need to be partnered, and they didn’t need to be sexually active. Slightly over 800 women responded, ranging in age from 40 to 99 with a median age of 67. Most (90 percent) were in good to excellent health. Almost two-thirds were postmenopausal and 30 percent were on estrogen therapy.

What the researchers found, somewhat to their surprise, was that half the women reported being sexually active in the previous four weeks. Unsurprisingly, sexual activity declined with age (83 percent of younger women were sexually active versus 13 percent of the oldest women). Yet, one in five of the sexually active women over 80 reported arousal, lubrication, and orgasm “almost always” or “always.” They were also as satisfied with their orgasms as the youngest women in the study. (You go, girls!)

Sexual desire (libido)—or lack of it—was another surprise. One would think that desire might precede the act itself, but not so. What the researchers found in this study was that one-third of sexually active women had little or no sexual desire. Yet, most of them (61 percent) were satisfied with their sex lives. This suggested to the researchers that “women engage in sexual activity for multiple reasons, which may include nurture, affirmation, or sustenance of a relationship.”

The interesting thing about desire was that, although the younger women had the highest levels of desire, they were less satisfied with sex. They were also more likely to be distressed about their relative lack of desire (low libido). The oldest women, on the other hand, were more likely to be content with their sex lives and less bothered by lack of desire. But that doesn’t mean they weren’t getting any. The oldest women in the study who were sexually active experienced orgasm with the same frequency as the youngest women.

Hormone use was linked to higher libido and to greater sexual activity, but that doesn’t translate to greater emotional closeness with a partner. Emotional closeness wasn’t linked to age or use of hormones, but it was linked to more frequent sex. And most of the sexually active women in the survey were emotionally close to their partner. The researchers didn’t address the question of whether emotional closeness leads to better sex or whether good sex creates emotional intimacy. Cause or effect? Chicken or egg? I’m not sure anyone cares.

The final nugget unveiled by the study was that almost half of the women who aren’t sexually active are satisfied with their (non)-sexual lives, too. The researchers guess that they “may have achieved sexual satisfaction through touching, caressing, or other intimacies that have developed over the course of a long relationship.”

Overall, the survey seems to suggest that, given good health and a capable partner, older women are sexually active and quite content with that activity, and that, despite lack of desire, they enjoy sex just as much as younger women.

“A more positive approach to female sexual health focusing on sexual satisfaction may be more beneficial to women than a focus limited to sexual activity or dysfunction,” writes Susan Trompeter, MD, and one of the study’s authors.

Amen to that.