August 23, 2010

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comfort ›   intimacy ›   sensation ›  


Q: Could thyroid problems affect my ability to orgasm?

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 an orgasm with intercourse alone. Most women need more direct stimulation. As we get older and in the absence of estrogen, having an orgasm without direct stimulation becomes even more difficult. It may not be realistic to expect to have an orgasm with intercourse or penetration.

A vibrator can be a great addition for that direct stimulation. You might want to try one with a warming lubricant, and see what happens! The Gigi2, Liv2, and Siri2 are three options we have offered at MiddlesexMD that have more intense stimulation than some others on the market. I have seen some amazing results from women who hadn’t had an orgasm in years because of medications that interfere with orgasm or medical conditions that make orgasm more difficult. They were successful using these products, so give it a try and good luck!

July 06, 2010

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conditions ›   intimacy ›   sensation ›  


Q: Incontinence with stimulation? What’s up with that?

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 stimulation of the area nerves causes the urge to urinate and then contraction of bladder muscles (for some women it's just a strong urge, for others it's actual leaking).


While it poses no risk to you or your partner, it is definitely undesirable! Make sure to empty your bladder just before sexual activity. See your doctor to rule out a bladder infection. Performing regular Kegel exercises may be of benefit. The type, duration, and location of stimulation may influence the urge; more practice may help you better understand cause and effect. Certain positions may decrease leakage (for example, woman on top or side-lying position).

There are medications for urge incontinence that could be trialed just before having sex. Taken 10-60 minutes before sex play, the medication can decrease the urgency sensation and actual loss of urine.

This issue can really interfere with sexual expression, so addressing it sooner than later is important. See your gynecologist or urologist to further discuss which of these options are best suited to you based on your medical history.

Her First Vibrator (Pt 3)

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 couple likes and needs can be a real turnoff for the next.

While my partners and I shopped for the collection we offer at our online store, we kept these factors in mind:

Size and Shape Vibrators come in sizes and shapes destined for specific as well as general use. You will find mini vibrators great for clitoral and prostate stimulation. These small devices may fit in the palm of your hand or strap to a finger (especially good for making love in the dark).

There are larger clitoral vibrators shaped to cup the clitoris and labia. These can be combined with a dilator or dildo, used during intercourse, or used on their own to help stimulate vulvo-vaginal tissues.

Midsized vibrators are often wand-shaped for vaginal and g-spot stimulation. Large women find these useful for the reach they provide, and they can also provide leverage for women who have difficulty with hand strength.

Massagers are dual use devices, used for vulvar stimulation as well as massaging muscles anywhere in the body (really!). Attachments for these devices can transform them into vaginal and g-spot stimulating wonders.

Power Older women generally need more power, both a stronger vibration and a longer session time. For that reason, rechargable batteries or plug-in devices are usually a better bet than disposable battery-operated devices.

Materials Hard plastics and stainless steel are easy to clean. Look for materials that are guaranteed to be phthalate-free. Silicone surfaces are wonderfully warm to the touch, with a skin-like feel. They clean up with soap and water or with cleaners made especially for sex aids, but owners need to be careful not to use them with silicone-based lubricants. Some manufacturers now use anti-microbial plastics, medical-grade materials formulated to discourage bacterial growth.

Heat Feature Vibrators that warm up before and during use are great for those of us who flinch from the cold.

If that’s too many variables to maneuver in one shopping experience, may we make a recommendation? If this is your first vibrator ever, why not start with one designed specifically for clitoral and labial stimulation? That way you’re sure to have a device that will help you improve circulation, keeping your vulvar tissues responsive and ready for sex when you are.

When you have your new device in hand, be sure to charge it fully before you use it. Start slowly and gently, using plenty of lubricant with the device, learning what your device will do and how your body likes it. If it’s been awhile since you have had any sexual stimulation at all, be patient. Give your body time and a number of sessions to awake to this new sensation. And if you’re bringing this new toy into an old relationship, talk through it, explore this device together. The more communication, the better.

And you tell us! What advice or questions or stories do you have about selecting a vibrator or bringing one into your sex life for the first time? We would love to hear from you!

Return to Pt 1 of 3

June 07, 2010

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about middlesexmd ›   sensation ›  


Her First Vibrator (Pt 2)

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 next step is to go home and discuss this with her partner, if she has one.

Many times, at our age, we’re talking about spouses — sexual partners we’ve had for a very long time. And if that sexual partnership has not included the use of any sexual aids, bringing that first vibrator to bed can be a daunting change.

The truth is, we don’t know how our partners will respond to our need or desire to use a vibrator until we raise the subject. One good way to do that is to say — "Well, Dr. Barb said this could help." Show your partner these blog posts, and browse the MiddlesexMD.com website together, where you’ll find lots of information that can help you communicate what your body is going through and what you and your partner can do about it to continue to enjoy your sex life.

It can help to shop for your first vibrator together, whether in a store or online. The lines of vibrators we’ve gathered at MiddlesexMD.com are designed especially for women in midlife who need vibrators that will hold a long charge and deliver a strong vibration.

But even with all this information at the ready, one or both of you may be suffering from some vibrator mythology that will make you hesitate to use one of these devices. So let me do a little dispelling:

Myth 1: Vibrators are for people whose relationships aren’t strong — Actually vibrators work best for couples whose intimacy is solid and secure, playful and creative. Introducing a vibrator at our age can awaken those qualities in a strong relationship, and underscore an important lesson, that the nature of our sexuality shifts as we age, period. Accepting that with grace and creativity is important for any partnership.

Myth 2: Vibrators make it hard to have an orgasm any other way — Actually the exact opposite is true. The more orgasms women have, the more easily we can achieve them. Every orgasm helps to strengthen the muscles and nerve pathways that ready us for our next one. While, having easier orgasms with a vibrator may encourage its regular use, no vibrator can ever replace human contact. Women generally crave intimacy first.

Myth 3: Vibrators are for masturbation — While that one is true, vibrators are not only for masturbation. They have gone mainstream among couples who have figured out that vibrators are great for stimulating every erogenous zone, and in addition to the boost they give women, are particularly good for stimulating a man’s prostate. They are great for foreplay, during sex, and for gentle stimulation after intercourse, too.

Myth 4: Vibrators are for sex maniacs — Sex maniacs may like them. But so may your neighbor, your pastor, your doctor, your auto mechanic. We’ve been using electronic vibrators since we harnessed electricity, and they are more mainstream than you might expect.

On to Part 3 of 3…
Or go back to catch Part 1.

Her First Vibrator (Pt 1)

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 city in the middle of the Midwest, where sex aids are of course in use — as they are everywhere and for millenia — but they are hard to find and almost never openly discussed, at least not among the generation hitting menopause right now.

Vibrators for sensation and satisfaction

But, yes, Virginia, a vibrator, for you, and especially now. Here’s why… As we approach menopause, our sex hormones are in a constant state of flux. Perhaps flooding our systems one minute, depleted the next. What they are, especially, is unreliable. They are just not reliably there when you need them to do their work in bringing you to arousal, helping to lubricate your vagina, to make sex possible, much less pleasurable.

Then, once we have fully reached menopause, our hormones are more predictable, but they’re in shorter supply. That might not bring any measurable sexual changes for one woman, but for another, it can feel like a door has been shut in her face. Her vaginal tissues may not respond to the same sexual stimulation that always worked in the past. That can leave some of us feeling as if we have just stopped functioning, sexually.

Of course, the whole point of this blog and our website is to share the news that it ain’t over until you say it’s over. The secret to keeping sex alive after menopause is MORE. Follow our recipe: More knowledge, more lubrication, more stimulation, more intimacy, more exercise.

What came without trying when we were young — reading the small print, responding to sexual stimuli — now requires assistive devices. Reading glasses… and a vibrator. (And moisturizers, maybe dilators, a sexy movie or two, a pillow?…)

But especially vibrators. And not just any vibrator, but a vibrator with more power and endurance than a young girl needs. Clitoral stimulation at our age needs to overcome the sluggish circulation in a clitoris that, if unused, will go dormant, pulling up into the body. Our vibrators need more power, over a longer period, to replace that circulation and encourage a clitoris to come out to play.

On to Part 2 of 3...

Patience, patience!

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 life from painful to normal. "Oh boy!" you think. "Orgasm tonight!"

Please, please, please, slow down. I know it's hard to wait when you've been anxious to find an answer.

The conditions that cause painful intercourse in the first place can be comforted and in many cases reversed, but only with practice and time. Practice and time that are worth taking, when the result is the kind of sexual intimacy you want.

Picture a young athlete. She is powerful, flexible, supple, and graceful. She practices her sport every morning and night. Then she graduates, gets a desk job, has a couple of kids, spends nearly every waking hour sitting at her desk or in her mini-van, carpooling. Her fitness slowly drains away.

One day, she decides to get back into shape. If she tries to complete a workout at the level she did when she was in peak condition, she will get hurt. No doubt about it. She knows, or will soon realize, that she must start slowly. She'll get her fitness back, but only if she works within her comfort zone. When things start to hurt, she needs to back off. Keep moving, but slow down, decrease the intensity. Please approach your new sexual aids, your vibrator of course, your vaginal dilators, especially, with this same understanding. Pushing too hard, going too fast, will hurt you. You are trying to restore pleasure, and I recommend letting comfort and pleasure be your guide.

As always, if the pain just won't resolve, do discuss it with your doctors. Finding the real reason for the pain is the fastest way to resolve it.

Meantime, put the box down. Have a healthy dinner. Take a nice bath. Relax. Then begin, slowly.

Our Secret Recipe for Sex after Menopause

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 good health secret.

So here, today, long before going live with our website, we are happy to divulge our recipe for sex after menopause. The ingredients are:

Tada!  Whooot!!! We have balloons falling and confetti rising over here at MsMD headquarters!! How about you?! No?

Wait, No?

Maybe you don’t realize how hard it is to distill good-sex-after-menopause down to an easy-to-remember system? So let me explain: Months ago, we began our work with a hard look at the American Psychiatric Association's DSM-IV description of disorders contributing to Women’s Sexual Dysfunction (There’s a phrase we won’t use a lot around here, because it worries us. If we don’t yet understand Women’s Sexual Function, how can we comfortably describe its dysfunction?).

We embraced (and strive to remain mindful of) the point of view of women’s sexual problems developed by the New View Campaign, and their concerns about the medicalization of human sexuality. We reduced by our focus on peri-menopausal and menopausal women. Filtered all of these concerns through recent research and publications by members of the North American Menopause Society (NAMS) and the International Society for the Study of Women’s Sexual Health (ISSWSH).

We surveyed current literature on female sexuality. We added recent work by sex researchers and therapists and coaches, relationship coaches and mindfulness gurus.

That was the first step.

The next step was sorting all of the helpful advice, tips, skills, and learning into clear descriptions of conditions and pragmatic actions so that women in menopause can understand exactly what is going on with their bodies and what they can do about it if they want things to be different.

Portrait of Dr. BarbWe didn’t go looking for the recipe. It surfaced from the work, organically. We began to see how all of the latest and best advice of medical, psychiatric, and sex researchers and coaches, seeking to help older women enjoy their sexuality, clustered into just a few central goals. What does a woman need to do to enjoy sex after menopause? (Assuming, of course, that she wants to enjoy sex after menopause at all. Because that is still her choice.)

1. Knowledge

She needs to know the physiology of menopause, so she understands what is happening when it happens, and especially that though her experiences are unique to her, she's not alone. And she needs to know some new sexual techniques that will keep sex enjoyable as she ages.

2. Vaginal Comfort

She needs to learn how to take care of her vulvo-vaginal tissues so that sex remains comfortable.

3. Pelvic Tone

She needs to learn how and why to strengthen and maintain her pelvic girdle to encourage circulation and maintain or strengthen her orgasms.

4. Genital Sensation

She needs to compensate for less blood flow and less sensitivity in her genital tissues by providing herself with more stimulation, more sexual sensation.

5. Emotional Intimacy

She needs what every woman needs at every age for sex to be good. Sex needs to be intimate. It needs to mindfully create and reinforce a real connection. There it is. No secrets. When we take our site live in April, you’ll get all the rest, descriptions of conditions that get in the way of achieving these five goals, actions you can discuss with your doctor or take on your own to enjoy sexuality for life, and products we have selected to help you on your way.

Adult Trade Show Newbies

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, advice, and products they need to sustain good sexual health as they age — is all there in my original paper.

Taking a business from paper to reality takes a lot of work, and skill, and putting in hours doing things you might not have ever pictured yourself doing. But in this life, a woman’s got to do what she’s got to do to get it all done. Right?

I was lucky enough to find the right business partner, a woman I like and respect who has impressive business credentials, is reaching midlife herself, and understands the need for better information for women of our generation.

So when she suggested, early in our business planning, that we head to a trade show for sex products, both to shop for appropriate products for menopausal women, and to learn about the industry, I took a deep breath, and swallowed hard. She knew it was the right thing to do, and I knew she knew what she was talking about.

So off we went to the AVN Novelty Expo in Los Angeles.  Three days of product and toy makers hoping to entice buyers from all of the big sex stores and distributors. Thousands of people familiar with the trade and the spectacle and the atmosphere of the Los Angeles sexpo… Plus the two of us: A gynecologist from the Midwest and her friend, the corporate exec.

We stayed close to each other as we breezed past the signs suggesting we had to be over 18 to enter the show. And, you know how it is, waiting for your eyes to adjust when you’ve walked into harsh lighting after being in a low-lit room? At first you blink a lot, but before long you can make out where you are?

I suppose going to this show for the first time was a bit like that. We spent the morning blinking, remembering to breathe, feeling a bit jumpy. But after a while, our agenda kicked in.

What surprised us more than anything was the prevalence of really poor quality products made of questionable materials, with no warranty, yet made to be used inside the body. As a doctor, that’s a little hard to see.

But among all the thorns there were really great products too, ones designed with health and durability and a great experience in mind. And products with smart, dedicated people standing behind them. We  found all of those that we could.

By the afternoon it was easy for us to cruise down those aisles and aisles of multi-colored, throbbing, bobbing, moist, flavored, leather-covered, studded, and hinged things, to find the exact products and people we needed to meet.

-- A guy who developed an organic line of glycerin-free and paraben-free lubricants because his wife was allergic to everything on the market.

-- The woman from the UK whose target market was menopausal women, her products developed to function exactly as we need them to.

-- Companies whose sexual aids are designed by thoughtful designers, in beautiful, tactile materials. These aren't toys. They're objects so lovely and well-made anyone would want to own them.

My partner was right. We did need to see that show. We learned what we needed to know and found what we needed for the store faster than we could have sitting at home with our search engines.

Navy blue Fin vibrator by Dame ProductsWe have pulled together a really nice collection of products, spanning price ranges and functions. We'll be able to show you the results of our shopping expedition in April, when the site is ready. Meantime we'd love to hear your questions, advice, and experiences in finding and using the products that work for you.

January 22, 2010

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about middlesexmd ›   comfort ›   sensation ›  


A Sex Shop for Us

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 takes more—more time, more moisture, more sensation.

I like to use the reading glasses analogy. When you reach 40, suddenly it’s not easy to read the fine print. When that happened, did you give up reading? Of course not. You got reading glasses and went on. Or bifocal contacts. You adjusted.

Many of my patients have little to no experience using sexual aids. I may recommend that they consider using a vibrator or a lubricant or a positioning pillowbut they have to actually purchase these things. I can just picture my patients walking out of my office and shaking their heads at the thought.

A majority of my patients are not going to visit a sex shop. They are not likely to be comfortable or happy visiting the sex shops online either. I looked and looked for a good place to send my patients, where the focus is on sexual health, on sustaining our sexuality. We need a safe place to shop, where the products are durable and made of safe materials. And frankly, we need a place that doesn’t cast women as sexual toys, and that acknowledges a healthy sexuality for people over 40.

My patients are from a generation of women who have redefined female sexuality, and are now redefining menopause. As pioneers, we all had a lot to learn, and still do. Many of us have never used sex toys or lubricants at all. The language of these products is completely foreign to many of us. We can learn from and teach each other.

Portrait of Dr. Barb in lab coatSo I'm trying to build a sexual support site for us. And that includes a product store for us. A store that’s comfortable, private, but has  the advantage of including guidance that will help women who are new to this language choose products that will make sense for their own sexuality, their conditions, their goals.

We won’t offer hundreds of items. We will keep the information informative, tasteful, and clear. We’ve been working hard (no, really) shopping, testing, choosing, sorting—pulling together a portfolio of products specifically for midlife women who want to enjoy sexuality for life.

I can’t wait for you to see the selection. And when you do, please share your thoughts. I very much want our product selections to be influenced by our customers and the menopause community.

January 19, 2010

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arousal ›   sensation ›  


Let's Get Aroused

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 almost 30 years of togetherness with the same guy. Despite aches and pains, stress and too little time, and all the physical surprises of menopause. Despite all of that, we are nowhere near ready to hang up our sheets.

So when my own friend (we served undergraduate years together) and doctor (my own menopause doctor, because I’m lucky), Dr. Barb, asked me to help her develop her website, I jumped at the chance. I needed to learn about this myself. What better way?

I’ve been writing for years and years, and for many years researching and writing on health  topics. But I have never written about sexual health. Barb is teaching me—you would not believe the size and density of these textbooks.

So, day one, lesson one, Basson’s Model. I had no idea that there is a difference between Sexual Desire and Sexual Arousal. I really always thought they were the same thing, or flip sides of the same impulse, or something. Because that’s the way I’d experienced it for most of my life. Arousal and Desire arrived on my doorstep, it seemed, instantaneously.

But they are considered distinct aspects of the sexual experience. And now that menopause has slowed me down a bit, I understand better.

We can achieve arousal with or without desire. We can have comfortable, enjoyable, emotionally satisfying sex with or without desire. That is, we need arousal for sex. But we don’t need desire. We like it. We want it. We enjoy it. But we don’t need it to engage in sex or get a lot out of our sexual experiences.

The easiest way for me to tease these ideas apart is this way: Desire happens in your head. It’s an idea. Arousal happens all over. It’s physical. Certainly the idea can spark a physical response. But it works the other way more often for women. Sexual stimuli—physical sensations, emotional feelings, sights, sounds, smells—arouse us physically. Our arousal readies our bodies for sex and can breed desire.

So, when we start talking about the kinds of sexual problems women may experience with menopause, the distinction becomes very important. Are we having difficulty with arousal or with desire? Or both?

What used to follow automatically from sexual stimuli—the arousal part—may now take more time and more stimulation. We may have to ask for and give ourselves more help and support to become aroused. This isn’t a lack of desire, but a greater need for stimulation.

We may be receiving all the same sexual stimuli that we always have, that always worked before, but we don’t respond to it as readily. We love our partners just as much or more. But our bodies just don't respond as quickly now. Or we may now have physical or emotional limitations or illness or medications that muffle the effect of sexual stimulation.

This was lesson one for me. A real eye opener. I used to worry that I didn't feel the same desire as I did when I was in my 20s and 30s. Worry isn't the word. It upset me. I am much more relaxed about it now. I'm learning to tune in to stimulation, to appreciate and notice my body's response more. And that helps a lot. Well, I suppose writing about sex every day doesn't hurt either...

There have been and will be many more lessons. Some embarrassingly basic. Some I wish I’d known 30 years ago. I will always be willing to show my ignorance in these matters, followed by Dr. Barb’s patient teachings.

Meantime, I’m gathering up all my favorite stimulants: I’m with Reka, a visitor from the last post, on the potency of Dr. Gregory House. And Dr. Andrew Weil too (his relaxation tapes have an opposite, unadvertised effect on me). I have a thing for David Strathairn. Indian food. Tango/dance movies. And I have this special drawer in my bedroom….  And you? Care to share?

(Anonymous sharing is always welcome. Or make up a name, if you like!)

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