“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.

Finding a Sexually Literate Doctor

None of us get through our adult lives without some questions about sexual functioning. And we go lots of places for answers, consulting family, friends, texts, the Internet, piecing together a quilt of inter-generational wisdom and ideas, sifting through marketing hype at the drugstore, trying to self-diagnose our situation and find the fastest-best-cheapest way to make it better.  Or sometimes we simply live without answers to our questions, wondering and miserable.

This is a time-consuming and inexact way to learn that can lead to some uncomfortably misguided behaviors (Yogurt douche, anyone?).

Is there a better way? We think there is: You deserve a Sexually Literate Doctor.

Surveys tell us only 14 percent of men and women between ages of 40 and 80 have EVER discussed sexuality or sexual health with their doctors.  I attended a women's sexual health conference this month, and out of 100 people in the audience, only one had EVER been asked by her doctor about sex.

That is, women who have worked for years with their gynecologist to bring their babies into the world don’t discuss sex with them. When discussing menopause symptoms and treatment, sex doesn’t come up. Women are more comfortable ignoring the sexual changes or treating  sexual difficulties from drugstore or pantry shelves than through interaction with their health care providers.

And there’s good reason. For most of our lives, our physicians couldn’t help us. Most of them simply didn’t know how.

Until very recently, not many doctors had the training to discuss female sexual function, and particularly post-menopausal sexual function. As recently as 10 years ago it was common for a physician to receive just an hour or two of training in female sexual function during their entire residency.

That's why I started MiddlesexMD!  Sexual literacy among physicians is getting better every day, but until thorough sexual health training is common in our medical schools, we still have to look around a bit to find a Sexually Literate Doctor who can answer our questions when we need help.

Female Anatomy 101

Writing for my gynecologist friend has included a lot of Aha! moments. I admit some of this learning makes me blush. It's not just because I blush when talking about sex—though I do. It's because I’m embarrassed when I’m caught not knowing things I think I should have known a long, long time ago.

So, I’m reading along in Dr. Barb’s enormous textbooks on female sexuality, when I come across an illustration of the clitoris, sort of like the one below. I nearly passed it over, because, what’s to know at my age? I've lived with this equipment for 50 years. I'd like to think I know my way around it.

But this illustration colored in the entire structure of the clitoris. Not just the glans, but also the shaft and the crus clitoris, or crura.

Excuse me… the shaft?... and the crura?

No.. please picture me picking my head up like a prairie dog, looking around my office, and asking the air...

“The shaft?!"

"And the crura!?!”

Somehow in all my curious, bookish, research-happy past, I never learned more about the clitoris than about the little buttonthe glansthe part that sticks out from the prepuce at the top of the labia.

Who knew my clitoris had legs? And a shaft, even?

But yes, indeed. It's practically a little penis under that hood. With long, long legs that extend waaay back toward the perineum, which fill with blood when I’m aroused.

Now, of course, the cool, rational part of my mind tells me I have enjoyed my crura—and possibly even the shaft—because they’ve been there all along. But I would have liked to know about them from the start. I can’t help but wish for a few years back in which I could quite clearly visualize my long, leggy crura.

What can we do with this information? Well, with age, the clitoris loses some sensitivity. We may find it useful to use warming oils and gels or vibrating sex aids to increase stimulation to the clitoris as we prepare for or engage in sex.

And of course, to do that, it really does help to know where it is.

Back to the books...

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.

So 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.

Bouquet-Worthy

A big bouquet of roses waited for me at the front desk of my clinic.

It wasn’t my anniversary or my birthday. And doctors just don’t get a lot of flowers. When I saw who sent them, I smiled that special “good sex” smile, even though the sex I was smiling about wasn’t my own.

I've been a women's health doctor for more than 20 years, focused on midlife women for the past four. These flowers were not from a new mom or a patient with a difficult disease. These came from a patient who got her sex life back.

That may not seem like a big win in the scheme of things, but it was a wake-up call for me. My patient, now in menopause, was distraught that her sex life seemed to be over so soontoo soon. Sex was effortless for most of her life. It had been very satisfying. And suddenly, it wasn't any more.

We talked about sexual response with her hormonal changes, all of the many factors that could be influencing her experience. Then we talked about her options for managing these changes. She tried different routes, but when I introduced her to a deviceshe had not used them beforethat made the difference for her. With the help of a simple tool, she was able to adapt to her new reality, and enjoy sex again.

It was a fairly straightforward doctor-patient exchange, but not a common one. Women rarely talk to their doctors about sex. As a menopause practitioner, though, I know that changes in sexual response are a key source of distress for a lot of women and their partners at this age.

Is it a doctor's job to help their patients have good sex? I think it is, absolutely. A healthy sex life sustains our overall health and well-being. Sex is good for us, and helps us to remain vibrant and strong. Menopause isn't a disease. It's a natural process. The more we understand this process, and discuss it openly, the easier it will be for us to make adjustments to accommodate our bodies' changes.

The roses were evidence that my patient's sex life had been restored. How many women like her have never raised the question with their doctors. Their gynecologists? Or sisters? Or friends?

Natural changes during meopause can make it feel like the door is closing on your sex life. For some of us, that’s not a huge loss. For others, it’s seriously distressing.

But these changes don't have to stop your sex life. They will certainly change things a bit. They may require learning some new things, trying some new techniques, experimenting with a few products.

I'm working with my friends to launch MiddlesexMD. We will reach out to women like my patient, women at midlife who aren’t ready to close the door on sex, and who aren’t sure how or when to talk with their doctors about their experiences. My partners and I want to build a trustworthy (and bouquet-worthy!) sexual health resource for midlife women, combining helpful advice, clinical expertise and a carefully selected set of products with a record of helping women continue to enjoy a satisfying sexual life as they age.

By launching our blog first, we're starting the conversation. We'd love to hear what you think, need, want. What do you think about a website devoted to midlife sex? Can you relate to the changes in your sex life? Please leave a comment to join the discussion, and/or sign up to receive the posts by email.

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