The Sensual Grandmother?

For the first 10 or 15 years that we knew her, we were not to call Elaine “Grandma.” At least and especially not in public. She was too busy attending to her coiffure and hosting wild parties for the American film productions in Rome to acknowledge this shift in her life. Holly GoLightly at the age of 55, she did not orchestrate or ask for grandmotherhood, so why should she assume the title?

Elaine is a footnote to this post, so let’s back up a bit.

It’s supposed to work this way:You have a baby, and your whole life changes forever. You prepare carefully, but nothing can quite ready you for motherhood. It shakes you up and places you down in another realm of life entirely. Your role as mother now trumps all the other roles you play. And all your family, friends, and neighbors understand, are happy for you, and supportive. Because we know what a mother is. Right?

But how is it supposed to work when your child has a baby? The shift in your roles is just as momentous, really, but less understood by everyone around you, and also by our ever-changing culture.

Sunday is Grandparents' Day, and we thought we’d take a minute to ponder this change in identity that comes along, for many of us, close on the heels of menopause.

My girlfriends are going through this identity shift now. But I remember listening in when my mother and her friends became grandparents. They advised and consoled one another daily. For them there was anguish in being sidelined, or demoted. They expected to be involved, but they were not. Distance was the word of the day. The mom role, the central role of their adulthood, was somebody else’s job now, and being demoted while still in the room is nothing but awkward. That problem alone can be stunning (stun-gun set on paralysis).

This distant role was completely different than the role many of their grandmothers played. And our grandmothering will be very different from our mothers’. We just don’t quite know how yet. We are writing our new job descriptions on the job. Grandmotherhood will be whatever we make of it, shaped by family dynamics not entirely in our control. It can become the central role of your life, an enriching extra dimension. Or you can pull an Elaine, and pretend it never happened. (Her grandchildren thought she was fabulous, by the way.)

Our new role will need to encompass very well-developed mothering skills, fit bodies, pretty darned agile minds, and a new phenomenon for women our age: A lot of us are still enjoying just being girls. You know, being fit, fashionable, fabulous, garrulous girls. We are not prepared for the invisibility cloak that has long been the costume for the role of Granny.

I’ve had friends in tears, wondering whether they should cut their hair off and get a perm? Should they start wearing stretchy pants? Certainly no grandma should wear a thong anymore, right? And spikey heels are just… gross for grandma. Or are they?

These may not seem like pressing or important questions at the moment of bringing a new life into the world, a new generation into your family, but they represent a complete emotional upheaval. We’re moving into the upper ranks of our families. The end is not near, but you can see it from here. It’s awful at the very moment when everything should be wonderful. It's emotional quicksand. Even the most stable among us can get trapped in it.

So. Got a girlfriend who’s a new grandmother? Our advice is: Pamper her. Make coffee dates, and give her your ear. Listen and attend as she carves out her own philosophy of grandmothering. This might be you some day. And then come back and tell us about what grandmothering means to the girl in you, will you? We would love to hear about your experiences.

To mark the day, we've developed a few special Grandma’s gift sets as a comfort and assurance for a grandmother in your life. We hope you like them--and she does, too.

Happy Grandparents’ Day!

STIs--Not Just Your Daughter's (or Granddaughter's) Concern

She's 54 years old. She's spent most of her adult life in a long-term monogamous relationship. She's just been diagnosed with genital herpes.

This happens more often than you might think.

Even I -- who should know better! -- have been guilty of age bias when it comes to testing for sexually transmitted infections (STIs, also called STDs, for sexually transmitted diseases).

In my former practice, when a 20-year-old came in presenting with symptoms (discharge, discomfort, irritation) that might indicate an STI, I would automatically screen her. When a 50- or 60-year-old came to me with the same symptoms, I was more likely to ask before I tested: "Is this a possibility?" If she said "no," I tended to trust that. I was trusting my patients. They were trusting their partners.

Times have changed.

Over the past decade, STI rates among people 45 and older more than doubled. In April, the Centers for Disease Control and Prevention reported that senior citizens accounted for 24 percent of total AIDS cases, up from 17 percent in 2001.

Researchers point to climbing divorce rates at mid-life, the rise of online dating services, the increasing number of men availing themselves of treatment for erectile disfunction. And all of these are contributing factors, I'm sure. But in my experience, the most likely cause of the up-tick in STIs among women past their child-bearing years is lack of awareness and prevention.

If you know that pregnancy is not a possibility, why use a condom?

Unfortunately, the risk of contracting STIs -- including syphilis, gonorrhea, genital herpes, HPV, hepatitis B, and HIV -- does not end at menopause. In fact, sexually active postmenopausal women may be more vulnerable than younger women; the thinning, more delicate genital tissue that comes with age is also more prone to small cuts or tears that provide pathways for infection.

And -- it's not fair, but there it is -- with almost every STI, exposed men are less likely to experience symptoms, simply because they don't have the equivalent of a cervix and a vagina and the skin of a vulva. The kind, older gentleman who gave my 54-year-old patient genital herpes might honestly not have known he was infected.

These days, when a 50-or-60-ish woman shows up in my office with symptoms that point to a possible STI, I go ahead and screen. I'll say, "I understand this is not a likely outcome, but I want to make sure I'm checking all possibilities."

Worry about STI can be a real drag on sexual enjoyment. We'll talk about what you can do to insure that contracting an STI is not a possibility for you in my next post: "When Was the Last Time You Used a Condom?"

Your mom had sex.

I hate to be the first to break it to you, but your Mom had sex. She did. And it’s possible she even enjoyed it. View full article →

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.

We 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.

A Little Conversation About Mindfulness

Since launching MiddlesexMD, I have to say, my dinners have gotten a lot more spicy.

You know how it is when dining with buddies. It’s polite—required—for them to ask what you’ve been up to lately.

When I tell them about MiddlesexMD, you would think it might stop the conversation cold, but I’ve found just the opposite is true.

My friends do want to talk about this. It’s not surprising when men are there that they are a bit more quiet, but they are engaged, too. We all appreciate our partners’ attention to these discussions—because we’re not always alone with these changes. They affect our sexual partners, of course.

I had dinner the other night with an old friend. The subject of our conversation turned to the idea of how important it is, especially for long-partnered people, to keep their sexuality top-of-mind if they want to keep their sex life going. I talked about how older women, particularly, need extra stimuli (both physical and emotional) as they get older.

We need more opportunities to think about sex, consider it, fantasize about it, and more emotional intimacy throughout the day to find or sustain the mood.  Sex is like any pursuit, if you want to get better at it, it requires your attention. Some call this "work" Awareness or Mindfulness. And I think this dimension of a relationship is valuable enough to “do the work.” (Smile.)

It was a simple conversation. I didn’t think it had any sort of profound effect at the time. But I ran into that friend a few weeks later. She pulled me aside, and whispered, “Hey Barb! Thinking about sex more? It WORKS.”

I wasn’t surprised, if it works for me, it should for you too!

Gee, I love my job.

January 28, 2010


menopause ›   sex ›   Under the Covers ›  

How I Came to Care about Menopausal Sex

...and why you should care too!

It began when I partnered with the local hospital in my hometown to evaluate local women's health services, looking for any gaps where additional services were needed. In the process, it became clear that our community needed and could support a healthcare practice devoted to the special needs and care of women who were past their child-bearing yearsthese special needs were largely ignored by existing providers.

I decided to transform my practice. That was 4 years ago. I studied and became certified by the North American Menopause Society as a menopause care provider, and while welcoming patients into my practice, used their questionaire—a thorough document that makes it easy for new patients to give me a comprehensive view of their symptoms and health histories. On that eight-page-long form there are just a few questions for women to answer about their current and past sexual experiences:

  • Do you have concerns about your sex life?
  • Do you have a loss of interest in sexual activities (libido, desire)?
  • Do you have a loss of arousal (tingling in the genitals or breasts; vaginal moisture, warmth)?
  • Do you have a loss of response (weaker or absent orgasm)?
  • Do you have any pain with intercourse (vaginal penetration)? If yes, how long ago did the pain start? Please describe the pain: Pain with penetration? Pain inside? Feels dry?

Well, I was amazed by the responses from my new patients. 60 percent of my patients have experienced a loss of interest in sexual activities, 45 percent have a loss of arousal, and 45 percent a loss of sexual response. And when I talked to them, they were:

  • Perplexed—because they don’t understand what’s changed.
  • Disappointed—because they expected there to be more .
  • Frustrated—because they don’t know what to do about it.

And when you carry those numbers from my practice to the rest of the countrywell, more than 44 million women are aged 40 to 65 in the US alone. Some 6,000 of us reach menopause every day. And at least half of us experience sexual problems with menopause. Probably more.

That’s a lot of disappointed women. And a lot of disappointed men too… I believe there can be more, and women don’t have to just accept the changes if they don’t want to. I see MiddlesexMD as a real caregiving opportunity: Make it easy for women over 40 to gather the information and products they need to sustain their sexuality after menopause.

And that could make everyone happier!

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.


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.