Q: Is weight gain a side effect of the estrogen ring?

Studies consistently show that estrogen use is not associated with weight gain. The estrogen ring (you are probably referring to Estring, although there are other estrogen ring products) should not be a factor causing weight gain. More common contributing factors are age and lifestyle, unfortunately. As we grow older, we need to be more active to burn the same number of calories.

Q: Is there an alternative to Zoloft that won’t decrease libido?

Zoloft is an SSRI (selective serotonin reuptake inhibitor), which increases serotonin. That improves mood, but more serotonin is not good for women sexually. Sometimes changing meds within that same class can have different side effects.

Wellbutrin (buproprion) is an antidepressant that increases dopamine. That can have the effect of improving libido, so sometimes adding it is helpful. In this situation, it might also be helpful to measure free testosterone and consider adding testosterone if it’s low.

If you consult with your physician and can't change your anti-depressant, you'll find some other ways to help with libido on our website.

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

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...

“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.

Sex: Deciding to Just Do It

We are learning more and more about what motivates women to have sex -- enough to know that we still don't know that much.

We do know that our motivations change with our situations. What motivates us when we're young and single is very different from what motivates us when we're older, and in long-standing relationships, or older and single.

So when we suffer from lack of desire -- are we missing the sort of drive we had when we were teenagers? And is it possible we just haven't found a new motivation for sex?

The more we learn from women, the more it seems that for us sex doesn't always begin with lust, but instead starts in our hearts and minds. We engage in our heads first, decide to have sex, and then with enough mental and emotional stimulation, our genitals respond. The older we grow, the more this is true. Age and maturity bring a new game into the bedroom.

For us, having sex is less an urge than a decision. One we can choose to make and then act upon. When we decide to say yes instead of no, decide to schedule sex instead of waiting (perhaps for a very long time…) for our body to spontaneously light on fire, decide to engage with media or methods that will put us in the mood rather than wait for romantic moments to happen along, we're using our heads to keep sex in our relationships.

Deciding to be intimate unlocks the pleasure. And the more sex we decide to have, the more sex we will feel like having. That's the secret to regular bonding.

Why just decide to do it? This much we know:

* Sex leads to a longer life.
* Sex, like all exercise, helps protect us against heart attack and possibly stroke.
* Hormones released during sex may decrease the risk of breast cancer and prostate cancer.
* It bolsters the immune system.
* Sex before bed helps us get to sleep.
* Of course, sex burns calories.
* Sex can help relieve chronic pain, including migraines.
* An active sex life is closely correlated with overall quality of life.
* Good sex can protect us against depression.
* Good sex reduces stress and increases self-esteem.
* Sex with your significant other stimulates feelings of affection, intimacy and closeness.

Making sex a focus in your life as you get older doesn't make you unusual. A study by AARP found that 66% of women age 45-59; 48% of women age 60-74 and 44% of women over the age of 75 believe that a satisfying sexual relationship is important to their quality of their life.

We think those numbers would be higher if women knew they could engage in thoroughly satisfying sex without waiting around for desire. Just by using their heads.

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.

The Maintenance Years

Turning 50 is like walking through a doorway into another world. Suddenly we notice our bodies, primarily because they are not functioning as effortlessly as they used to.

Welcome to the maintenance years. So many things we used to do without effort or thought now require both. What we used to take for granted, we don’t any more. The best part about being our age is no longer wasting our time on things that aren’t very important to us. Now the game is maintaining our ability to do the things that do matter.

In my practice, I see so many women who are struggling to maintain their bodies, to age gracefully even as they are fighting to keep their good health: Women fighting cancers, auto-immune diseases, diabetes, heart disease, high blood pressure. Or perhaps their partners are fighting these illnesses. The fight requires treatments that are known libido-killers. Treatments that sap our strength, surgeries and therapies that leave us in pain. When this happens, our sex lives can take a back seat pretty quickly.

Without meaning to, without even realizing it, illness can leave couples growing physically distant just when they need physical affection more than ever.

The best cure I know for this situation is talking. Maybe you’ve never openly discussed it. Maybe it embarrasses you. But try to move past your embarrassment, because this is an important topic. To be at our healthiest, humans do need emotional support. Physical affection helps sick people get well and caregivers remain committed. If you need help broaching the subject, your clergy, a good couples counselor or sex therapist can help you comfortably move through that conversation.

One thing I like couples to consider when facing a debilitating illness: Consider expanding your notion of sexual contact well beyond intercourse or orgasm. Holding, snuggling, looking into one anothers’ eyes, kissing, fondling. All of these can do wonders for both of you, elevating your mood, keeping the ties strong, making a sick person feel like getting well!

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 →