Sex, midlife and a sense of purpose
Sexual desire. In midlife, sexual function and sexual desire aren’t well understood, primarily because there are so many factors that enter into equation. This may be why certain silver bullets, like a female viagra, has failed to show any significant improvements in the desire department. And yet, researchers continue to accrue more information about the things that influence desire in women, ranging from the quality of intimate relationships to social support and overall wellbeing. The manufacturer who discovers a pill that addresses all of these will have struck gold. Meanwhile, back in reality, as many as 75% of women in midlife rate sexual health as important enough to warrant further exploration.
Fortunately, we may have another piece of the puzzle: ‘sense of purpose,’ which appears to be associated with greater wellbeing, happiness, life satisfaction, self-esteem, personal growth and optimism. A sense of purpose also appears to improve health, prevent certain diseases and may even improve cognitive function, thereby staving off mental diseases associated with aging. In a study that appears in the online version of Menopause, 459 menopausal women who were sexually active with a partner were followed over three years. Each year, they were asked about their emotional wellbeing (including their general mood, anxiety and depression as well as how often they engaged in and enjoyed sexual activity (specifically desire, type of activity and hugging and kissing). In the final year, they took a test that rated their sense of purpose on a five point scale ranging from ‘there is not enough purpose in my life’ to ‘the things I do are all worthwhile.’
The findings?
A greater sense of purpose equaled a great enjoyment of sexual activities, independent and regardless of other specific life circumstances. In other words, psychosocial functioning, e.g. social support, quality intimacy and overall wellbeing influenced the quality of these women’s sexual lives. On the other hand, menopausal status and use of hormone therapy did not appear to play a significant role in how often women engaged in sex or if they enjoyed it. This is important, as it means that psychosocial wellbeing may ultimately be more important than hormones.
In so far as the desire to engage? Women who were younger, had more social support, felt better about themselves and weren’t suffering from vaginal dryness tended to want sex more than their older peers who didn’t enjoy these factors.
Not surprisingly, many of the factors that researchers stress may help desire and engagement are associated with greater nitric oxide levels, which Dr. Christina Northrup says can help combat sexual dysfunction and improve pleasure.
When it comes to sex in midlife? It may help to think ‘sense of purpose,’ a real sense of purpose, now. (Poetic license, Chrissie!) I’m all for it if improves activity and desire without drugs.
Read MoreWednesday Bubble: Let’s talk about sex…again
[youtube=http://www.youtube.com/watch?v=qzfo4txaQJA]
True confession: I’ve already posted this video previously but I love the song so indulge me won’t you? And while we’re at it, let’s indulge in these two completely divergent headlines:
Middle-aged Americans unhappy about sex vs. We may be broke, but at least we’re having more sex than ever before!
Um, Okay. So..are we or aren’t we?
The first headline belongs to a Washington Post article highlighting results from a recent Associated Press survey of Boomers (45 to 65 year olds). The findings? In summary, “faced with performance problems, menopause blues and an increased mismatch of expectations between the sexes, middle-aged Americans are the unhappiest people of all when it comes to making love.” For example:
- 24% of 45 to 65 year olds express dissatisfaction with their sex lives
- Nearly three in five women and half of men have stopped experimenting and claim to know all they need to about sex
- 48% of men’s expectations are not being met in the bedroom in terms of their partners not desiring sex however, two in five men in this age group have problems with sexual functioning, compared to 19% of women
The second headline belongs to a piece that appears on an Irish website regarding a Durex survey geared towards a slightly younger age group (25 to 34), but like the AP study, also makes comparisons to younger and older groups. Not only does this piece highlight results of the large study that appeared in the Journal of Sexual Medicine suggesting that Americans of all ages were having more sex than ever, but also reports that:
- The ‘over-55’ set is having sex at least once weekly
- Almost three-quarters of respondents believe that sex gets better with age
- Women are as eager as their male counterparts to have sex
- A growing number of Irish men and women are broadening their sexual horizons and re-engaging in the Swinger scene
Confused yet? Which of these bubbles needs to be burst?
All three of these reports are surveys, although only one qualifies as a bonefide study (the National Survey of Sexual Health and Behavior). And this particular survey doesn’t necessarily highlight major issues when it comes to sex and Boomers. Even more ironic is that the AP survey appears to have been done for a website that features an article on sex over age 50 that actually disputes the findings.
Wow! So, shall we talk about sex? I mean, really talk about it. I truly don’t believe that the generation that brought sexual exploration out of the closet is driving it back into the closet and abandoning it altogether. Life changes, physical changes, environment changes, relationship changes…sex changes. Let’s talk about something that matters for a change, like the “why’s,” “how’s” and “what if’s.”
I’ve said it before and I will say it again. No matter what life transition you are in, work it, don’t let it work you. That includes sex.
Read MoreWednesday Bubble me this: end the ‘silent suffering’
Bubble me this. When you think “chronic health condition,” what do you think of? I think heart disease, diabetes, multiple sclerosis or cancer. I don’t automatically think vaginal atrophy. And yet, it’s what’s for World Menopause Day.
The International Menopause Society (IMS) joined forces this year with Novo Nordisk FemCare Ag (marketers of Activella®) to ‘end silent suffering’ and promote recommendations for the management of vaginal atrophy during the menopause. A key problem, they say, is that results of a phone survey show that women are not discussing vaginal atrophy with their practitioners, who in turn, are not openly asking questions about vaginal health.
Vaginal atrophy refers to the thinning of the vaginal and vulvovaginal tissues due to a decline in estrogen, and can lead to pain, burning and soreness during sexual intercourse. Recent estimates suggest that vaginal atrophy affects about 50% of menopausal women. Symptoms can be mild or severe, and unquestionably, the more a woman feels pain, the more she is likely to be distressed during intercourse or lose interest in sex altogether. What’s more, according to survey results, the majority of postmenopausal women incorrectly attribute vaginal atrophy symptoms to urinary tract and yeast infections. More importantly, the report notes that roughly 63% of surveyed women did not realize that vaginal atrophy was “a chronic condition requiring ongoing treatment of the underlying cause.”
A chronic condition requiring treatment?
Granted, a chronic condition is defined as a health problem lasting three years or longer. And depending on how long a woman’s menopause lasts, well, vaginal atrophy theoretically fits into that category. But aren’t we being a bit alarmist about the ‘silent suffering’ of women with this chronic condition?
Mind you, I am not mocking or doubting the horrible impact that vaginal atrophy can have on a woman’s life. In fact, aging and its accompanying aches and pains aren’t fun. Neither are hot flashes, night sweats, mood swings or vaginal pain. And I am heartened to see that the IMS has published recommendations for recognizing and managing vaginal atrophy. They include:
- Greater collaboration and open discussion with postmenopausal women about their vaginal health
- Early detection of vaginal atrophy
- The value of estrogen therapy in treatment, including HRT or preferably, vaginal tablets, cream or rings
According to these recommendations, lubricants and moisturizers are not universally recommended for use by themselves because they can be irritating and offer only temporary relief of symptoms. However, as Dr. Diana Hoppe points out in her book, Healthy Sex Drive, Healthy You, “to get the vagina adequately lubricated, I initially recommend lubricants [e.g. Replense or Astroglide]. If lubricants do not work to make sex more comfortable, I prescribe vaginal estrogen therapy, which comes in different forms.” The point that she makes is that it is important to consider lubrication issues (and the resulting atrophy) as something that can be addressed in a step-wise fashion. Nor does she discuss atrophy and dryness as if they are symptoms of a chronic condition. In fact, like Dr. Christine Northrup, Dr. Hoppe emphasizes that women’s health issues, in particular desire, are multifaceted and emotionally and physically related. Toward that end, is it possible that by focusing solely on the physiological aspects of atrophy, practitioners might miss other important factors?
The IMS recommendations also fail to mention selective estrogen receptor modulators (SERMS), which mimic the action of estrogen in the body but theoretically, without associated risks and side effects. Most importantly, while ‘localized’ estrogen (i.e. topically or vaginally applied) may have a better safely profile than systemic estrogens (which directly enter the bloodstream after being ingested or injected) it is not without risks; according to its package insert, Activella is associated with pain, headache, nausea, vomiting, irregular bleeding and thickening of the vaginal wall and and also has a boxed warning about heart disease, stroke and blood clotting.
There’s an inherent lesson here, which is why this piece is featured on Wednesday: by all means, seek help for vaginal atrophy but ask questions about the therapy your doctor or practitioner recommends. If your symptoms are severe, well, you might want to skip the lubricants and go for the big guns. And be sure to consider factors other than estrogen depletion that might be contributing to a declining libido. If there’s one thing that appears to permeate all women’s health issues, it’s this: nothing is as cut and dry as it seems.
I hardly believe that we’re on the verge of an atrophy epidemic or that we need to dramatize the “silent suffering” of countless women across the globe.
Bursting this one? Yeah, you bet.
Read MoreBouquet-Worthy, a guest post by Dr. Barb DePree, M.D., Menopause Care Specialist and founder of MiddlesexMD.com
I recently had someone comment that I write about sex often.
I wasn’t aware of that.
In fact, I don’t really. But reader impressions are always welcome; who knows what people see or read or think or interpret, right?
So, on the heels of the write about sex comment, I thought it would be appropriate to include a post about sex, more specifically a website geared towards sexual desire, function and expectations in mid-life. I liked what I saw when I perused the site, so much so that I felt that this post would be most appropriately written by MiddlesexMD.com’s founder, healthcare provider and menopause care specialist, Dr. Barbara DePree.
A big bouquet of roses waited for me at the front desk of my clinic. It wasn’t my anniversary or my birthday. 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 soon — too 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 device — she had not used them before — that 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?
I founded MiddlesexMD.com for women 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.
MiddlesexMD is organized around five “recipe” elements – Knowledge, Vaginal Comfort, Genital Sensation, Pelvic Tone and Emotional Intimacy – that are essential to sexual well-being. It provides a factual guide on how they contribute to a healthy sex life, how they change with menopause, and how to use different techniques and products to make up for those changes.
I hope that MiddlesexMD gives you a trustworthy (and hopefully bouquet-worthy!) resource to explore issues you might be having, conditions that could be causing them, and steps you can take to enjoy sexuality for life.
About the Author
Barb DePree, MD, is a women’s health provider in West Michigan, specializing in menopause care. She founded MiddlesexMD.com, a safe, comfortable place where women can learn how aging affects sex after 40, find advice and techniques, and purchase specially chosen aids such as a personal vibrator, moisturizers and lubricants.
Read MoreGoing Green with Micro-Kitty
Love this! Who knew that you could do the planet and your planet some good simultaneously?
When a certain unnamed friend turned me on to this (no pun intended), I knew that I had to share it with you dear readers. Micro-Kitty: The World’s First Solar Powered Vibrator. And it’s phtalate-free as well, meaning that it is not only environmentally friendly but health friendly as well. Eco-consciousness has a whole new meaning now!
So, do you need to play around in direct sunlight? Well, hell now because evidently, the Micro-Kitty can be charged by both natural and artificial light. What’s more, it holds power for two and a half hours in the dark. No need to compromise comfort or convenience.
When it comes to toys, I am a huge fan of the Swedish brand Lelo. And admittedly, I’ve not yet tried the Micro-Kitty although I’d be more than happy to give it a test drive if its manufacturers would care to send me one.
Who knew that going green could be sexy too?
Meow!
Read MoreThis Just In! FDA Advisory Panel Unanimous Against Flibanserin
The verdict’s in! The Reproductive Health Advisory Committee did not consider flibanserin, the female Viagra equivalent, to be any more effective than placebo.
Shocking eh?
Here’s the AP report. And more information from this morning’s post on Flibanserin.
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