Vaginal atrophy? Tight pelvic floor muscles? FeMani®Vibrating Massage Wand can help.

5/15/2016: I have updated a previous 2010 review of vaginal dilators, now that the FeMani®Vibrating Massage Wand is available. I've also added some wonderful wisdom from Ellen Barnard.   

Women write to me that after a long period of celibacy, they find someone they want to have sex with again. Often they didn't think they would discover love/lust again after so many years.

Their elation dims when they attempt penetration and discover that their vaginas feel too dry and fragile for comfort if they try to accept a penis (or sometimes even fingers).

There are several reasons that vaginal fragility, tightness, discomfort, or pain can happen (which I discuss in my books, Naked at Our Age and The Ultimate Guide to Sex after 50). With age, especially if you're sexually inactive, the vaginal tissues thin and there's less blood flow to the genitals, causing dryness and fragility, known as vaginal atrophy. A separate but related problem is that the pelvic floor can lose its ability to relax, and in its contracted state, the vaginal opening feels too tight to admit a penis or a larger-than-slim sex toy.

Here's how Ellen Barnard, co-owner of A Woman's Touch sexuality resource center, helps women distinguish between menopause-related vaginal dryness and atrophy and "high tone pelvic floor dysfunction" that can be caused by the lack of blood flow to the genitals after menopause:

If you feel like your skin is very dry, fragile and tears easily then you have vaginal dryness and atrophy. You may experience tearing during penetrative sex and find a little bit of pink discharge after sex. If you feel like the skin is stretching or tearing at the opening of the vagina that is another sign of vaginal atrophy. A good quality, long lasting lubricant relieves your symptoms, and the Vaginal Renewal program will provide further relief and comfort both during daily activities and during sex.

If you engage in penetrative sex and your partner feels like they "hit a wall" either at the opening of the vagina or about 1-1/2 inches inside, or you feel pain deep inside the vagina with deeper penetration you may have an over-tight pelvic floor. The pelvic floor is made up of 3 layers of muscles. After menopause, those muscles can tighten up and not relax because there is not enough blood going to them once estrogen is no longer present. 

If this happens to you then your first step is to see a pelvic floor therapist and get an evaluation of your pelvic floor muscles. If you have over-tight muscles the therapist can work with you to get them relaxed and learn appropriate exercises so you can consciously relax them once the therapy is over. The Vaginal Renewal program may or may not help your pelvic floor muscles, so it is important to get additional help if the description above sounds like what happens to you.

Please download the Vaginal Renewal program from the wonderful folks at A Woman's Touch sexuality resource center, and put it into action for the sake of your sexual health and future joy.

Part of this program is at least one orgasm a week (you don't need a partner for that!) and internal massage using vibration. Yes, really. Internal massage with vibration brings blood flow to the vagina and helps strengthen the tissues. If you're so tight that insertion hurts, slim wands (a.k.a. dilators) will help. These start very slim and progress in graduated sizes as your body adapts and is able to accept more. Barnard adds,

A set of dilators may be used to treat the involuntary tightening of the outermost layer of the pelvic floor that happens with a condition called vaginismus, or when you have high tone pelvic floor dysfunction (over tightening of the pelvic floor muscles that surround the vagina) in the outermost, middle and/or deep layers of the pelvic floor. You would work with a pelvic floor therapist to use the dilators to help you learn how to relax with progressively larger dilators inside the vagina. This work may be accompanied by other work such as psychotherapy when the tightening is caused by pain or trauma; meditation; and relaxation breathing in the case of high tone pelvic floor dysfunction.

It used to be a hassle to even find vaginal dilators, but A Woman's Touch has done the research and development and created FDA-registered, therapeutic vibrating wands that are ideal for the Vaginal Renewal program:

Sizes 2 and 1

The FeMani Vibrating Massage Wand is made of smooth, durable, medical-grade ABS plastic and comes in three graduated widths: Size 1 (3/4" diameter), Size 2 (1" diameter), and Size 3 (1-3/8" diameter).

Order two sizes in a kit with one silicone controller (detachable handle that controls the vibrations). These vibrating wands use AAA or AA batteries (included), depending on the size.

To figure out the size that's right for you, A Woman's Touch recommends this:

Determine how many lubricated fingers you can insert into your vagina when you are not aroused. For one finger, choose the 1 & 2 set, for two fingers choose the 2 & 3 set. If you are unsure or between sizes, we recommend choosing the smaller choice, which will still provide the beneficial massage without the potential strain or discomfort of being too big.

Using vibrating wands is a process for your own sexual health and the health of a relationship you might have now or in the future--and it can be extremely pleasurable, besides!

FeMani Wellness Sexual Health Massage Wand

If you've read my book, Naked at Our Age, or the advice given on this blog, I hope you've noticed the valuable information contributed by Ellen Barnard and Myrtle Wilhite, MD, co-owners of A Woman's Touch. They are brilliant sex educators and compassionate human beings who devote themselves to women's sexual health and pleasure, with a special emphasis on helping women with sexual pain and limitations.

I've recommended A Woman's Touch's Vaginal Renewal Program often, and many of you told me how helpful it has been for you. An attendee at one of my workshops recently emailed me:

I wanted to let you know how much I benefited from your workshop. Using some things that were discussed, the Vaginal Renewal Program you recommended, your books that I purchased (I went straight to chapter 11 -- "When Sex Hurts" --  in Naked at our Age), and some steamy stories from Ageless Erotica, I was able to have penetrative intercourse for the first time in 4-1/2 months. It can only get better from here and hubs is very happy.

Ellen Barnard

I'm including this testimonial here not only because she specifically mentioned AWT's Vaginal Renewal Program, but also because  much of what I know about vaginal pain and self-help solutions I learned from Ellen and Myrtle. I consult and quote them often, and you've benefited from their expertise several times on this blog as well as throughout the pages of Naked at Our Age.

Myrtle Wilhite

Ellen and Myrtle have been working for years on developing the best sexual health internal massage wand for women who have pain and/or limitations with penetration and with medical internal exams due to aging, cancer, or other issues. They (and we) were dissatisfied by the wands -- aka vaginal dilators -- that were available to women with sexual pain, either from doctors or online.

After years of research, they've designed and tested the FeMani Wellness Sexual Health Massage Wand, which has been perfected to their high standards. FeMani Wellness Sexual Health Massage Wand is ready for manufacturing -- but their funds have run out.

That's why I'm appealing to you. These amazing educators have been (and continue to be) generous with their expertise, helping anyone who needs them. Can you be generous to them now? You'll be helping yourself and many other women who will be able to have comfortable, pleasurable sex because of these tools.

If you've been helped by the expertise of Ellen and Myrtle, either through my books or elsewhere, or you just want to help other women, can you assist with a donation of any size?*  Go here to learn more.

* You know I don't use this blog for fund-raising appeals. You may not know that I turn down about one worthy project a week, because I know you come here for senior sex news and views, not to be asked for money. But this project and these people are so special in our world that I had to make an exception.

No Sex for 12 Years, Now Vagina Too Tight for Penetration

[1/19/14: So many readers are landing on this post from 2007 as they search for information about vaginal tightness and pain that I updated it, including current links. 

-- Joan]

Frustrated in Florida, age 61, had not had sex for nearly 12 years, until recently. She wrote in an email to me:

Apparently one's vagina does change after not using it for a long period of time. I always thought sex was like riding a bicycle, but it is not. One can't just get back on and ride! I experienced such pain during the attempted penetration that we had to stop. What a disappointing and embarrassing moment. My partner was very understanding, however I was just frustrated and disappointed.

I went to my GYN for an examination soon after and explained my circumstances. She gave me a thorough exam and said although I had many tiny lacerations and redness, my vagina seemed normal. She explained how one's vaginal lining becomes thin after menopause and her advise was to abstain from sex for two weeks, using lubrication to aid in healing.

When we engaged in sex again, very gently, I was once again disappointed with the level of pain even though using lots of lubrication. We once again had to stop.

So now I am wondering if there is some way I can stretch my vagina for it seems like it has shrunk. (Perhaps it is just my imagination running wild!)

Have you had anyone else write you with a similar problem and if so is there a solution? For your information I have never been on hormones and my partner's penis is of normal size.

No, it's not your imagination, and yes, it's true that the vagina will seem to shrink after a long period of abstinence, especially after menopause, and penetration will be painful or sometimes impossible. You'll find a helpful chapter in my book, Naked at Our Age: Talking Out Loud About Senior Sex and several other posts about vaginal pain on this blog.

I'm disappointed that your gynecologist is not this helpful. Telling you you're "normal" while you have lacerations and pain is not helpful, is it? Most doctors do not know how to diagnose or treat vaginal pain, and it 's wise ask for a referral to a sexual pain specialist.

Please read Vaginal Renewal Program  by Myrtle Wilhite, M.D., at A Woman's Touch, a wonderful sexuality resource center in Madison, WI. It tells you step by step how to massage and stretch your vagina. Here's an abridged version:

* External Moisturizing and Massage: Increase the suppleness and blood circulation of the skin of your vulva and vagina with a five- to ten-minute massage with a moisturizing sexual lubricant like Liquid Silk®, a water-based lotion that will soak in and moisturize your skin, won't get sticky, and will help you massage with very little friction.

Push in to the skin with circular strokes, and massage what's underneath the skin, rather than brushing across the skin. Include the inner lips, the hood of the clitoris, the head of the clitoris and the perineum.

To complete your external massage, massage into the opening of the vaginal canal, using the same circular strokes. The massage itself does not need to be self-sexual in any way, but if that is comfortable for you, by all means explore these sensations.

* Internal Vaginal Massage: To massage inside your vaginal canal, we suggest using a lucite dildo which is very smooth and will not cause friction or tearing. Choose your size based upon how many fingers you can comfortably insert into the opening of your vagina.

After a session of external vulva massage, apply the same massage to the inner surfaces of your vagina with your dildo with lubricant applied on both skin and dildo. Rather than pushing the dildo in and out, use a circular massage movement. You are increasing skin flexibility so that your body can adjust to comfortable sexual penetration if you choose it.

You might also choose to use a slim vibrator for massaging the vaginal walls. Coat it in Liquid Silk and then insert it gently. Turn it on and let it run for about five minutes. You don't need to move it around, just lie there and let it do its work.

* Orgasm: For women who stop having orgasms, the blood vessels literally can get out of shape, preventing future orgasms. If you are able to bring yourself to orgasm, do so at least once a week (for the rest of your life -- seriously). This is preventive maintenance of your body.

* Kegel Relaxation: Kegels increase both the strength and flexibility of your pelvic floor muscles. Pay attention to the relaxation and deep breath part of the exercise. Learning to relax your pelvic floor will help you to avoid tensing up before penetration. (Read A Woman's Touch's Step-by-Step Kegels in this article about pelvic floor health.)

In my earlier book, Better Than I Ever Expected: Straight Talk about Sex After Sixty, I had interviewed a 75-year-old woman who had been celibate for 38 years and was in a new relationship. She was unable to have intercourse because her vagina had dried and narrowed to the point that penetration was impossible. She sought help from her gynecologist (a wonderful woman who bought dozens of copies of Better Than I Ever Expected to give to her patients!), who helped her. 

Best wishes for a joyful resolution to this problem -- please keep me posted.

--Joan

Cancer Survivor: Can I Have an Intimate Relationship Again?

A reader wrote:

 I am 62, single, and once was a very sexually active woman. I've undergone treatment for breast cancer twice. My recovery required my full attention for years, but now I feel ready for new adventures -- hopefully including sex. After rounds of chemotherapy, surgeries, radiation, and continued estrogen blocking medications, sex with another became a thing of the past. 

Currently, sexual intercourse may no longer be possible for me -- but I still enjoy having orgasms and I desire the wonder of touch. However, I am so concerned about my limitations as a sexual partner that I am afraid to attempt to date again. 

I have no idea what men in my age group expect or desire in terms of performance from their partners. What are woman experiencing in the 60-year-old dating world in terms of performance expectations? Would my current physical circumstance deter most men from being interested in exploring an intimate relationship with me?

I am grateful for this message and all it conveys about hope and healing and moving forward. I understand why you're apprehensive. I would encourage you to get out there and go after what you want.

I know that many single men in our age group also fear "performance expectations"  when erections are no longer possible or predictable. There are many who would welcome a sexual partner who did not expect intercourse, who would be happy exchanging touch, oral and manual stimulation, and fabulous orgasms -- without intercourse.

These men may be cancer survivors themselves, wanting to return fully to life, including sex and intimacy, but they don't know how to navigate the dating world either -- when to divulge the cancer, when to divulge the sexual issues.

You might find out if there's a local cancer survivors' singles group. Or try online dating: I did a search on "cancer survivors singles" and came up with several sites that promote themselves as dating sites for cancer survivors.

There's even one -- "2date4love" --  that "enables people who cannot engage in sexual intercourse to meet and experience love, companionship and intimacy." I haven't vetted any of these sites -- if any of you have tried them, I hope you'll share your experiences.

You don't need to limit yourself to dating companions who share a similar medical history, though. Just be up front about your cancer on a first date if it looks like there's potential for a second date. (If not, you don't need to mention it.)

Then if you progress to a few dates and there's chemistry, it's important to explain that yes, you are interested in sex, but no, this might not include intercourse. Be prepared: Men who desire intercourse may want to discontinue getting to know you, and that's okay.

When all the cards are on the table, if the relationship progresses, you have the delightful journey of exploring all the ways you can be sexual without intercourse!

Even when a date doesn't progress to more, it's still worth getting to know new people, "practicing" dating, trying out how to tell a potential partner about your needs, desires, and challenges.

If you take it all as part of the brave new world of dating experience, you don't need to feel regretful or shamed when a new relationship (or potential relationship) doesn't work out. Most of them will not work out -- that's the nature of the game.

Everything I've said so far presumed that you're right that intercourse will not be possible for you. But please explore whether there are ways that you can heal yourself vaginally, if this is something you want to pursue. An excellent resource is "Vaginal Recuperation after Cancer or Surgery" from A Woman's Touch, one of my favorite sexuality resource centers.


I hope you'll check in again and share what you tried, how it worked for you, what you learned and gained.

I hope that you'll share your thoughts, too, readers.

Adult Sex Ed Month: HuffingtonPostLive, AASECT conference, and a new senior sex book

 June has been declared Adult Sex Ed Month (#AdultSexEdMonth) by Ms. Quote (@GoodDirtyWoman on Twitter) who blogs at A Good Woman's Dirty Mind. This idea caught on, and this month, hundreds of posts designated #AdultSexEdMonth from sex educators and bloggers appeared all over the Internet. View the list with links here.

In my world -- advocating for senior sex and educating about older-age sexuality -- every month is Adult Sex Ed Month. This month has been particularly fruitful.

***

This month, I participated in a Huffington Post Live event titled "How Old Is Too Old To Have Sex?" with fellow panelists Ashton Applewhite, Walker Thornton, Sidney Schwab, and Ken Solin, hosted by Abby Huntsman. Of course the answer to the question in the title is obvious to us (though not obvious to Abby, until we raised her consciousness), but you'll find the discussion interesting even though you know the answer! Watch it here:

***

The annual conference of the American Association of Sexuality Educators, Counselors and Therapists conference always makes my brain swell with new information and ideas from sex educators who are trailblazers in the field. Counselors, therapists, sex educators in community or medical settings, and other people who care about your sexual knowledge and enrichment gather to learn from the leaders. Then people like me come home and spread it around – to people like you.

As always, it was impossible to attend all the sessions of interest, and there’s no way I can share all of the 25 pages of single-spaced notes that I took on my laptop, no matter how many blog posts I write. But here are some highlights and tips that are especially relevant to our age group:

• Some sexual issues are psychological; some are medical or physiological. But even when it's a medical issue, a sex therapist can be important to help you work with whatever is going on. Medical sexual issues affect your sense of self and your relationship. “Any pharmacotherapy for sexual dysfunction should occur within the context of sex and relationship therapy.” (Ricky Siegel)
• One more good reason to quit smoking: Nicotine has been shown to decrease blood flow to the penis and increase venous outflow from the penis -- in other words, less ability to get and maintain an erection. (Ricky and Larry Siegel)
• Women with vulvar or vaginal pain have a difficult time getting the pain diagnosed and treated effectively. Possible causes of pelvic pain are varied, and with the wrong diagnosis (or no diagnosis!), the wrong treatment follows. Look for a three-pronged approach: a sexual medicine physician, a pelvic floor physical therapist, and a certified sex therapist, such as used by the Summa Center for Sexual Health in Akron, Ohio. (Kimberly Resnick Anderson)
• Pelvic floor physical therapists are trained to do internal evaluation of the pelvic floor muscles -- evaluating muscle function, strength, tone, and any points of tenderness. Regular physical therapists are not trained to do this. (Amy Senn)
• Men with low libido: Anxiety, mood, relationship, and religious factors affects libido. “First know what’s going on in the relationship before throwing medication at it.” (Larry Siegel)
• "Nerve sparing" prostate surgery is "a bit of a misnomer." Erectile nerves on the outside of the prostate are very difficult to see and avoid during surgery. "The prostate is deep in the pelvis, and they go pushing around with stainless steel instruments. If cauterizing instruments are anywhere near nerves, it damages them for life. Nerves recover from the pushing and pulling – it takes a long, long time. Nerves go into shock and stop sending message to blood vessels to relax and let blood in.” (Anne Katz)
• “Sexual arousal requires healthy blood flow for everything else to work. Otherwise, nothing happens. Take a 15 minute walk with your partner before sex. It will prime the pump.” (Ellen Barnard)
• After treatment for female genital cancer, using a vibrating wand internally will reduce scar tissue. "Vibration directly to the scar tissue starts breaking up that scar tissue, allowing it to expand, become more comfortable, and allow penetrative sex if we want it.” (Ellen Barnard)
• After cancer treatment, start getting to know “what is”: “What feels good? What doesn’t feel good? What’s numb? What’s painful? How does arousal happen? What does it take? How does orgasm happen and feel? When during the day do I have energy?” (Ellen Barnard) You need to learn this for yourself before you can teach your partner.  (JP: This applies to aging in general, also.) A Woman's Touch has excellent educational brochures for both men and women online at no cost, for example, Healthy Sexuality After Cancer. Visit  www.sexualityresources.com, see the Educational Brochures link in the upper left hand corner of the menu bar for a complete selection.

***

The huge news this month for me as a senior sex educator was an invitation from Cleis Press to write a book for them: The Ultimate Guide to Sex after Fifty! I'm thrilled to have a new book to write on my favorite topic, and I'm proud to be part of the fabulous Ultimate Guide collection of sexuality guidebooks. You can be sure you'll hear more about my new endeavor as it unfolds.

Meanwhile, if there's a topic you want to be sure that I cover in this new book, please either post it as a comment here or email me. I love to hear from you. I'm too busy to promise to answer all your questions in detail, but I try to acknowledge your email and point you in the right direction. I admit sheepishly that I have about 400 unanswered emails waiting. If one of these is yours, I thank you for your patience!  (I do give private, educational consultations answering your questions by phone or Skype for a modest fee -- email me for more info about this.)

Kegel Magic: Pelvic Floor Shape-Up For Better Sex

Diagram from Wikipedia

 January is "shape-up" month, with every lifestyle magazine and website proclaiming a new exercise program.

I've got a shape-up program for you, too, and though it's a muscle workout, you won't see the results in the mirror or show them off to your friends -- except for intimate friends -- and then the results will be felt, not seen.

This workout strengthens the muscles of your pelvic floor -- the "PC" (pubococcygeus) muscles that run along the pelvic floor and surround the entire vagina. These are the muscles that contract during orgasm.

 Regular pelvic floor workouts, AKA Kegel exercises, lead to more enjoyable sex: easier arousal, stronger orgasms, more pleasure. If that's not enough, strengthening the pelvic floor muscles also protects against urinary incontinence. (Ah, now I have your attention!)

You've been told, "Do your Kegels," but you haven't been told how to do them most effectively. Here are step-by-step instructions for your pelvic floor workout, thanks to Myrtle Wilhite, MD, MS and staff of A Woman's Touch Sexuality Resource Center in Madison, Wisconsin:

Step-by-Step Kegels

1. Lie down on your back in a comfortable place with your knees bent. Lying down takes the weight off your pelvic floor and leads to earlier success. Have your tool (if you are using one) and lubricant with you.

• If you're using a tool, coat it with lubricant and insert it into your vagina until it comfortably slips into place just behind the pubic bone. You can't push it in too far; it cannot get lost inside of you.


• If you're using your finger(s), wash your hands first, then coat your finger(s) with lubricant. Next, insert your finger(s) about 2 inches into your vagina. 
 
• You can also practice Kegels with nothing at all inside your vagina, or a hand placed on your perineum, to feel the muscle contract from the outside.

2. Contract your pelvic floor muscles. It will feel like you're pulling up and in toward your belly button. Don't push out, unless specifically advised by a health care provider. If you're using a tool, you should feel it rise a bit. If you're using your finger, you should feel a gentle tightening around the finger. Try to keep your leg, buttock, and abdominal muscles relaxed, and remember to breathe normally throughout the exercise.

3. Hold the lift for a count of 5. If you're using a tool, you can add resistance by pulling gently on it as you continue using your muscles to pull the tool inward and upward. Remember to breathe!

4. Relax your muscles.

5. IMPORTANT: After each contraction, take a deep belly breath. Inhale deeply and gently blow out the air while you relax your pelvis completely. This deep relaxation is just as important as the other steps, because the deep belly breath relaxes the muscles that are not under your conscious control.

For much more about Kegels from A Woman's Touch, click here.

The deep relaxation phase is often omitted when we're told how to do our Kegels, but they're as important to practice as the contraction. Many women of our age, especially after a period of celibacy, experience what feels like tightening or shrinking of the vaginal opening because the muscles don't fully release. This can interfere with our enjoyment of penetrative sex.

"Pay equal attention to the contraction and the relaxation of the muscles that surround the vagina in particular," says sex educator and counselor Ellen Barnard, MSSW, co-owner of A Woman's Touch. "Otherwise you may find that these muscles are stiff and inflexible, which will also get in the way of comfortable penetration when you are ready to have it."

You can practice with your own fingers, a partner's fingers or penis (fun for both of you!), or a sex product designed for vaginal penetration (that's the "tool" mentioned above) such as a dildo, dilator, or a special Kegel exerciser.

You can also practice your Kegels without tools or fingers, even on the go: standing in the grocery line, driving, walking, working at your desk, during your Pilates, yoga, or dance class. If you're doing them in public, be sure you've mastered the part about not contracting your buttocks, or anyone standing behind you will see what you're doing!

Although I've directed this article to women, Kegels are also important for men. These muscles located in the perineum, the area between the scrotum and the anus, contract during a man's orgasm. Kegels can make sex more pleasurable for men with age-related, less intense orgasms.

"By strengthening the muscles of the perineum, you will pump more blood to this vital area, achieve greater ejaculatory control, and increase the intensity of your orgasms," says urologist Dudley S. Danoff, MD, FACS, author of Penis Power: The Ultimate Guide to Male Sexual Health.  (Read my interview with Dr. Danoff here.)

Kegels are recommended for all ages, and they're especially important for Boomers now and through our later years.

Kegels can be fun as well as useful. Though there's nothing sexual about the pelvic floor exercises per se, there's nothing to stop you from pleasuring yourself or your partner while you do them, or right afterwards!

(This post first appeared 12/28/12 on the Post50 channel of The Huffington Post here.)

 Please read the companion piece to this one: Kegel Exercise "Tools" for Better Sex to learn about cool tools that will make your Kegels lots of fun.