Doctors, Talk to Us about Our Sex Lives!

4/3/16: I'm bringing this 2014 post to the top because I'm giving a talk to doctors and other medical professionals tomorrow in Milwaukee. I want these comments from my readers to be easy to find if they read my blog after that -- which I hope they will!

About half of all sexually active men and women aged 57-85 in the United States report at least one bothersome sexual problem; one third report at least two. Yet only 38 percent of men and 22 percent of women reported having discussed sex with a physician since the age of 50 years. 

Why does this information barrier exist? And what can you, as professionals, do to overcome it with your patients and clients?

These are the questions I posed to the attendees at the beginning of “Talking about Senior Sex: A Presentation for Medical Professionals, Therapists, and Others Working Professionally with the Older-Age Population,” which I presented at The Smitten Kitten in Minneapolis on June 19, 2014. I was so jazzed by the responses during that workshop that I wanted to continue the discussion, so I took it to my Naked at Our Age Facebook page (which I invite you to read and “like”).

Our community jumped in eagerly with their comments and experiences. Here are some of those:

• It would suffice if they just asked. I think they are 1) embarrassed, and 2) afraid that a nestful of psychological tangles would emerge, which would take a lot of their time. As a doctor, you would have to believe that relationships, beliefs, and habits contributed to illness, and I think most of them are just looking for a set of symptoms. The mind-body connection is far from their thoughts. 


• It may be difficult for physicians to broach topics on sex because of their lack of education on sexual matters - not just with senior sexuality. Often such topics are delegated to nurse specialists or physician assistants. There are also shades of sexuality beyond the range of physiology, endocrinology, anatomy, and other hard sciences that are beyond the scope of topics covered in med school and continuing medical education. We need to take charge and help drag medical providers along with us on this topic.


• Sex over 55 is often challenging if your parts are in perfect working order, but if they are not, then it’s an entirely different ball game. As someone who has lived with a sexual challenge for 20 years (and who is now 67), I found, in the beginning that it was helpful to write a letter to the doctor prior to the appointment - an ice-breaker. Now, however, after such a long-term medical problem, I am really very open with all the doctors I see and they either handle it or they don't - they can choose!


• We live in a culture that allows only a few sexual subjects to be discussed and those in limited ways. Having lived a lifetime hiding or being ashamed of our sexual natures, it can be a huge challenge to just start talking about "it" when we reach those years. The mechanics of sex may be easier to discuss than unmet needs and innate desires. It is a gift to be sexually sovereign in our culture.


• In my case, no doctor ever broached the subject. I was always the initiator. After 12 years of fertility work, four ectopic pregnancies, numerous spontaneous abortions and nerve damage resulting from a rape, surgeries and malpractice (they refused to remove the infamous Dalkon Shield IUD after the rape and subsequent STD infection), it's not a stretch to understand why I had a damaged libido. Only with recent help from two amazing physicians, with whom I can discuss anything, have I begun to find help! Finding this and other groups online has also been salvation of yet another kind. Thanks for opening so many doors to those of us who have foundered for so long!


• Actually, it was through conversations with my nurse practitioner that my road to sexual freedom opened up. Also through my wonderful husband's patience, and Joan's book, Naked at Our Age. There is a taboo about sex at a certain age, but for us it has just been renewed!
  
  
• Particularly as sex and disability is also a taboo subject and many people will have genital dermatoses and that will make it even harder for them to open up to anyone. I am 67 and despite lichen sclerosis, I remain sexually active.


• The doctor needs to be calm, confident and comfortable with the subject. If the doctor is squirmy and clearly uncomfortable, it won't help the patient to open up. Speaking for myself, if I'm a little squirmy and hesitant, I'd appreciate it if the doctor would give me the time and space to squirm a little and build up my courage. I had that experience with a doctor; he asked what was clearly a scripted question, I hemmed and hawed a little struggling to express an answer. Since the answer wasn't immediately forthcoming he just jumped right to the next question. I got the distinct feeling he really didn't want to hear it, so the subject was dropped. On the other hand, a doctor might ask a question and get a very forthright answer they weren't expecting. They better be ready for that too; no eyes bugging out, no jaw dropping, no flinching. They might need to develop the 'warm positive regard' thing that therapists are taught.


• I’m 73, have an older woman doctor trained in Europe who brought the subject up in the course of an annual physical, and was quite matter of fact about it, made me quite comfortable discussing the subject, and referred me to an endo.


• I'm not your target age group but my nurse practitioner at Kaiser simply asked if I was happy with my sex life and, after I affirmed that I was, proceeded to tell me that orgasm was good for my vaginal health (not to mention my psyche) and encouraged me to take charge of my pleasure because it would help make perimenopause easier to take, keep my bladder where it belongs and generally support my wellbeing. Hell yeah -this I knew - but what was even better was that she made it clear that she was there to help. My sexual health was not some secondary aspect. It was a full-fledged piece of my gynecological workup. To which I say - well done!


• I'd like to see it simply become a matter of routine during all regular check ups, or anytime the visit is for more than a sniffle really, as well as anytime mental health/ relationships are discussed. We need to be in the habit of treating the whole person, not just fixing bits and pieces and mending boo-boos.

I hope you’ll continue this important conversation by commenting here. (And if you’d like me to bring this presentation to your organization, please contact me.)

#AdultSexEdMonth

Simply Aware: STI Testing at Your Convenience

https://simplyaware.co/

Have you wished for an easy, confidential way to get tested for sexually transmitted infections?

Now that huge numbers of sexually active seniors are engaging in relationships with new or multiple partners, shouldn't there be a way to get private testing without telling your family doctor or risking running into your grandson's girlfriend or boyfriend in the clinic waiting room?

Simply Aware saw a need and filled it. They provide a confidential service that tests for gonorrhea and chlamydia ($99 includes both) with a mail-in urine sample and an at-home kit that tests for HIV ($39). There's also as much support as you need -- you can phone with your questions, or get an online followup consultation with a licensed physician, or simply ask for help and hand-holding while you take the tests.

"We started this business because unfortunately there is a stigma attached to STD testing that can make the process awkward and uncomfortable," Tom Peacock emailed me, introducing Simply Aware and offering to let me try it myself. I did. Here was my experience:

Gonorrhea and chlamydia test:

I signed up, and within just a few days received the test kit, along with a code which I would need to receive my results. Included was a sterile urine sample container, a biohazard bag, and a prepaid thermal shipping envelope.

All I had to do was pee into the container first thing in the morning (or, in my case, pee all over the container -- maybe you didn't want to know that), screw on the cap (extra step just for me: wash off the outside of the container), put the container in the bag and the bag in the shipping envelope, and pop it in a mailbox. Very simple.

A few days later, I checked in with my code and my results were ready. So easy!

HIV test:

At first glance, this test seemed complicated. There was a Rolodex-like collection of instruction cards and a tray that contained more information, a swab test stick, a capped test tube with liquid in it, and a pencil for marking down start and read times. I got nervous, especially with all the warnings in the instruction cards that if I didn't follow directions exactly, I would not get accurate results.

It turned out, though, once I started, that the directions were very simple and explained so clearly that making a mistake would be difficult indeed. I was to wait 30 minutes after eating, drinking, or using any oral hygiene products, swab my gums, put the swab stick in the test tube, and wait at least 20 and less than 40 minutes to view the results.

I was impressed that everything that was included -- even little holders for the test liquid and the swab.

I set a timer for 20 minutes, then checked my results: One line next to the "C" and no line next to the "T" means negative. One line next to the "C" and another next to the "T" means positive.

Mine was negative, but I wondered what the support phone line would tell me if it was positive. I phoned, explaining that I was writing a review of the service. The man who took my call said that in case of a positive result, he would explain the need to follow up with a blood test in a medical setting. A positive result on this test, in other words, means more testing is needed -- it doesn't mean that you're definitely HIV+. The instructions say this several times, too.

I was very impressed with every stage of this service, from the initial sign-up through the testing, the results, the support, and especially the ease of understanding everything.

Here's a video showing what's in the HIV test kit and how it works:




Please understand that these tests show your status as of three months ago, and that a negative result is only meaningful if you're using barrier protection with any partner other than someone with whom you've been in a long-term, sexually exclusive relationship.

So use safer sex precautions with new partners,  non-exclusive partners, and partners whose other relationships or STI status you're not sure of.  Not convinced? Please read the safer sex chapter in The Ultimate Guide to Sex after 50!

Note: I welcome Simply Aware as a new advertiser on my blog. That does NOT mean that this review was a sponsored post in any way -- my review is completely honest (as all my reviews are). If I had not been impressed with the service, I not only would have said so, I also would have refused to accept Simply Aware as an advertiser. I only accept ads from companies that I endorse and recommend to you, and your trust is most important to me.

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.)

Warning re Kegel Exercise "Tools" for Better Sex

UPDATE to IMPORTANT UPDATE, 4/4/13:

I've had a nice email exchange with Je Joue's customer service. They assure me that this was a manufacturing defect that they caught and rectified, and this problem should not ever happen again. They are replacing my broken Ami with apologies. 

I appreciate their responsiveness, and I'm happy to say that I can again recommend the Ami. 

If you have the Ami 1 and I've got you worried, try tugging on the cord. If it doesn't come loose, your Ami is safe and good to go, Je Joue assures me. I'm not deleting either my "shocked" experience nor my previous review, just adding this to the mix so you have a whole story. 

Previous IMPORTANT UPDATE, 3/27/13:

I am truly shocked. I just peeked in the box holding my Ami Silicone Kegel Exercisers, and I discovered that the ball of the Ami 1 -- the largest and lightest of the three -- had become completely disconnected from the pull cord.

Whatever glue had fastened the two sections had dried or dissolved or something -- there was no way to reconnect the parts.

Now understand, this did not happen due to overuse or misuse. I actually only used the other two because their diameters are more comfortable for me. So this broken exerciser was only used once, and then remained in its box for the next three months.

I am appalled: What if this disconnection had happened not in the box, but inside a vagina? How could you ever get hold of the slippery, lube-covered ball to pull it out? Could you even squeeze and shoot with enough force to pop it out? Not if you're an older woman with a tight vaginal entrance. Yikes.

We've all heard shudder-provoking tales of items that ER doctors have pulled out of body orifices. I'd rather not consult a doctor about extracting a Kegel exerciser.

I left the rest of this 12/28/12 post intact so that you can get valuable content from it, but I can no longer recommend the Ami Kegel Exercisers.

ORIGINAL POST:

I just posted "Kegel Magic: Pelvic Floor Shape-Up For Better Sex" on the Post 50 channel of Huffington Post here -- describing how Kegels can strengthen your pelvic floor muscles and make sex more enjoyable through easier arousal, stronger orgasms, and more pleasure, with step-by-step instructions for doing them right.

In that article, I referred readers here for an introduction to Kegel exercisers that make Kegels more effective and entertaining. Here are some tools that will make you look forward to your Kegel "workout"! (These are not vibrators -- all movement comes from your pelvic floor muscle power.)

Ami Silicone Kegel Exercisers.You get three separate exercisers in this kit, each a different size, shape, and weight.

• Ami 1 - 1.65oz, 4.37" (length with cord), 1.41" (length excluding cord), 1.41" diameter
• Ami 2 - 2.75oz, 6.14" (length with cord), 3.14" (length excluding cord), 1.25" diameter
• Ami 3 - 3.73oz, 5.66" (length with cord), 2.75" (length excluding cord), 1.1" diameter

JeJoue, creator of Ami, suggests that you start with Ami 1 (the single ball) and work your way up to Ami 3. If your vaginal opening is tight, however, skip Ami 1 because it's the biggest, and being ball shaped instead of tapered, you may have discomfort inserting it. Go right to Ami 2, a double ball which is heavier, but smaller. Ami 3 is the smallest and heaviest.

Why are the so-called harder levels made smaller? Instead of just lying on your back squeezing your Ami, get up and go about your day, Ami in place, squeezing as you drive, walk, compute, do Zumba. The heavier the Ami, the more you have to resist it falling out. (Practice a lot at home before you take it into town!)

You can also use your Ami of choice while you pleasure yourself with a clitoral vibrator. If you like, put one finger in the loop and "yo yo" your Ami, pulling it partway out, using your PC muscles to pull it back in. Fun!

Aneros EVI Hands-Free G-Spot Massager. Insert the bulbous end of this odd looking object in the vagina so that the longest part of the top (heading towards my thumb from my index finger in this photo) is over your clitoris. The idea is that by doing your Kegels, the EVI gives you pelvic floor muscle resistance and stimulates your clitoris at the same time.

I wanted to love this -- it's a great idea and a well made, bodysafe product.

But although I could use it well as a Kegel exerciser, my particular body shape kept the extending part hovering over my clitoris, barely touching it or not touching it at all, when it was perfectly in place vaginally. I could press it down on the clitoral extension, but there goes the hands-free attribute.

The label makes this claim: ""Designed to Fit ALL Women... Both the G-Spot and clitoris are perfectly stimulated in a toe curling rhythm."

I wish this were true, but for me, it wasn't. Other reviews have praised the EVI as a Kegel exerciser, and I concur with that, but I wonder if others actually felt their toes curling with it. FYI, the EVI is 1.5” at the widest insertable part, and if your vaginal opening is tight, you might find it uncomfortable to insert and pull out.



Some useful tips:

• If you wear a vaginal estrogen ring, take it out before inserting these Kegel exercisers for comfort and ease of insertion.
• You may feel increased bladder pressure wearing the Ami or EVI. Remove it before peeing, or, in the case of Ami, at least pull the string out of the way or you may splash where you don't want to splash.

Thank you , Good Vibrations, for providing samples of EVI and Ami.

If you've got strong pelvic floor muscles, your next step is weight lifting with a barbell -- Betty Dodson's Vaginal Barbell, that is, available from Dodson's website. This hefty, stainless steel tool weighs almost a pound.

For your first workout with Betty's Barbell, lie on your back, knees bent, feet planted. You can insert either end, depending on comfort and preference, and hold onto the other end. Then let go, and use your PC muscles to keep the barbell in position..
When you do your Kegels and squeeze the barbell, you'll see it lift a bit.

Once your pelvic floor muscles are really strong -- or to find out how strong they are! -- try standing up and see if you can keep the barbell from falling to the floor for a minute. Read Betty Dodson's instructions for using her Barbell here: (Read about Joan's memorable meeting with Betty Dodson here.)

If you've tried these or other Kegel exerciser products, please add your comments and recommendations. (Please, no retailers promoting your own store.)

Enjoy your Kegels!

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.

Penis Power: Interview with Dudley Danoff

Urologist Dudley S. Danoff, MD, FACS, is the author of Penis Power: The Ultimate Guide to Male Sexual Health (Del Monaco Press, 2011). It’s an upbeat and even entertaining guide to the complexities, myths, facts, and vagaries of owning a penis (or, in my case, liking penises and being endlessly fascinated by them). Dr. Danoff covers how they work and what’s going on when they don’t work—psychologically as well as physiologically.

My male readers often write me with age-related questions about their penises: what’s a “normal” change with age vs. what’s a medical problem, how they can deal with erection difficulties, how to negotiate new needs and issues with a partner. “We are tragically ill-informed about the penis,” says Dr. Danoff, and he aims to change that.

 Although this book is not specifically aimed at our age group, all of it applies to us, and I guarantee you’ll say, “I didn’t know that” several times as you read, even if you’ve owned a penis for 50, 60, or 70 years.

I invited Dr. Danoff to answer questions that specifically address men age 60+ and the women in their lives. I welcome your comments.

Q&A WITH DUDLEY S. DANOFF, MD, FACS 

Q: What is your big message to our older men? 

A: Sex is good for you. It maintains overall physical strength and cardiovascular health, and most of all, it keeps you invigorated. A man’s penis is there to serve him from puberty to old age.

 Q: What are the most common misunderstandings that men age 60+ have about their penises or about their sexuality in general? What do you wish all men knew as they aged? 

A: By far, the most frequent complaint I hear from men is that they do not have the same level of sexual desire they used to have. It takes longer to get an erection, it takes longer to ejaculate, it takes longer to get aroused again after they make love, and their erections are not as firm. These conditions are all predictable changes that occur as men get older.

Attitude is the key to penis longevity. My super-potent patients tell me that sex gives them as much joy at 70 as it did at 20. Some say the sex is even better! Equal pleasure can be obtained from occasional, prolonged intercourse with one orgasm as with frequent, rapid intercourse with multiple orgasms.

All men, as they age, deserve active, healthy sex lives as long as they remain physically fit. Do not expect to do at 60 what you did at 40. Adjust your sexual activities as your body changes, just as you adjust other activities. Look upon the adjustment as both a new challenge and a new opportunity.

As you age, learn to use your mind and imagination to make up in creativity what you may lack in physical strength. As long as you are able to breathe, move your extremities, maintain relative control over your bodily functions, remain alert enough to identify the date and day of the week, and sustain a positive mental outlook, you can continue to exercise your penis power indefinitely.

Q: What would you say to many men age 60+ who tell me that they don’t get good information or direction from their urologists when they report undependable or nonexistent erections? They are commonly told, “Well, you’re older now,” or “It’s ED,” without a medical workup to see whether some underlying condition is causing the ED.

A: Find another urologist who is knowledgeable about erectile dysfunction and is willing and able to thoroughly evaluate you. A comprehensive evaluation, including a full cardiovascular evaluation, by a qualified urologist is essential. Endocrine issues, such as low testosterone or unrecognized diabetes, can then be treated, and erectile dysfunction will improve. Knowledge is power. There are many treatments on the urologic menu for erectile dysfunction, but first you need a proper diagnosis to identify the underlying cause. Treatment is both available and effective in almost all cases and will result in satisfactory erections.

Q: Many men would rather sever their own leg than admit to a doctor that they are experiencing erectile difficulties. Why is it important to see a doctor before self-treating with drugs or other assists?

 A: Many serious medical conditions that are first manifested by erectile difficulties go unrecognized. It is absolutely essential to get a full evaluation by a qualified urologist in all cases of erectile dysfunction in order to determine the presence or absence of some serious (or not so serious) medical problem and treat it accordingly. For example, if low serum testosterone is found, testosterone replacement therapy can give spectacular results. Under no circumstances should a man self-treat his erectile dysfunction with over-the-counter preparations without first determining the presence or absence of an underlying medical condition that is correctable.

Q: How can women enhance their partner’s and their own sexual pleasure when erections and intercourse are not the main events?

 A: Most importantly, do not think old! Sexual pleasure is all about attitude. If your mind is strong and your partner’s mind is strong, intimacy and sex without vaginal penetration can be enormously pleasurable. The key is not to lament what you have lost. Be grateful for what you still have and make the most of it. Age is not a deterrent to great sex. Rather, it is a challenge and an opportunity.

If you keep your enthusiasm, you can compensate for or even delay the effects of aging. You do not stop having sex because you are old—you get old because you stop having sex! Talking candidly with your partner about aging is the best way to find a solution for maintaining a healthy sex life.

Q: What else do you want women to understand about their male partners?

 A: Older men are just as penocentric as younger men are, even though capacity may be diminished. I would encourage older women to become more “penis oriented.” Older women who are penis oriented have more fun and also have better marriages, more faithful partners, and greater personal fulfillment in all aspects of their lives. If you believe that each partner has the mutual responsibility to satisfy the other’s needs, then it follows that you will hold up your end of the bargain as a woman by making your partner’s penis one of your top priorities.

Being penis oriented does not imply a belittlement of female sexuality. It simply means learning to understand and accommodate an older man’s penis needs by approaching that task with all of the pride and skill that you would bring to any other endeavor. I assure the older woman that if you take the steps to become informed, you and your man will reap rewards you have only dreamed about.


Images are from Penis Power: The Ultimate Guide to Male Sexual Health by Dudley Seth Danoff, MD. ©2011 Dudley Seth Danoff. Reprinted by permission of Dudley Seth Danoff. Copies of the book are available at your local bookstore or may be ordered through Amazon.com.

Healing Painful Sex: Interview with Deborah Coady, MD

Many women in our age group write me that they’re experiencing pain with sex or avoiding sex because of pain. I consulted several experts for their advice in chapter 11 of Naked at Our Age: “When Sex Hurts: Vulvar/Vaginal Pain,” but reading that chapter is just the beginning of solving that problem. You need a diagnosis – vaginal/vulvar pain can be caused by a number of medical issues, and you need to understand why you’re having pain before you can get it treated effectively.  

I was happy to receive a review copy of Healing Painful Sex: A Woman's Guide to Confronting, Diagnosing, and Treating Sexual Painby Deborah Coady, MD and Nancy Fish, MSW, MPH. This book is entirely devoted to sexual pain in women: the myriad possible causes, how to figure out which one or combination is yours, and what to do about it.

The authors are a power team: Deborah Coady is a gynecologist and a pelvic/vulvar pain specialist. Nancy Fish is a therapist with degrees in social work and public health, and she personally experienced chronic pelvic pain until Dr. Coady helped her resolve it.

I asked Dr. Coady if she would answer some questions that women our age often ask me:

Q. Many older women are reluctant to ask their gynecologists about sexual pain because a) they’re embarrassed, b) they think this is part of aging, and c) they fear their doctors will be dismissive. What would you say to these women?

A: These feelings and fears are completely understandable. Unfortunately, the medical profession has until now given too little attention to the sexual concerns of women as we get older. Women often are dismissed or rushed when they bring up their problems. And this is not the fault of the patients: A recent survey of gynecologists by Stacey Lindau, MD of the University of Chicago hints to their discomfort, as well as their lack of experience and formal training in this area of medicine. While 60% responded that they did ask about sexual problems at the first visit, only 14% asked about pleasure with sexual activity. It is often up to women themselves to be pro-active, ask the hard questions, and remember that they are entitled to medical therapy for this medical problem, or referral to an MD who can help.


Q. My readers sometimes report that after a long time without sex (due to lack of a partner or disinterest from a partner), they try to have sex again -- and they can’t: It’s too painful. What should a woman do about this?

A: On average, about 5-6 years after their last menses, most women develop thinning of their vulvar and vaginal tissues, often causing pain with sexual touching or intercourse, or with urination after sexual activity, or itching, burning and even surface bleeding after sex. This can occur even in women taking systemic estrogen therapy. As estrogen levels decline both the surface skin and underlying connective tissues thin, shrink, and lose elasticity. Most pain is actually located at the vaginal opening itself, rather than deep inside the vagina as previously thought. The good news is that since these tissues are exquisitely hormonally sensitive, even small doses of estrogen, with or without testosterone or DHEA, applied to the vaginal opening (the vestibule), can reverse these changes within 2-4 weeks, and then even lower doses can be used to maintain the improvement. Some women with severe loss of elasticity will also be helped by a course of pelvic floor manual physical therapy, to help normalize the connective tissue, and relieve the reflexive muscle spasms that some women develop due to their pain.

Q. I like your questionnaire (107-111) because women often don’t know how to pin down just where and what the pain is that they’re experiencing. I recommend that women scan or photocopy that questionnaire to show their medical professionals. Would it be a good idea to carry a copy of Healing Painful Sex to the appointment, too, in case the doc hasn’t heard of your book?

A: One of our missions in writing the book is that women would have it as a resource to get their gynecologists informed and up to speed on treating sexual pain.  Many patients have done just this, and their MDs have actually been grateful for the introduction to the book.

Q. If a gynecologist says, “You just need lubricant” or – worse! – “Well, at your age, you can expect that,” what should an older woman say to get diagnosis and treatment? I tell women to say, “If you don’t know how to help me, please refer me to someone who does,” but that might seem more confrontational than you would recommend! What would you advise her to say?

A: I would advise her to say exactly that.  We have to advocate for ourselves and we deserve up-to-date treatment for sexual pain.  A healthy sexual life is a basic human right, even defined as so by the World Health Organization!

Q. How can a post-menopausal woman weigh the benefits of HRT vs. the health risks if she’s experiencing vaginal thinning and tearing?

A: There is absolutely no evidence that the small amount of estradiol or estriol available for use at the vaginal opening is absorbed to any degree that would induce breast cancer. The doses are tiny compared to HRT doses that are meant to be systemic, that is, to go to all parts of the body. To help hot flashes the doses need to reach the brain in quantities much much higher than the topical estrogen will ever give. And with the evidence now showing that estrogen alone does not increase the risk of breast cancer anyway, women can be assured that topical therapy, especially if mostly applied to the vaginal opening, is safe. It is also now known that the thicker and more estrogenized the vulvar and vaginal tissues are, the less absorption into the body.  So a stable constant regimen is better than going on and off the topicals, with the tissues thinning again in between.

Q. How do we educate our medical professionals to stop being dismissive and take our sexuality seriously, whether we’re 60, 70, or 80?

A: This is a work in progress, but educational outreach through professional societies like NAMS, the International Pelvic Pain Society (IPPS), and the International Society for the Study Of Vulvovaginal Disorders (ISSVD), as well as patient advocacy organizations, especially the National Vulvodynia Association (NVA) is helping. The websites of these societies all list health professionals by area to help patients find a knowledgeable MD. We also need to devote more time to formal education on sexuality and pain in medical schools and residency programs.


As always, I welcome your comments. If you’re experiencing pain with sex, I hope you’ll read both Naked at Our Age and Healing Painful Sex. Then please carry both books with you to show your doctor! 

CatalystCon: celebrating sexuality

I'm basking in the joy of CatalystCon, a weekend of learning and sharing with other sex educators and self-proclaimed sex geeks. The mission of this event was "Sparking Communication in sexuality, activism and acceptance." Oh yes, mission accomplished.


Though most attendees were younger and I was the only speaker on senior sex, there were other people with grey hair (or they would have had grey hair had they not colored theirs). I felt total acceptance from all the people I met, even those decades younger. The sex-positive nature of the event conveyed this message to everyone: "I celebrate my own sexuality, sexuality in general, and your sexuality, no matter how different from mine yours might appear to be."

Megan Andelloux

I tried to choose from 40 sessions presented over two days, wishing I could attend them all. For every session I attended, there were four I had to miss.

Charlie Glickman

Some of my favorite sex educators featured in Naked at Our Age were speaking:  Carol Queen, Charlie Glickman, Megan Andelloux. There were names that inspire recognition and awe, such as Dr. Marty Klein.

 (Want your own "Sex Geek" shirt?  Order from Reid Mihalko here.)

I attended sessions where I'd learn information that you, dear sex-positive senior readers, would benefit from knowing, and others where I'd come away with plenty of "huh! I didn't know that!"

For example, the "Toxic Toys" session with Metis Black, founder of Tantus, high quality silicone sex toys; Jennifer Pritchett, founder of Smitten Kitten; and feisty educator and author, Ducky Doolittle. I was amazed by their stories of activism in an industry where sex toys used to be cheap, easily broken, and made of noxious materials that leached chemicals into our mucous membranes.  We have women like these three activists to thank for the safety and quality of sex toys today.


One of the most memorable speakers I heard was Buck Angel. Buck calls himself "a man with a vagina" -- he's a transgender man who elected to have top surgery but not bottom surgery.

As a child named Susan (but everyone called him Buck), he was a “total tomboy” and thought of himself as a boy. “Occasionally someone would say, ‘You’re a girl,” and I’d beat the crap out of them, and they’d say, ‘OK, you’re a dude,’” he says. “Everything was fine until at 15, puberty hit. Not puberty as a boy – but puberty as a girl. Here I am bleeding, my boobs are growing, I’m turning into a woman.”

He had his sex change 20 years ago, before female-to-male changes were done. He was the "guinea pig" for the surgeon who removed his breasts. “For years I hated what I was, and now I love it," he says.

Now Buck is 50 years old, a porn star (“the man with a pussy”), transgender activist, and motivational speaker. His past includes alcohol and drug addiction, modeling, hustling, attempted suicide, and death threats. “I should be dead," he says. "Why am I still here? Because I have a message to give the world: Deprogram yourself, and love your vagina.” Buck Angel's story is worthy of a  book. (Buck, do you need a ghostwriter?)

Carol Queen & Robert Lawrence

Another provocative session was "Why Talk about Sex and Disability?", co-presented by Robin Mandell and Dr. Robert Morgan Lawrence (who also gave a fascinating talk on "The Anatomy of Pleasure" with his partner Carol Queen).

Robin Mandell

Robin referred to people without disabilities as "temporarily able-bodied" and made the point that we have much to learn from sex-positive people with disabilities. Robert, who referred to himself as “old and crunchy,” jolted us all when he spread out all the medications he has to take for myriad medical challenges including pain that limits mobility. He has had to make many accommodations sexually as well as in other ways. “It took being crippled to realize that sex wasn’t penetration," he says.”

I had fun at a workshop learning to use the new version of the female condom, called the FC2. If your experience was with the first female condom, which felt and sounded like having sex with a shower curtain, you'll be happy to know the material is completely different now. It's great for folks of our age, because the penis can be inserted even if it’s not erect, and lube in the condom doesn’t dry up or get absorbed.It can also be used for anal sex for either gender, just remove the inner ring. One man in the workshop said it was a way "to feel bareback sensations while staying protected." (This video shows how to insert it and gives lots of info.)

Okay, the female condom does look funny (especially in this model with a dildo in it that we passed around -- should I not have shared this?), but the workshop leaders, Planned Parenthood sex educators Alma de Anda and Mayra Lizzette Yñiguez, advised us to give it three tries to discover how comfortable and empowering it is. They gave me a bunch of samples (three in a pack, to prove their point) to share with my workshop attendees!


My own session was titled "Senior Sex Out Loud," the story of my journey from high school English teacher to fitness professional/ health writer to sex educator/ senior sex advocate, with experiences along the way that were sometimes amusing, sometimes amazing, occasionally appalling. I started out wearing a jacket, but shed it when I talked about body acceptance. (Want to hear this speech yourself, or offer one of my workshops at your venue? I have a suitcase packed, would love to come to you. Please email me and let's talk.)


But CatalystCon was more than the knowledge, more than the networking, more than the opportunity for me to share what I do and how I feel about it, more than learning what other sex educators do and how they feel about it. It felt like a brave new world was possible, one in which acceptance and celebration reigned.

Imagine living in a society free of closed-minded people and repressive attitudes and policies, where we celebrate our similarities and our differences and are truly kind to each other. That was in the air at CatalystCon.

I applaud Dee Dennis, who conceived and birthed CataystCon; the sponsors who made it possible and affordable; the extraordinary speakers who were willing to donate their wisdom and incur their own travel expenses; and the attendees who were eager to absorb new knowledge, communicate openly (even those who wore the "I'm shy" wristbands that Reid gave out), and take our messages home. CatalystConWest will become a yearly event, and CatalystConEast will rock your world March 15-17, 2013 in Washington, DC.


As always, I welcome your comments.