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.)
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:
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!
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 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.
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.
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.