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.)
|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:
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.
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.
Q: What is your big message to our older men?
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.
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.
receive a review copy of Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing, and Treating Sexual Pain
by 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.
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.
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
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
Q. How can a post-menopausal woman weigh
the benefits of HRT vs. the health risks if she’s experiencing vaginal thinning
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.