Midlife Intimacy: Myths vs. Reality

That your sex life has to sour after a certain age may be one of the biggest myths of midlife sex.

Challenges exist, to be sure. However, issues with lagging libido or performance anxiety can be largely addressed with modern treatments. Cheryl Iglesia, MD, a urogynecologist at MedStar Washington Hospital Center, explains the many steps you can take to prevent your sex life from becoming ho-hum.

For example, women who are experiencing perimenopause or menopause and going through hormonal changes often encounter dryness in the vaginal area, or what’s been coined genitourinary syndrome of menopause (GSM).

Dr. Iglesia recommends starting with either a lubricant during sex or a daily moisturizer, both of which are non-hormonal. Many moisturizers are designed to reset pH levels and prevent overgrowth of unhealthy bacteria.

If either of those options don’t ease the dryness, you may want to look into a hormonal topical treatment. Topical creams include  Estrace® and Premarin®. Other options are a vaginal tablet (Vagifem®) and a ring (Estring®) that is inserted in the vagina and releases daily estrogen for three months.

Might the extra estrogen present health risks? “Now that these treatments are FDA-approved, the doses are so low that there really isn’t any significant cancer, blood clot or heart disease risk,” explains Dr. Iglesia.

Another issue couples face is waning libido. Men have had solutions for some time now, such as name brand Viagra® or Cialis®. And even though Flibanserin has been touted as the new “female Viagra,” it’s only FDA approved for premenopausal women.

Dr. Iglesia reassures this doesn't have to be a roadblock. In fact, lowered libido may be more mental and emotional than chemical, particularly in women. "There’s a lot of things that go into desire, just in terms of the way women feel about their bodies. Changes can occur in the architecture of the vagina, particular after you’ve had children. It takes longer to orgasm, maybe you don’t feel as much, you’re just feeling very different about your body, less confident. And, of course, there can be relationship issues."

The key is to switch things up.

“Everybody’s got to change their game. I would say change the location, change the time of day, even get some toys in there. Read the Kama Sutra, look at different positions, start doing other fun things together to revitalize your relationship.”

If you and your partner have unresolved issues, a couples therapist or sex therapist can also be beneficial.

Finally, don’t neglect any outside influences. Many drugs can negatively impact libido, including antidepressants and blood pressure medications.

Dr. Iglesia’s last piece of advice is to not give up. “If it’s something that’s really bothering you and really bothering your partner and you really want to make improvements, don’t blame all your problems on age. You can see a specialist, someone who’s going to validate these concerns and offer a very thorough evaluation, give you the appropriate referrals, and provide advice on other things to try.”

By giving yourself permission to explore your options, you can push past the misconceptions and maintain your sex drive well into your elder years.

Listen in on Dr. Iglesia’s full podcast interview here.

Want more podcasts? Listen or subscribe on iTunes or iHeartRadio.

What Does Heart Failure Mean for Intimacy?

What does Heart Failure Mean for Intimacy?

Patients with advanced illnesses face a variety of side effects. But little thought may be given to the concern of compromised physical intimacy.

That’s why our palliative care specialists decided to explore the matter further. Hunter Groninger, MD, director, Palliative Care, and Anne Kelemen, LICSW, Palliative Care social worker, designed a simple tool to assess sexuality and intimacy concerns among patients hospitalized with advanced conditions.

During the pilot study, 57 patients at MedStar Washington Hospital Center and MedStar Harbor Hospital were asked these questions during a palliative care consult:

  1. How much has your illness affected intimacy?
  1. How has your illness affected your relationships?
  1. Has this been discussed before during your hospital stay?
  1. Is this helpful to talk about?

Some 72 percent said that their condition had significantly or moderately impacted intimacy. For those facing the end of life, 83 percent reported the same feelings. Further, they wanted more conversation on the subject with their health care providers.

Defining Intimacy

Intimacy was defined broadly, including physical and emotional closeness, affectionate contact, sexual interactions and the communication of thoughts and feelings.

“Intimacy is bigger than just sexual intercourse. It can include cuddling, holding hands or playing with children or grandchildren,” Kelemen says.

Patients’ concerns included low libido, erectile dysfunction, lack of privacy and fear.  They also cited difficulties in finding and maintaining relationships overall.

“We had talked about the issues around intimacy, and knew they were overlooked,” Dr. Groninger says. “Then a family member brought up the issue, and we realized that it should be part of all routine palliative care consults. Patients do want to talk about intimacy, however they define it for themselves.”

Raising Awareness and Encouraging Open Conversations

Patients may not know how to bring up the subject. Kelemen describes such a case.

“I had a patient who had been hospitalized a very long time, and was nearing the end of his life. His wife wanted to talk to me; she wanted to have some ‘alone time’ with her husband, but didn’t know how to ask his doctors about that.”

Both researchers noted that important biases often exist.  First, clinicians often assume that intimacy only means physical sexuality or sexual health.  Second, clinicians often assume that patients with advanced conditions were too sick to be concerned with intimacy and sexuality.

“But we found that even patients at the end of life wanted to talk about these issues,” Dr. Groninger says.

George Ruiz, MD, MedStar Heart & Vascular Institute’s chief of Cardiology at MedStar Union Memorial Hospital and MedStar Good Samaritan Hospital, who was an advanced heart failure provider at the Hospital Center for 10 years, also believes that intimacy is important to these patients, and should be addressed.

“Heart failure systematically steals people’s humanity, taking away their ability to engage in living a full life,” Dr. Ruiz explains. “This includes walking around the house, climbing stairs and sharing intimacy. As physicians, we are so focused on the day-to-day challenges of caring for very sick patients, that we can overlook important quality-of-life issues these patients face.”

Kelemen stresses that addressing the issue is the whole point. “This is not just about addressing their concerns with VIAGRA®, it’s about having the conversation and encouraging conversations with their partners.”

It can be simple to do. “This is something any clinician can do,” Kelemen adds. “We just need to raise awareness and facilitate conversation.”

Samer Najjar, MD, medical director of Advanced Heart Failure for MedStar Heart & Vascular Institute at MedStar Washington Hospital Center, supports the effort. “We recognize that intimacy is important to patients at every stage of life,” he says.  “This is an important part of patients’ overall health.”

The end result? “We hope to educate providers about how to initiate this conversation,” Dr. Groninger says.

Have Questions?

If you're interested in learning more, or to schedule a consultation, call us at 202-877-3627.

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