Birth Control Side Effects: The Good and The Ugly

Image from Bedsider.org

Image from Bedsider.org

Hormonal birth control often comes with side effects that vary from slightly annoying to bad enough to make you switch. These include (and are not limited to) headaches, breast tenderness, nausea, decreased libido, depression…The list goes on and varies depending on the method you choose.

The folks at Bedsider remind us, however, that while side effects are not typically fun, they’re usually not that noticeable either. We can get caught up in all the pharmaceutical warnings and forget that birth control also has many positive benefits such as clearer skin and more regular periods.

If taking birth control is the right thing for you, be sure to talk to your doctor about how to manage side effects, both negative and positive. Check out Bedsider’s link to help decide if birth control is right for you.

This article was originally published here

BY BEDSIDER | Bedsider.org

Side effects! Boo!

Two little words that totally freak people out. And for good reason. Nobody wants to wind up feeling crappy because they’re using a method that’s supposed to be good for them.

See through the hype

You deserve to know the real deal about side effects before you get on birth control, or any other medicine. But the hard part is seeing through the hype so you can weigh the pros and cons of each method and make an informed decision.

Positive side effects

We think it’s important to tell the whole story—the good, the bad, and everything in between. Here’s the thing, though. People tend to forget about the potential positive side effects of birth control, like clearer skin or shorter periods. (Or not having a baby before you’re ready, for that matter.) And when they hear the negative stuff, it sticks in their brain like a cheesy old song you can’t stop humming. That’s just human nature, and it happens to all of us.

Even aspirin sounds nasty

Drug companies list every single scary thing you could possibly experience with a medication. Even if it’s super rare. They have to. It’s the law. So before you run for the hills, consider this: The potential side effects of something as harmless as aspirin are pretty scary when you read them, too. Check it out.

If taking birth control is the right thing for you, we believe there’s a method that will make you feel good about using it. Find one here.

bedsiderBEDSIDER is an online birth control support network for women operated by The National Campaign to Prevent Teen & Unplanned Pregnancy. Bedsider is totally independent (no pharmaceutical or government involvement). Honest and unbiased, Bedsider’s goal is to help women find the method of birth control that’s right for them and learn how to use it consistently and effectively, and that’s it.
Find Bedsider on twitter @Bedsider

Sex and the Plus Size Gal

Photo credit Christi Nielsen

Photo credit Christi Nielsen

A world that sets narrow standards of “beauty” has a real impact on how we evaluate our bodies and value ourselves. It also directly impacts how we feel when dating or experiencing sexual pleasure; sharing an intimate bodily experience with another is a serious exercise in self image.  As Elle Chase (a.k.a. Lady Cheeky) states in this article, women of all shapes, sizes and abilities have internalized negative attitudes towards their bodies from childhood.

As someone who once struggled with body shame, Elle shares how she overcame the negative narrative in her mind and transformed it into loving acceptance. This led her down a path of renewed sensual discovery and enjoying her sexual body to the fullest.

Here are some key points of advice Elle offers for how to feel more confident sexually:

This is tailored for plus-size women in particular, but it can apply to all people who want to improve their perception of self.

  • Confidence begins with accepting positive messages about yourself. Feeling sexy will result in others finding you sexy.
  • Transform the negative self-talk. Begin with small gestures like telling yourself, “This is the way I look and that’s that.”
  • Find inspiration and support by reading body positive resources and listen to stories from others who have overcome their body shame and embraced their sexual being.
  • Indulge in body positive porn that features real and large women enjoying hot sex. Elle offers a list of recommendations below.
  • Remember: Personality, confidence and acceptance of one’s sexuality is what makes someone attractive. Body shame functions to hinder one’s ability to enjoy sexual pleasure. One gains no benefit from negative self-talk.

This article is posted on smutforsmarties.com

BY ELLE CHASE | ElleChase.com

Image from SmutForSmarties.com

Image from SmutForSmarties.com

I happen to live in Los Angeles where being over a size 8 is a felony. This can be depressing when I am searching for a cute bathing suit or a stylish pair of jeans in a city that considers the ‘norm’ a size 2. At those times I like to remind myself that the average dress size for women across America and the UK is a size 14 and that a size 2 is more an aberration than the norm. However, it’s disappointing to note that at size 14, those average women are also considered “plus size”, labeling them in a category that, in this media ridden age, might send a woman’s ego to the back of the proverbial bus. This size stereotyping (especially in metropolitan cities like Los Angeles and New York City) can compound the list of reasons why single “plus size” woman are intimidated by dating and sex.

I have found that a lot of my single friends complain they can’t find a nice guy or even a good lover. When I suggest online dating, taking a class or going to events to meet a guy, I almost universally hear “maybe when I lose some weight” as the first excuse not to engage. It seems that no matter what we look like, women are always first to dissuade themselves from dating by knocking their perceived physical shortcomings. This kind of dysmorphic thinking doesn’t discriminate it seems, women of all shapes and sizes do it. Though being a “plus sized” woman has its challenges, dating shouldn’t be one of them. In fact, as a plus sized woman myself, I had to get past my own mental lambasting and take a leap of faith, even though at the time I still hated my body. It’s not easy to do but it IS possible.

When I made the decision to start dating again after my divorce, I had to examine my history with my body image. My whole teen and adult life I was lead to believe, through society, other women and some really immature boys, that my body was “less than” because it had more lumps, bumps and curves than the women portrayed in television, film, advertising, fashion magazines (including Seventeen magazine which can be horribly destructive to a young woman’s ego) and the like. Add to that the unconscious conditioning I received from my well-meaning mother and I was set up to fail.

I thought about all the women this kind of conditioning affects, as most women do not have “perfect” bodies and have even less perfect body images. It was interesting to me that regardless of size, all the women I knew loathed portions, if not all of their bodies. Not only does this affect quality of life in general, it substantially affects a healthy sex life. So what can we, as women, do to begin to accept the parts of us that we have heretofore shamed ourselves into hating?

Rebecca Jane Weinstein, Lawyer, Social Worker and Author, was told by her grandmother at nine years old that no man would ever love her because she was fat. So started Ms. Weinstein on her journey of figuring out her womanhood on her own. She relates her pilgrimage to satisfying sex in her book Fat Sex: The Naked Truth. I asked Ms. Weinstein what her advice would be to plus-sized women who are trying to feel more confident sexually. Here is her answer:

“In interviewing the many large sized women I have about body image and sexuality, I have found a common thread. When a woman feels sexy, she projects sexy, and men (or other women) find her sexy. This seems almost simplistic, and it is, in a sense. Perception is everything, particularly self-perception. What is not simplistic is coming to that realization and then internalizing those feelings. Women seem to find that place in themselves two ways. First is personality. Some of us are just lucky to have an inner core of confidence that has no clear genesis. It just exists. But even women who aren’t so lucky to be somehow born with the “I feel sexy” gene, seem to be able to learn to feel sexy. The key is listening and believing when you are told you are attractive and that someone is attracted to you. So often we are told such a thing, and every available evidence supports it (like there is a person lying next to us in a bed), and yet we don’t believe it. We must overcome that disbelief. It is not easy when all the societal messages tell us fat is not sexy. But those messages come from disreputable sources – mostly people trying to sell us stuff. They want us to feel badly about ourselves so we will buy diets and cosmetics and clothing and medical procedures. Those people are liars. The ones telling us the truth are sharing our beds and our hearts. It is them we must believe. And the truth is, even if there is no one giving those positive messages, telling ourselves works too. When you feel sexy, you project sexy, and others find you sexy. It’s not so important how you get there, but that you get there.”

She’s right.

I had a lover once with whom I had some of the most erotic, connected, exciting and sensual sex of my life (some of our exploits are detailed on my erotica site www.smutforsmarties.com) and I was considered plus-sized at the time. Though I felt confident that he wanted me, I still didn’t feel comfortable in my body. Still, before our first tryst I panicked about how he would react to actually seeing me naked. Would he still want me when he saw my overflowing stomach and flabby thighs? I was terrified.

When we first got together I was so ashamed of my physique that I kept my nightie on thinking “maybe he won’t notice my fat.” Though, in contrast to what the little devil on my shoulder was whispering in my ear (“you’re disgusting,” “you should be ashamed to think he wants you”,) my lover couldn’t have been more effusive and complimentary about how seduced he was by my body. He continued to sincerely voice how attracted to me he was, yet I kept that nightie on for two months until I “believed” he was really yearning for me. What in the world did he have to do to get me to believe him? The answer is “nothing.” The issue was with me and my own narrative about my body. I used the shame and the humiliation I took on from others’ opinions about body size during my childhood and young womanhood to inform my ability to receive full pleasure in the moment. What a shame.

Later on in our relationship, figuring a bigger gal was his bag, I brought up the subject of a woman’s body type and asked him if he had always been attracted to plus-sized women. For me, his answer was revolutionary. My lover explained that body shape or size had nothing at all to do with his attraction to a woman. To him, a woman’s physical appeal (among other things like chemistry, personality, intelligence, etc.) was based on how sexual/sensual the woman was. He continued, that when a woman felt she was a sensual being and was confident about her sexuality, that it drove him wild. “I could be lying in bed with a supermodel but if she didn’t own her own sexuality I would be completely limp,” he said. Furthermore, the men he knew in his life felt the same way. He continued by saying that those same men were often frustrated with the fact that women in general don’t own their bodies and often let it get in the way of “letting go and enjoying the moment.” Again, revolutionary to me. I thought back to when I was praying he wouldn’t notice my fat and thought “Wow. If I were just able to let go and take in that he was having sex with me because he WANTED to and was ATTRACTED to me, I would have enjoyed myself so much more.” The change needed to start with me. I needed to give myself a break. If it was true that he found me physically attractive then it was equally true that other men would as well. It was clear, I needed to start accepting my body as is, otherwise I would be living a lonely existence waiting for the day I would be happy with my body … and that day will never come. This was evidenced by my smaller framed friends who had a litany of complaints about why men wouldn’t find them attractive. Again, the unrealistic body dysmorphia rears its ugly head no matter WHAT you look like.

Pamela Madsen, who wrote the book Shameless: How I Ditched The Diet, Got Naked, Found True Pleasure and Somehow Got Home in Time to Cook Dinner says “If you work on embracing who you are – every single day just like a religious practice – things will change in your world.” I completely agree. No more negative self-talk … ever.

So here’s the deal … I’m not going to tell you to look in the mirror and say affirmations that you’re beautiful and sexy or tell yourself “I love you the way you are;” that’s too big a jump. What I AM telling you is that if you can’t muster up something nice to think about yourself, at least say something factual and neutral like, “this is the way I look and that’s that.” It’s accurate and at the same time makes you accept yourself the way you are. Once you have that under your belt move on up to “I look pretty good today” etc, but wait until you believe it. The point being, you are never to put yourself down. And if you can’t compliment yourself, then at least say something objective, something you can believe.

The next step would be to start to become more comfortable in your body sexually … as it is right now. Whether you’re plus-sized or not, I highly recommend you read the aforementioned book Fat Sex: The Naked Truth by Rebecca Jane Weinstein. She’s plus sized, smart and has the experiences to back up what she preaches. Her book will feed you stories of women (and men) who feel the same or worse about their bodies and will inspire you. Reading the stories of how others achieved their positive body image and started enjoying sex will help you get used to the notion that there are other people out there (perhaps even larger than you are) that have found their inner sex gods and goddesses.

There are also a plethora of body image and sex positive websites at your fingertips. One of my favorites is Betty Dodson and Carlin Ross’ website www.dodsonandross.com that has a wonderful DVD called Bodysex Workshop. This DVD teaches women not only how to feel good about their sexuality but shows REAL women with REAL bodies “taking care of business” (if you know what I mean.) Other validating websites to check out: I Feel Myself http://www.Ifeelmyself.com which feature women from all over the world masturbating to orgasm. It’s liberating watching women of all shapes, sizes, colors and backgrounds enjoying the sexual pleasure that is their right. Pamela Madsen’s blog offers Pamela’s words of wisdom on the spiritually based “sacred sexuality movement” and body image.

If you are feeling frisky, even the porn world has something to offer. The multitude of amateur porn online also affords us the opportunity to watch women who look like us engaging in hot sex. There are even porn sites dedicated to plus sized nude models like (my favorite) London Andrews and very popular plus sized porn star Kelly Shibari. There’s also “feminist porn” (also known as women’s porn or couples porn) brought to us by pioneers in the field like Candida Royalle, Erika Lust and Tristan Taormino. This type of porn is made by women for women (and men) who enjoy a more sensual story and a focus on the woman’s pleasure as well as the man’s. Checking out this kind of porn might make you feel more a part of “the club” than traditional porn where the focus is mainly on the man’s gratification while they screw thin women with fake boobs (not that there’s anything inherently wrong with that).

Poor body image doesn’t have to be debilitating. Your sexuality is part of who you are as a woman and human being and the plus sized woman should take steps to start empowering herself as an erotic, sexual being … every woman should, really. If we can divorce our self-loathing (while we work on it, of course) from our sensual selves, then dating or sexual expression doesn’t have to be tied into body image and as a result, we can work on accepting ourselves while at the same time experiencing sexual pleasure.

Since I have accepted my body “as is,” not only have I had no problem finding men that find me and my body sexy, but I’ve been allowing myself to have some of the best sex of my life. I have come to understand and believe that sexual pleasure is not just meant for the “beautiful” and the “hard-bodied,” it’s a natural enjoyment that is your right as a human being. So take back that right. Ignore the messages from people, agencies and corporations trying to make you feel “less than” and take back control of what is inherently yours.

elle Sex educator, writer and coach, Elle Chase is best known for her award-winning and highly trafficked sites, LadyCheeky.com (NSFW) and SmutForSmarties.com, which have both garnered multiple awards, including LA Weekly’s Best Sex Blog 2013. Elle’s focus is on positive body image, reigniting sexual expression and better sex after 40. She speaks nationally at universities, conferences, and teaches workshops about all things “sex.” Currently, she is hard at work on a book based on her popular workshop “Big, Beautiful Sex”. Find Elle on facebook.com/TheElleChase and follow her @TheElleChase or @smutforsmarties.

Disabled People Need Sexual Health Care Too

Image by Maria Iliou. From the Disabled Artist Guild.

Image by Maria Iliou. From the Disabled Artist Guild.

BY ROBIN MANDELL | ReadySexyAble.com

Most safer sex guides take it for granted that all of us are going to have the manual dexterity (ability to move our hands) to unwrap and use a condom, that getting STI testing is as easy as booking (and keeping) an appointment at a free or low-cost sexual health clinic, and that communicating with a partner about safer sex is as easy as having a few face-to-face conversations about it. For those of us who have any sort of physical, cognitive, or psychological disability, these and other “basic” safer sex strategies may not be so easy.

It doesn’t help that disabled people are assumed to be nonsexual, or to have more important things to worry about than the “luxury” of sexual feelings or a sexual relationship, or any number of other myths about sex and disability all of which miss the mark in one way or another.

People with disabilities who are sexually active, or planning to be sexually active, need to practice safer sex, and get regular sexual healthcare, just like anyone else.

A Quick Overview of Safer Sex

If you’re disabled, know that you have the right to whatever expression of your sexuality you want to have, and you have the right to be safe when expressing your sexual self, both alone and with partners.

Safer sex is about taking care of your sexual health, and protecting yourself from sexually transmitted infections (STIs). Preventing unwanted pregnancy is known as birth control, not safer sex, but it’s still part of your sexual healthcare if pregnancy is something that can happen to you or someone you’re sexually involved with.

Safer sex includes using barriers (such as condoms or dental dams) for genital contact with a partner, and getting regular sexual healthcare, including STI testing.

Let’s look at a few considerations around safer sex specific to being someone who has any kind of disability. You can get more safer sex info by reading through the other articles on this site.

Sexual Health Care

Most sexual health services aren’t set up to meet the needs of disabled people. In the U.S., many providers don’t get training in working with patients who have disabilities. Coupled with assumptions about disability and sex, this can lead to you not getting the sexual healthcare you need. That might be a healthcare provider who doesn’t ask you about sex, or asks in such a way that assumes you’re not having it.

Or, it means examination tables that don’t accommodate people whose bodies don’t move in the ways expected for traditional exams. This includes staff unable, unwilling, or untrained to assist with positioning your body on the table.

Or, it means reams of forms to fill out, and informational pamphlets and brochures that are only available in print.

Even one step into a building- or doorways that are too narrow- can keep you from seeing a healthcare provider of your choosing.

Healthcare providers aren’t immune to the myths about disabled people and sex, which can result in them assuming their disabled patients aren’t having sex and consequently not asking questions about sexual health, evaluating someone’s need for birth control or STI testing, or even conducting routine genital exams.

Sometimes healthcare providers can fall into the trap of thinking that any problem a patient presents with is related to their disability; or, it may be assumed that what would be a problem for some people (such as fertility problems or the need for frequent STI testing)) will not be a priority or even a problem for disabled people.

Steps you can take to get the sexual healthcare you need if you have a disability:

  • Look for a sex-positive healthcare provider.
  • Find a provider who can meet your disability needs. Members of the Gimp Girl community have put together this list of accessible gynecologists. The list is short, but can give you an idea of what sorts of accommodations you can ask for, and expect, from any private medical practice or clinic.
  • Be prepared to ask for the sexual healthcare you need. Sadly, preparing yourself might also include being ready to fend off judgment, condescension or surprise.If your provider doesn’t bring up sex, you can. You can ask for STI testing, or to discuss birth control options.
  • Be sure when you’re discussing birth control, or if you are being treated for an STI, that the treatment won’t interfere with any medication you take and that any possible side effects won’t trigger physical or psychological symptoms of your disability.

Some assumptions you might encounter:

  • “Oh, I guess we don’t have to talk about birth control, do we?” Quickly followed by the next question in the provider’s list.

Possible response: “Yes, actually, I do need to talk about that. I’ve been wondering what method would be easiest to use considering the problems I have with my hands.”

  • “Is there someone who can help you with your birth control pills?”

Possible Response: “No, I want to keep that private. Maybe I need a different kind that will be easier for me to use on my own.”

  • “I know it’s hard for us to do a pelvic exam on you. Let’s skip it this year.”

Possible Response: “I know it’s hard to examine me, but with what I told you about my sexual history, is a pelvic exam advisable medically? I don’t want to skip any steps I need for my health.”

Sometimes, if the provider assumes the answer to a question, like that you don’t need to have birth control, or of course you’re not sexually active so there’s no need to talk about that and they can move right along with the questions, their words are accompanied by nervous laughter. You might want to drop through a hole in the floor when hearing that, but just because they’re nervous doesn’t mean you have to be. As disabled people, we’re often encouraged to help people feel less nervous around us. This is your healthcare provider, though; it’s their job to meet your healthcare needs and to deal with whatever feelings they have around doing that on their own time. So, just take a deep breath and set them straight about what you need from them.

Once you’ve found a provider you’re able to work with, talk with them to make sure you’re getting the best care you can. The following resources might help you and them. (Unfortunately, most of the writing and research on this topic has been geared towards patients who have what medical people have defined as female genitals. If you don’t have a vagina/vulva, your healthcare needs will be different but your provider can still work with you to find creative solutions to disability-related problems that might come up during examinations.)

Table Manners and Beyond: The Gynecological Exam for Women with Developmental Disabilities and Other Functional Limitation, and Reproductive Health Care Experiences of Women With Physical Disabilities: A Qualitative Study are both resources you and your provider can read through together to help problem-solve any accessibility challenges you’re having with your healthcare.

Accessing Safer Sex Supplies

Transportation problems, inaccessible buildings, worries about being judged, or lack of trusted help can keep you from getting safer sex supplies. Perhaps you’re in a wheelchair and need to ask a store employee to reach your preferred pack of condoms. Or maybe you have a visual impairment and need to ask for help reading the wide variety of lube bottles. Being in these situations may make you feel vulnerable to being asked intrusive questions or judgmental comments. Considering that people ask visibly disabled strangers how they have sex, these fears aren’t unfounded. How can you get supplies while maintaining self-respect and privacy?

Many resource centres on college campuses and sexual or reproductive health clinics provide free condoms. If you get your healthcare needs taken care of at a private practice, and you have a good rapport with your provider, consider asking them if they can obtain condoms, gloves, or other safer sex supplies for you.

You also might consider asking a trusted friend to pick supplies up for you- they can find somewhere that offers them for free so no one has to pay -and handing them over when you see each other.

Many reputable suppliers also sell safer sex supplies online at decent prices and provide clear , detailed information on what you’re buying.

Communication

Do you have the words to talk about sex, and about your body? A lot of us, whether we’re disabled or not, don’t grow up learning the right words for our body parts, or clearly understanding how our bodies work.

When you’re talking to someone you are (or want to be) having sex with, making sure you can communicate accurately and clearly is important. You can’t consent to take part in a sexual activity if you can’t understand your partner, or if they can’t understand you. It’s hard to agree on safer sex practices if, say, one or both partners are unable to speak clearly, are hard of hearing or deaf, or has trouble paying attention to written or spoken words for more than a moment.

You and your partner might want to have a few ways you communicate with each other about sex, both when you’re discussing it and when you’re doing it.

Your communication toolbox can include talking or signing, gesturing, writing notes back and forth, or any other way you can both understand each other. If verbal communication is difficult, or doesn’t happen at all, you’ll want to agree ahead of time on how you’ll communicate things during sex like “I need more lube” or “let’s get the dental dam.”

If talking and writing are both difficult, you might try reading through safer sex information together, and using words or body language (such as nodding your head, shrugging, looking confused, and so on) to indicate when you’ve read something you want to start doing, or that you want to learn more about.

If you use any assistive or augmentative communication devices, you might find the following list of sexual vocabulary words and phrases useful. These can also help you when you’re communicating with a healthcare provider or caregiver.

A Word On Coercion

Disabled people are at an increased risk of experiencing sexual assault. Sometimes that abuse can take the form of sexual coercion, someone talking you into sex you don’t want to have, or attempting to convince you to ditch the safer sex practices you’ve made it clear you want to use. Some people with disabilities are told—sometimes by partners, sometimes by family or friends–that they should be grateful for any sexual attention they get even if it’s not precisely what they want or need.

I call BS on that!

If someone is trying to talk or force you into sex that isn’t safe for you in any way, and they’re trying to use your disability (or anything else) to convince you, that’s just not okay. A person’s disability is no excuse for abuse.

More Resources on Sex and Disability

The following are some sex-and-disability resources that you may find useful:

ROBIN MANDELL is a healthy sexuality and disability rights advocate based in the Washington D.C. area.
She holds a Bachelor’s degree in Women’s Studies from Queen’s University in Canada and a Professional Writing Certificate from Washington State University. Over the years, Robin has amassed extensive experience working with people at vulnerable times of their lives, both as a crisis hotline worker and a sexuality and relationships education advocate with Scarleteen.  Robin has discovered over the years that disability issues receive significantly less attention in academia and social justice movements than they’re due. She has developed a passion for starting dialogues on sex, disability and accessibility, and has come to the realization that, as much as she just wants to be like everybody else, she can use her visible reality as a blind woman to start these dialogues. Robin blogs on disabilities, sexualities, and the connections between them at ReadySexyAble.com and has published articles on various sexuality and sexual health topics at Scarleteen and Fearless press.

Should Older Women “Use It or Lose It”?

use it or loose itFor both sexes, the old saying “use it or loose it” is indeed true. Sex educator and aging specialist Melanie Davis explains why maintaining a sex life is healthy and does your body good.

As we age, however, our sexual bodies change and Melanie Davis advises that we adapt to those changes and re-think our ways of being sexual. For example, investing is lubrication, trying new sex positions to protect joints, being sexually active during the afternoon instead of the evenings, etc. Melanie Davis explains the biological changes to expect in post-menopause and offers ways to accommodate these changes in order to maintain a healthy sex life (men are no exception to the “use it or loose it” rule and do experiences changes as they age too. This article happens to focus on women.)

In sum, our sexuality is not solely for reproduction. Just because a woman’s body no longer produces eggs does not mean she is void of sexuality.

Here are Melanie Davis’ key points on why the “use it or loose it” approach is beneficial to your health:

  • Solo or partnered sex exercises muscles and increases flexibility. The contracting vaginal muscles during sex and orgasm conditions the vaginal walls and works the tendons and muscles of the pelvic floor.
  • Sex can be physically energetic which gives the heart and joints a great workout!
  • Research has shown that orgasm can ease pain for hours.

All of these benefits point to the power of “using it!”

This article was originally published here.

BY MELANIE DAVIS, PhD | MelanieDavisPhD.com

I’ve consulted with several women lately who are 50-65 year old and are planning to have sex after a multi-year break. Their main concern has been whether that old “use it or lose it” adage is true.

It can be, since the ability to enjoy penetrative sex depends in large part to tissue moisture and suppleness. The good news is that women can maintain and regain their sexual enjoyment.
Decreasing estrogen in an older woman’s body plays a large role in her level of sexual enjoyment. If you look at sex from a strictly biological standpoint, once there’s no guarantee of “good eggs” due to age, the body shuts down the reproductive factory, starting with estrogen production. Estrogen keeps tissues supple and triggers transudation (the process of natural lubricant flowing through tissues in the vagina and vulva). Once a woman can no longer reproduce, the body has no biological use for sex; ergo, there’s no use fornatural lubrication or supple tissues.

But that’s not what women want to hear! Women consider ourselves more than reproductive vessels, and many women want to be sexually active — for myriad reasons — until the day they die.

Because the loss of estrogen causes tissues to thin, the already delicate vaginal, vulvar and anal skin is more apt to tear or feel painful from handling that once might have felt great. Also, the muscles in the pelvic floor start to get lax, so the bladder and other organs may droop, causing unpleasant pressure during penetration. This news can sound dreadful, and many women just assume their sex lives are over. However, if women make accommodations mentally, behaviorally, and, if need be, medically, they can enjoy post-menopausal sex. The key to enjoying sex while aging is to understand naturally occuring changes and to adapt to them.

Older women may need to consider some sexual behavioral changes, i.e., body positioning to protect joints and tissues, using condoms or dental dams if they have new partners, and rethinking when they engage in sex. For example, switching from late night to late afternoon sex can be helpful because medications have kicked in and fatigue hasn’t. Now’s also the time to load up on lubricant — silicone or water-based or even olive oil from the kitchen cabinet (but don’t use oil with condoms!)— to lubricate vulvar tissues and the entrance to the vagina or anus. If tissues are uncomfortably dry, see a healthcare practitioner for advice on whether an estrogen-containing product is indicated.

The act of sex, solo or partnered, exercises muscles and increases flexibility. The clenching and unclenching of vaginal muscles during sex and orgasm conditions the vaginal walls and works the tendons and muscles of the pelvic floor. And, if a woman expends a modicum of energy and movement during sex, the heart and joints get a workout. Orgasm has another benefit — research has shown it to ease pain for hours. All of these benefits point to the power of “using it.”

If you don’t have partnered sex, pleasure yourself. If you’ve never masturbated before, experiment with what feels good to you. If you have a partner who’s willing to get back into the groove after a long break (or if you have a new partner), schedule an internal exam with your healthcare provider to see whether your vagina is supple enough for penetration. If you’ve had some atrophy, stretching with dilators or physical therapy may be indicated.

Communicating with a partner is important because older women may require more time to become aroused enough to naturally lubricate. And those delicate tissues mean that the level of sexual touch and/or penetration may need to change. Older adults typically feel an decreased need for athleticism in the bedroom, too. Getting used to this change may require on-going conversations so both partners get the sexual satisfaction they desire.

Older women also need to attend to their self-esteem as they deal with the loss of their younger body — including less firm breasts, changing fat deposits, the thinning and graying of pubic hair and less plump labia. There may also be the diminishment of a partner’s looks or sexual function to adapt to, as well. It can be helpful to re-think was sex “looks like,” so to speak. Perhaps the goal need no longer be orgasm, but intimacy — at least some of the time. It’s also good to be aware that intimacy may be very different in older age if one’s partner dies and cuddling with a friend becomes the easiest way to satisfy skin hunger.

Unsure what size

melanie_davisMELANIE DAVIS, PHD, consults with individuals and couples to help them build sexual knowledge, comfort, and pleasure through the New Jersey Center for Sexual Wellness. Through her firm Honest Exchange LLC, she provides professional development in sexuality. She’s a popular speaker on self-esteem and body image, and the sexual impact of cancer, menopause and aging. She’s an AASECT-Certified Sexuality Educator. On Twitter @DrMelanieDavis

How to Talk with Your Doctor About Sex

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BY MELANIE DAVIS, PhD | MelanieDavisPhD.com

Chances are, you haven’t talked to your doctor about sex lately, but you should: your sexual orientation, gender identity, relationships, body image, and sexual activities can all affect your physical and emotional health.

Physicians rarely bring up sex during office visits, other than to ask a basic question or two. They are focused on diagnosing and treating problems that have an immediate impact on your health, and many sexuality topics are out of their area of expertise and comfort.

Another issue is that physicians, like everyone else, act in accordance with their perceptions and assumptions. Your provider may assume you have all the information you need; that you either aren’t at risk for sexually transmitted infection or unintended pregnancy; that you know how to protect yourself; or that your levels of sexual function and pleasure are acceptable to you.

When it comes to talking about sex, you may need to take the lead. Don’t be embarrassed – if you can discuss your indigestion and bowel habits with your doctor, you can discuss sex! Here are some tips to get started:

• Don’t wait until your doctor is ready to leave the room before you bring up a sexual concern. Mention your question or concern at the start of your visit, in case the doctor needs to look at a specific part of your body to answer the question.

• Consider booking a second visit. Doctors have little time to spend with each patient, so they focus on acute health issues. Sexual concerns often take longer to discuss. To ensure that all of your concerns are addressed, schedule a visit specifically related to your sexual questions and concerns. If it’s an urgent matter, let the doctor know at the first visit.

• Acknowledge that sexuality may be a difficult topic to discuss, but it’s important to you. If your doctor can’t give you useful answers or seems judgmental, find another doctor. Urologists treat male sexual concerns; gynecologists treat female sexual concerns.

• Ask your doctor to alert you to possible sexual side effects of medications, treatments, and surgeries.

• Be honest about the sexual activities you participate in, so your sexual health risks can be appropriately assessed and you can be tested and treated for sexually transmitted infection (STI) or unintended pregnancy. People of any orientation may enjoy oral sex, body rubbing, anal sex, mutual masturbation, etc., so a discussion of your sexual activities will not reveal your orientation unless you choose to disclose it.

• Ask about sexual activities that may affect pre-existing medical conditions. If you have circulatory problems, being tied up could be risky. If you have heart problems, physically stressful sex may need to be modified. If you have blood-clotting issues, you may need to avoid activities that could break the skin. If you have multiple partners, you are at higher risk for STIs. If your doctor can’t suggest satisfying modifications, seek out a sexuality educator or occupational therapist who can help you find ways to enjoy your favorite activities.

• If you have psychological and relationship concerns, consider seeing a sex therapist. If you need information and practical solutions/skills, see a sexuality. You can find certified sex therapists and sexuality educators at www.AASECT.org

 

melanie_davisMELANIE DAVIS, PHD, consults with individuals and couples to help them build sexual knowledge, comfort, and pleasure through the New Jersey Center for Sexual Wellness. Through her firm Honest Exchange LLC, she provides professional development in sexuality. She’s a popular speaker on self-esteem and body image, and the sexual impact of cancer, menopause and aging. She’s an AASECT-Certified Sexuality Educator. On Twitter @DrMelanieDavis