Join us at noon CT (1 p.m. ET/10 a.m. PT) on Tuesday, April 5, to chat about older women's sexual health with Tribune reporter Judy Graham and panelists, Dr. Lauren Streicher and Sheryl Kingsberg.
Lauren Streicher, M.D. is an assistant clinical professor of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine in Chicago. She is a fellow in the American College of Obstetricians and Gynecologists, a diplomat of the American Board of Obstetrics and Gynecology, and a member of the American Association of Gynecologic Laparoscopic Surgeons, among several other organizations. An in-demand speaker and media commentator, Dr. Streicher has a particular interest and expertise in sexual health, menopause, minimally invasive surgery, laparoscopic hysterectomy and alternatives to hysterectomy.
Sheryl A. Kingsberg, Ph.D., a clinical psychologist, is a professor of reproductive biology and psychiatry at Case Western Reserve University School of Medicine and chief of the division of behavioral medicine at the department of obstetrics/gynecology at University Hospitals Case Medical Center in Cleveland. Kingsberg is a principle investigator for clinical trials in hypoactive sexual desire disorder and co-editor of an online curriculum on sexual health published by the North American Menopause Society. Her main interests are female sexual function and the psychological aspects of infertility and menopause.
Welcome, everyone, to our chat on older women's sexual health. We're looking forward to an interesting, lively discussion starting at noon.
Tuesday April 5, 2011 11:47 Judy Graham
Here's a question for you, Dr. Streicher. "I have absolutely no interest in sex, and furthermore, I'm a little embarrassed to admit that I don't really care. I feel like the whole world is obsessed with sex. Is it weird that I have no desire to change things?"
Tuesday April 5, 2011 12:00 Judy Graham
While roughly 40% of middle aged and older women have difficulties related to sex such as painful intercourse, lack of libido, and vaginal dryness only 12 percent indicate that those issues are a source of significant personal distress affecting quality of life. In other words, the majority of women with sexual problems are not particularly motivated to do anything to fix it. In our sex-obsessed society it’s important to acknowledge that many individuals are not sexually active but are also not necessarily lonely, feeling sex starved, or unhappy about it. Many couples, particularly older couples, have solid relationships, intimacy and affection without being sexual.
Tuesday April 5, 2011 12:00 Lauren Streicher
Here's another one, for Dr. Kingsberg: "I've been experiencing bothersome hot flashes for the past year, and I wake up almost every night sweaty and then get cold. My sex life was fine until menopause, but I'm just not interested any more. Could the hot flashes be affecting my libido?"
Tuesday April 5, 2011 12:01 Judy Graham
Anything that consistently interferes with good sleep could certainly cause problems with sexual desire. Hot flashes, especially if they're associated with night sweats can disrupt your sleep (although it has been shown that many women at menopause will have sleep disruption even without night sweats) and sleep disruption, certainly could affect your sexual interest. The consequence of chronic poor sleep is poor overall quality of life. Sleep may become the priority but also, we tend to be more irritable and unhappy and this mood is not conducive to wanting to be sexual. Although hormone therapy (with estrogen or with estrogen plus progestogen) is associated with risks, if the hot flashes are disruptive and other attempts to treat them have not been successful, the benefits of hormone therapy often outweigh the risks for healthy women in early menopause. It is important to talk to your healthcare provider about your individual risk vs. benefits.
Tuesday April 5, 2011 12:01 Sheryl Kingsberg
This woman sent me a question earlier today. " I am 76 and quite healthy, good weight, walk 2 miles a day. But each night I am throwing offf my covers. What your opinion of these progestrene creams? HS
Tuesday April 5, 2011 12:03 Judy Graham
The average woman can expect to experience moderate to severe hot flashes for about 5 years, but as you know better than anyone, around 20% of women will continue to have flashes forever. It's also important to know that not all flashes are related to menopause. Many medications or medical illnesses can cause bothersome hot flashes so if this is new, check with your doctor. As far as progesterone creams, they are completely worthless. The progesterone molecule is quite large and difficult for skin to absorb, so progesterone creams are not “bioavailable”…in other words they do nothing. That is why there are a number of excellent transdermal estrogen products (estrogen is very well absorbed through the skin) and no FDA approved transdermal progesterone creams.
Tuesday April 5, 2011 12:03 Lauren Streicher
We know many participants have signed on to this chat. Please send in your questions.
Tuesday April 5, 2011 12:04 Judy Graham
[Comment From BettyBetty: ]
Can there be too many drugs to restore the vagina of an older woman and her sex life...I take three and I am in my late 70s.
Tuesday April 5, 2011 12:04 Betty
Would you mind telling us which drugs you're on?
Tuesday April 5, 2011 12:05 Judy Graham
While we're waiting for one of our experts to answer, here's a resource for women interested in this topic.
From the National Women's Health Information Center, part of the U.S. Department of Health and Human Services, Office of Women's Health
Actually, Betty it is fine to use more than one drug to relieve vaginal dryness. It would be nice if lubricants alone solved the vaginal dryness problem, but sometimes the ravages of menopause make the vaginal walls so thin and dry, that the only way to reverse the vaginal clock and make intercourse comfortable is estrogen. I know -- estrogen. Everyone thinks breast cancer, blood clots, bad stuff. And if you weren't thinking that, you will when you read the FDA required package insert. Keep in mind the package insert is the same weather you are taking systemic estrogen pills or using a vaginal product. The dire warnings required by the FDA were based on data from the 2002 study of women taking oral estrogen and progesterone. None of the complications listed on the package insert have ever been shown to result from using vaginal estrogen. Currently, there are three types of prescription vaginal estrogen products. Estrogen cream (Estrace and Premarin) has the advantage of giving both internal and external help, but tends to be on the messy side. The reusable applicator, while environmentally friendly, has to be washed, put away (where the kids won't find it) and reused. Vagifem is a pre-loaded estradiol tablet that avoids the messy factor, but has the disadvantage of only treating the vaginal walls. The final vaginal estrogen product is Estring, a silastic vaginal ring that you insert in the vagina and replace every three months. For many women the best way to go is with a combination approach. Use the ring or the tablet to get rid of the sandpaper sex feeling, and apply cream on the outside a couple of times a week. All vaginal estrogen products restore vaginal blood flow, decrease vaginal pH (making you less susceptible to infections), and improve the thickness, elasticity and lubrication of your tissue.
Tuesday April 5, 2011 12:09 Lauren Streicher
[Comment From WendyWendy: ]
How safe are vaginal hormone creams like Estrace?
Tuesday April 5, 2011 12:09 Wendy
Lots of questions are coming in and here's another resource while we're waiting for an answer to Wendy's question:
From the Mayo Clinic
Sexual Health and Aging: Keeping the Passion Alive
It is very safe, it is concerning when the product has a package insert that practically has a skull and cross bones on it making you wonder if it's worth risking your life in the name of good sex. Keep in mind that the FDA requires any product containing estrogen to have the same warning -- a warning that was not is not based on research that has anything to do with vaginal estrogen. The miniscule amount of estrogen absorbed from the vagina doesn't even increase blood estrogen levels above the normal menopausal range, so there is no reason to think that there will be enough circulating estrogen to have any impact on breast cancer recurrence. What little data there is regarding the use of vaginal estrogen in women with breast cancer is very reassuring. One study which was published in a medical journal (Climacteric 2003; 6:45-52) followed 1,472 breast cancer patients who routinely used vaginal estrogen and were found to have a LOWER recurrence rate than women who did not use vaginal estrogen. There is essentially no evidence that using tiny amount of estrogens directly on vaginal tissues to increase lubrication and elasticity of tissue that has become thin and dry causes an increased risk of breast cancer recurrence. In addition, current vagina estrogen products have much lower amounts of estrogen than in products used even a few years ago and many women require even less than the recommended dose to reverse thin, dry tissue. I have many patients who only use tiny amounts of vaginal estrogen once or twice a week for maintenance and find that it does the job just fine. Take a look at the answer to Betty's question for more information.
Tuesday April 5, 2011 12:11 Lauren Streicher
[Comment From KimKim: ]
what are your thoughts about testosterone use in women, either topical or via implant - safety, efficacy, how is this monitored to determine appropriate dosage
Tuesday April 5, 2011 12:12 Kim
[Comment From TracieTracie: ]
Was wondering about the plus or minus of taking testosterone to increase libido and energy overall.
Tuesday April 5, 2011 12:12 Tracie
There is abundant evidence supporting the use of testosterone for the treatment of low sexual desire or hypoactive sexual desire disorder (HSDD) in postmenopausal women. Currently, there are no testosterone products approved by the US Food and Drug Administration (FDA) for the treatment of HSDD in women. However, a number of practitioners are prescribing testosterone off label after discussing the risks and benefits with their patients. Over 2 million prescriptions for testosterone were written for women in 2006-2007 . Over the last decade, numerous large, well-designed clinical trials have shown that topical (transdermal) testosterone in doses equivalent to what premenopausal women have naturally is effective in the treatment of postmenopausal women with HSDD with few side effects.
Testosterone transdermal gels that are FDA-approved in the United States for use in men are sometimes used off-label for women by reducing the amount applied to estimate what has been shown to be the effective dose in women. Testosterone compounded by pharmacies, can be obtained locally by prescription or on the Internet. Custom-compounded testosterone pellets of 25 to 100 mg are available in the United States from compounding pharmacies. They are inserted through a small surgical incision using local anesthesia. They are normally implanted every 3 to 4 months. An oral pill that combines estrogen and testosterone is also available. This is the only testosterone product approved for use in women in the U.S. but not for the indication of HSDD and the manufacturer discontinued supplying the product to the U.S. market in March 2009. It is also associated with significant decreases in high-density lipoprotein (HDL) cholesterol, increased total cholesterol/HDL ratio, but a significant decrease in triglycerides. There is limited, prospective, randomized clinical trial data on this treatment . While intramuscular injections are also used, they are probably the least optimal because they have such a peak and trough effect (they give women a bolus—large amount at first and then by 2 weeks the effects wear off ).
Several clinical trials testing a testosterone patch on almost 3000 postmenopausal women with HSDD have demonstrated significant increased in sexual desire compared with placebo. The testosterone patch (Intrinsa ®) was approved by the European Medicines Agency of the European Union and has been available in Europe since 2007. Long-term safety concerns have stalled FDA approval of topical testosterone therapy for postmenopausal women with HSDD in the U.S. However, recent reviews suggest a good safety profile has been demonstrated and there is now a report on 4 years of clinical use in European women who have been using the Intrinsa testosterone patch.
The most common side-effects of testosterone therapy are acne, hirsutism (e.g. women will complain of additional chin hair,) and thinning hair. The majority of clinical trials have not shown a significant risk of serious/life-threatening side effects. However, currently BioSante is conducting a large safety trial of their topical testosterone gel for postmenopausal women. BioSante is following women for up to 5 years who are at risk for developing cardiovascular disease and who are using their testosterone gel daily. They are also monitoring the occurrence of breast cancer in their subjects over time.
Tuesday April 5, 2011 12:13 Sheryl Kingsberg
Many women wonder if there is a blood test to evaluate whether testosterone is for them. There is actually no correlation between testosterone levels and low desire. THerefore it is an "empirical" question and if it works it works--it may take 12 weeks to see an effect. However, it is helpful to have your provider measure your levels once you are on to make sure you stay within a normal range for a premenopausal woman
Tuesday April 5, 2011 12:15 Sheryl Kingsberg
[Comment From Beth ParenteauBeth Parenteau: ]
I'd like to suggest another resource that I've found helpful. It's a website called MiddlesexMD.com. It offers information and advice to help women in perimenopause and menopause maintain their sexual health. http://MiddlesexMD.com
Tuesday April 5, 2011 12:15 Beth Parenteau
[Comment From KimKim: ]
how is the dosage determined? is there a test or just how a woman responds
Tuesday April 5, 2011 12:16 Kim
I assume you are asking about the dosing for testosterone. The typical dosage for women is 300 micrograms per day (or about one tenth of a daily dose for men). Then you can tweak the amounts as needed based on effect and blood levels and side effects
Tuesday April 5, 2011 12:17 Sheryl Kingsberg
[Comment From GuestGuest: ]
what do you recommend to increase clitoral sensation.
Tuesday April 5, 2011 12:17 Guest
Many women require more stimulation to achieve orgasm as they get older. If you have never considered using an external vibrator to enhance sensation you may want to. Many older women (and young women as well) use a vibrator either with or without a partner to increase sensation. Some women also find that hormones such as estrogen and testosterone will enhance sensation.
Tuesday April 5, 2011 12:17 Lauren Streicher
I like to give people lots of resources to turn to. Here's another one from the National Women's Health Resource Center
I prefer sex once a week,but my husband would like it 2-3 times weekly.........This is beginning to cause stress inour relationship
Tuesday April 5, 2011 12:19 Lorissa
It is rare for couples to have exactly the same level of sex drive and it is more common for men with higher testosterone levels to have higher drive. My best advice is to have a discussion with him and talk about the fact that too much of a good thing is not always a good thing. Negotiating a compromise works great. If you are pushed to have sex more than you want it starts to feel like a chore and the likelihood is you get annoyed. But on the other hand, women often choose to be sexual for other reasons than their drive (say for the desire for intimacy) and so you may want to have sex a bit more than your body craves--negotiating is great!
Tuesday April 5, 2011 12:21 Sheryl Kingsberg
[Comment From BruceBruce: ]
My wife went from being interested all the time to 0 interest. Very frustrated and don't know what to do
Tuesday April 5, 2011 12:23 Bruce
We're glad some men are listening in to this chat as well.
Tuesday April 5, 2011 12:24 Judy Graham
Libido is complex and is impacted not only from hormonal changes, but also from relationship problems, stress, medical conditions, medications, or from sex that is painful. Having said that when someone has an abrupt change in libido, it is very often from a specific thing such as a drastic decline in hormones. If your wife is newly menopausal, she may benefit from hormone therapy. If she is not newly menopausal, it would be worth exploring other relationship or life issues.
Tuesday April 5, 2011 12:24 Lauren Streicher
[Comment From CindyCindy: ]
What about taking something like viargra? I saw some cream called "Befar" on the internet but I don"t see it listed in any drug books
Tuesday April 5, 2011 12:25 Cindy
When Viagra came to market in1998 the hope was that this drug (and Levitra and Cialis) would be the sexual salvation for men and then the sexual salvation for women. Since these pills, known as PDE-5 inhibitors, restored erections in men by increasing blood flow to the penis, why couldn't they restore desire or arousal in women by improving blood flow to the vagina? Despite the hope, clinical studies found that while PDE-5 inhibitors did increase genital blood flow in women, for most women this did not result in any real increase in desire or arousal compared with placebo. Although a study has shown that Viagra reduced adverse sexual side effects in premenopausal women taking antidepressants associated with sexual problems it seems unlikely that these PDE-5 inhibitor drugs will win FDA approval for improving sexual function in women.
Most of the other creams and potions offered on the internet have no clinical trials to support their efficacy and are likely helpful as "placebos". Some creams/ointments such as Zestra and L-Arginin do have support for increasing sensation and arousal in some women
Tuesday April 5, 2011 12:25 Sheryl Kingsberg
[Comment From TracieTracie: ]
the studies you cite for testosterone usage implies post-menopausal women. what about peri-menopausal women?
Tuesday April 5, 2011 12:26 Tracie
Their are very few studies looking at the use of testosterone in peri-menopausal women. Unlike estrogen levels which tend to fluctuate during peri-menopause, testosterone levels are more stable. Having said that, I have had a number of patients who have benefited from testosterone therapy.
Tuesday April 5, 2011 12:27 Lauren Streicher
[Comment From GuestGuest: ]
Is fsd the same as hsdd?
Tuesday April 5, 2011 12:28 Guest
FSD stands for Female Sexual Dysfunction. HSDD stands for Hypoactive Sexual Desire Disorder. Actually FSD reflects the general idea of women's sexual problems (lumps them all together). HSDD is one of the 6 sexual dysfunctions listed in the Diagnostic Statistical Manual that we use in medicine to determine diagnoses. HSDD is the most prevalent sexual dysfunction and refers to the persistant loss of interest in sexual desire that causes personal or interpersonal distress
Tuesday April 5, 2011 12:28 Sheryl Kingsberg
I know there's some controversy over whether hypoactive sexual desire disorder is a valid medical condition or a "mediczliation" of ordinary experience? Can you comment? Is this just about the drug industry pushing more drugs on women?
Tuesday April 5, 2011 12:29 Judy Graham
I am so pleased that someone has asked about this. Yes, indeed there has been a lot of controversy over the question of whether female sexual problems are real or have been manufactured in a pharmaceutical company's laboratory or marketing office. The controversy has been played out much more in the media (it is a sexy controversy) than in an academic or scientific debate.
There is a small but vocal group who argue that reports about female sexual disorders, particularly hypoactive sexual desire disorder, are essentially a conspiracy of the pharmaceutical industry to create a disease in order to profit from treating it.
They argue that drug companies are trying to make women feel inadequate about their loss of sexual desire rather than having women embrace this loss as normal and therefore not needing treatment. They are essentially arguing that female sexual problems are a medical myth. I find this very ironic and extremely worrisome to women. The potential negative impact of this message to women who are experiencing sexual problems is huge and will likely damage women's sexual empowerment. Sexual disorders have been accepted as medical conditions for over 30 years, long before there was any pharmaceutical industry interest in treating them. They have entered way too late in the history of female sexuality research to be given the distinction of inventing sexual disorders!
I would suggest that the "right" answer to the debate comes from women themselves. Healthcare providers, researchers, policy-makers, drug companies and activists need to listen to women and respect what they are saying about their lives and experiences. It is wrong to make women feel like they are defective when they do not feel that way themselves (this is why the criteria for a sexual dysfunction requires "causes personal distress"). However, it is just as incorrect to discount women's distress when they express it. This sounds eerily similar to the "it's all in your head dear" approach to women's complaints that has characterized too much of women's healthcare historically.
Tuesday April 5, 2011 12:29 Sheryl Kingsberg
[Comment From KWKW: ]
I have been to a number of doctors with frustrating results after early onset of menopause (30's) and subsequently no libido and painful sex - other than word of mouth how do we find an informed educated and sensitive doc, locally - is there a national database?
Tuesday April 5, 2011 12:30 KW
There appears to be a technical difficulty. We do apologize. Here is Lauren Streicher's response to KW's question: "It can be very difficult to find a doctor who is knowledgable about menopause and sexual issues. The North American Menopause Society maintains a database of certified menopause practitioners who are experts. Go to menopause.org to find a doctor locally who is qualified to help you."
Tuesday April 5, 2011 12:34 Chicago Tribune
[Comment From CindyCindy: ]
If you are using systemic estrogen and vaginal estrogen will you still have shrinking of the labia and clitoris?
Tuesday April 5, 2011 12:35 Cindy
While estrogen will have some impact on preventing shrinkage of the labia and clitoris, you may still notice a difference. Fortunately with the right lubricant and estrogen product the shrinkage will not interfere with sexual satisfaction.
Tuesday April 5, 2011 12:37 Lauren Streicher
[Comment From Larry PotashLarry Potash: ]
How can I get my wife to open up to me about her sexual health? She separates our sexual intimacy from her sexual health. Why does it have to be a secret?
Tuesday April 5, 2011 12:37 Larry Potash
[Comment From Larry PotashLarry Potash: ]
Though my wife and I have no problems with sexual intimacy she refuses to share information about her own sexual health with me. How can I get her to be more open about her sexual health? As an example, she says that I won't understand what her OB-GYN says as a part of her regular exams. I want to understand but she refuses to share those details with me.
Tuesday April 5, 2011 12:37 Larry Potash
While most women with sexual concerns want to discuss them, they are often quite hesitant. Postmenopausal women are concerned about embarrassing their partners or healthcare providers. Asking open-ended questions and showing patience and support is the best way to have your partner open up. Many partners ask but with an agenda of --"get it fixed" or what is the matter with you. Asking in a way that makes her feel like you are concerned about her and not what her lack of desire does to you will make a big difference. Desire actually is way more about intimacy than biologic urge so talking is actually a wonderful way to increase desire. Good luck!
Tuesday April 5, 2011 12:39 Sheryl Kingsberg
[Comment From KimKim: ]
and while we are on hsdd, will "female viagra", flibanserin possibly resurface - i know someone in the trial who was very positive about it
Tuesday April 5, 2011 12:39 Kim
Flibanserin was in development for a number of years and showed some positive results in clinical trials. The company that was working on Flibanserin ceased work on the drug when the FDA indicated that it would likely not become approved. Their is no expectation that it will be on the market in the future.
Tuesday April 5, 2011 12:41 Lauren Streicher
Here's a good question from a reader: I've had vaginal dryness and pain with intercourse since menopause. We use lubricants and i've even tried vaginal moisterizers, but sex is still uncomfortable. Yet, I'm nervous about using estrogen. Should I be?
Tuesday April 5, 2011 12:41 Judy Graham
Although higher doses of estrogen which are taken by mouth and work throughout your body and are the doses needed to treat hot flashes, are associated with risks, including heart disease in older women and breast cancer, the very low doses of estrogen needed to treat vaginal dryness and atrophy (thin and fragile tissue), and which are applied directly in the vagina, are considered safe. Blood levels of estrogen in women who use only low doses of vaginal estrogen are minimally elevated compared with women not using any estrogen, and are still within the normal range for women at menopause and afterward.
Tuesday April 5, 2011 12:41 Sheryl Kingsberg
[Comment From moore60526moore60526: ]
Are there any increased health risks associated with early menopause? I ceased menstruating over two years ago, and am 47.
Tuesday April 5, 2011 12:42 moore60526
While the average age of menopause is 51, 47 is actually considered to be a normal time to go through menopause. An earlier menopause is associated with osteoporosis and heart disease, so it is important to take steps to ensure bone and heart health.
Tuesday April 5, 2011 12:44 Lauren Streicher
[Comment From Kelley connorsKelley connors: ]
I don't think women should be expected to share their sexual health unless it has impact on partner. Maybe they can talk about sharing info when it's highly personal?
Tuesday April 5, 2011 12:44 Kelley connors
Kelly, while sexual health is quite personal, it typically does impact a partner. We always ask about partner sexual function when considering sexual health and intimacy is such an important aspect of healthy sexuality it is important for couples to be able to discuss sexuality. Communication in and out of the bedroom is key to good sexual relationships.
Tuesday April 5, 2011 12:46 Sheryl Kingsberg
Dr. Streicher, I'm going to shoot this one your way: I have breast cancer and have terrible vaginal dryness. My gynecologist says it is fine to use a vaginal estrogen product. My internist says I shouldn't. I don't know whom to believe.
Tuesday April 5, 2011 12:46 Judy Graham
It's always difficult to feel comfortable using a product when you have received conflicting advice from two physicians that you respect. It doesn't help when the product has a package insert that practically has a skull and cross bones on it making you wonder if it's worth risking your life in the name of good sex. Keep in mind that the FDA requires any product containing estrogen to have the same warning, a warning that was not is not based on research that has anything to do with vaginal estrogen, much less women with breast cancer who use vaginal estrogen. The miniscule amount of estrogen absorbed from the vagina doesn't even increase blood estrogen levels above the normal menopausal range, so there is no reason to think that there will be enough circulating estrogen to have any impact on breast cancer recurrence. What little data there is regarding the use of vaginal estrogen in women with breast cancer is very reassuring. One study which was published in a medical journal (Climacteric 2003; 6:45-52) followed 1,472 breast cancer patients who routinely used vaginal estrogen and were found to have a LOWER recurrence rate than women who did not use vaginal estrogen. There is essentially no evidence that using tiny amount of estrogens directly on vaginal tissues to increase lubrication and elasticity of tissue that has become thin and dry causes an increased risk of breast cancer recurrence. In addition, current vagina estrogen products have much lower amounts of estrogen than in products used even a few years ago and many women require even less than the recommended dose to reverse thin, dry tissue. I have many patients who only use tiny amounts of vaginal estrogen once or twice a week for maintenance and find that it does the job just fine. Even many breast surgeons and oncologists are now comfortable allowing women with breast cancer to use vaginal estrogen. I have to go with your gynecologist on this one.
Tuesday April 5, 2011 12:46 Lauren Streicher
Dr. Kingsberg, here's one for you: What should a recently divorced postmenopausal woman know about safe sex?
Tuesday April 5, 2011 12:47 Judy Graham
Older age is not a protection against sexually transmitted infections (STIs). In fact, if you're postmenopausal and not using at least a vaginal form of estrogen, your vaginal tissue may be more vulnerable to infection than it was before menopause. Although you may think of HIV or herpes when you hear about STIs, chlamydia is the most commonly reported STI. It's easily cured with antibiotics but often goes undiagnosed and untreated and can lead to pelvic inflammatory disease. Gonorrhea is another STI that is easily treated with antibiotics but may go undetected. Human papillomavirus (HPV), which can cause cervical cancer, is also very common. Pap tests are still the recommended screening option for cervical cancer. Ideally, you should ask your partner to be tested for STIs before you have sex. Even then, you should use a latex condom or dental dam until you're sure he or she is disease free and your relationship is monogamous (a dental dam is a thin square of latex rubber or silicone placed over the vulva to allow oral stimulation without skin contact or exchange of bodily fluids). Condoms can protect against most, but not all, STIs. I have this information posted on the North American Menopause website www.menopause.org healthy sexuality module.
Tuesday April 5, 2011 12:49 Sheryl Kingsberg
[Comment From CindyCindy: ]
Do you know of any research that is being done to prevent menopause all together. There are a few books out there about it. Lack of estrogen causes too many serious conditions for it to have it's symptoms just treated. Like putting a band aid on.
Tuesday April 5, 2011 12:50 Cindy
. There is no way to prevent ovaries from stopping production of estrogen.It is part of the normal aging process.The focus of research is to alleviate symptoms associated with menopause and medical conditions associated with lack of estrogen Many of those "experts" who write those books are not really knowledgeable in this area.
Tuesday April 5, 2011 12:53 Lauren Streicher
I know many women wonder about this: I'm still interested in sex but my husband isn't. How can I talk with him about this? Should I just give up?
Tuesday April 5, 2011 12:53 Judy Graham
Your husband's lack of desire may be related to several things, and identifying the cause(s) is the first step. As in women, desire in men is affected by both psychological and physical factors. Psychological factors could include life stressors. Is he having difficulties with his job? Is he concerned about finances? Psychological factors also include the quality of your relationship outside the bedroom. Are you experiencing conflicts in your marriage? Might he be holding some resentments? If he's suffering from other psychological problems, such as depression or anxiety, these could affect his desire as well. Physical factors may also contribute to your husband's decreased desire. Many men may suffer low desire if they develop erection problems and feel anxious about or ashamed of their inability to get a good erection. Problems with erections are common as men age, particularly in those who smoke or have conditions such as high blood pressure, diabetes, or obesity. In addition, many men suffer from a significant drop in testosterone as they age. This drop in testosterone, known as hypogonadism, often results in a loss of sex drive (and depressed mood and fatigue) but is often overlooked by healthcare providers. A simple blood test can determine if a man's testosterone levels are in the normal range. In addition to uncovering (and addressing) the source of a partner's decreased desire, individual or couples counseling may help a couple resume a healthy sexual relationship that has been interrupted, regardless of the cause.
Tuesday April 5, 2011 12:54 Sheryl Kingsberg
You're right, many women do wonder about this. It is always difficult when a couple is not on the same wavelength as far as sexual activity. It is definitely worth discussing and it may be worth meeting with a therapist who has expertise in sexual relationships. Your husband may also have erectile dysfunction that makes him want to avoid intimacy. Sometimes it is helpful to let him know that you can have a sexual relationship without intercourse.
Tuesday April 5, 2011 12:56 Lauren Streicher
[Comment From GuestGuest: ]
Can you try to de-mystify "bio-identical vs not" hormones or send us somewhere with "peer reviewed" data to learn more
Tuesday April 5, 2011 12:56 Guest
Excellent question. So many women get caught up in the labels of things as natural vs synthetic and are confused by what is safe or not with the assumption that "bioidentical" means natural and safe. I would recommend that you go to www.menopause.org for an excellent position statement from the North American Menopause Society that explains bioidentical hormones.
Tuesday April 5, 2011 12:56 Sheryl Kingsberg
[Comment From Streicher Fan ClubStreicher Fan Club: ]
So just where does one go for STD testing?
Tuesday April 5, 2011 12:57 Streicher Fan Club
Your gynecologist of course can test for sexually transmitted infections. Many internists and family practitioners are also comfortable doing so. If you prefer to have anonymous testing you can go to a Planned Parenthood or Board of Health Clinic.
Tuesday April 5, 2011 12:58 Lauren Streicher
I can't believe an hour has passed already. The time has flown. Thank you so much, doctors, for giving us your time, your sound advice and the benefit of your experience. Please tune in next week on Tuesday, noon, central time, to Julie Deardorff's chat on the controversy over food die and hyperactivity in child. Have a good week, everyone!