Sunday, January 19, 2014

No Sex for 12 Years, Now Vagina Too Tight for Penetration

[1/19/14: So many readers are landing on this post from 2007 as they search for information about vaginal tightness and pain that I updated it, including current links. 
-- Joan]

Frustrated in Florida, age 61, had not had sex for nearly 12 years, until recently. She wrote in an email to me:

Apparently one's vagina does change after not using it for a long period of time. I always thought sex was like riding a bicycle, but it is not. One can't just get back on and ride! I experienced such pain during the attempted penetration that we had to stop. What a disappointing and embarrassing moment. My partner was very understanding, however I was just frustrated and disappointed.

I went to my GYN for an examination soon after and explained my circumstances. She gave me a thorough exam and said although I had many tiny lacerations and redness, my vagina seemed normal. She explained how one's vaginal lining becomes thin after menopause and her advise was to abstain from sex for two weeks, using lubrication to aid in healing.

When we engaged in sex again, very gently, I was once again disappointed with the level of pain even though using lots of lubrication. We once again had to stop.

So now I am wondering if there is some way I can stretch my vagina for it seems like it has shrunk. (Perhaps it is just my imagination running wild!)

Have you had anyone else write you with a similar problem and if so is there a solution? For your information I have never been on hormones and my partner's penis is of normal size.

No, it's not your imagination, and yes, it's true that the vagina will seem to shrink after a long period of abstinence, especially after menopause, and penetration will be painful or sometimes impossible. You'll find a helpful chapter in my book, 
Naked at Our Age: Talking Out Loud About Senior Sex and several other posts about vaginal pain on this blog.

I'm disappointed that your gynecologist is not this helpful. Telling you you're "normal" while you have lacerations and pain is not helpful, is it? Most doctors do not know how to diagnose or treat vaginal pain, and it 's wise ask for a referral to a sexual pain specialist.

Please read Vaginal Renewal Program  by Myrtle Wilhite, M.D., at A Woman's Touch, a wonderful sexuality resource center in Madison, WI. It tells you step by step how to massage and stretch your vagina. Here's an abridged version:

* External Moisturizing and Massage: Increase the suppleness and blood circulation of the skin of your vulva and vagina with a five- to ten-minute massage with a moisturizing sexual lubricant like Liquid Silk®, a water-based lotion that will soak in and moisturize your skin, won't get sticky, and will help you massage with very little friction.

Push in to the skin with circular strokes, and massage what's underneath the skin, rather than brushing across the skin. Include the inner lips, the hood of the clitoris, the head of the clitoris and the perineum.

To complete your external massage, massage into the opening of the vaginal canal, using the same circular strokes. The massage itself does not need to be self-sexual in any way, but if that is comfortable for you, by all means explore these sensations.

* Internal Vaginal Massage: To massage inside your vaginal canal, we suggest using a lucite dildo which is very smooth and will not cause friction or tearing. Choose your size based upon how many fingers you can comfortably insert into the opening of your vagina.

After a session of external vulva massage, apply the same massage to the inner surfaces of your vagina with your dildo with lubricant applied on both skin and dildo. Rather than pushing the dildo in and out, use a circular massage movement. You are increasing skin flexibility so that your body can adjust to comfortable sexual penetration if you choose it.

You might also choose to use a slim vibrator for massaging the vaginal walls. Coat it in Liquid Silk and then insert it gently. Turn it on and let it run for about five minutes. You don't need to move it around, just lie there and let it do its work.

* Orgasm: For women who stop having orgasms, the blood vessels literally can get out of shape, preventing future orgasms. If you are able to bring yourself to orgasm, do so at least once a week (for the rest of your life -- seriously). This is preventive maintenance of your body.

* Kegel Relaxation: Kegels increase both the strength and flexibility of your pelvic floor muscles. Pay attention to the relaxation and deep breath part of the exercise. Learning to relax your pelvic floor will help you to avoid tensing up before penetration. (Read A Woman's Touch's Step-by-Step Kegels in this article about pelvic floor health.)

In my earlier book, Better Than I Ever Expected: Straight Talk about Sex After Sixty, I had interviewed a 75-year-old woman who had been celibate for 38 years and was in a new relationship. She was unable to have intercourse because her vagina had dried and narrowed to the point that penetration was impossible. She sought help from her gynecologist (a wonderful woman who bought dozens of copies of Better Than I Ever Expected to give to her patients!), who helped her. 

Best wishes for a joyful resolution to this problem -- please keep me posted.


Tuesday, January 14, 2014

Herbs for Sexual Enhancement, guest post by pharmacist Paul Roberts

As we age and encounter sexual challenges, many of us turn to herbs for help. Yet how do we cut through the hyped-up claims and figure out whether a certain herb actually works for the reason we want to use it? And how do we know if it's harmful or dangerous ("contraindicated") because of a medical condition or other drugs we're taking? 

I asked pharmacist Paul Roberts to give us some answers. Here he comments on herbs that people our age often buy, hoping to improve our libido, erections, and sexual responsiveness. 
-- Joan

Herbs for Sexual Enhancement
by Paul Roberts R.Ph., M.S., 
Certified Geriatric Pharmacist and nutritionist

Some herbs are reputed to enhance sexual libido and function. Do they work? Herbs for sexual function are rarely used alone. Rather they're found with several others in combination. Therefore it's difficult to determine which individual ones work, and adequate studies for safety are generally lacking. Fortunately herbs have generally mild effects and a good safety record overall, compared to prescription medications.
Be sure to tell your doctor what herbs you’re taking or considering taking, because they may interact with another medication you’re taking or aggravate a condition you have.
These herbs are commonly used for sexual function:

Tribulus (Tribulus terrestris) "Puncture Vine"
        Uses: to treat impotence, infertility, and increase muscle strength. Tribulus is widely used in combination with other herbs for sexual dysfunction in men.
Contraindications: Do not use if you are diabetic (it may lower blood glucose levels); take lithium; have benign prostate enlargement, prostate cancer, hormone dependent cancers, or other hormone-linked medical conditions. Tribulus may interact with some heart and blood pressure medicines, such as beta-blockers, calcium channel blockers, digoxin, and diuretics. Avoid this herb for sexual dysfunction in women, as it’s likely to aggravate the condition.
Conclusion: Tribulus is included in most herbal formulas for sexual dysfunction, although there’s little scientific evidence that it works. It is possibly effective for men and may be worth a trial for up to 8 weeks if you do not have any of the contraindications.

Korean ginseng (Panax ginseng)
Uses: to improve erectile dysfunction, libido, sexual arousal in women, orgasmic function, sexual satisfaction, physical stamina.
Contraindications: Avoid if you are taking blood thinners. Avoid if you have autoimmune disease (it may stimulate immune function). Avoid if you have schizophrenia unless prescribed by your doctor. It also has some estrogenic effects and should be avoided by women with estrogen-sensitive cancers or conditions.
Cautions: Use caution and check your blood sugar frequently if you're diabetic. Use only under medical supervision if you are taking antidepressants or antipsychotics. It may cause insomnia and increase the effect of caffeine, use with caution if you have difficulty sleeping. One study of a product containing Korean ginseng, yohimbine , Horny Goat Weed, Muira Puama, and other ingredients found the combination can interact with medications and may lead to irregular heartbeats.
Conclusion: Adverse effects rarely reported in doses of 500mg to 2,000 mg for 4 weeks to 6 months. Found to significantly improve sexual function over 4 to 12 weeks. Libido, orgasmic function, and sexual satisfaction have been shown improved over 8 weeks, but probably not effective for increasing physical stamina. Used by over 6 million Americans, Ginseng can be considered for improving sexual function in men and enhancing sexual arousal in women if you do not have any of the contraindications or cautions.

Maca (Lepedium meyenii)
Uses: for impotence, as an aphrodisiac, and to relieve stress. Maca root in dried form has been consumed by Peruvians as regularly for several thousand years, but never the fresh root, which is considered unsafe.
Contraindications: Avoid in hormone-dependent cancers, or other hormone-linked medical conditions.
Cautions: Although traditionally used to establish female hormonal balance, no studies have been done in women.
Conclusion: Maca is possibly effective for increasing libido and increasing sperm amount at 1.5 to 3 grams daily of the dried powdered root. More studies are needed to verify other uses. Likely safe (in the dried form) for short term, up to 3 to 4 months. Due to widespread use and safety, in spite of lack of studies, combinations with Maca may be worth a trial in healthy individuals.

Chrysin "Passion Flower"
Uses: for impotence and increasing testosterone. It is purported to inhibit the conversion of testosterone into estrogen, however studies that show this are lacking.
Contraindications: Avoid with prescription aromatase inhibitors (Femara®, Arimidex®, Aromasin®) because it may increase the drug’s effect. May interfere with anticoagulant, platelet treatments or cause low blood pressure. Avoid if you are immunosuppressed or immunocompromised. Avoid in hormone-dependent cancers, or other hormone-linked medical conditions.
Cautions: May increase levels of some drugs cleared by the liver enzyme "Cyp1A2" including caffeine. Ask your pharmacist or doctor if this could affect any of your prescriptions.
Conclusion: Avoid this herb until more is known.

Wild Yam (Dioscorea villosa) 
Uses: to increase energy and libido in women
Cautions: Claims that Wild Yam is a natural progesterone or has progesterone effects are not supported by studies.
Conclusion: No reports were found of adverse effects when used in appropriate doses for short term. However, Wild Yam is not converted to hormones in the body as is commonly believed, only in the laboratory. Avoid this product.

Damiana (Turera diffusa)
Uses: to prevent and treat sexual dysfunction and as an aphrodisiac.
Cautions: The research studied Damiana in combination with other ingredients, however studies of the herb alone are lacking.
Conclusion: May be safe in appropriate doses for short term, but possibly avoid this herb until more is known.

*WARNING: One study of a product containing Korean ginseng, yohimbine, Horny Goat Weed, Muira Puama, and other ingredients found the combination can interact with medications and may lead to irregular heartbeats. Horny Goat Weed may increase bleeding if you’re taking blood thinners. In combination with blood pressure medications, it may lower blood pressure, leading to dizziness or falls.