Your Vagina does not Need Feminine High Jinx Products to Stay Healthy

Lolling in front of the TV one evening, I sat bolt upright when a commercial for a “vaginal wash” appeared on the screen.   The product contains “LactoPrebiotic” to “help maintain a healthy pH balance to fortify natural defenses”. They recommend women “use it every day as an important step towards good feminine health”.  Shades of perfumed, daily panty liners, here we go again.  A healthy vagina should have a “light and fresh scent”.

I assumed LactoPrebiotic was an invented term.  But no, there is such an animal.  WebMD explains,

“Probiotics are “good” bacteria that help keep your digestive system (my emphasis) healthy by controlling growth of harmful bacteria. Prebiotics are carbohydrates that cannot be digested by the human body….The primary benefit of probiotics and prebiotics appears to be helping you maintain a healthy digestive system (again, my emphasis).”

Their marketers have extrapolated benefits from one body system to another.

I found an article examining one of these “daily care for intimate skin” products, including a detailed examination of the ingredients.

I am horrified that these products continue to find a place on the market.

We know how to look after our vaginas; and countless articles have been written about maintaining good vaginal health.  Even this recent article mentions avoiding douching; but it neglects to warn women away from other vaginal cleansing products.  There is plenty of good advice, but also some missed opportunities.

Normal Vaginal Fluids

Vaginal fluids are normal.  Mucus produced in the cervix comes out through the vagina throughout the menstrual cycle indicating the most and the least fertile times in the cycle.  Vaginal lubrication is produced by the Bartholin glands.  Female ejaculate, a clear fluid that is projected from the urethra, is not strictly speaking vaginal but may be perceived as such.

Women who are aware of their normal vaginal fluids will likely be aware when these fluids look, smell or feel different.  Over the counter (OTC) products encourage women to self treat when there is a perceived problem.  I often see ads for OTC yeast treatments; and recently one for Bacterial Vaginosis (BV) came across my TV screen.  The latter surprised me, because the treatment for symptomatic BV is antibiotics.

The other issue I have with self treating is that there are several Sexually Transmitted Infections (STIs) that produce similar symptoms, like irritation and unusual discharge.  If a woman has had unprotected sex with a new partner, male or female, she would be well advised to have a swab taken to diagnose the problem.  If she has chlamydia or gonorrhea, she will need to take antibiotics.  Her partner(s) should also be treated.  Untreated chlamydia or gonorrhea can result in Pelvic Inflammatory Disease (PID) and eventual infertility or ectopic pregnancy.

I acknowledge that a woman who has had yeast infections in the past and is well aware of the symptoms may choose an OTC medication; but symptomatic BV requires an antibiotic.  It has also been linked to PID.

Bayer has a product that claims it can “permanently beat Bacterial Vaginosis”.

They say it restores the pH balance in the vagina.

There is no guaranteed prevention for BV.

Women coming to the sexual health clinic where I worked would frequently return with symptoms of BV.  I followed the research closely for years as scientists looked for a way to encourage and maintain the vaginal production of the necessary lactobacilli.  They did, however, discover some reasons why women may produce fewer of these bacteria critical to vaginal health.

“Vaginal douching or other washing practices are frequently cited as a cause of disturbance of the vaginal flora leading to the onset of BV. In a prospective study, douching was associated with loss of protective H2O2-producing lactobacilli and acquisition of BV. A case-control study…investigated associations between vulval washing, vaginal washing, and douching and BV… Use of bubble bath, antiseptic solution, and douching was more common in women with BV…”

Vaginas should smell like vaginas

Lysol was once used as birth control (nope, didn’t work) but also to help women practise “complete feminine hygiene”.  For decades, women were told they needed to stay fresh, clean and essentially cover up their natural odours.  But being aware of our personal odour is what helps us to monitor our vaginal health.  My feminist cohorts were railing about this issue from the early 1970s.  Have we come a long way, or are we still stuck in the rose bushes hoping we’ll smell like one?

 

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Teaching consent

Sexual health educators have been teaching about consensual and non-consensual sexual activity for decades.  Despite gains made by the women’s movement since the late 1960s, sexism is far from eradicated.  Rape culture, although under scrutiny and challenge, is still the norm.  Sexual harassment and assault are as common as dirt.  How can we make a fundamental change in our society through education?

If all genders are not on board with the concept that consensual sexual activity is enjoyable and fulfilling, we will not make any headway.  If boys and men in particular are not included as allies in this struggle, classroom education will remain no more than an exercise.

I created a lesson plan about sexual assault at least 20 years ago which continues to be used by former colleagues.  It is a two part activity.  In the first part, the facilitator reads a series of statements and asks students to agree, disagree or indicate that they are not sure; in the second part, students work in small groups and read through two scenarios, one told from a girl’s point of view where it is clear there was no consent; and the other from the boy’s.  Then they answer questions on the board which are later discussed by the whole group.

One of the statements in the first part, “It is OK to say no at any time” (during sexual activity) provoked a grade 8 boy to insist that once you had initiated sexual activity, you couldn’t stop.  I asked the class why someone might want to stop (fear, pain, flashback, changed their mind etc.), but this kid wasn’t budging.  So I said, “Suppose you’re on top of her and you can see that she is in pain”.  He said, “Turn her face away”.

That is an unusual response from a 12 year old, but indicative of the far end of the consent spectrum; viz., a total lack of empathy and clear exercise of power.

After each group reads their story, I read them both out loud, where it becomes clear that what happened was not consensual.  I remind them that there are medical issues that need to be explored (Emergency Contraception, Sexually Transmitted Infection testing) psychological/emotional issues (the need for counselling since most people blame themselves after an assault) and legal issues.  Because the stories are written in a way that demonstrate a miscommunication based on the popular cultural ideas we explored earlier, exacerbated by alcohol, I suggest that if the police came to this boy’s door and said they were investigating a sexual assault, he would probably say, “Who got raped?”  We end the class by brainstorming how it could have been prevented.

Gray zone

Girls and women are still seen as gatekeepers in heterosexual relationships.  In spite of the current support for affirmative, ongoing consent, it continues to be difficult for a girl/woman to live this new norm.  Societal ambivalence rules: is it really OK for women to want sexual activity and say yes to it?

I remember teaching that to say no, it is important that tone and body language be congruent; i.e., to say no in a way that is clear and unequivocal.  But no to what?  No means no to a particular sexual activity at a particular moment in time.

People are complicated and so are their desires – they can change during the course of any sexual encounter.

In a more sophisticated discussion with older students, this can be illustrated with a continuum: from enthusiastic mutual consent to playful seduction; to giving in; to coercion; and to forced sexual contact.

People may move back and forth along the continuum from mutual consent to playful seduction during a single or multiple encounters.  One may not initially want to engage in a particular sexual activity, but could become interested.  There is a difference between talking someone into it and turning them on.

There is also a difference between hearing no and ignoring it.  We are familiar with the power dynamic and the culture that facilitates this crime.

For boys/men, saying no to sexual activity with girls/women may be difficult for other reasons.  Society tells them never to refuse what is handed to them on a silver platter.  Women who sexually assault men are more likely to use shame and coercion than force for obvious reasons.

Same gender assault involves many of these same dynamics.

Politics and pedagogy

We want affirmative, ongoing consent to become the norm.

We detest rape culture and want it eradicated.  We are appalled when images and videos of assaults are posted as entertainment.  Good pedagogy includes teaching empathy for survivors in order to eliminate this ghoulish feasting on others’ misery.

While it is useful to explore the underlying ideas that lead to assumptions, miscommunication and/or predation – a simple unpacking may be preferable to political rhetoric.

In their fervour to drive home the harmful outcomes of rape culture, some educators are using materials that are more likely to alienate the boys and young men in the classroom than to enlist them as allies.  We want them to accept the premise that there is an advantage to mutuality in relationships.  I read recently that consent culture is a resistance movement to rape culture.  It is a lot to ask for young men to see themselves as freedom fighters against rape culture and sexual assault.

I think Wiseguyz is on the right track in the way they address young men directly.  There are also some excellent public campaigns like the one from Norway “Dear Daddy” and New Zealand’s “Who are You?” that bring home these messages in a simple, clear and direct manner that appeal to the positives.

Because good lessons on consent and sexual assault are so hard to come by, well thought out print materials can play a role.  I would love to see a good pamphlet which includes the language of consent and refusal as a guide for young people to take home.

There is work to be done.

 

Birth Control: is it in you?

At a recent meeting of the Sexual Health Network of Ontario, health care providers came together to examine and extol the virtues of the Intra Uterine Device (IUD).  The IUD is a plastic device wrapped with copper that is inserted into the uterus.  I have always been a proponent of this method of birth control, especially for women looking for an alternative to hormonal methods.

The IUD had to overcome a terrible reputation from the bad old days of the Dalkon Shield.

I remember the Shield well.  I was a very young married woman when I had one inserted.  I complained to my gynecologist that I had ongoing pain on one side which lasted several days a month.  It felt like there was a plumb line attached to my ovary.  It wasn’t until returning from overseas that I had it taken out – or rather dug out – because that’s what it felt like.  The little claws were embedded in my uterus.

It was a deadly device.  The Dalkon Shield’s strings acted like a wick, drawing bacteria into the uterus, causing infections – and in nearly two dozen cases in the US – death.  The deaths in developing countries continued as “developed” countries offloaded their products abroad.

However, in the early 1980s, long after the discredited Shield had tarnished the reputation of all IUDs, new research indicated that the newer copper IUDs were both safe and effective and, in particular, did not cause ectopic pregnancies.  It also became clear that they functioned as a true contraceptive by creating an unfriendly environment in the uterus which repelled sperm.  This opened the door to women who had worried it was an abortifacient.

Copper IUDs

Copper IUDs are 99 – 99.8% effective.  In those rare cases where pregnancy occurs with an IUD in place, the pregnancy can continue as long as it is not ectopic.  Statistically, pregnancy outside the uterus is more likely with an IUD; but given its high effectiveness rate, the risk is very low.  A copper IUD can usually be removed if there is a pregnancy; but that would increase the risk of miscarriage.

A woman with average or no cramps and average bleeding is a good candidate.  She can expect a 10 -20% increase in cramping and bleeding with a copper IUD.  Counselling has changed over the years with regard to multiple partners.  Health care providers were concerned about untreated Sexually Transmitted Infections (STIs) causing Pelvic Inflammatory Disease (PID) with an IUD in place.  However, now STIs can be treated without removing the IUD; although, clearly, a woman with more than one partner is encouraged to use condoms.

Adolescents and women who have not been pregnant can also use the IUD.

Copper IUDs can also be used as emergency contraception up to seven days after unprotected intercourse.

There were a number of questions asked during the presentation; for example, the reason why some IUDs can stay inside the uterus longer than others.  Copper IUDs vary in the number of years they can stay in place: 3, 5 or 10 years.  The main difference between one copper IUD and another is the quantity of copper used.  Although Nova-T is a five year IUD, one practitioner said that they do not use it beyond 30 months because, after that point, they have found an increased risk of pregnancy.  10 year IUDs are larger and more difficult to insert and may cause more cramping on insertion.

The only contraindications to the use of a copper IUD include allergy to copper or other components of the IUD, pregnancy, endometriosis, an abnormally shaped uterus, very heavy bleeding or cramping; or active Pelvic Inflammatory Disease. There are a few risk factors, like perforation of the uterus with insertion, but perforation is rare and the uterus often repairs itself.

Intra Uterine System (IUS)

This progestin-releasing device can assist women with severely heavy bleeding as well as women with endometriosis .  By three to six months, most women who use Mirena (the first IUS on the market) experience dramatically reduced bleeding.  About one third of women will stop having periods after 12 months.

Because it uses the synthetic progestin levonorgestrel, it causes similar effects to Depo Provera which also uses a synthetic progestin; i.e., changes in the cervical mucus and uterine lining, making it harder for sperm to reach the uterus.  And similar to Depo Provera, there may be side effects, including:

  • bleeding and spotting between periods
  • heavier bleeding during the first few weeks after device insertion
  • headache/migraine
  • nausea
  • bloating
  • breast tenderness or pain
  • weight gain
  • changes in hair growth
  • acne
  • depression
  • changes in mood

As always, it is important that health care providers explain fully what a woman may expect.

I learned about some newer IUS devices aside from the more commonly known Mirena: Jaydess, a smaller, low-dose version, good for three years; and Kyleena, which releases the lowest dose of hormones for the longest amount of time.  Mirena has the highest dose of progestin of the three and is approved for five years, although data indicate it is effective up to seven.

The IUS can cause spotting for two to six months.  During the presentation, I had noticed two Orthodox Jewish women and a Muslim woman in attendance.  I made a comment about my birth control counselling at clinic regarding spotting.  Because there may be religious strictures about having intercourse in the presence of blood, I always made sure that women for whom this was an issue were well informed.

Speaking of blood, there was an interesting discussion around using a menstrual cup with the IUD.  Because of the suction on the vaginal walls with a cup, to avoid expulsion it is best to gently break the suction before removing the cup.  Another precaution would be not to use a menstrual cup for two months after an IUD insertion because the risk of expulsion is highest in those first two months.

The copper IUD is an excellent choice for women who want long-term, safe and effective contraception, but prefer not to use hormones.  Make sure that your health care provider has plenty of experience with insertion.

 

 

 

 

 

Women in Lust – The Sex Goddess Project

In April of this year, I attended the Toronto International Porn Festival.  I spent a few hours watching films – and clips of films – curated from the last ten years of feminist pornography.  I am not a consumer, but I figured any sex educator worth her salt should dip in every now and again.  I’m glad I did: There was fun; there was joy; and consent was the order of the day.

My views of pornography had evolved over the years.  Consumer prevalence remains high.  An article in the Canadian Journal of Human Sexuality reports that, when asked about their recent online solitary arousal experiences, 91.7% of the men interviewed said they had watched sexually explicit videos involving men and women; and 47.4% of the women.  The sample: 239 young adults at a Canadian university.  Current mainstream heterosexual pornography, where the scenes are rough and misogynistic, appeals particularly to young adult males.  While they work for self-pleasuring, they are not so good at helping men figure out how to be good lovers.

There is quite a difference between what one considers to be great sex and popular depictions of sex aside from pornography.  On TV doc-and-police shows, the scene goes straight from the mutual recognition that two people want to get it on, to ripping off each other’s clothes at the nearest opportunity.  No slow build and little context.  And standard, gorgeous bodies.

In the new TV series, The Good Fight, so far, there is only one loving, ongoing intimate relationship – Maia and her wife – and sadly, their sexual intimacy gets splashed all over the Internet in retaliation for her father’s Ponzi scheme.  Maia’s mother has a long-term adulterous relationship with her brother-in-law.  Lucca the lawyer, (remember her from The Good Wife?) seems to be as cold blooded as The Good Wife’s Kalinda.  Diane Lockhart sleeps with her ex-husband, which she says the next morning, was nice, but then refuses to renew their relationship beyond friendship.

Perhaps the lack of relatable intimate relationships is a metaphor for the series’ theme of whom to trust.  After all, trust is the hallmark of a positive relationship.  And from vanilla to kink, consent needs to be the order of the day.

Enter Ricardo Scipio

Ricardo contacted me about his newest book, “The Sex Goddess Project”.  Huffington Post recently interviewed him about it and  included some of his photos.  I liked what I saw and willingly posted excerpts from his press release on my professional Facebook page.

Says Scipio,

“If sexual images were food, people would be inundated with cheap junk food. I wanted to create a body of work that offers something more nutritious and satisfying for the health conscious, more discerning palette.”

He sent me a preview of photos from his latest book.  Lucky me: I had the opportunity to peruse dozens of images of women having a lusty old time doing all kinds of sexual activities in a variety of positions with a variety of partners.  These images reminded me of those I had seen at the porn festival – except they are not porn.

Scipio is not producing porn, which he doesn’t watch and whose messages he abhors.

“I’m a lover of all things authentic, and porn isn’t authentic.”

“Women have for too long, and in too many cultures, had their sexuality suppressed – only to be pseudo-released within the stiflingly unkind world of porn. I’m extremely humbled and proud to provide a vehicle for women to unapologetically express themselves with love and authenticity; something porn cannot offer. Sex is way too important to leave in the hands of pornographers.”

His photos portray real people of all body types, skin tones, genders and orientations. One of his models said,

“This was important.  It was a chance to be an activist in the sensual world. To reclaim sex for the othered bodies. The fatties, the people of color. To call bullshit on the ones who say ‘we’ don’t do this simply because they had never seen it done.”

Many of the women in his photos are looking straight at the camera with a huge smile on their face.  It is not the come-on of porn: It’s “Look at me; I am having such a good time”.  Most of the focus is on their pleasure.

To be honest, I did not get a buzz from the photos; my pleasure as a viewer was aesthetic and political.

His models understand this:

“Let’s just say that the bloom is beginning to fade. I’m a 51-year old woman who is 150 lbs overweight…  After Ricardo asked if I would be photographed for his Sex Goddess book, I realized that showing the inner me – the one who loves sex and feels that it is her special, healing gift – should be shown in full daylight. Yes, I’m fat. Yes, I’m older. However, I don’t want to be shamed into feeling badly about my body because our culture deems it ‘ugly’ or ‘gross’ to be sexual if you’re of a certain age and size…”

I am looking forward to seeing the rest of the collection.  The book is not available to the general public – just to Scipio’s supporters and those who collect his work. However, in order to showcase the “ethos” of the project, he is planning an invitation-only online gallery screening for Canadians on May 20 and 21. Anyone can request an invitation.  I recommend that you do.

 

 

Dealing with Aunt Flow

I haven’t had to deal with so-called feminine hygiene products AKA blood catchers for about 20 years.  I generally only take an interest when it comes to safety and environmental issues, like dioxins in tampons.

So when I was contacted by a journalist at CBC about Mensez Feminine lipstick I thought the product was a (bad) joke.  This guy wants women to glue their labia shut so they can let out their blood when they pee out their urine.  She sent me a few links to articles that methodically shredded this ridiculous (patented!) invention bit by unsavoury bit.

During the interview, she asked me for my first impressions.  What immediately came to mind was infibulation the most dramatic form of Female Genital Cutting, where the exposed part of a woman’s clitoris is removed, as well as her labia; and the remaining tissue is sewn together, leaving a small opening for urine and menses.  One of the results is back-up flow which can cause infection, especially when there are clots of blood that cannot pass through the opening.

Labiaplasty also crossed my mind – this cosmetic fiddling with women’s anatomy which sometimes results in loss of sensation due to scar tissue.  “Labiaplasty involves reducing or removing the labia minora—or inner lips—of the vulva.”

The journalist also asked me about available products and potential problems with them.  She wanted to know, for example, if girls were still frightened of using tampons.  We talked about how some moms worried about their daughters’ losing their virginity (tearing the hymen, that is, as opposed to having sex with a tampon) and Toxic Shock Syndrome.  We’ve known about dangers associated with tampons for nearly 40 years.

I told her that starting from the 1990s, we were bringing more environmentally friendly, reusable products into the classroom.

I started to wonder: aside from menstrual cups is there anything new in the world of blood catchers?  I found several web-sites with information on alternative products.  This one was particularly enlightening regarding “dirty cotton”.

Rachel Krantz’ personalized review of some natural products is a hoot.  Reading her account reminded me of my friend’s injunction not to wash your menstrual cup out in a public washroom (“It looked like I had killed a chicken”).

In the “old country”, my mother washed out bits of cloth.  I guess it was progress when I first got my period in grade 8, (1961) and we learned how to attach a pad to a sanitary belt .  I still remember the sensation of walking around listing from side to side because I couldn’t keep my legs together.

There are many areas around the world where menstrual hygiene is still a challenge.  But when I read about campaigns that help girls and women deal with their periods, I sometimes worry about pad and tampon companies profiting through NGOs’ distribution of their products.

So I was pleased to come across this refreshing innovation:

“To ensure girls get the protection they need, and don’t have to miss school just because they have their periods, Femme International provides kits to girls in East Africa that equip them with all the supplies they need. Each kit contains a menstrual cup or reusable pads, a bowl for washing the reusable cup, a small towel, a bar of soap and a handheld mirror.”

Here in Canada, it is a struggle for women in the North as well as poor and homeless women in the South.  When we make decisions about our own blood catchers, let’s also be conscious of the products that we give or send to our sisters.  We all have the same needs for comfort and safety.  And that means, no labia lipstick, unless they are seriously looking for some vajazzling.

 

 

 

Hello, SOGC

Hello.  It’s Me.  I am ranting once again about HPV

Well, not about HPV, just the vaccines.  Actually, not just the vaccines: pretty much everything I heard at a day-long SOGC workshop with the long-winded title, “Women and their Reproductive Health Across the Continuum: Setting Priorities for Women’s Reproductive Health Research”.  Attending were both health professionals and interested individuals.  And me: women’s health advocate and HPV vaccine skeptic.

Regarding the latter, I waited till the very end of the day to finally screw up my courage.

“I am about to state a very unfavorable opinion.  There are reputable health professionals who are opposed to mass HPV vaccination; in part, because some of the research has been tainted by conflict of interest; and also because of the way public messaging has stigmatized parents who have decided not to vaccinate their children.”

I added that equating infection prevention and cancer prevention is what has made public health and Big Pharma messaging so compelling to the general public.

There was absolutely no response.

The Sunnybrook Hospital meeting space was set up like a dinner party, with long lines of tables, labelled with discussion topics for the afternoon.  Speakers’ topics were preceded by the title, “State of the Evidence”: Human Papillomavirus, Fertility, Contraception, Menopause and The Environment.  Three out of five talks set my teeth on edge.

First up, Dr. Nancy Durand.

After giving some basics about HPV types and statistics (10 – 30% of adults are infected at any given time – good one) and the risks for persistence (being over age 30, smoking, having multiple sub-types and immunosuppression) she launched into straight into HPV vaccines as public health strategy.

Dr. Durand assumed, correctly, that she had the room in terms of the evidence she presented on the three available HPV vaccines regarding efficacy and safety.  She said that doctors should treat these vaccines like flu shots and encouraged doctors to say, “Have you had your HPV shot yet?”  She suggested it could be administered to babies with their childhood vaccines.  She quoted research that indicated there should be no upper limit in vaccinating; and that even if one had already been infected, vaccination was still effective (first time I’d heard that).  And yet…

Hello from the other side

My electronic files are full of evidence of conflict of interest (COI) between researchers and pharmaceutical companies and the attempts to expose them.

Moreover, the accepted medical evidence also insists that the only adverse side effects are irritation at the site of injection and increased fainting.

Japan has changed direction on HPV vaccination.  France, Spain  and Denmark have also reconsidered their position.

Fertility

Dr. Heather Shapiro did not mention potential environmental causes of infertility.  When I asked her about this, she said that was a whole other talk.  She leapt into Assisted Reproductive Technologies starting at IVF without passing through less invasive techniques like IUI.  I did find out that 90% of IVF babies are healthy; and the rates of success decline with age; and that there are now fewer multiple births.  Her talk was less about fertility and infertility that assisted reproductive technologies.  One presumes the research is directed towards treatment rather than prevention.  No mention of Pelvic Inflammatory Disease.

Contraception

I was glad to hear Dr. Dustin Costescu discuss unintended births in the context of the social determinants of health.  He said they occurred more often in younger, racialized, poor and Indigenous women; and that the greatest risk was due to systemic factors.  Among the contributors to non-use were being a sexual or gender minority, funding, and failure to initiate contraception.  He also blamed health care providers who sometimes recommended a “washout”; i.e., stopping a method to see if side effects subsided without offering a replacement method.

He pointed out changing trends.  With women having their first child around age 30, they require about 11 years of contraceptive use.

I was glad to hear him say that researchers needed to understand women’s experience through qualitative research regarding access, counselling, decision making and understanding side effects.  In our discussion session in the afternoon, he acknowledged that front-line workers have a lot to contribute to research.  Here are some of my contributions in WordPress:

 

Menopause

Any of the women attending who had not already gone through menopause and were listening to Dr. Jennifer Blake were probably bug-eyed looking at the list of what sounded like inevitable symptoms.  Early on in her talk, she said that perimenopause, the 2 – 3 years preceding the cessation of menses, was the “best time to get help”.  Now if that isn’t a clear medicalization of menopause, I don’t know what is.

Dr. Blake was quite definitive.  The “pleats” that make women’s vaginas stretch more easily smooth out.  You’re going to shrink, was the message.  Not to mention the loss of bone mineral density, the release of lead stored in the bones, changes in blood vessels, changes in abdominal fat metabolism, decreased carbohydrate tolerance, loss of lean muscle mass, vasomotor symptoms (hot flashes that could last up to 20 years), mood changes, reduced stress tolerance and memory changes (or as comedian Sandra Shamas tells us, loss of nouns.

And, oh, yes, loss of libido.  I’ve had a few thoughts on that one as well.

Dr. Blake gave a nod to the importance of exercise and good nutrition before moving ahead with hormone therapy (HT), “the single most effective treatment”.  She spent a good deal of time discussing the history of research on the effects of estrogen, in particular, how the Nurses’ Health Study was written and interpreted.  One telling statement at the end of her remarks on HT: “there is a higher risk of breast cancer with later pregnancy than with hormone therapy”.  In other words, you don’t need to worry about using HT.

Not all women experience menopause the same way – and that also applies to women around the world, their diets and lifestyles.  Women who suffer greatly from menopausal symptoms who consider HT are well advised to limit the duration of its use.

Environment

I’ve saved the best for the last. Dr. Eric Crighton laid it all out.  There are currently 80,000 registered chemicals currently in use.  7,000 new industrial chemicals are introduced annually.  Pregnant women have 43 different chemicals in their bodies.

He pointed out that some people are at higher risk than others, most notably those Indigenous people who are living with contaminated water and mercury poisoning.  Of course, we are all exposed to environmental toxins.  According to Health Canada’s 2010 statistics, they caused 13% of disease burden, an increased risk of prenatal and early childhood effects.  He talked about pesticide exposure and its effects on the brain development of four year olds…in short, he scared the *&*^% out of his audience.  I was sadly familiar with some of these issues, in particular through the Canadian Women’s Health Network.

There is good work being done by CPCHE which has published a number of useful brochures, but he pointed out that individual actions are not enough.  Moreover, he said when someone is struggling, for example, to feed their family, environmental toxins are low down on their list.  If you can barely afford formula, the plastic in the bottle becomes a non-issue.

I spoke with him afterwards, thanking him for mentioning the struggle of nail salon workers to limit their exposure to workplace toxins.  He was aware of the work of the Toronto Healthy Nail Salon Network.

Hello from the outside.  At least I can say that I’ve tried

I’m not sorry I went.  I did learn a few things and have checked out a dozen links to the studies quoted.  But there was little opportunity to challenge the experts or change the tone of the discourse.  It does make me wonder why the SOGC invited us in the first place.

Aging and sex – what do we really want?

Recently over coffee, a friend complained that none of her friends seemed to want to talk about their sex lives any more.  Bear in mind, we are both hovering around 70.  You might be thinking: of course your peers don’t want to talk about their non-existent sex lives.

And you would be wrong.  Several of my aging women friends have healthy libidos and a strong sense of themselves as sexual people.  But they are sad that health issues get in the way.

Despite my friend’s regret that her friends did not want to open up, because I am a sexual health educator, other women have been very chatty with me.

“I miss it”, said one.  “It’s not like we aren’t loving with each other, but I miss sex, the way we used to enjoy it.

“I feel a sense of loss”, said another.  Because of my partner’s medication, his libido is completely gone.  He is happy to please me when I initiate, but it feels so one-sided”.

“We’ve worked something out,” said a woman whose husband is disabled due to a stroke.  In other words, they have figured out how to be sexual by getting around the impediments.

“My partner is like a teenager.  In his early ‘70s, he is ready – and able – at any time.”

“When my husband was in his early ‘80s, he found that he was unable to have an orgasm after his prostate surgery, so intercourse went on too long and too painfully.  We finally just gave it up.”

When I told one of my friends that I wanted to quote her in this article, she wrote:

“I would add that it isn’t just “health” issues per se that gets in the way, but our naturally aging bodies.  I don’t consider my thinning vaginal wall that makes sex painful a health issue as much as one of the unfortunate consequences of my body – at this age, biologically speaking – not needing so much estrogen anymore.”

Quite the range of responses.  And I haven’t even asked my lesbian friends.

What does the research say?

I have written before about sexuality and aging  as well as the “joys” of online dating and the sexual pleasures of aging.  I have given workshops on the issue and spoken at conferences, but I can’t seem to let this topic go.  And the personal stories are so compelling.

The studies tell their own stories.

“One such study noted that, “61% of all women in this cohort were satisfied with their overall sex life. Although older age has been described as a significant predictor of low sexual satisfaction, the percentage of…sexually satisfied women actually increased with age, with approximately half of the women over 80 years old reporting sexual satisfaction almost always or always.” This confirmed an earlier study by the National Council on Aging which concluded, “Seventy-four percent of the sexually active men and 70% of the sexually active women reported being as satisfied or even more satisfied with their sexual lives than they were in their 40s.”

And lest we forget, no matter how we define “sex”, intimacy generally trumps sensation.  Alex McKay of SIECCAN  said in a talk on mid-life sex and STIs, that there was, in his opinion, a “six-minute rule”.  Quoting a study on heterosexual use of condoms, he said 71% of women who had 6 – 10 minutes of post sex affectionate behaviour rated their last penis in vagina (PIV) intercourse as ‘very pleasurable’ as opposed to 44% of women who experienced 0 – 5 minutes.

Health Canada is encouraging us to carry on as is the Canadian Public Health Association.

“Along with better health and active aging comes sex! A nationally representative sample of 3,005 Americans between 57 and 85 years of age revealed that nearly three quarters of seniors aged 57 to 64 were sexually active; while more than half of seniors aged 65 to 74 and more than a quarter aged 75 to 85 reported being sexually active.”

However, medication can interfere with one’s sex life at any age.  For example, “currently available antidepressants may aggravate sexual dysfunction and make depression worse, a new survey of US adults with major depressive disorder (MDD) suggests.”

There are other meds that can get in the way of sexual functioning.

And people get scared to become “active” after an illness like a heart attack.

“Although most younger patients are sexually active 1 year after an acute MI [AMI], one in 15 women and one in 20 men never resume one of life’s greatest pleasures, a new report finds.”

Tell me what you want, what you really, really want

Another factor in maintaining sexual relationships into our ‘70s and ‘80s may be loss of interest, especially for those in long-term relationships.  Like lesbian bed death, for heterosexuals, the statistics are just a bit less “drastic”.

Then there are those older people having great sex, by which I mean at least connection and intimacy.  Others may be having more PIV sex because of erectile dysfunction medication, which may bring its own problems, like oppressive demands.  According to a study  back in 2003, “few studies have focused on the possible detrimental effects for women of Viagra use within a heterosexual relationship”.

“We argue that while previous medically-oriented research in this area has generally assumed an unproblematic link between Viagra use and the resumption of penetrative sex within heterosexual relationships, more attention needs to be paid to partners’ perspectives and desires, and to the specific dynamics of any given relationship.”

One wonders which people would choose: great sex without intimacy or intimacy without full sexual functioning.

I guess we want it all.  Love.  Intimacy.  Good sex, however we define “sex”.

Surely when there is open communication and a willingness to please, there is pleasure to be had.  If we see ourselves as desirable, some of that can translate into – if not desire and the mechanics that go with it – at least the desire to please.  And while some of us are wistful, others may be envious of others’ good fortune, however much of it “all” we have.

I look forward to hearing your stories.

Here are some disability resources that may be useful to people who are aging.