Download Overwhelmed

Presented by:
Dr. Veronika Kolder
Medical Director,
Menopause &
Sexual Health
Clinic
University of Iowa Hospitals
and Clinics
(319) 356-2294
© 2012 Spirit Health Group. All rights reserved.
 I do not have any financial ties or interests in
the drugs mentioned in this talk
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Relationships and Intimacy
 Relationships are a balancing act of two people
sharing their lives, providing each other with love
and support while still maintaining their identities
as separate individuals.
 As years pass, the general stresses of life can
interfere with a couple’s intimacy
So what can you do to keep that closeness and
maintain the va-va-voom in your relationship?
© 2012 Spirit Health Group. All rights reserved.
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Keeping the Spark Alive
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Maintain your interests
Establish meaningful conversation
Give importance to your sexual relationship
Don’t take your partner for granted
© 2012 Spirit Health Group. All rights reserved.
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Set the Stage for Romance
There’s an old myth that says as people get older they aren't
interested in intimacy. Try a few of these tips to help
increase the intimacy in your relationship:



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Take care of your appearance
Go to bed at the same time
No T.V. in the bedroom
A.M. affection
© 2012 Spirit Health Group. All rights reserved.
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Staying in Sync
 Successful relationships are those where the
couple is in sync both in and out of the bedroom
 Try doing some daytime activities together; these
can help increase your connection before
heading into the bedroom
 Cooking class
 Golf lessons
 Dance lessons
© 2012 Spirit Health Group. All rights reserved.
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Men vs. Women
 Understanding how your partner’s mind and
body reacts is essential to maintaining intimacy
 A woman’s sex drive is associated with emotion
and intellectual connection
 A man’s sex drive is not typically driven by
thoughts or feelings; they show more of a
physical response
© 2012 Spirit Health Group. All rights reserved.
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Basson’s model
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Aging
Sexual activity
57-64
65-74
75-85
with a partner years old years old years old
In the previous
12 months
61.6%
39.5%
16.7%
If sexually active, have
sex more than 2 to 3
times per month
62.6%
65.4%
54.1%
 Prevalence of sexual activity in women declines with age
 However, even in the oldest age group, 54% of sexually active
women have partner sex 2-3 times per month
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Lindau et al, NEJM, 2007; 357:762-74
Intimacy During Your
Golden Years
 Use protection – age does not protect you from STDs
(sexually transmitted diseases)
 Sexuality can become challenging as health conditions
change
 eg.: cardiovascular or joint health issues
 ergoerotics.com
 Talk to your doctor about available options so you and
your partner can continue to enjoy a healthy and
active love life
© 2012 Spirit Health Group. All rights reserved.
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Exercise
 Increases blood hormone levels of estrogen, progesterone, &
prolactin
 Increases secretion of pleasure and pain-relief chemicals in
the brain, particularly β-endorphins
 Has an antidepressant effect and may increased well-being,
resulting in fewer midlife mood and sleep problems
 Can reduce the sexual side effects of some anti-depressant
medications
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Menopause &
Sexual Health Clinic
Elizabeth Graf, PA-C, NCMP
Veronika Kolder, MD, NCMP
Medical Director
Carole Long, MA
Eugenia Mazur, MD,
NCMP
Julie Youngblut, RN
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The Web of Female Sexual Problems
painful
sex
Decreased
desire
Decreased
arousal
SEXUAL DISORDERS
&
PAIN/PENETRATION DISORDERS
unsatisfying
encounter
Decreased
orgasm
inadequate
stimulation
Adapted from Phillips. Am Fam Physician 2000;62(1):127-36
Multidisciplinary Approach
Behavior
modification
Alternative
medicine
Structured
sexual
tasks
Sexual
devices
Sexual
pharmacology
Treat
systemic
illnesses
Treatment
Evaluate
medications
Consultations
Psychotherapy
Pain
management
Patient and
partner
education
Krychman www.medscape.org/viewarticle/575789_5
Interest/
Arousal Disorder
BEFORE
MENOPAUSE
AFTER
MENOPAUSE
Cognitive behavioral therapy
Cognitive behavioral therapy
Trial of discontinuing birth control pills
or DepoProvera®
If on hormone therapy, switch to
transdermal
Bupropion (Wellbutrin®)
? Bupropion
?On demand buspirone (BuSpar®)
? On demand buspirone
?On demand testosterone
? Sildenafil (Viagra®) for women with diabetes,
only with effective contraception or after hystectomy
neurologic problems, or antidepressant-induced problems
Transdermal systemic testosterone
Panzer 2006
Grossman & Polan, 2013
http://www.emotionalbrain.nl/
On Demand Treatment
http://charcoalpencilart.com/tag/spock/
http://www.emotionalbrain.nl/
www.nytimes.com/2013/05/26/magazine/unexcited-there-may-be-a-pill-for-that.html?pagewanted=all&_r=2&
On Demand Treatment
Brain insensitive to cues
http://charcoalpencilart.com/tag/spock/
http://www.emotionalbrain.nl/
www.nytimes.com/2013/05/26/magazine/unexcited-there-may-be-a-pill-for-that.html?pagewanted=all&_r=2&
On Demand Treatment
Brain insensitive to cues
Automatic brain inhibition
http://charcoalpencilart.com/tag/spock/
http://www.emotionalbrain.nl/
www.nytimes.com/2013/05/26/magazine/unexcited-there-may-be-a-pill-for-that.html?pagewanted=all&_r=2&
Sexual Pain/Penetration Disorders
Example: vulvar pain with penetration
Mechanism(s)?
Triggering Factors
infection
allergy
vulvar trauma
childbirth
birth control pills
Vestibular
Tissue Changes
inflammation
cytokine changes
mast cell degranulation
oxidative nerve damage
increased blood flow
hormone receptor
changes
Vestibular Nerve
Fiber Proliferation
CNS Changes
PNS Sensitization
‘Central
Sensitization’
Pelvic Floor Muscle
Dysfunction
Pain Feedback Loop
Predisposing / perpetuation factors
(eg. genetic & environmental factors)
CNS central nervous system
PNS peripheral nervous system
National Vulvodynia Association-supported CME, slide 19, http://www.medscape.org/viewarticle/780555
Sexual Pain/Penetration Disorders
Example: Vaginal dryness
 FDA-approved
 Estrogen

creams


Estrace Vaginal Cream®
Premarin Vaginal Cream®


tablets (Vagifem®)
vaginal ring (Estring®)
 Ospemifene (Osphena®)
 Compounded
 DHEA vaginal ovules
Osphena®
 Taken by mouth
 For moderate to severe sexual pain due to menopause
 ‘Selective Estrogen Receptor Modulator'
 Same drugs group as Tamoxifen® and Clomid®
 Boxed warning: can thicken the uterine lining
 May increase risk of
 blood clots to the legs or lungs
 stroke
 May cause or increased hot flashes
 Contraindications same as estrogen therapy
Sources
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
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www.psychologytoday.com/blog/compassion-matters/201102/staying-compatiblestaying-yourself
voices.yahoo.com/how-reclaim-sex-life-508795.html?cat=41
voices.yahoo.com/the-impact-daytime-intimacy-improving-relationships434128.html?cat=72
www.mayoclinic.org/news2010-mchi/5924.html
www.nia.nih.gov/health/publication/sexuality-later-life
What Do Women Want? By Daniel Bergner.
www.nytimes.com/2009/01/25/magazine/25desiret.html?_r=2&pagewanted=print
‘Good enough sex’, Men’s Sexual Health by McCarthy & Metz, 2008, Routledge
© 2012 Spirit Health Group. All rights reserved.
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