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Presented by: Dr. Veronika Kolder Medical Director, Menopause & Sexual Health Clinic University of Iowa Hospitals and Clinics (319) 356-2294 © 2012 Spirit.

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Presentation on theme: "Presented by: Dr. Veronika Kolder Medical Director, Menopause & Sexual Health Clinic University of Iowa Hospitals and Clinics (319) 356-2294 © 2012 Spirit."— Presentation transcript:

1 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.

2  I do not have any financial ties or interests in the drugs mentioned in this talk 2

3 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. 3

4 Keeping the Spark Alive  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. 4

5 Set the Stage for Romance  Take care of your appearance  Go to bed at the same time  No T.V. in the bedroom  A.M. affection 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: © 2012 Spirit Health Group. All rights reserved. 5

6 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. 6

7 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. 7

8 Basson’s model 8

9 Aging Sexual activity with a partner 57-64 years old 65-74 years old 75-85 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% 9  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 Lindau et al, NEJM, 2007; 357:762-74

10 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. 10

11 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 11

12 Menopause & Sexual Health Clinic 12 Elizabeth Graf, PA-C, NCMPVeronika Kolder, MD, NCMP Medical Director Carole Long, MA Eugenia Mazur, MD, NCMP Julie Youngblut, RN

13 unsatisfying encounter inadequate stimulation painful sex Decreased desire Decreased arousal Decreased orgasm SEXUAL DISORDERS & PAIN/PENETRATION DISORDERS The Web of Female Sexual Problems Adapted from Phillips. Am Fam Physician 2000;62(1):127-36

14 Multidisciplinary Approach Treatment Alternative medicine Structured sexual tasks Treat systemic illnesses Evaluate medications Patient and partner education Pain management Psycho- therapy Consultations Sexual pharmacology Sexual devices Behavior modification Krychman www.medscape.org/viewarticle/575789_5www.medscape.org/viewarticle/575789_5

15 Interest/ Arousal Disorder BEFORE MENOPAUSE AFTER MENOPAUSE 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 only with effective contraception or after hystectomy ? Sildenafil (Viagra®) for women with diabetes, neurologic problems, or antidepressant-induced problems Transdermal systemic testosterone Panzer 2006 Grossman & Polan, 2013 http://www.emotionalbrain.nl/://www.emotionalbrain.nl/

16 On Demand Treatment http://www.emotionalbrain.nl/ www.nytimes.com/2013/05/26/magazine/unexcited-there-may-be-a-pill-for-that.html?pagewanted=all&_r=2& http://charcoalpencilart.com/tag/spock/

17 On Demand Treatment Brain insensitive to cues http://www.emotionalbrain.nl/ www.nytimes.com/2013/05/26/magazine/unexcited-there-may-be-a-pill-for-that.html?pagewanted=all&_r=2& http://charcoalpencilart.com/tag/spock/

18 On Demand Treatment Brain insensitive to cuesAutomatic brain inhibition http://www.emotionalbrain.nl/ www.nytimes.com/2013/05/26/magazine/unexcited-there-may-be-a-pill-for-that.html?pagewanted=all&_r=2& http://charcoalpencilart.com/tag/spock/ STOP

19 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 PNS Sensitization Pelvic Floor Muscle Dysfunction CNS Changes ‘Central Sensitization’ 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/780555http://www.medscape.org/viewarticle/780555 Mechanism(s)? Sexual Pain/Penetration Disorders Example: vulvar pain with penetration

20 Example: Vaginal dryness Sexual Pain/Penetration Disorders  FDA-approved  Estrogen  creams  Estrace Vaginal Cream®  Premarin Vaginal Cream®  tablets (Vagifem®)  vaginal ring (Estring®)  Ospemifene (Osphena®)  Compounded  DHEA vaginal ovules

21 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

22 Sources  www.psychologytoday.com/blog/compassion-matters/201102/staying-compatible- staying-yourself  voices.yahoo.com/how-reclaim-sex-life-508795.html?cat=41  voices.yahoo.com/the-impact-daytime-intimacy-improving-relationships- 434128.html?cat=72  www.mayoclinic.org/news2010-mchi/5924.html  www.nia.nih.gov/health/publication/sexuality-later-life www.nia.nih.gov/health/publication/sexuality-later-life  What Do Women Want? By Daniel Bergner. www.nytimes.com/2009/01/25/magazine/25desire- t.html?_r=2&pagewanted=print www.nytimes.com/2009/01/25/magazine/25desire- t.html?_r=2&pagewanted=print  ‘Good enough sex’, Men’s Sexual Health by McCarthy & Metz, 2008, Routledge © 2012 Spirit Health Group. All rights reserved. 22 Visit www.uihealthcare.org/spirit-of-women to download the Frisky Business fact sheet


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