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Sexual Health as You Age Maximizing the enjoyment of sex throughout your lifetime. Presented by: Kenneth E. Smith, MD & Elmer Pineda, MD.

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Presentation on theme: "Sexual Health as You Age Maximizing the enjoyment of sex throughout your lifetime. Presented by: Kenneth E. Smith, MD & Elmer Pineda, MD."— Presentation transcript:

1 Sexual Health as You Age Maximizing the enjoyment of sex throughout your lifetime. Presented by: Kenneth E. Smith, MD & Elmer Pineda, MD

2 Let’s Talk About It Who gives a hoot? According to a New England Journal of Medicine 2009 study – 65-74 year olds-53% – 75-85 year olds-26%

3 Sexual Health When you're in the mood, it's a sure bet that the last thing on your mind is boosting your immune system or maintaining a healthy weight. Yet good sex offers those health benefits and more. Sex does a body good in a number of ways. The benefits aren't just anecdotal or hearsay -- each of these health benefits of sex is backed by scientific scrutiny.

4 Sex Boosts Self-Esteem "Boosting self-esteem was one of 237 reasons people have sex, collected by University of Texas researchers and published in the Archives of Sexual Behavior. That finding makes sense to Gina Ogden, PhD, a sex therapist and marriage and family therapist in Cambridge, Mass., although she finds that those who already have self- esteem say they sometimes have sex to feel even better. 'One of the reasons people say they have sex is to feel good about themselves,' she tells WebMD. 'Great sex begins with self-esteem, and it raises it. If the sex is loving, connected, and what you want, it raises it.

5 Sex Relieves Stress "A big health benefit of sex is lower blood pressure and overall stress reduction, according to researchers from Scotland who reported their findings in the journal Biological Psychology. They studied 24 women and 22 men who kept records of their sexual activity. Then the researchers subjected them to stressful situations -- such as speaking in public and doing verbal arithmetic -- and noted their blood pressure response to stress. Those who had intercourse had better responses to stress than those who engaged in other sexual behaviors or abstained."

6 Sex Burns Calories "Thirty minutes of sex burns 85 calories or more. It may not sound like much, but it adds up: 42 half-hour sessions will burn 3,570 calories, more than enough to lose a pound. The number of calories burned during sex is about the same as the number burned by walking at 2 miles per hour. Doubling up on the 30 minute sessions, you could drop that pound in 21 hour-long sessions."

7 Sex Improves Cardiovascular Health "While some older folks may worry that the efforts expended during sex could cause a stroke, that's not so, according to researchers from England. In a study published in the Journal of Epidemiology and Community Health, scientists found that the frequency of sex was not associated with stroke in the 914 men they followed for 20 years. And the heart health benefits of sex don't end there. The researchers also found that having sex twice or more a week reduced the risk of fatal heart attack by half for the men, compared with those who had sex less than once a month."

8 Sexual Problems Psychological Issues Stress Performance Anxiety Unresolved Relationship Problems Physical Issues Age/Hormonal Changes Substances/Medication/Sleep/Fatigue

9 Sex-Drive Issue: Stress You may be the kind of person who does many things well when under stress. But feeling sexy isn't likely to be one of them. Job stress, money troubles, caring for a sick family member, and other stressors can decrease libido. To keep your stress levels in check, learn helpful stress management techniques or seek the advice of a counselor or doctor

10 Menstrual Cycle He wants it and you want to curl up with a hot water bottle? This comes down to a difference in comfort—and squeamishness. But using your period as a blanket excuse is a missed opportunity to talk about how you both feel. Bust out: If having sex during your period isn’t your cup of tea, he should respect that, but intercourse isn’t your only option those days. Also, showers do wonders for messes. “Make compromises and be generous,” recommends Masini.

11 Menopause Symptom: Sex Problems Less estrogen can lead to vaginal dryness, which may make intercourse uncomfortable or painful. Try using a water-soluble lubricant. Libido may also change, for better or worse, but many factors besides menopause -- including stress, medications, depression, poor sleep, and relationship problems -- affect sex drive. Talk to your doctor if sex problems occur -- don't settle for a so-so sex life. And remember, sexually transmitted diseases (STDs) don't end with menopause; "safer" sex still counts.

12 Other Menopausal Treatments Other treatments include low-dose birth control pills if you're peri- menopausal; antidepressants, blood pressure drugs, or other medications to help with hot flashes; and vaginal estrogen cream. Hormone replacement therapy can ease menopausal symptoms. Various prescription products are available to treat hot flashes and vaginal symptoms. Some are also recommended to prevent osteoporosis. The FDA recommends taking the lowest dose that helps, and only for the shortest time because studies have linked long- term use of hormone replacement therapy to a greater risk of heart attacks, strokes, blood clots, and breast cancer.

13 The Pros and Cons of Hormone Replacement Therapy for Women? Pros: Prevents bone loss that can lead to osteoporosis Relieves symptoms of menopause Lowers risk of colon cancer Lowers risk of vision loss that occurs when the macula, the part of the retina at the back of the eye that provides sharp, central vision, deteriorates with age Cons: While HRT may help many women get through menopause, the treatment is not risk-free. Known health risks include: An increased risk of Endometrial Cancer (if a woman still has her uterus and is not taking progesterone along with estrogen) Increased risk of blood clots Increased risk of stroke Increased risk of gallbladder disease Increase in blood pressure in some women Increased risk of larger, more invasive breast cancers (combination HRT only )

14 Sex tonight? Sometimes you’re legitimately not into it, but be honest: Do you occasionally make excuses to avoid making love? In some long-term relationships partners go on auto-pilot, says Christina Steinorth, psychotherapist and author of Cue Cards for Life: Thoughtful Tips for Better Relationships. “They stop checking in, touching one another, talking.” This leaves you feeling disconnected— and more apt to pull a get-out-of- sex card.

15 Excuse: I’m too tired tonight. Raise your hand if you’re not tired. Between jobs, kids and housework, we’re all running on empty. But careful you’re not using “too tired” as shorthand for “I don’t want to deal with you right now,” says Steinorth. Bust out: First, sex usually doesn’t take that much time away from sleep (and you might sleep better!). Second, if you really mean there’s too much on your mind, say so: “I’m occupied with the bills/the bathroom leak/my boss’s attitude.” Clearing the air can clear the way for sex.

16 Great Sex Tip: Schedule Sex...Really! "'There's this powerful mythology that says you should fall into each other's arms spontaneously, with string music playing and the sun setting in the West, and if that doesn't happen there's something wrong with you,' Castleman says. 'Nonsense. Real life doesn't work that way.' Rather than heightening the pressure to perform ('It's now, or never!'), scheduling can actually make sex more relaxing. You can develop sensual rituals; make romantic gestures in anticipation of your encounter. You can give each other massages or take a shower together. Castleman says that scheduling sex also eliminates conflict over desire differences. 'People say, 'What if I'm not in the mood?' Well, one of the things about relationships is that you sometimes make compromises. But what astonishes people once they start scheduling sex is that they can actually enjoy it.'"

17 Excuse: What's the point? I never orgasm anyway. Ouch. Also: Yikes. “When you write off the possibility of enjoying sex, you aren’t giving him an opportunity to improve his skills as a lover,” says Steinorth. And you’re selling yourself short, too. Bust out: Imagine how you’d feel if he told you that you didn’t ever please him. You’d be upset, and you’d want to know what to do to make it better. Tell him. Your silence (and belief that he should just “know”) is doing no one any favors.

18 Sex-Drive Issue: Unresolved Issues Unresolved relationship problems are one of the most common killers of sex drive. For women in particular, emotional closeness is a major ingredient in sexual desire. Simmering arguments, poor communication, betrayal of trust, and other barriers to intimacy can steer your sex drive off the road.

19 Sex-Drive Issue: Alcohol A drink or two doesn't always put you in the mood. Alcohol famously makes you feel less inhibited about sex. But it can also numb your sex drive. And even if it doesn't numb your sex drive, inebriation can be a turn-off for your partner. All of this goes for recreational drugs, too

20 Sex-Drive Issue: Smoking Smoking causes erectile dysfunction. If you want to smoke in the bedroom, quit smoking. It can cause erectile dysfunction. For men in their 30s and 40s, smoking increases the risk of erectile dysfunction (ED) by about 50 per cent.

21 Sex-Drive Issue: Too Little Sleep If your sexual get-up-and- go is gone, maybe you're getting up too early or getting to bed too late. Or maybe you have insomnia or sleep apnea. Whatever it is that's interfering with your sleep, it's also interfering with your sex drive. Too little sleep creates fatigue. Fatigue saps sex drive.

22 Sex-Drive Issue: Medication Drugs commonly linked to libido loss include: Antidepressants Blood pressure medications Antihistamines Oral contraceptives (some studies show a link; others don't) Chemotherapy Anti-HIV drugs Finasteride (Proscar) Synthetic progesterone- medroxyprogesterone Changing to a different medication or different dosage may solve the problem. Other drugs may affect sex drive, too. If your sex drive shifted into park soon after beginning a new medication, talk with your doctor. Never stop taking a medication without consulting your doctor.

23 Sex Drive issue: Poor Body Image It's hard to feel sexy if your self-esteem suffers from poor body image. For example, feeling ashamed of being too heavy (even if you're not) will douse your love light. If your partner has these feelings, it can really help to reassure him or her that you still find him/her sexy. And there's a flip side to the equation: Working out not only enhances your self-esteem, but also ups your sex drive.

24 Sex-Drive Issue: Low T Testosterone increases sex drive. As men age, their testosterone levels may decline slightly. Not all men lose the desire for sex when their testosterone levels drop - - but many do. Testosterone is linked to sex drive in women, too. But a woman's hormonal balance is more complex than a man's. It's not clear whether testosterone therapy is as safe and effective in boosting sex drive for women as it is for men.


26 Treatment of Erectile Dysfunction

27 Definition “The inability to attain and/ or maintain penile erection sufficient for satisfactory sexual performance.” NIH Consensus Development Panel on Impotence Goal: Get an firm erection AND maintain it until orgasm

28 Good News TREATABLE! Treat it like a disease – Life style changes – Medical treatment – Surgery

29 Lifestyle Modifications Stop smoking 1,2 Limit or avoid alcohol 1 Follow healthy diet 2 Exercise regularly 3 1. Recommendations of the 1st International Consultation on Erectile Dysfunction. In: Jardin A et al, eds. Erectile Dysfunction. Plymouth, UK: Health Publication, Ltd; 2000:711-726. 2. Feldman HA et al. Prev Med. 2000;30:328-338. 3. Derby CA et al. Urology. 2000;56:302-306.

30 Medical Treatment: Vacuum Erection Device More accepted by men in a steady relationship Don’t use for more than 30 minutes.

31 Medical Treatment: Oral Medications Increase blood flow to penis (not sexual drive) Take one hour prior to sex NEED sexual stimulation Some people can’t take – ask your doctor

32 Penile Injection Very effective Trial in urologist office Inject penis 10 minutes before sex Be wary of too much of a good thing: EMERGENCY

33 Surgical: Penile Prosthesis After failure of medical treatment Inflatable and rigid forms Sensation the same Penis may look different May need to be replaced


35 Treatment of Female Sexual Dysfunction

36 Sexual Dysfunction: Male v. Female Diagnosis MaleFemale

37 Sexual Dysfunction: Male v. Female Diagnosis Erectile Dysfunction Disorder of sexual desire Disorder of orgasms

38 Sexual Dysfunction: Male v. Female Diagnosis Sexual desire disorder Disorders of Arousal – Subjective – Genital – Combined Disorders of orgasms Dyspareunia – Vestibulodynia Hormonally mediated Neuro-proliferative – Vaginal Atrophic vaginitis Desquamative inflammatory vaginitis Interstitial cystitis Vulvar disorders – Granuloma fissuratum – Dermatoses (lichen sclerosis, lichen planus) Candidiasis – Hypertonic pelvic floor dysfunction

39 Treatment of FSD Bad news – Not just blood flow problem – Complex – No FDA approved meds – Studies lag far behind those for male erectile dysfunction Good news – More and more studies physiology of female sexual function Disorders of female sexual function – Evidence based treatments Early – Physicians excited about this new field

40 Treatment of FSD  Treatment of disorders of desire, arousal, orgasms  Hormone and neurotransmitters Dopamine, oxytocin, norepinephrine, opioids, serotonin  Treatment of dyspareunia  Topical creams (eg estrogen)  Pelvic floor rehabilitation  Surgery Vestibulectomy Sacral nerve implant

41 Oxytocin – The Love Hormone "A study published in the Bulletin of Experimental Biology and Medicine examined the response of the 'love hormone' oxytocin on pain perception in an experiment with 48 volunteers. Study participants inhaled oxytocin vapor and then had their fingers pricked. Those who had inhaled oxytocin lowered their pain threshold by more than half."

42 Benefits of Kegel Exercises "Kegel exercises have a number of proven health benefits in addition to making sex more enjoyable. The strengthening of the pelvic floor muscles can help prevent prolapse (a slipping out of position) of the vagina, uterus, and bladder. Pelvic floor muscles may be weakened later in life as a result of childbearing, being overweight, and aging. Kegel exercises help offset the consequences of weakened pelvic floor muscles."

43 Treatment of FSD Psychosocial aspect and relationship factors very important in treatment

44 Successful treatment of sexual dysfunction is treatment of the couple

45 Resources

46 Q & A

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