Presented by: Veronika Kolder, MD

Transcription

1 Presented by: Veronika Kolder, MD

2 I do not have any financial 0es or interests in the drugs men0oned 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 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: 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. 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 ac:vity with a partner In the previous 12 months If sexually ac0ve, have sex more than 2 to 3 0mes per month years old years old years old 61.6% 39.5% 16.7% 62.6% 65.4% 54.1% Prevalence of sexual ac0vity in women declines with age However, even in the oldest age group, 54% of sexually ac0ve women have partner sex 2-3 0mes per month 9 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 Elizabeth Graf, PA-C, NCMP Veronika Kolder, MD, NCMP Medical Director Carole Long, MA Eugenia Mazur, MD, NCMP Julie Youngblut, RN 12

13 The Web of Female Sexual Problems painful sex Decreased desire unsa0sfying encounter Decreased arousal Decreased orgasm SEXUAL DISORDERS & PAIN/PENETRATION DISORDERS inadequate s0mula0on Adapted from Phillips. Am Fam Physician 2000;62(1):127-36

14 Multidisciplinary Approach Behavior modifica0on Alterna0ve medicine Sexual pharmacology Sexual devices Treatment Structured sexual tasks Treat systemic illnesses Consulta0ons Evaluate medica0ons Psycho- therapy Pain management Pa0ent and partner educa0on Krychman

15 Interest/ Arousal Disorder BEFORE MENOPAUSE Cogni0ve behavioral therapy Trial of discon0nuing birth control pills or DepoProvera Bupropion (Wellbutrin )?On demand buspirone (BuSpar )?On demand testosterone only with effec0ve contracep0on or acer hystectomy AFTER MENOPAUSE Cogni0ve behavioral therapy If on hormone therapy, switch to transdermal? Bupropion? On demand buspirone? Sildenafil (Viagra ) for women with diabetes, neurologic problems, or an0depressant- induced problems Transdermal systemic testosterone Panzer 2006 Grossman & Polan, 2013 hgp://

16 On Demand Treatment hgp://charcoalpencilart.com/tag/spock/ hgp:// there- may- be- a- pill- for- that.html?pagewanted=all&_r=2&

17 On Demand Treatment Brain insensi:ve to cues hgp://charcoalpencilart.com/tag/spock/ hgp:// there- may- be- a- pill- for- that.html?pagewanted=all&_r=2&

18 On Demand Treatment Brain insensi:ve to cues Automa:c brain inhibi:on STOP hgp://charcoalpencilart.com/tag/spock/ hgp:// there- may- be- a- pill- for- that.html?pagewanted=all&_r=2&

19 Sexual Pain/Penetration Disorders Example: vulvar pain with penetration Mechanism(s)? Triggering Factors infec0on allergy vulvar trauma childbirth birth control pills Ves:bular Tissue Changes inflamma0on cytokine changes mast cell degranula0on oxida0ve nerve damage increased blood flow hormone receptor changes Ves:bular Nerve Fiber Prolifera:on PNS Sensi:za:on Pelvic Floor Muscle Dysfunc:on CNS Changes Central Sensi:za:on Pain Feedback Loop Predisposing / perpetua0on factors (eg. gene0c & environmental factors) CNS central nervous system PNS peripheral nervous system Na0onal Vulvodynia Associa0on- supported CME, slide 19, hgp://

20 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

21 Osphena Taken by mouth For moderate to severe sexual pain due to menopause Selec0ve 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 Contraindica0ons same as estrogen therapy

22 Sources Visit to download the Frisky Business fact sheet magers/201102/staying- compa0ble- staying- yourself voices.yahoo.com/how- reclaim- sex- life html?cat=41 voices.yahoo.com/the- impact- day0me- in0macy- improving- rela0onships html?cat=72 mchi/5924.html later- life What Do Women Want? By Daniel Bergner. 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