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Sexuality and Health

Perimenopause and Menopause

Many women find that going through menopause does not impact their sex life. Some even find it even more exciting than ever because they are no longer concerned about becoming pregnant. For many women, though, some of the physiological effects of menopause do impact their enjoyment of sex. It is important to understand that these effects can be treated, and sex after menopause can be very fulfilling and enjoyable.

During menopause, there are certain physiological changes that can interfere with the enjoyment of sex. Due to loss of estrogen, these symptoms include:

  • Hot flashes that can occur at any time, causing discomfort and irritability

  • Night sweats that interfere with a woman's sleep, thereby decreasing her desire for sex

  • Vaginal dryness

  • Loss of androgens (including testosterone) that can lower a woman's sex drive or libido

It is likewise important to note that a woman's desire for sex can be affected by other physical changes related more to aging than to menopause. These changes may include:

  • Decreased blood flow to the pelvis - ovaries no longer need as much nourishment, and the reduced blood flow causes the vagina to become smaller and less elastic

  • Walls of the vagina may become thin and tender, causing intercourse to be very painful

  • Problems with urine leakage or increased urinary frequency due to weakening of pelvic muscle support

For both menopause-related symptoms, as well as symptoms of aging, there are steps you can take to ensure an enjoyable sex life beyond menopause.

  • Healthy living - exercise and a healthy diet can make a difference in your overall sense of well-being and dealing with some symptoms, like hot flashes

  • Hormone Replacement Therapy - can reduce the incidences of hot flashes and night sweats, as well as treating vaginal dryness

  • Various over-the-counter and prescription medications and sex techniques (be sure to discuss with your health care provider)

  • Compensate for vaginal dryness through the use of over-the-counter water-based gel lubricants (such as Waterslide, O'my, Sliquid and Jo H20) during intercourse

  • Continued sexual activity can also help to prolong and maintain vaginal health

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Breast Health

For some women – and men – the first time they consider the health of their breasts is when they find a lump or other unusual condition, and fear that they might have breast cancer. Or, some might reflect on their own breast health when a co-worker, friend, sibling, or mother is diagnosed with breast cancer or other breast disease.

However, good breast health is an essential part of overall physical – and sexual – health. Consider the following frequently asked questions:

Why should I do a breast self-exam?

Regular breast self-exam can help you know how your breasts normally feel and look, so you can notice any changes. When you find a change, you should see your health care provider. Most breast changes or lumps are not cancerous, but only a health care provider can tell you for sure. When breast cancer is found early, you have more treatment choices and a better chance of recovery.

What am I looking for when I do a breast self-exam?

You are looking for a lump or change that stands out as different from the rest of your breast tissue. If you find a lump or other change in your breast, either during breast self-exam or by chance, you should examine the other breast. If both breasts feel the same, the lumpiness is probably normal. As you get to know your breasts better by doing breast self-exams, you should be able to tell the difference between your normal lumpiness and what may be a change.

Besides a lump or swelling, other changes in your breast might be:

  • skin irritation or dimpling

  • nipple pain or retraction (turning inward)

  • redness or scaliness of the nipple or breast skin

  • a discharge other than breast milk

If you see any of these changes, you should see your health care provider right away.

Is there a right way to examine my breasts?

Yes. There are several proper ways to examine your breasts. Ask your health care provider to teach you how to do a breast self-exam to make sure you are doing it correctly and thoroughly.

How often should I do a self-exam?

A breast self-exam is recommended every month a few days after your period ends. During this time, your breasts are less tender or swollen. It is important to do your breast self-exam at the same time every month.

Is there anything I can do to improve my breast health?

Yes. Get more exercise. Studies show that increased physical exercise reduces your risk of breast cancer.

Will nipple piercing permanently damage my breast?

According to the La Leche League, renowned breastfeeding advocates, “Nothing in life, nipple piercing included, is without risk”. The LLL website also reports that neither the American College of Obstetricians and Gynecologists nor the American College of Nurse-Midwives have taken a stance on nipple piercing and your ability to breastfeed. However, as is the case with piercing any body part, infection, tetanus and hepatitis are possible risks as well as transmission of HIV.

It is also important to consider the impact of breast cancer and other breast diseases and conditions on sexuality and sexual health. Women (and men) who have experienced breast cancer or breast disease may be affected physically, mentally, emotionally, and spiritually. Even when there are no obvious physical changes or affects, there may be mental and emotional impacts following diagnosis and treatment. All of these factors can impact one’s sexuality and sexual health. However, it can be difficult to talk about these issues with a spouse or partner, or even a trusted friend. For people who have survived a life-threatening disease, the emphasis on survival – and carrying on with life – can overshadow concerns about sex and sexuality, or make them seem trivial or superficial.

Breast cancer may or may not change the way you look. But it can change the way you feel and affect your self image. While most women agree that their breasts are only part of what defines them as a woman, they are still deeply affected by the loss of a breast. A woman’s breasts symbolize so many positive things — motherhood, sexuality and being a woman. But for some women, breasts also now represent cancer. Most women, and their partners, will need to take time to grieve the loss of a breast.

Joining a support group may help you to cope with all the changes in your body and self-image. Some women find these changes difficult; others find strength in their new image of themselves. Remind yourself that healing takes time. At some point, every woman with breast cancer becomes more comfortable with her body. Accepting yourself as you are is all part of the process.

If it was difficult for a couple to talk about your feelings and about sex before breast cancer, it will probably still be difficult to talk now. While there is no such thing as the perfect time to talk, some times are better than others. Choose a moment when you are relaxed and alone together. When you feel comfortable, give yourself and your partner permission to talk about your feelings, both good and bad. Above all else, be honest. You may want to try talking about:

  • Your biggest fears — Women may be afraid their partner will leave or reject them because of their breast cancer. Men may be afraid of physically hurting their partner during sex. Talking about each other’s fears allows you to reassure each other.

  • Birth control — A baby that is conceived while you are undergoing radiation therapy or chemotherapy, or while using tamoxifen, could have birth defects. That is why it is important to talk to your partner about birth control. After treatment, do not assume that you are infertile unless your doctor tells you there is absolutely no chance of becoming pregnant.

  • Your “new” sex life — Breast cancer may change what you like to do and how you like to be touched during sex. You may not even want to have sex for a while. Your partner may not realize this. That is why you need to talk about it. You will probably find your partner is willing to do anything that will make you happy.

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Vaginal Health

Many myths and misunderstandings exist about vaginal health, and these are perpetuated by the lack of information and communication in our society - about sexual health in general and vaginal health in particular. In our line of work, it is essential that we understand the basics of vaginal health, as the products we sell can directly impact the health of the vagina. For example, women who have frequent yeast infections may be more sensitive to some products, particularly bath and body products. It is important to know which products would be most appropriate for women in this situation.

What is “normal”?

  • Understanding how the vagina protects itself against infection can help us stay healthy.

  • The vagina keeps itself healthy and clean by means of the cervical mucous and the acid/alkaline balance (a balance between acidity and alkalinity of all body fluids must be maintained).

  • A healthy vagina is slightly acidic, keeping many kinds of bothersome germs under control.

  • Mucous produced by the cervix moistens and lubricates the vaginal walls, and also plugs the cervical opening. This helps to keep germs out of the uterus.

  • Normal vaginal discharge has a mild odour and can be pasty white or clear and stringy, like egg white. It often leaves a yellow-white stain on underwear. The amount of vaginal discharge is affected by hormones and is different for every woman.

What causes vaginal infections and irritation?

Vaginal infections can happen through:

  • unprotected sexual contact, when sexually transmitted germs can be picked up.

  • imbalances happening in the vagina, leading to infections such as bacterial vaginosis or yeast.

  • There are many situations which cause imbalances and make the vagina more susceptible to infections. These include:

  • Less acidity and more alkalinity in the vagina during a menstrual period. Therefore, infections can get worse during or after a period.

  • Being on the birth control pill or being pregnant. Hormonal change increases the alkalinity and the chance of infection.

  • Being on antibiotics. These drugs kill the bad germs but also can destroy the good germs in the vagina and this allows unfriendly bacteria to overgrow in the vagina.

  • Unprotected sex. Semen is alkaline and this helps certain infections to grow. Also, sex introduces other germs into the vagina.

  • Douching. This can dry out the mucous membrane, irritate and damage vaginal walls and upset the natural balance.

  • Pad and tampon use. If tampons are left in too long, germs can start to multiply and cause irritation. Super-absorbent tampons can dry out the vaginal lining. Pads with plastic lining or perfume can also lead to irritation.

  • A diet high in sugars and carbohydrates - for example pop, fruit juices, alcohol, donuts and other sweets. Cells in the vaginal walls contain sugar and this creates a perfect place for germs and yeast fungus to grow.

  • Stress, anxiety and lack of sleep can lower your immunity and make it hard for your body to maintain the proper balance.

What can help prevent vaginal infections and irritation?

  • Wear cotton underwear and avoid thong underwear, except for short periods of time.

  • Don't wear underwear to bed (try boxers).

  • Avoid tight jeans and pants.

  • Wash genitals with warm water only and always wash/wipe from front to back. This prevents transferring germs from the anus (bum) to the vagina.

  • Rinse well if you need to use soap.

  • Avoid all bubble baths, perfumed soaps and feminine hygiene sprays.

  • Stop use of strong detergents and fabric softeners when washing underwear.

  • Never use anyone else's wet towel, washcloth or bathing suit.

  • Always use condoms for sex.

  • Never put anything in your vagina that has first been in your anus.

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Penile Health

What's “normal”, what's not...

  • The male penis is the largest of any primate. This fact doesn't keep almost every man from wondering about the size of his own penis.

  • The penis comes in many sizes: there is no average. Penis size is not directly related to a man's height, weight, body structure or ethnicity. It cannot be judged by the size a man's hand, foot, thumb, or nose.

  • No matter what size a soft penis is, most adult men's erections are the same size: 5 ½ to 6 inches. To reach that size, smaller penises grow more when they become erect, while larger penises grow less.

  • The majority of women say that penis size is not a factor in their sexual satisfaction... despite what most magazines tell you!

  • Circumcision is a surgical procedure, performed on some baby boys (and some adult men), to remove the foreskin (loose fold of skin) from the end of the penis. Circumcision is performed for cultural or religious reasons, not medical ones. It has no effect on penis size or function. Men who are not circumcised should gently pull back the foreskin when they bathe to wash the foreskin and tip of the penis.

What causes penile infections and irritation?

Penile inflammation or redness can be due to irritation or allergic reactions caused by:

  • tight clothing that rubs against the penis

  • new, unwashed fabrics

  • chemicals in laundry detergent

  • the latex in condoms

  • chemicals in spermicides for birth control

  • masturbation without lubricant

  • vaginal dryness during sexual intercourse

  • sexually transmitted infections

What can be done to prevent penile infections and irritation?

  • wear loose-fitting clothing and underwear, and wash new fabrics (clothes, underwear, sheets, towels, etc.) before use

  • use water- or silicon-based lubricant during sex and masturbation

  • if you suspect a latex allergy, try condoms made of polyurethane (ie. Avanti or Reality)

  • check ingredients in spermicides (nonoxynol-9 is a common irritant for both men and women, and may increase the risk of contracting STIs), or avoid using them altogether

  • use scent-free laundry detergents and fabric softeners

You should make an appointment with your doctor if you...

  • find any lumps in your testicles or groin

  • notice any skin sores, bumps, or other changes in your genitals

  • experience burning or pain when you urinate

  • notice a drip or discharge from the penis... discharge could be white and watery, or yellowish and thick

  • experience pain during or after sex

  • are having sex with more than one partner... you should be getting checked for STIs every six months

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Prostate Health

What is the prostate?

The prostate is the gland in your body that makes your sperm all gooey and sticky (so only men possess this gland). It secretes a clear fluid that contributes to about a third of the semen you produce when you ejaculate. It is located around the urethra and can be felt in medical exams. A healthy prostate is normally about the size of a walnut. It sits low in the pelvis, below the bladder and just in front of the rectum.

The prostate, and the perineum that surrounds it, are also known as the male “G-spot”. The important nerves that control the sexual organs, including those controlling erection, orgasm, and ejaculation, converge at the prostate and the perineum area. This means that this area is essentially a man's "command center" for sexual pleasure. Massaging the prostate has been a way to maintain and increase sexual health for men since ancient times. Men who suffer from prostate diseases such as prostatitis and BPH (see below for information about these conditions) can get relief from these problems through regular prostate massages, usually given manually by an urologist. It is also possible to do prostate “massage” without the assistance of a physician; this is commonly achieved through use of butt plugs, anal beads, and other anal sex toys.

What are common prostate problems?

The prostate gland surrounds the tube (urethra) that passes urine. This can be a source of problems as a man ages because:

  • The prostate tends to grow bigger with age and may squeeze the urethra, or

  • A tumor can make the prostate bigger

These changes, or an infection, can cause problems passing urine. Sometimes men in their 30s and 40s may begin to have these urinary symptoms and need medical attention. For others, symptoms aren't noticed until much later in life.

Tell your doctor if you:

  • Are passing urine more during the day

  • Have an urgent need to pass urine

  • Have less urine flow

  • Feel burning when you pass urine

  • Need to get up many times during the night to pass urine

Growing older raises your risk of prostate problems. The three most common prostate problems are:

One change does not lead to another. For example, having prostatitis or an enlarged prostate does not raise your chance of prostate cancer. It is also possible to have more than one condition at the same time. The keys to good prostate health are regular physical check-ups, and a generally healthy lifestyle that includes regular exercise and a balanced diet. In addition to exercising and eating well, you may also want to consider taking dietary supplements for prostate health. Extracts of saw palmetto, African pygeum bark, pumpkin seed, and lycopene have been shown to be beneficial for prostate health and may reduce the symptoms of difficult urination.

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Premature Ejaculation and Erectile Difficulty

When a man is unable to get or maintain an erection, medical intervention may be helpful. Men sometimes think the problem is their fault, or have been told that the problem is psychological. We now know that over 80% of the time impotence or erectile dysfunction (ED) is caused by a physical problem.

If you are having trouble maintaining your erection, you are not alone. It is estimated that 5% of 40-year-old men and 15-25% of 65-year-old-men are experiencing erectile dysfunction. To explore solutions, it is important to not only talk openly with your partner, but also to seek help from your health care provider. A physical exam and lab tests can help pinpoint the cause of your ED, and help determine the best way to help. The now very well known drug Viagra and other similar medications are helpful to 60-75% of the men who try them. Mechanical devices and surgeries are other options to discuss with your physician. There are also over-the-counter products that may be helpful for some men with ED (ie. Natural Arousal).

Sometimes illnesses and the drugs used to treat them can also interfere with sexual functioning. Open discussions with your physician can lead to changes in your medical regime that can mitigate these effects.

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Sex and Disability8

There is really only one thing that you need to know about sex and disability: Disabled people have sex, too. Beyond that, it’s pretty much impossible to generalize.

The word "disability" covers a huge range of conditions: physical disabilities like spina bifida, sensory disabilities like blindness, "invisible disabilities" like epilepsy, developmental disabilities like Down’s syndrome, psychiatric disabilities like bipolar disorder … the list goes on and on. Some people are born with a disability; others acquire one later in life - in fact, most people, if they live long enough, will experience a disability of some kind before they die. Disabilities can be so mild that they don’t have any effect on day-to-day life, or so severe that they require full-time care and assistance.

So there are very few things that apply to all disabled people. In fact, the main thing we have in common is that we have to deal with other people’s stereotypes and prejudices.

One common stereotype is that disabled people just aren't sexual. Media images of disabled people often present us as pathetic or child-like. Even images that are supposed to be more positive can have the same effect: "saintly" or "heroic" doesn’t always fit well with "just plain horny".

Of course, some disabled people, just like some non-disabled people, may choose to be celibate for part or all of our lives. And some conditions like depression or chronic fatigue syndrome may reduce interest in sex, at least temporarily. But there isn’t anything about having a disability that magically prevents someone from having sexual feelings. We feel desire and lust just like anyone else.

The other common myth is that, if disabled people do have sexual feelings, then we must go around in a permanent state of sexual frustration, either because we "can’t have sex", or because nobody could possibly want to have sex with someone with a disability. Many disabled people get thoroughly tired of being asked questions along the lines of "Um, can you, like, DO IT?" - with "IT", of course, being penis-in-vagina intercourse.

For a start, disabled people are just as likely as anybody else to be lesbian, gay or bisexual, so penis-in-vagina intercourse may not be something they are interested in. And many people (with and without disabilities) find that intercourse isn’t necessarily the best or most pleasurable form of sex anyway. In some cases, a particular disability might mean that intercourse is difficult or unsatisfactory for a particular person. For example, spinal cord injuries or diabetic neuropathy might mean that someone has reduced sensation in their genitals, or that a guy’s ability to get erections might be affected. But of course, there’s a lot more to sex than just intercourse.

Some disabilities may mean that you need to make practical adjustments to partnered sex, but these are usually pretty simple - with good communication and a bit of imagination (and if you don’t have those, you probably shouldn’t be having sex with anyone in the first place). For example, someone with a hearing impairment might want to make sure that the lights stay on during sex so that they can lip-read or sign to their partner. Joint or back problems might make certain positions uncomfortable or tiring. In many cases, the most important thing is simply making your partner aware of how you function for example, letting them know that that the side-effects of some medications can make it harder to reach orgasm, or warning them if you sometimes have seizures or muscle spasms. In my case, my disability (Asperger’s syndrome) can make my nervous system over-react to touch, so I need to make sure that people (friends or lovers) know not to touch me unexpectedly.

Another consideration for some people with disabilities is that sex toys, and other sexual products, may need to be adapted to better meet their needs. Information on this topic is quite limited, as many people assume that people with disabilities either cannot, or do not have a desire to, use sex toys. The best online source of information on this topic is the “Disability Resources” section of the Come As You Are website (listed under “Sexual Health” on their website at www.comeasyouare.com). Another excellent resource on the topic is the book, “The Ultimate Guide to Sex and Disability”, by Miriam Kaufman, M.D., Cory Silverberg and Fran Odette.

Of course, disabled people have to practice safer sex and birth control just like anyone else. This should be obvious, but it doesn't seem to occur to some people that anyone with a disability might get pregnant or contract an STD. In a few cases, a particular disability may affect your choice of safer sex or birth control methods. For example, some doctors feel that oral contraceptives (birth control pills) should not be prescribed to women who have poor circulation or mobility, as they may have a higher-than-average risk of thromboembolism. Many people with spina bifida are allergic to latex, so they need to use non-latex gloves, condoms and dams for safer sex.

Having a disability can sometimes make it harder to find a sexual partner. It can be difficult to socialize and meet people if social events are held in inaccessible buildings. Prejudice can also be an issue, especially in the teenage years for many teenagers, dating seems to be more about "getting" someone who’s seen to be a good "catch" than who you actually want to be with. And sadly, even in adulthood, there are some non-disabled people who can’t imagine anyone with a disability as a possible partner. That’s their loss. But there are plenty of people out there who don’t have that problem. Contrary to the media images we're fed, being attractive and sexy has nothing to do with having a "perfect" body or being "normal". If you fall for someone's gorgeous grin and deranged sense of humour, the fact that they use a wheelchair to get around may turn out to be a minor detail.

In a way, having a disability can actually become a positive advantage when it comes to sex. It means that you need to learn how to communicate and be up-front about what works for you and what doesn’t. Having to change and adapt the standard "script" means you have to be flexible and creative. And you have to focus on what actually feels best for you and your partner, instead of getting hung-up about what’s "normal" or how you’re "supposed" to have sex. And those are the real secrets of great sex for everybody.

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1This section adapted from “Menopause and Sexuality” http://www.stronghealth.com/ services/womenshealth/gynecology/sexandmenopause.cfm

2 Sources for this section: The Susan G. Komen Breast Cancer Foundation’s Fact Sheet “Sexuality and Intimacy” (http://www.komen.org/stellent/groups/harvard_group/@dallas/documents/-komen_site_documents/supportsexuality.pdf) and “Breast Health” from The Breast Site (http://www.thebreastsite.com/womens-health/).

3 Source: “More About Sexuality: Vaginal Health”, Peel Public Health (http://www.peelregion.ca/ health/hsexual/htmfiles/masvag.htm).

4Adapted from “Men’s Penile Health” at mens-sexual-health.org (http://www.mens-sexual-health.org/penisinflammation/).

5Adapted from “Penis Particulars” (http://www.uottawa.ca/health/information/men-penis-particulars.html).

6Adapted from “Understanding Prostate Changes”, National Cancer Institute (http://www.cancer.gov/ cancertopics/understanding-prostate-changes).

7Adapted from: “Lifelong Sexuality” at HelpGuide: Aging Issues (http://www.helpguide.org/elder/sexuality_aging.htm).

8Adapted from “No Big Deal (Sex and Disability)”, by C. Sainsbury at Scarleteen.com (http://www.scarleteen.com/politics /disability.html).