"Promise me you'll keep doing your work..."

 "Promise me you'll keep doing your work," Robert said, taking both my hands in his and pressing them to his heart, looking deeply into my eyes.

It was three years ago -- end of March 2008 -- and we had learned that his body was succumbing to multiple myeloma. There were treatments we could and would try, but this conversation marked the countdown to the end, as I think back on it.

He would have one more month of health -- fatigued, but able to live the way he loved -- going to his art studio to paint, dancing joyfully, and loving me as if his life depended on it (and maybe it did). Then, as treatments failed, his back fractured in multiple places. The extreme pain led him into another world -- a world where love was not enough to heal or even ease the physical, emotional, and spiritual pain. 

A world of preparing to die.

 "Promise me you'll keep doing your work..."

Our profound sexual connection had powered our relationship for our seven, soul-soaring years together. Neither of us had ever had a relationship as sexually exuberant or as emotionally satisfying! Professionally, our spicy hot afternoon delights propelled me to switch writing topics from health and fitness to senior sex. Better Than I Ever Expected: Straight Talk about Sex After Sixty celebrated our love affair. We married in 2006, the year the book came out.


We already knew that our love wasn't "forever" the way young people think of it. Besides being seniors, we had the challenge of Robert's diagnosis -- at that point -- of leukemia and lymphoma. Our wedding celebrated not only our love, but that six months of chemotherapy had sent Robert's cancer into remission. We were told we might have ten or more good years of health, a magical gift.

But we didn't have ten years -- we had two.

 "Promise me you'll keep doing your work..."

March 2011: Two countdowns shift in my mind. In August, I'll face the 3-year anniversary of Robert's death. (When does it get easier?) But before that, in June, I'll welcome a new book into the world -- Naked at Our Age: Talking Out Loud about Senior Sex -- the book I started working on with Robert. In fact, you'll see that he wrote part of the chapter, "Unlearning Our Upbringing: Men's Stories."

I think at our age, those of us who dare to live and love fully have this balancing act between the sweet surprises and rewards of living our dreams out loud and the inevitable losses. Robert gave me the right advice: "Promise me you'll keep doing your work." It sustains me and brings me great joy -- as does sharing it with you!

Viagra "not a sack of cement installer"

I'm writing the chapter about cancer and sexuality for my new book, Naked at Our Age: Talking Out Loud about Senior Sex. The stories people sent me about reclaiming their sexuality after cancer treatment fill me with admiration. I looked back at some older posts on this blog that deal with sex & cancer, and decided to bring back this one from 2006. With the prevalence of Viagra use, I think BillyBob's experience and his thoughts about it are important. - Joan

BillyBob, age 62, has told some of his story previously as a comment here. He recently sent me an email detailing an experience that he wants to share -- and he makes an important point:

I started dating a lady I have known for a year, mostly through phone conversations. I knew that she likes sex. Last weekend we went for dinner. After dinner she wanted to go back to my place for a while.

Well, as it turned out, it was the most embarrassing time I have ever had, all because of a misconception some woman have about impotency.

I took a Viagra after we got back to the motel hoping it worked fast! It did its normal thing and got me sexually aroused but not 100%. She knew I had to take it because of the prostate cancer killing my prostate.

Here is where the misconception comes in. It seems that women who do not know about Viagra seem to think if you take it you just get ramrodding hard, and they do not need to do any stimulation. Well that’s just plain wrong. Men still need stimulation along with the Viagra. The drug is not a sack of cement installer.

And I was not about to masturbate myself in order to get it hard. Not in the presence of a woman.

So as it turned out she turned me off instead of on. What a bummer. It was so disappointing. I had looked forward to our meeting for some time. And the possibility of finally enjoying good sex with some one that likes sex.

All a woman needs to know about the drug is that you do things as normally, using stimulation together. So please tell your readers what my experience was.

BillyBob, thank you for sharing this experience. Viagra helps when there's a physical cause for lack of erection, as you know, but it doesn't increase libido, or substitute for all those other crucial components of good sex that you (and I, and probably everyone reading this) crave -- touching, kissing, bonding, stimulating each other physically and emotionally, enjoying each other's pleasure as well as our own.

It sounds like most of this experience was missing for you. What a bummer, I agree. I'm sorry you didn't feel you could communicate your needs and desires to your partner -- I don't know, maybe she would have been happy to help you get aroused if she had understood. It's hard to understand why she didn't seem interested in stimulating you just as part of the sex play (with or without Viagra), since that's a good part of the fun of sex.

I know you were too embarrassed to masturbate in front of her when she didn't help arouse you, but as a woman, I find it very pleasurable and exciting to watch a man stimulate himself. I don't know if your partner would have reacted this way, but I'll bet she would have.

If you see a future or at least a repeat date with this woman, I hope you'll communicate candidly with her before you get to "the act." And please continue to write.

Thank you again, BillyBob.

-- Joan

Orgasm Inc.: stunning expose of drug for fake disease

I just saw the film Orgasm Inc. You must see it. It's a powerful expose of the medicalization of female sexuality, specifically the development and marketing of female sexual enhancement drugs based on a made-up "disease": Female Sexual Dysfuncton (FSD).  The "disease" was created by drug companies so that they could sell drugs and procedures that have not been proven to work and have not been proven safe!

Filmmaker Liz Canner was hired by one of these drug companies, and what she learned was so apalling that she went on to make this expose. I was stunned by it. Some of the reviews call it funny. Though there were some hilarious moments, the aftertaste isn't funny.

How did the drug companies invent a disease? They asked women questions designed to unearth if they ever had trouble becoming aroused or reaching orgasm (duh, who hasn't?) and labeled those dysfunctional who said yes to any of the questions. Although women's sexual responses are complex and based on relationship, health, energy, worries, other medications, and emotional issues as well as physical function, these issues were neither addressed nor ruled out.

The result: a new dysfunction and a drug to address it, both of which were then promoted by highly paid health "experts" on TV news and talk shows. I'm itching to name a visible, well-known "expert" who -- although she denied any financial interest in the drug -- was paid $75,000 a day for her media appearances on Oprah and other shows. You'll see her identified in the film.

Below is one video clip -- see the official trailer here (I couldn't embed that one).



6/7/10 update: When I wrote this post a few days ago, Orgasm Inc. was available on Amazon, and today when I checked it, it has disappeared from the listings. This is odd indeed. I'll keep checking for its return.  It is listed on Netflix, but the available date is unknown, as a reader commented. How frustrating -- I really want you to be able to see it. I'll update the info when this changes -- keep checking back.

Erectile Dysfunction: Michael Castleman Talks to Women

Update note: I first posted this interview in June 2007. I have so many new readers now that I wanted to bring it to the forefront, because it's such an important issue for both men and women. Often men feel they can't talk about ED with their partners. Women tell me their men seem to emotionally disappear and avoid sexual activity and discussion. Michael Castleman helps all of us understand what's going on. -- Joan

In a previous post, I interviewed Michael Castleman, a sex educator, counselor and journalist specializing in men's sexuality to answer some questions for men about erectile dysfunction. In this part of the interview, Castleman talks directly to women:

Q: What don't women understand about erectile dysfunction (ED)?

MC: Like men, few women understand the difference between true ED and erection dissatisfaction. [See Erectile Dysfunction: Michael Castleman Talks to Men for explanation of the difference.] Women also don't really appreciate how men FEEL when EDis or ED develop. It's sort of like how women feel when they lose a breast to cancer. You're still alive, but you feel diminished. A part of your body you took for granted isn't there anymore, or in the case of men, doesn't work like it used to. And this isn't just any part of the body. It's a body part that in a profound way DEFINES you as a man or woman. For women, loss of a breast raises issues like: Am I still attractive? Am I still sexual? Can I still please a man sexually? Men with ED and EDis wrestle with similar issues.

Beyond this, men have lived their whole lives pretty much taking their penises for granted: See a sexy woman, get hard. See porn, get hard. Think a sexual thought, get hard. Then all of a sudden--and in many men this happens pretty suddenly--they're in a situation where they expect to have to rearrange their underwear to accommodate some swelling down there, and then....nothing. Nothing happens.

Many don't understand what's happening to them or why. But even those who do, me for example, feel surprised, upset, disappointed, depressed. Change is stressful. But when the changes concern the penis, well, men get seriously freaked out.

Now women often (and rightly) believe that men are too focused on the penis. That's often true. It takes most young men years (sometimes decades) to leave penis-centric sex behind and understand the erotic value and pleasure of whole-body sensuality, a lovestyle more based on whole-body massage than on just sticking it in somewhere. Men who never get there, men who continue to view sex as penis-centered, when their penis stops behaving as they expect, they often think it's the end of sex, that they're over the sexual hill, that it's all over. In my experience as a sex counselor and writer, few women appreciate how diminished men feel as they get used to EDis... if they ever adjust.

Q: Why can't men express these concerns?

MC: Many reasons. In general, men tend to be less emotionally articulate than women. Men are socialized to be the "strong silent type," to keep a "stiff upper lip," to "grin and bear it." In other words, to deny what they're feeling and just go on. As a result, men get less practice than women discussing their emotions, and when they do, they're less skilled than women. Now some women believe that men don't HAVE emotions because they don't discuss them. Wrong. Men feel things just as deeply as women. They just are less likely to discuss them, and if they do, they're less likely to be able to really articulate how they feel.

The two genders have different natural histories of sex problems. With the exception of vaginal dryness, which is easily mitigated with lubricants, most women have most of their sex problems/issues when they're young. Young women wrestle with the mixed messages that they should be sexy but not trampy, that they should want love/sex, but not want sex "too" much, not be "too" easy. But how easy is too easy? Young women also have issues with orgasm. Many don't have them and have to learn how to release orgasms.

Meanwhile, few young men have sex problems--other than coaxing women in to bed. The young penis works just fine, thank you very much. Maybe the guy comes too soon (this is the #1 sex problem of young men), but only rarely do young men have problems with erection. Then they hit 45 or 50 and suddenly, the erections they took for granted their entire lives start to fail them. They freak. It's almost unthinkable. Many Americans found themselves speechless after Sept. 11. It was so horrible, unimaginable. Men don't discuss their ED or EDis in part because it's unimaginable--then it happens and they're speechless.

To many men, having reliable erections is a significant part of what defines them as men. If they have problems in the erection department, some fear that the women in their lives will view them as less than real men. So why talk about it? Why invite her to rub his nose in the fact that he's less of a man?

Q: When should a couple seek counseling?

There's no hard-and-fast rule on this. But when a problem festers, when you find yourselves having the same conflict over and over again, when there seems to be no way out, no resolution, basically, when you feel stuck, that's when to consider counseling.

Now every sex problem is also a relationship problem and visa versa. If the main issue is power/control/decision making or conflict resolution, then a couples counselor is probably the place to start. But if they main problem is sexual--a desire difference, orgasm issues for the woman, erection issues for the man--then I'd start with a sex therapist.

Personally, I'm a fan of sex therapy. This is not self-serving because I am not a sex therapist. But studies show that two-thirds of couples who consult sex therapists report significant benefit within 6 months. That's pretty good. Men with ED or EDis need to reframe their thinking about sex. They need to get away from porn-inspired sex and explore whole-body sensuality. This is often unfamiliar to men. They often fight it. So going back to a therapist week after week can help keep them on the path to self-discovery.

To find a sex therapist, visit the American Association of Sex Educators, Counselors, and Therapists (AASECT). Click the map of the U.S. and Canada, and get a list of all the AASECT-certified sex therapists in your state or province.

Q: What if the man won't go?

The woman should go by herself. This is not as good as the couple going. But going solo gives the woman a place to vent. It may equip her with new coping skills that can help deal with the couple's issues. And she may be referred to some written material, e.g. my book and others like it, that she can litter around the house and hope he picks up and checks out.

Michael Castleman, M.A., is the author of twelve books, including Great Sex: The Man's Guide to the Secrets of Whole-Body Sensuality and Sexual Solutions: For Men and the Women Who Love Them. From 1991-95, he answered the sex questions submitted to the Playboy Advisor. Visit his website about sex after midlife, http://www.greatsexafter40.com/.

Naked At Our Age: an invitation

I'm repeating this invitation because I know I have many new readers now:

What's stopping you from having a satisfying sex life as a senior or elder?

Four years after publication of Better Than I Ever Expected: Straight Talk about Sex After Sixty, I am working on my new book on senior sex: Naked at Our Age. This book will concentrate on the sexual problems and challenges we face as women and men 50 - 80+ and how to resolve them and enjoy our sexuality throughout our lives.

I invite you to submit your candid questions, problems, and real-life experiences, which will be the focus of Naked at Our Age, with commentary and tips from sex educators, therapists, physicians, couples counselors, and other valuable experts.

The problem with Better Than I Ever Expected, many readers told me, was that it was too upbeat! “My sex life isn’t ‘better than I ever expected,’” many of you wrote me, and here’s why it’s not….” You confided questions and problems and shared intimate details of your obstacles to a satisfying sex life in later life, and you continue to write to me, thank you.

That's why I'm inviting all of you to tell me which problems and issues you hope my new book will address, what experiences you'd like to learn about, and what questions you wish you could ask an expert (I'll find the right expert to answer you). Post a comment below -- instructions here if this is new to you -- or, if you'd like me to follow up with you, email me.

If you'd like a copy of the confidential interview to be a part of this new book, please email me and I'll send it right out.

If you're a sex educator or other expert in some area of senior sex, please email me if you'd like to contribute your helpful tips.

(For those of you who have emailed me questions and not heard from me -- I apologize. It seems that whatever I do to catch up, I'm always 300 emails behind. Thank you for your patience!)

Thank you for joining me in talking out loud about senior sexuality,

Joan

Restless Vagina Syndrome?

"'Restless Vagina Syndrome': Big Pharma's Newest Fake Disease" by Terry J. Allen discusses the attempt to medicalize women's sexuality as if we were men with faulty functioning who need fixing. Allen, senior editor of In These Times, writes,

It’s not your fault, ladies (and certainly not your partner’s), that you don’t orgasm every time you have intercourse, or that you lack the libido of a 17-year-old boy. You have a disease: female sexual dysfunction (FSD), and the pharmaceutical industry wants to help.

You are among the “43 percent of American women [who] experience some degree of impaired sexual function,” according to a Journal of the American Medical Association article. The FDA’s evolving definition of FSD includes decreased desire or arousal, sexual pain and orgasm difficulties—but only if the woman feels “personal distress” about it.

So, convincing women to feel distress is a key component of the drug company strategy to market a multi-billion-dollar pill that will cure billions of women of what may not ail them.

Allen goes on to describe the big pharmaceutical companies' attempts to define women's sexuality as men's sexuality gone awry -- we should get turned on easily and have mind-blowing orgasms every time -- and their failed attempts (so far) to give us instant arousal and explosive orgasms with drugs. She discusses several drugs and how they have not turned out to be helpful to women.

I agree that we're not defective men, and we absolutely should not fall for attempts to medicalize what might be perfectly normal. I encourage you to read Allen's article in full. (I itched to retitle it "Restless Clitoris Syndrome," however!)

On the other side, I hear from enough unhappy women (and men) to assert that we often DO have medical reasons that our sex functioning isn't working the way we want, especially as we age. I encourage both women and men who are experiencing changes in their desire and/or ability to get aroused and experience orgasm to see a trusted medical professional. It's important to learn whether there's a medical reason for the change and to explore treatment options, if so. The right hormonal treatment, or a change in other medications that are affecting our sexual response, can make an enormous difference in our enjoyment of our sexuality.

If the change is due to psychological and/or relationship issues, then a counselor or sex therapist can make the difference between a dissatisfying or non-existent sex life and a richly rewarding one.

Doing nothing about an unhappy sex life only insures that it will remain the same or worsen.

No Erection, No Intimacy, No Discussion

Molly, age 63, wrote a comment that was featured in a blog post titled "He thinks he can't please her without an erection, so why bother?" She recently emailed me an update, and I asked her permission to share it with you:

I wanted to thank you for trying to help with my situation. I was the person who asked what to do when he doesn't want to have intimacy anymore because he couldn't get an erection. He just said "why bother?"

Unfortunately, our relationship ended. Not by me, by him. He does not communicate in any way with me. I've tried everything to get him to talk to me, but it's as if I've fallen off the face of the earth. This is after over two year relationship.

I took your advice and have contacted a therapist. She has been a great help to me. But somehow I think he would benefit so much from seeing someone, too.

It's just so unfortunate that my guy thinks so little of our relationship that he only based it on one thing. I wish I could try to turn back time and make him understand that an erection is not everything in a loving sex life. But that's not possible, he has completely cut me out of his life. Won't talk, or accept any communication from me.

I still love the man and I think I always will. It's so sad. Life is so very short not to enjoy it all.

Thanks again for your wonderful blog, I can't tell you enough how it has helped me cope.

I feel the heartbreak in Molly's words. She obviously loves this man, but he has shut her out completely.

I don’t think, though, that Molly's partner’s inability to communicate or accept her loving means that their relationship doesn’t mean enough. I think he's devastated and depressed by what he perceives to be the end of sexual possibility. It isn't, we know that, but that's how he sees it. He may be too stuck and too afraid to seek help.

I hear from men who say they have to unlearn the “I am my penis” lessons they learned as boys and teens. This notion becomes deeply ingrained and is a difficult lesson to unlearn, but the old story no longer serves them, or us.

I know it was difficult for Molly to share her story here, and I hope, readers, that you'll show her how valuable it was by sharing what you learn here that helps in your own relationship. I'm sure she'll welcome your warm comments.

"Not only bone dry, but I have shrunk"

My blog posts are occasionally republished with my permission on SuddenlySenior.com and Eldr.com*. I thought you'd be interested in a reader question on Eldr and my response:

Have any women readers had this problem? All sorts of hormonal treatments and creams and oils have failed. I am not only bone dry, but I have shrunk. Just when Viagra has done wonders for my husband, I am unavailable. I want so badly to get back what we used to have and be his partner again. We have tried alternative acts, but it just isn't the same. He seems to feel that affection should lead to sex, so we are losing the intimacy we used to have. There are all kinds of dildos and vibrators for women. Are there any fake receptacles for men that we could use? I could use suggestions and advice. My next step is to ignore my embarrasment and try to ask at a "toy" shop.

Thank you for posting these questions -- I know other women are hungry to know the answers, too.

You related many things you tried to resolve the dryness and shrinking (vaginal atrophy), but you did NOT say whether you consulted your physician. This should be your first step -- get the hormone tests, find out what's going on. If you don't want to go on full-out HRT, you might want to use an estrogen ring which is inserted in the vagina.

You definitely want to use a lubricant -- I advise you to try sample sizes of several types until you find one with the degree of slickness and comfort that enhances your pleasure. My personal favorite is Liquid Silk, available from A Woman's Touch, which is also a fabulous educational resource, and even from Amazon.

My book, Better Than I Ever Expected: Straight Talk about Sex After Sixty, offers a number of self-help strategies for just the kinds of problems you relate, and my new book (in progress!) will offer more.
As for whether there are "fake receptacles for men," yes. They're called "penis sleeves" and you can find a varied selection at Good Vibrations.

I've mentioned two of several woman-friendly sex shops that offer trustworthy educational resources as well as sex toys, lubricants, and other products that solve many of the problems we face at our age. Both Good Vibrations and A Woman's Touch have both brick-and-mortar and online stores staffed with people who know how to advise us (at all ages) and care about our comfort and pleasure. (No sleaze, dark corners, or sticky floors, in case that's what you pictured when you thought "toy shop.")


*October 2009 update: It is with great regret that I have asked ELDR.com to remove all my content. If you've been there lately, you'll see the comments have been overrun by spam. Unfortunately, this high-quality publication and website fell victim to inadequate funding, and although past content remains, the site isn't being maintained. I hope ELDR readers will continue to come here for news and views about sex & aging.

First Magazine wants your "intimacy challenge" story

A journalist from the national women's magazine FIRST (4.6 million readers) is seeking mature, married women to profile in a new true-stories health department called "Private Confidence." Here, women will share their candid stories about how they overcame/handled perimenopausal or menopausal intimacy challenges to eventually improve their sex life and their relationship. (Possible examples: vaginal, low libido, chronic back pain, chronic constipation, a spouse's ED...)

If you're interested and you'll be willing to discuss your intimacy challenge, please email me a brief summary, along with your name, email, and phone number, and I'll pass it along to the writer, Lisa Maxbauer. Take a look at FIRST at your local grocery store if you're not familiar with it and aren't sure whether you're a fit.

Sex and Intimacy after Cancer

If you or your partner has been diagnosed with cancer, what part does sexuality play in your quality of life? How will cancer treatment impact your sexuality -- physically and emotionally? How do you cope with changes in function, libido, body image, and pain? How can you maintain intimacy in the face of these challenges?

“Sexuality is all about who you are as a man or a woman,” says Sage Bolte, MSW, LCSW, OSW-C, a renowned authority on sex and intimacy after cancer and an oncology counselor at Life with Cancer®, an Inova Health System service in northern Virginia. “It’s a critical part of your quality of life.” Sex and intimacy are key ways to affirm, “I’m alive, I’m human,” and of getting back what was important to you before cancer.

On March 11, 2008, the Leukemia and Lymphoma Society presented a teleconference with Bolte for 1,400 listeners. It was superb. Fortunately, the teleconference will be available as a transcript and MP3 recording sometime in April 2008 at www.lls.org/survivorship.

Forty to 100 percent of people with cancer will experience some form of change in sexual function, says Bolte, which can impact willingness to engage in sexual activity. However, she assures us, “Patience and techniques can help you regain a sense of sexual self and confidence.”

Although Bolte’s message was targeted at the special challenges of cancer, all of her suggestions also apply to living with any chronic or life-threatening illness, as well as the sexual challenges of aging itself. Here are some of her techniques for coping with specific problems:

Vaginal dryness and discomfort: Apply 100% vitamin E oil to the vaginal tissues and clitoris on a regular basis after showering, and use a water-based lubricant as needed during sex. Talk to your doctor about whether an estrogen ring or testosterone patch would be appropriate to regain moisture and restore elasticity of the vagina.

Erectile dysfunction: Tell your physician about this problem and have him/her look at all your medications. Have your testosterone levels checked. If you’re having a harder time maintaining an erection, try finding the positions that is most stimulating for you. Help your partner reach orgasm before intercourse. Devices for men that may help include penile pump; penile injections, suppositories, penile implant, penile rings. But if you’re on blood thinner or have low platelets, you need to consult with your physician before using any of these devices, because they might put you at risk. Viagra and similar medications are not recommended for men who have heart concerns or are taking blood pressure medications.

Pain and fatigue: After cancer treatment, the time of day that’s right for sex might change. If you’re too exhausted in evening, switch to morning or have a special lunch break. Take pain medication 30 to 60 minutes before activity. Get exercise, which can minimize fatigue and assist in decreasing some joint pain. “Remember that we can rest during sex,” says Bolte. “It’s not a marathon.”

Fear of rejection: Consider seeing a couples counselor or sex therapist. Often the problems of miscommunication, misinterpretation, and anxiety get in the way of your sexuality and intimacy. Work on your communication skills. (Note: I’ll be writing more on this topic in another post.)

Difficulties reconnecting with your partner: Communicate your own desires, ask for what you need, and ask your partner to communicate honestly, too. Be affectionate. Take it “slow and easy.” Take time to be together and to connect. Find other ways for both of you to have pleasure.

Redefine your expectations,” suggests Bolte. “Sometimes you can’t get back to the function you had prior to cancer, but that doesn’t mean it can’t be good or pleasurable.” Focus on touch, sensation, pleasurable feelings. Use sex toys. Engage in mutual masturbation. Read fantasy to each other. Touch yourself. Massage each other and cuddle.

“Take more time to get stimulated, talk yourself into sex,” Bolte recommends. Realize that instead of the physiological response coming first and driving the emotional response, it may need to be the other way around, a “mind thing first.” Schedule your sex time – plan it, think about it, fantasize, and work yourself up to the mental excitement that will stimulate the physical excitement.

Don’t let sex feel like pressure to perform. Sometimes practice just touching without the expectation of intercourse. Re-explore alone what feels good to your body now. “Start with self-pleasuring experiences,” says Bolte. “Your body has changed since treatment. You need to be comfortable touching yourself and knowing what feels good now.”

I applaud the Leukemia and Lymphoma Society for recognizing the importance of sexuality to people diagnosed with cancer and Sage Bolte for generously providing her expertise.

Tom, 55, “My wife had her first orgasm in six years”

Tom, age 55, wrote me a beautiful account of how he and his wife rediscovered their intimacy and sexual pleasure after a combination of health issues and medications left his wife unable to have orgasms. She was taking blood pressure medicine and antidepressants, and had stopped hormone replacement therapy. Tom had his own health issues, including low metabolism and testosterone levels. Combined with his wife's lack of lubrication, decreased sensation, and anxiety, "our sex life seemed to be drying up."

We slowly reached the point where we decided we needed to fix the situation. We started taking more time in our lovemaking and trying different lubricants, and that did work much better for us. I also bought your book Better Than I ever Expected, and it has been very helpful.

However, I found that when we had romantic weekends, I would occasionally have problems maintaining my erection. That had never happened before and was really stressful, so I now use Levitra to have confidence that I can be erect. The effects of Levitra seem to linger, so I don't feel like I need to take it right before lovemaking. I can take it anywhere from one to 12 hours ahead of time and it still works for me.

Unfortunately, no amount of foreplay, oral or manual stimulation was able to bring about an orgasm in my wife. This was really frustrating to me, since I felt that our lovemaking was too one-sided. I think it maybe bothered me more than my wife. In the past, I was very good at knowing her body and her response and I could bring about very nice orgasms by a combination of oral and manual massaging. So, after reading your book, and doing some additional reading and research, I spent $225 on an Eroscillator. We had never experimented with sex toys, so I wanted to get something that looked like it would be effective, and this seemed to have the recommendations and documentation to back it up.

What a difference! The first time we tried it, we spent some time together getting warmed up, and I used the soft fingertip attachment on her, and my wife had her first orgasm in six years within just a few minutes, and she cried in my arms afterwards. This has made a huge difference in our lovemaking, and my wife now has very strong orgasms.

We are still trying to figure out the best way to work it into our lovemaking, we had never used any vibrators or sex toys before. I love it because I now can be sure that I can please her, and I want her to be able to come first. I like it because it is nearly silent, and very effective.

Thank you, Tom, for your candor and for the details that will help other people in the same situation. As you know, I've been a fan of the Eroscillator (the soft fingertip attachment is my favorite, too!), and I found my own eyes starting to water when I read about your wife crying in your arms after her first orgasm in six years. As for how to work it into your lovemaking, the woman can hold it and use it for clitoral stimulation while her partner is caressing and arousing her manually, and she can also use it during intercourse, depending on the position.

"What would you tell others in your situation?" I asked Tom.

I would just tell others that there are ways to make things better. Talking with doctors and counselors can help, but I think that the familiarity of their doctors with sexual issues may be lacking, so specialists may be needed. I do know from personal experience how difficult it is to go to a doctor and ask for help on sexual matters. Requesting a prescription for Levitra was a very tough thing to do, so I can imagine that talking about more difficult issues can be very hard.

Fortunately, with some effort, the Internet can be a good source for information. That (Amazon.com) is where I learned about your book and blog, and I also picked up Dr. Ruth's book. I also used it to search for different lubricants to try and learn about the Eroscillator. Especially for people who are not in a major city the Internet is a great tool.

Please click on the picture below to learn more about the Eroscillator:

73-yr-old man pleases wife with "ten fingers and a tongue"

A reader who wants to call himself "Buttonbob" sent me this email:

I am a 73 year old male. For the past few years I have been using Viagra. I must confess that most of the time it didn't do the trick. But an old friend of mine reminded me that I had ten fingers and a tongue.

I found to my surprise that my lady didn't need intercourse and was more than happy to settle for hugging and oral touching and caressing. Once over the shock I discovered I began to enjoy the touching and caressing even more, My advice to others is get over the idea that intercourse is the end all. Enjoy your close relationship with your spouse that touching and hugging can give.

This is a subject that comes up over and over. Many men think that intercourse is the goal of sex, and that if they have erectile difficulties, they might as well give it up. Not true! Sex is two minds, two bodies, and two hearts making love -- not just two sets of genitals! There are many ways to please a partner without intercourse, and this reader is right on track with "ten fingers and a tongue"!

I welcome your comments.

Intimacy after prostate surgery

Several readers have posted and emailed me about sex and intimacy after prostate surgery. I asked Anne Katz , RN PhD, author of Breaking the Silence on Cancer and Sexuality: A Handbook for Health Care Providers and sexuality counselor at CancerCare Manitoba in Winnipeg, Manitoba, to respond to a common question:

Ever since my husband had his prostate removed because of prostate cancer, he has been reluctant to touch me. This is so upsetting. I love him very much and don’t know what to do.

It is common for men to be unable to have an erection after this surgery. Depending on the type of surgery (nerve sparing or not), his ability to have erections may or may not return. Many men are deeply distressed by this and may avoid all physical contact with their partner so as not to “lead them on” or disappoint them. This leads to a very unhappy partner who wants to express his/her love and support but feels cut off and cut out.

What is important is for the couple to TALK. It is often really difficult to talk about a sensitive topic when emotions are running high. But talking goes a long way to healing and connecting. Start with an “I” statement: “I miss touching you and being touched by you. How can we reconnect again?” Or perhaps: “I love you so much and want our relationship to be the way it was before the surgery. What can WE do to help this happen?”

While there are medications and treatments that may help, further treatment should be a couple’s decision and the man should always include his partner in medical appointments so that both people can express themselves and have their questions answered. Because communication is so important, the couple may need professional help to start the communication flowing. But seeking help is the first step.

For more posts about cancer and sexuality, please click "cancer" in the "labels" list in the right-hand column.

Is this helpful? Let me know what questions you'd like me to explore as we age and encounter physical and emotional challenges to our sexuality.

--Joan

ABC: Seniors Get It On

There's a terrific interview on ABC News with sex therapist Laura Berman, LCSW, Ph.D., about the New England Journal of Medicine study. Berman gives an overview of the findings and comments on the important messages, such as the importance of sex throughout life, medical implications, and resources for help.

I loved the many visuals of older people hugging, kissing, and smiling romantically at each other. Ah, it's about time we got to see this reality! Check it out. (You may have to navigate several obtrusive ads as you try to view the video clip.)

New England Journal of Medicine: Seniors having sex despite "bothersome problems"

When the news splashed all over the media today that older adults are, indeed, having sex, my first reaction was to laugh and say, "Duhhh!" The idea that senior sex is alive seemed to me as much a news story as the revelation that most people find feet at the end of their legs!

But there was much more to the story. "A Study of Sexuality and Health among Older Adults in the United States," published today in the New England Journal of Medicine, was a major study of 3005 U.S. adults (1550 women and 1455 men) 57 to 85 years of age which revealed some fascinating facts and a few surprises:

The majority of older adults are sexually active and regard sexuality as an important part of life. The prevalence of sexual activity declines with age, yet a substantial number of men and women engage in vaginal intercourse, oral sex, and masturbation even in the eighth and ninth decades of life.

The frequency of sexual activity reported by sexually active older adults (age 57+) is similar to the frequency reported among adults 18 to 59 years of age.

The study reported that 78% of men 75 to 85 years of age, as compared with 40% of women in this age group, had a spousal or intimate relationship. Since women live longer, and on average, older men marry younger women, this disparity can be accounted for by the lack of available men for the older single women.

The sexually active people in the oldest age group interviewed -- 75 to 85 years of age -- reported having sex at least two to three times per month, and 23% reported having sex once a week or more.

About half of the sexually active men and women reported at least one "bothersome sexual problem," and almost one third reported having multiple problems. The women's most prevalent sexual problems were low desire, difficulty with vaginal lubrication, inability to climax, finding sex not pleasurable , and pain, usually during entry. The most prevalent sexual problems for men were erectile difficulty (14% of all men interviewed reported using medication or supplements to improve sexual function), lack of interest in sex, climaxing too quickly, anxiety about performance, and inability to climax.

About one quarter of sexually active older adults with a sexual problem reported avoiding sex as a consequence.

Most surprising, given the extent of these problems that prevented sex from being satisfying or pleasurable, was this fact:

Only 38% of men and 22% of women reported having discussed sex with a physician since the age of 50.

The study suggests that the reasons for poor communication include the unwillingness of both patients and physicians to talk about sex and the gender and age differences between patients and their physicians.

Negative societal attitudes about women’s sexuality and sexuality at older ages may also inhibit such discussions.

When I give workshops and talks, both women and men frequently bring up physical problems that affect their sexuality and want me to provide a solution. I always say, "Please get a diagnosis from your doctor." I emphasize that the problem may be caused by retreating hormones, or by an underlying health condition that you don't know you have, or a medication, or interactions of medications. You can't treat a problem until you know what's causing it.

As the NEJM article states,

Sexual problems may be a warning sign or consequence of a serious underlying illness such as diabetes, an infection, urogenital tract conditions, or cancer. Undiagnosed or untreated sexual problems, or both, can lead to or occur with depression or social withdrawal. Patients may discontinue needed medications because of side effects that affect their sex lives, and medications to treat sexual problems can also have negative health effects, yet physician–patient communication about sexuality is poor.

I invite your comments!

Gerald Haslam talks about prostate cancer and sex

Gerald Haslam, author of Grace Period, is living with prostate cancer. He wrote a stunning summary of his views of the importance of sexuality while living with cancer for my upcoming book. I know I have many readers who are looking for information on sexuality and cancer, so I'm giving you an advanced look at some of the insights he shared:

A seventyish man who was recovering from a prostatectomy asked fellow members of a prostate-cancer support group how they could have sex if they were leaking urine. He ended with a timeless observation--"My wife is willing to be pissed off but not pissed on."

Despite the laughter that followed, his was a serious problem, but the first response solved it: "Put a band on your penis --a cock ring. A lot of older guys who aren't incontinent use them to maintain erections, but if you're leaking they're a good answer, especially if you use a pump."

The first man was honest enough to admit, "I hadn't thought of that. We've never used any...devices. Of course, I've never had prostate cancer before, either." In fact, the prostate cancer world introduces many guys to devices and positions and concepts previously unimagined.

A physician pal said to me shortly after I was rendered impotent by prostate surgery and radiation, "You'd better start pumping up your penis every day, whether you're going to use it right away or not, or it'll shrivel into a Vienna sausage. As soon as you lose spontaneous erections you lose penile tone. No tone, and there'll be nothing to pump when you do want to use it."

In fact, sex seems to be the second most common topic--after cancer therapies--in discussions at most prostate cancer support groups, and I learned that many men, rendered impotent and perhaps stripped of libido by hormonal ablation, simply but not happily accepted the verdict that their sex lives were over, a defining activity lost. A dread frequently mentioned to me by my fellow prostate-cancer survivors has been not only the sudden absence of sex but of sexuality itself. This is especially grave since sex and sexuality can represent the life force's most powerful affirmation in the face of death.

Unfortunately, many of us men grow up believing that our sexuality dwells almost exclusively in our genitals, so a damaged penis may lead to a damaged personality. As one wife admitted at a session for couples, "There's not much fun in our lives anymore, and I don't just mean sex. He's just so sad." A penile fixation may also lead one to forget how much sexual satisfaction can be achieved by giving pleasure to a partner you love.

Please read my review of Gerald Haslam's Grace Period. Click here to view or order Grace Period on Amazon.

No Sex for 12 Years, Now Vagina Too Tight for Penetration

Frustrated in Florida, age 61, had not had sex for nearly 12 years, until recently. She wrote in an email to me:

Apparently one's vagina does change after not using it for a long period of time. I always thought sex was like riding a bicycle, but it is not. One can't just get back on and ride! I experienced such pain during the attempted penetration that we had to stop. What a disappointing and embarrassing moment. My partner was very understanding, however I was just frustrated and disappointed.

I went to my GYN for an examination soon after and explained my circumstances. She gave me a thorough exam and said although I had many tiny lacerations and redness, my vagina seemed normal. She explained how one's vaginal lining becomes thin after menopause and her advise was to abstain from sex for two weeks, using lubrication to aid in healing.

When we engaged in sex again, very gently, I was once again disappointed with the level of pain even though using lots of lubrication. We once again had to stop.

So now I am wondering if there is some way I can stretch my vagina for it seems like it has shrunk. (Perhaps it is just my imagination running wild!)

Have you had anyone else write you with a similar problem and if so is there a solution? For your information I have never been on hormones and my partners
penis is of normal size.

No, it's not your imagination, and yes, it's true that the vagina will seem to shrink after a long period of abstinence, especially after menopause, and penetration will be painful or sometimes impossible. I did, in fact, deal briefly with this in my book, Better Than I Ever Expected: Straight Talk about Sex After Sixty. I had interviewed a 75-year-old woman who had been celibate for 38 years and was in a new relationship. She was unable to have intercourse because her vagina had dried and narrowed to the point that penetration was impossible. She sought help from her gynecologist (a wonderful woman who has bought dozens of copies of Better Than I Ever Expected to give to her patients!), who helped her with stretching exercises.

I'm disappointed that your gynecologist is not this helpful. Telling you you're "normal" while you have lacerations and pain is not helpful, is it?

Please read Step-by-step program for Vaginal Renewal by Myrtle Wilhite, M.D., at A Woman's Touch, a wonderful sexuality resource center in Madison, WI. It tells you step by step how to massage and stretch your vagina. Dr. Wilhite permitted me to quote an abridged version of these steps in Better Than I Ever Expected, and I'm repeating them here for you:

* External Moisturizing and Massage: Increase the suppleness and blood circulation of the skin of your vulva and vagina with a five- to ten-minute massage with a moisturizing sexual lubricant like Liquid Silk®, a water-based lotion that will soak in and moisturize your skin, won't get sticky, and will help you massage with very little friction.

Push in to the skin with circular strokes, and massage what's underneath the skin, rather than brushing across the skin. Include the inner lips, the hood of the clitoris, the head of the clitoris and the perineum.

To complete your external massage, massage into the opening of the vaginal canal, using the same circular strokes. The massage itself does not need to be self-sexual in any way, but if that is comfortable for you, by all means explore these sensations.

* Internal Vaginal Massage: To massage inside your vaginal canal, we suggest using a lucite dildo which is very smooth and will not cause friction or tearing. Choose your size based upon how many fingers you can comfortably insert into the opening of your vagina.

After a session of external vulva massage, apply the same massage to the inner surfaces of your vagina with your dildo with lubricant applied on both skin and dildo. Rather than pushing the dildo in and out, use a circular massage movement. You are increasing skin flexibility so that your body can adjust to comfortable sexual penetration if you choose it.

You might also choose to use a slim vibrator for massaging the vaginal walls. Coat it in Liquid Silk and then insert it gently. Turn it on and let it run for about five minutes. You don't need to move it around, just lie there and let it do its work.

* Orgasm: For women who stop having orgasms, the blood vessels literally can get out of shape, preventing future orgasms. If you are able to bring yourself to orgasm, do so at least once a week (for the rest of your life). (Seriously.) This is preventive maintenance of your body.

* Kegel Relaxation: Kegels increase both the strength and flexibility of your pelvic floor muscles. Pay attention to the relaxation and deep breath part of the exercise. Learning to relax your pelvic floor will help you to avoid tensing up before penetration. (In Better Than I Ever Expected: Straight Talk about Sex After Sixty I also give Dr. Wilhite's tips for perfect Kegels.)

I plan to go into more detail in the new book I'm writing, which goes more deeply into the challenges of staying sexually vibrant in an aging body, and how to cope with these challenges.

Best wishes for a joyful resolution to this problem -- please keep me posted.

--Joan

What Don't Older Men/Women Understand about Pleasing Each Other?

I received this email from Jeane, who doesn't feel that men understand older women's sexual needs. I've had similar complaints from men about women.

I have found through an eternity, that the only good sex partner I ever had was my first husband. None could beat him. And that meant going through husband number two as well who didn't know much. And during those years of my divorce, and was single, I have been with a few. I have found what men don't know about pleasing women could fill an encyclopedia that would wind around the earth's circumference.

The Big Bravado they show from teen-aged boys through the ages is just that...Big Bravado. They haven't got a clue to a woman's sexually and what really "gets her going." No wonder women have given up and use dildos and other prosthetic objects to obtain some satisfaction. I'm at the "ho-hum" stage...live with it or without
it...and of course, there's always a dildo. Just sick of it all... Over-exposed and repressed all at the same time.

As for pleasing women, older women need MORE TIME being aroused. Problem is, with time, most men require less or else they "lose it." There are sex shops now that will accommodate needs for both.I found out about them because I had "brachytherapy" treatments in the spring of 2005 after a hysterectomy and have to use "something" once a week to keep myself "open" or I can close up from scar tissue from these radiation treatments. Therefore, I can tell you that I got rid of modesty when my physical well being was involved and went to one of these shops.

You have my permission to use all this material. Maybe someone else out there went through something similar.

I know that Jeane's email may seem anti-men, and I hope you realize that this blog is absolutely pro-men as well as pro-women. I encourage you to express yourself, and by communicating candidly, perhaps we can begin to erase (or at least smudge) the lines that divide us.

Let's open up a dialogue about what we'd like the other gender to understand about pleasing us. Please add to the discussion by posting a comment or by emailing me, and I'll post it for you.

-- Joan

Erectile Dysfunction: Michael Castleman Talks to Men

So many readers--both male and female--have been asking for information about erectile dysfunction that I asked Michael Castleman, a sex educator, counselor and journalist specializing in men's sexuality to answer some questions. His interview starts here and continues here.

Q: Explain erectile dysfunction (ED) and why it happens.

MC: Only a small fraction of men from age 45-60 have true ED. A larger but still modest fraction of men over 60 have true ED. True ED is the inability to raise an erection despite vigorous extended hand massage of the penis. True ED is usually the result of a medical problem, either a problem with the nerves that control erection, or more likely, narrowing of the arteries that carry blood into the penis. Like the arteries of the heart, the arteries into the penis can become narrowed by atherosclerotic plaques. Causes of plaque formation: heart disease, diabetes, smoking, high blood pressure, high cholesterol, high-fat diet, sedentary lifestyle. In other words, all risk factors for heart disease are also risk factors for ED. In addition, ED can be caused or aggravated by stress and anxiety, which constrict the arteries and limit blood flow into the penis.

Q: What about men who are capable of erections, but they're less reliable than they used to be and require more stimulation?

MC: While only a fraction of men over 45 experience true ED, just about every man experiences what sex therapists call "erection dissatisfaction" (EDis). After 45 or 50 or so, men with EDis can still raises erections, but they don't rise as quickly as they used to. They no longer rise from fantasy alone--seeing an attractive woman or some erotic scene. Men begin to need direct penis stimulation by hand or mouth. When erections rise, they may not look/feel as firm as they were in the man's 20s. They may also droop from minor distractions, anything from donning a condom to hearing a motorcycle roar up the street.

The good news is that EDis is a normal and natural part of aging. If older erections wilt a bit, hand massage and/or oral stimulation bring them back up again--IF the man remains relaxed and patient with himself. If the man gets stressed and anxious, this reduces the likelihood of a return to fullish erection.

Many (most?) older men are unclear on the distinction between true ED and EDis. Many mistakenly think they have ED when they experience the normal age-related erection changes of EDis. Now EDis can be disconcerting. I've been a sex educator for 30 years. I knew all about what happens to erections after 50. But when those changes started happening to ME, I found them unnerving. P.S. Erection medication (Viagra etc) helps treat EDis. In fact, most men who take erection drugs don't have true ED. They have EDis.

Q: Many men fear that they can't please a woman without an erection, or they give up on sex altogether. Is an erection necessary for sex?

MC: Of course not. As you know, women's pleasure organ is the clitoris. Many women prefer cunnilingus to intercourse. Surveys show that only 25% of women are reliably orgasmic from intercourse, no matter how vigorous or how long it lasts. So women know that an erection and vaginal insertion are not necessary or sufficient for sexual pleasure and orgasm. But many men DON'T know this.

Q: How did men's sexual education skip that important concept that women's orgasms are based on clitoral stimulation, and that most women don't need penis-in-vagina penetration for their pleasure?

Most men get most of their sex ed from pornography. Porn is totally penis-centered. Porn actors have monster cocks, which makes normally endowed men feel they're "too small." Mainstream porn includes a bit of massage and cunnilingus, but it's mostly about sucking and fucking, so that's what men come to believe sex is all about.

I've spent my life as a sex educator and counselor trying to persuade men that they'll have better sex and get better reviews from women if they ditch their preoccupation with their penis and focus instead on leisurely, playful, whole-body, massage-based sensuality. But compared with porn, which is viewed overwhelmingly by men and is by far men's #1 source of sex ed, the combined voices of every sex expert on earth amount to a little whisper in the hurricane of porn porn porn.

Here's where I plug my book, Great Sex. Its message to men: If you want great sex, if you want women to sing your praises as a lover, stop trying to imitate porn. In fact, do the opposite of what you see in porn. Not only will she be happier, you will be, too. You'll enjoy sex more and have fewer sex problems--more cooperative erection and better ejaculatory control.

Michael Castleman, M.A., is the author of twelve books, including Great Sex: The Man's Guide to the Secrets of Whole-Body Sensuality and Sexual Solutions: For Men and the Women Who Love Them. From 1991-95, he answered the sex questions submitted to the Playboy Advisor. Visit his website about sex after midlife, http://www.greatsexafter40.com//.

Sex and Older Bodies

I invite you to read my second column for Suddenly Senior: Sex and Older Bodies: Tips, Tools, and Tricks that Work! Here's an excerpt:

I‘m often asked in media interviews for tips for great senior sex. Here's what has worked for me:

1. Communicate. Tell your partner what you're feeling, or not feeling, and describe what would make sex better or more comfortable for you. Your partner wants to understand and please you.

2. Take lots and lots of time. We need more time to become aroused and make the delicious journey to the crashing waves. Set aside a couple of hours so you have time for the full experience, from the first kiss to the afterglow cuddle.

3. Find positions and props that enhance your comfort. A special shaped pillow like the Wedge and a silky lubricant can make all the difference in comfort!

4. Explore erotic helpers. I wrote a whole chapter on sex toys in Better Than I Ever Expected: Straight Talk about Sex after Sixty, including divulging my favorite.*

* I didn't go into more detail about my favorite in my Suddenly Senior column, but I'll tell you here -- it's the Eroscillator. Click on the photo below to visit the Eroscillator website. You'll have to read my book to learn just how this magical machine enhances our love life -- though if you ask, I'm likely to reveal more here!



I also talk in this column about how sexual expression can be an affirmation and celebration of life when dealing with a severe, even catastrophic, illness:

Many of you are familiar with the love story I tell in Better Than I Ever Expected about my romance with Robert.

Since the book was written, two major events in our lives happened: Robert and I got married, and Robert had six months of chemotherapy to treat his leukemia and lymphoma (happily now in remission).

Each chemotherapy treatment left Robert sick, depressed, and exhausted. Then, as he started to come back, he wanted to make love."I sought to be whole, not damaged by cancer and chemo, celebrating the source of life," he told me. "I needed to feel alive and well, not just a 'survivor.' I wanted to express myself completely through this body that felt violated."

I'd love to hear from other people who have had similar -- or different -- experiences.