(Dr. Altman's 2nd visit to Power Surge)

Dearest:   Alan Altman, M.D. is a Gynecologist specializing in menopause and 
midlife sexuality, Harvard Medical School Asst. Professor and co-author with 
LAURIE ASHNER of the new book, "Making Love the Way We Used to....or Better: 
Secrets To Satisfying Midlife Sexuality"

Welcome back to Power Surge, Alan (I hope it's okay if I call you Alan). As women 
age, is it possible that it's not so much loss of libido (although that is a 
problem for many women), but self-esteem or an insecurity about still being 
attractive to their partner? 


Dr. Alan Altman:    Good evening everyone. First I want to say that Laurie may or 
may not be with us tonight as her hand is painful.


Dearest:   Sorry to hear that, Dr. A. We hope Laurie is better soon.


Dr. Alan Altman:    To answer the question, it's really a little of both. Libido 
can naturally diminish with age along with the decrease in testosterone 
production by the ovaries.  However body image and self esteem enters into 
midlife through the normal changes in the body and the redistribution of body fat 
as well.  This creates a contrast with who we think we are and what the media 
tells us what we should look like. This is where the problem can begin.


Dearest:   That was actually going to be my next question, Dr. A. What, exactly, 
is the cause for a woman's lack of libido during perimenopause?  Low estrogen? 
Low progesterone? Testosterone? All of the above? Lack or decrease - since not 
all women "lack" libido during meno.


Dr. Alan Altman:    Mostly low estrogen and low testosterone but there are many 
other impacts on libido from the grand taffy pull of life around us.  Kids, 
family, job relationships, power struggles... all these can impact libido as well 
as hormones.


Dearest:   Thank you, Dr. A. NUFONE, go ahead, please.


NUFONE:   What about the husband?  Why does he not want sex so much  (age 50)  Is 
it the same for a man?  If both men and woman have the same feelings, then what?


Dr. Alan Altman:    The husband can have similar problems with respect to outside 
effects as well as hormonal and blood flow effects on sexual function.  The 
largest cause of decreased sexual activity in women over the age of 60 is lack of 
any partner.  For your information, 50% of men over the age of 50 have some 
degree of erectile dysfunction.  60% over 60 and 70% over 70.

But often I hear about the discrepancy in desire between members of a couple.  
It's not always the male who wants it more. Often its female. The discrepancy is 
what's important.  Male levels of testosterone gradually diminish as well.


NUFONE:   It is just the opposite from when we were first married. Now I want to 
have sex.


Dearest:   Dr. A., take a woman who's experienced pubic hair loss. How do you 
suggest she talk about it with her husband, or, even more difficult, a new 
partner? 


Dr. Alan Altman:    It's my new do...


Dearest:   Hahaha!


Dr. Alan Altman:    It's easier to be honest and explain, if it's at all necessary 
to, that it's normal to have those kinds of changes, but there are a bunch of 
other changes that are better. 


Dearest:   Share some of the better changes, please. 


Dr. Alan Altman:    Freedom to enjoy your sexuality without fear of pregnancy, 
periods and interruptions.  The ability to make love when and where you want and 
at the speed that you want.  For him, especially if he had premature ejaculation 
before he'll be able to last much longer now.  Quality takes over from quantity.


Dearest:   Thanks. Ellen, go ahead.


Ellen629:   I have the same problem - husband has no sex drive and I seem to have 
an increased libido now - is this normal?  I am 49 he has had an angioplasty is 
there hope?


Dr. Alan Altman:    The cause of his angioplasty may also be the cause of 
decreased blood flow to his penis and he might be experiencing performance 
anxiety due to an inability to maintain or achieve an erection.


Ellen629:   He was like that before the angioplasty, but now there is no drive- 
he is going for counseling. 


Dr. Alan Altman:    By avoiding intimacy he can avoid the embarrassment of the 
dysfunction.


Ellen629:   He's good at that!


Dr. Alan Altman:    If you reassure each other that intercourse is not necessary 
all the time he may be able to be more intimate without the fear of failure. 


Ellen629:   I am trying to be affectionate to him. I have such a strong desire 
lately


Dearest:   Dr. Altman, what do you mean by "Are you caught in the taffy pull?" 


Dr. Alan Altman:    The taffy pull describes everyone and every tension pulling 
you in 15 different directions. This can deeply affect desire for both male and 
female. 


Dearest:   And make it difficult to find "time" for sex? Do you believe couples
should people set aside time, or make appointments for sex? 


Dr. Alan Altman:    Sometimes that can be helpful especially if it's in a romantic 
area or private room with candles, etc.  But some couples find that more time 
away from each other makes sexual activity much easier and more enjoyable when 
they finally do get together. so time can work either way.


Dearest:   Thanks, Doc A. Nufone, go ahead, please.


NUFONE:   Why is it SO hard for men to talk about their sexual problems, or even 
My problems? I try to tell him I am in the beginnings of Menopause..and my 
symptoms are causing a lot of my "craziness" 


Dr. Alan Altman:    We discuss this quite a bit in the book and part of the reason 
for the book is to explain in every day language to men what their partners are 
experiencing and why.  Generally, as we all know, men tend to find it more 
difficult to discuss their own problems so sometimes women need to initiate the 
discussion.  The best way to initiate is to be positive and say I really like 
when you do xxx, lets try and do it more often. 


Dearest:   What about when there's been a betrayal in a relationship.  Can a 
couple successfully move past a betrayal (affair) and resume a normal life 
without the one who's been hurt remembering it all the time, or being afraid it 
will happen again? 


Dr. Alan Altman: :   After betrayal the history and strength of the relationship 
and potentially the therapist involved all enter in to whether this relationship 
will survive.  There are many variables that impact this potential for solution. 
If it is not the first betrayal, it's certainly more difficult.  Sometimes this 
can act to bring the couple closer together to face the needs that were not being 
met and caused the betrayal in the first place. 


Ellen629:   I was feeling so sexual this summer that I got on a chat and got 
involved with someone- only on the computer- it was scary and crazy, but it made 
me realize what wasn't happening in my marriage. When I ended it and told my 
husband,  we decided that he needed to go for counseling. I begged him for a long 
time. Why did it have to come to that insanity for him to realize what's wrong?


Dr. Alan Altman:    Sometimes we keep secrets in the bedroom because we're afraid 
of hurting someone we love.  So instead we go out and search to find the answers. 


Ellen629:   But he knew how I felt about the lack of intimacy in our lives. Look 
what I did in order to feel sexual. It was wild!


Dr. Alan Altman:    It was a wake up call for him that it was a serious concern in 
your life and he had to put up or shut up and potentially lose you. This is how a 
betrayal or affair can work positive for a relationship.


Ellen629:   Yes it was and boy, am I glad that he woke up. This was a very scary 
feeling for me. I thought I was losing my mind between the flashes and these 
strong feelings of arousal.


Dr. Alan Altman:    The feelings or arousal may have been a re-birth for you and 
helped both of you sexually.


Ellen629:   It was a rebirth for me. I had started walking over the summer and 
feeling great about myself then I got into the chats. Bad move!!


Dearest:   Other than vaginal dryness, why is sex often painful for peri or 
postmenopausal women?


Dr. Alan Altman:    You can have pain for many other reasons: one would be 
problems in the pelvis due to ovarian cysts or uterine fibroids which can 
increase in appearance during the perimenopausal transition. Secondly, vaginal 
atrophy can occur which limits the ability of the vagina to receive a penis.  
There are painful conditions of the opening of the vagina that can cause 
muscular spasm when anything comes near it. 


Dearest:  Do you think most women really want to make love the way they used to... 
or better?


Dr. Alan Altman:    Absolutely, according to what I hear in my office. Some women, 
however, see this transition as giving them the ability to stop having 
intercourse or sexual activity that they never really enjoyed.  The best 
indicator of sexual activity after menopause is the kind of sexual activity 
and enjoyment the woman had prior to menopause.


Dearest:   And aren't there really hundreds of ways a couple can please each 
other without having intercourse?


Dr. Alan Altman:    No question about it.  Intimacy can take many successful forms. 
Just touching or kissing can be fabulous.


Dearest:   Oftentimes even better


Dr. Alan Altman:    Some of us are losing the art of doing this for successful 
lovemaking without intercourse.  In the book we discuss many non-pharmaceutical 
methods of stimulating each other physically and mentally.  Mostly using all five 
of your senses can work wonders as an example.


Dearest:   Thanks, Dr. Alan. Ellen, go ahead, but one question at a time, please :)


Ellen629:   Dr. what can I do to show my husband that I want him to be closer to 
me? I  hold him  and flirt with him lately. I sure hope something happens soon. 
I really miss the intimacy- and I am a little apprehensive about this sexuality 
that I am feeling lately. 


Dr. Alan Altman:    Share it with him as best you can. Show confidence and 
happiness with yourself feeling this way and try to bring his confidence up to 
meet you on that level.  In the meantime, self stimulation can be enjoyable and 
if you are stimulated by chat on the internet as long as that is the limit of it 
you may at least find a release during the repair of the sexual relationship. 
This however has its risks. 


Ellen629:   I know he sees the difference in me. He has verbalized it. I know 
he doesn't like when I am on the computer too much- it probably scares him!


Dearest: Debrikkia, go ahead with your question for our guest, Dr. Alan Altman.


debrikkia:   What is the cause of vaginal atrophy and is there a way to guard 
against it happening?


Dr. Alan Altman:    The cause is diminished blood flow to the vagina and 
diminished estrogen activity in the vagina.  The best way to guard against it 
other than hormone replacement therapy is USE IT OR LOSE IT which means sexual 
activity including intercourse, masturbation with our without a vaginal device or 
vibrator with some regularity.


Dearest:   Once hormones level off during postmenopause, don't many women 
have a return of natural lubrication? 


Dr. Alan Altman:    Any vagina that goes long enough without the presence of 
estrogen will experience a degree of atrophy and decreased lubrication. This is 
a normal response of the body.  Some women notice it more than others and some 
not at all.


Dearest:   Thank you. Mary, go ahead.


MaryO:   If a woman was never very sexual, is it possible to become so, in 
midlife or later?  If so, how? 


Dr. Alan Altman:    That's another book that hasn't been written yet.


MaryO:   Ah...let us know when then, please :)  


Dr. Alan Altman:    But, kidding aside, it's never too late to become sexual as 
long as you find what stimulates you and helps you enjoy new sexual feelings.


Dearest:   Can you give us some examples of your ten proven ways to age-proof our 
sex lives?  


Dr. Alan Altman:    First would be to fill up your senses...touch, smell, sight, 
hearing, all are important and can open up new areas of enjoyment.  We're talking 
candles, bubble baths, music, massage, etc.  Then there is finding other passions 
in your life.  You can't be passionate about sex if you're not passionate about 
your life itself.

Change something. Take a risk. reinvent yourself. try something new. Challenge 
yourself.  Start to strength train in the gym or at home. Numerous studies have 
shown an increase in libido and self esteem as well as a decrease in depression 
with strength training.  In fact one paper demonstrated an increase in orgasm if 
you  have sex within an hour after working out.

Keeping healthy is very important. Drinking plenty of water. Stopping of smoking 
and other obvious lifestyle changes can increase your sexual desire through body 
image changes.

Communication is the most important thing between two partners.  Sometimes you 
need a guide to communicate like a therapist or a book.  Sharing this information 
is often the beginning of age proofing your sex life. 


Dearest:   And, if I might add, try to keep (or find) humor in our relationships -- 
even through the difficulties of menopause. Ellen, go ahead.


Ellen629:   I have had some very sexual stimulating feelings on the computer. Is 
that normal? It scares me sometimes and is it because I haven't had real sexual 
intimacy in a long time. I have always had a stronger libido than my husband . 
I think walking has made me a new woman. Oh boy!  I am in trouble!


Dr. Alan Altman:    You're not necessarily in trouble...you're answering a need 
that isn't being met.


Ellen629:   how true that is!!!  At least he realizes that now.


Dr. Alan Altman:    You're trying to meet that need in a way that's new to you and 
a little frightening. the decision you will ultimately need to make, will be can 
I get the need fulfilled with my partner of many years or if I'm unable to get 
that need met must I seek it elsewhere. Many relationships especially across the 
pond successfully continue if the need is met elsewhere freeing up the original 
relationship to function on its strengths but the danger here is obvious... the 
relationship can be destroyed.


Ellen629:   I wouldn't want to jeopardize 27 years of marriage it is just that I 
feel renewed.


Dr. Alan Altman:    Work at it with him, show him new ways and don't frighten him 
with your desire.


Dearest:   Alan,  thank you for a stimulating and informative chat. I urge 
everyone to get a copy of Dr. Alan Altman and Laurie Ashner's new book, Making 
Love the Way We Used to....or Better: Secrets To Satisfying Midlife Sexuality 
(Contempoary Books). Be sure to visit Dr. Altman's Web site at www.AlanAltmanMD.com

Read the transcript of Dr. Altman's first visit




Disclaimer:  Every guest in Power Surge is a highly respected professional whose
opinions are his/her own. An appearance in Power Surge does not constitute an 
endorsement of a guest's views.

None of these transcripts may be reprinted or reproduced without 
the express permission of Power Surge™ and the respective guest.

Read other transcripts by returning to the Library.


Dearest
aka Alice Stamm
Power Surge
Founder, Facilitator, Host


Copyright©1994-2012 by Power Surge.  All Rights Reserved.