Self Care for Women With Urinary Incontinence

Incontinence is a condition that results in the involuntary loss of urine without the owners’ permission. It is a condition that affects millions of American men and women. There are many changes that occur in the human body as we get older. Like many other bodily system, the urinary tract undergoes changes with age. These changes make middle age and older men and women more likely to become incontinent of urine as they grow older. It is important to remember that incontinence is not a necessary part of the aging process but it is more common in older men and women. There are a number of actions that women can take to decrease or even limit this embarrassing situation.

The skin around the outside of the vagina in women is called the “vulva”. This area includes the skin around the urethra and the vaginal “lips” or labia. Frequently, in incontinent women this area is red, raw, and sore from urine irritating the skin. If this is a problem for women, these tips may help make women more comfortable and avoid irritation of the bladder, urethra, and surrounding skin.

• Women who are incontinent should wear cotton underwear instead of underwear made of synthetic material such as nylon. I also suggest that women do not wear synthetic pantyhose, especially not under pants or jeans. Women will also find that the underwear will be less irritating to the vulva if the underwear is washed in pure soap or soap flakes and not in harsh detergents or with the addition of fabric softeners. I suggest that women wash the vulvar area no more than twice a day, using only plan water or mild soap such as Ivory or Dove.
• Women who are incontinent should avoid bath oils, bubble baths or bath salts. All of these can be very irritating to the already sensitive skin of the vulva. Vaginal deodorants or douches should also be avoided. Tampons should not be used as they may irritate the bladder and the urethra.
• After bathing, the vulvar area should be gently dried with a towel, and then use a hair dryer on cool or low setting to dry the vulva completely.
• If you need a powder to help keep the vulvar area dry, I suggest using ordinary cornstarch and not talcum powder.
• Finally, try drinking pure water as much as possible and avoid caffeinated beverages such as coffee, tea, and cola beverages. Avoid alcohol especially in excess as alcohol may irritate the bladder and the urethra.

Nearly every woman with incontinence can be helped and most can be cured. If this is a problem that is affecting your quality of life, I suggest you contact your physician.

Urinary Incontinence-What It Is and What Can Be Done

What is urinary incontinence?

Urinary incontinence is the uncontrollable and involuntary loss of urine that affects more than 10 million Americans. Incontinence can be very embarrassing as it can interfere with a normal, full life. Fortunately, today something can be done about it and in most instances it can be cured completely.

What are the types of incontinence?

There are three common categories of urinary incontinence. These are stress incontinence, overflow incontinence, and urge incontinence. Although all people with incontinence experience a loss of bladder control, each type of incontinence has its own pattern of signs and symptoms. People with stress incontinence leak urine when they cough, sneeze, or laugh. They may be dry at night but leak upon getting up from the bed in the morning. People with urge incontinence wet themselves if they don’t get to the bathroom immediately. They get up frequently during the night to urinate. They go to the bathroom constantly. They may wet the bed at night. People with overflow incontinence take a long time to urinate and have a weak, dribbling stream with no force. They dribble small amounts of urine throughout the day and night.

What causes incontinence?

Stress incontinence is due to the loss of the support from the pelvic floor muscles. Commonly the pelvic organs bladder and uterus slip down into the vagina (vaginal prolapse). Overflow incontinence is to either a narrowing of the tube (the urethra) that allows the urine to exit from the body or inability of the bladder muscle to contract and expel the urine from the bladder. Urge incontinence can be a result of bladder irritability such as a urinary tract infection or to neurologic problems in the brain or spinal cord.

How is the diagnosis of urinary incontinence made?

An accurate diagnosis is the essential first step in the treatment of incontinence. The evaluation consists of a medical history followed by a thorough physical exam that includes a pelvic exam and a rectal exam. Certain diagnostic tests such as a urinalysis, urine culture, cystometrogram (bladder pressure test) and cystoscopy (inspection of the bladder with a small lighted tube) are usually required to complete the diagnostic evaluation.

What is the treatment for urinary incontinence?

The treatment for stress incontinence depends on the degree of anatomical abnormality. In mild cases pelvic exercises and/or medication may be all that’s needed. However, in more severe cases surgery is the best treatment. The treatment for overflow incontinence may be alleviated with medication or intermittent self-catheterization to drain out the urine. Surgery may be required when the cause is a narrowed urethra or a nerve problem. The treatment of urge incontinence consists of antibiotic medication to treat the infection or medication to relax the irritated bladder.

Summary

Urinary incontinence shouldn’t take over your life. It is almost always treatable, and often completely curable. Working as a team, we can put you back in control of your bladder and your life. That means you’ll be free-free to get a night of uninterrupted sleep, to travel comfortably, to be as active as you want to be. Instead of worrying about embarrassing accidents, you’ll be able to do the things you most enjoy.

Urinary Incontinence-Tests You May Need To Do

The purpose of the evaluation is to identify the cause of the incontinence, to determine the damage to the bladder and kidneys, and to select the appropriate treatment for the specific cause of the leakage. All of the tests can be performed in the office or as an outpatient at the hospital. All of the tests are associated with minimal discomfort. You can resume normal activity immediately following the procedures. The evaluation of urinary incontinence can include any of the following tests or procedures:

Cystoscopy – A local anesthetic is inserted into the urethra (the tube that drains the urine from the bladder). A small telescope is inserted in the urethra to examine the inside of the bladder. In women, a pelvic examination is performed at the end of the procedure. The examination takes approximately 5 minutes. After the procedure there may be a small amount of bleeding or mild burning with urination.

Flow Rate – This is a procedure to measure the efficiency of the bladder and the muscles or sphincters that hold the urine in the body. You will be asked to drink several glasses of water, When you feel that you have to urinate, you will be asked to urinate over a toilet that contains a recording device. The device will measure the volume of urine and the time it takes to empty your bladder.

Cystometrogram (CMG) – This is a procedure in which a small catheter (a plaster or rubber tube smaller than a pencil) is inserted into the bladder. The catheter is used to deliver sterile water or gas (carbon dioxide) into the bladder. You will be asked to describe the first sensation to urine and the strong urge to urinate. This procedure takes approximately 10-15 minutes. After the cystometrogram the catheter is removed and you will be asked to cough, strain and then urinate. This test is performed to determine the extent of leakage. You can expect some burning or passage of air with urination,

Voiding Diary – This is a record of the amount and time of day that urination takes place and when leakage occurs, (The amount of urination should be recorded in ounces.)

Voiding Cystourethrogram (VCUG) – This is an X-ray procedure in which a catheter is inserted in the bladder and the bladder filled with iodine. The catheter is removed and X-rays are taken while voiding.

Intravenous Pyelogram – This is an X-ray procedure that requires an injection of iodine into a vein and pictures are taken of the kidney at various time intervals. This determines the anatomy and the presence of damage to the kidneys. There is occasional nausea, bad taste in the mouth, or lightheartedness with the procedure. You will be asked to take laxatives before the procedure. (Please notify me or the radiologist if you are allergic to iodine or seafood.)

Not all of these diagnostic tests are required for each patient.

When Things Aren’t Right “Down There”-Pelvic Organ Prolapse

This is a common condition that affects millions of American women. It is a condition that occurs when one of the pelvic organs such as the uterus, bladder, intestines, or rectum protrudes through the vagina. Prolapse ranges from mild to severe levels where mild prolapse is found by the doctor at the time of a pelvic exam and a severe condition when the organs protrude the vaginal opening and is visible and can be felt by the women when she is in the standing position.

Prolapse is caused by a weakness in the muscles and support structures in the vagina that normally hold the pelvic organs in place and when weakened allows one of the organs such as bladder or uterus to drop into the vagina and when severe protrudes through the vaginal opening. The process of childbirth through the vagina stretches the vaginal muscles and supporting structures and weakens the vagina and allows the organs to drop into the vagina. Each additional vaginal delivery adds more stretch and leads to the potential for more prolapse. Also aging and the accompanying estrogen deficiency also promotes weakness of the vaginal muscles and promotes prolapse. Less common causes include obesity, asthma, bronchitis and other pulmonary conditions that are associated with chronic coughing.

Symptoms of Prolapse?

The most common symptom of prolapse is a feeling of pressure in the vaginal or rectal area. Women often describe a sensation as if they have a ball in the vagina. If the prolapse is severe, the woman can see the lump protruding from the vagina. If the protrusion is present all the time, the tissue can be come irritated and be associated with a discharge or bleeding. With more severe degrees of prolapse it may be difficult to urinate because the urethra, the tube that transports urine from the bladder to the outside of the body, becomes kinked causing the women to strain in order to empty the bladder. In rare situations the woman may be unable to urinate and have to go to the emergency room to have a catheter inserted. Occasionally, prolapse is associated with urinary incontinence especially when the woman coughs and sneezes. Sexual problems include irritated vaginal tissues and painful intercourse. When the rectum prolapses through the vagina, there may be a problem of constipation and the woman may have to insert her finger in the vagina to express the stool. With very severe prolapse the tubes from the kidney to the bladder or the ureters are kinked and can cause obstruction and lead to kidney failure if the prolapse is not repaired.

Treatment of Prolapse

There are two treatment options for prolapse especially if the prolapse is producing significant symptoms. These are the insertion of a pessary or surgical correction.

A pessary is a device that is usually made out of a plastic substance and is usually in the shape of a donut or ring. It is placed in the vagina, like a tampon, to restore the organs to their normal position. Pessaries are quite safe, although in some patients they seem to be associated with recurring bladder infections.

If a pessary works, and it is comfortable, it can be a lifetime treatment. It can be left in place for several months at a time, however, it needs to be removed and cleaned and then reinserted.

Surgery to correct prolapse is indicated if there are significant symptoms such as a protrusion that is uncomfortable or causes vaginal bleeding, for women who have difficulty with urination such as straining to urinate or urinary incontinence, or chronic constipation. If the uterus is prolapsed it may be necessary to have a hysterectomy as well as repair the prolapse. In addition, it may be necessary to repair incontinence. Most of the surgery is performed through the vagina and can be done on a one-day stay basis or with one overnight stay in the hospital. Women have to avoid heavy lifting for 4-6 months after the surgery and must abstain from sexual intercourse for a similar time period. The surgery is successful in most cases and restores the quality of life to those who suffer from this common condition.

For additional information please visit my website, www.neilbaum.

Some Practical Advice On the Management of Urinary Incontinence

If you suffer from incontinence, whatever else you do, these practical tips can make your symptoms less severe:

• KEEP THE BLADDER AS CLOSE TO EMPTY AS POSSIBLE. Go to the restroom even when the urge is not overwhelming, and stay as long as it takes to empty the bladder.
• TIME YOURSELF. If you lose control at regular intervals (say every four hours), empty your bladder before it happens. Wear a wrist alarm to remind you.
• WEAR CLOTHES AND TROUSERS THAT ARE EASY TO OPEN, or remove quickly, so that you won’t lose time fumbling when you need to void.
• CONSUME LESS alcohol, fruit juices, carbonated beverages, spicy foods, dairy products, sugar, and artificial sweeteners. These all can irritate the bladder and worsen your symptoms.
• DON’T WEAR girdles, corsets, pants or high heels — all can weaken the pelvic muscles that control urination.
• TRY CROSSING YOUR LEGS before you sneeze or cough. Chances are you will leak less.
• AVOID CAFFEINE in any form.  It is a diuretic for most people
• DON’T SMOKE. Women who do are twice as lucky to become incontinent.

You Don’t Have to Be Wet When You Exercise

Stress urinary incontinence refers to the leakage of urine that occurs during physical activities, such as coughing, sneezing, walking and lifting.  It is not surprising that many women lose urine during exercise given the impact exercise may have on the bladder, the urethra or the tube that allows urine to exit the body, and the pelvis.  If women have urinary incontinence during exercise, it is not uncommon for many women to give up exercising entirely because of the social embarrassment associated with this condition.  One-fifth of women who exercised recreationally stopped exercising because of the incontinence.

Nearly one-third of recreational athletes have some urinary incontinence during exercise.  Exercises that involved repetitive bouncing, such as aerobics or running, are most likely to provoke urinary incontinence.

Loss of urine during exercise is not only limited to middle-aged women who have had children.  Over 25% of young college varsity athletes or physical education majors who had not had any children reported some leakage while participating in their sport.  Nearly 2\3 of gymnasts reported some leakage, but only 10% of the swimmers had loss of urine.  This is not surprising since swimming is a much lower impact activity.  Another study compared incontinence in physical education majors which was nearly three times more common than in students studying nutrition.  Both of these groups of women were just as likely to have occasional incontinence in other activities of daily life, regardless of whether they were athletes or not.  This suggests that exercise alone does not cause incontinence but that the high intensity of exercise raises the pressure in the bladder and exceeds the woman’s continence threshold.  The continence threshold is the amount of pressure that the urethra is able to withstand before loss of urine occurs.  This threshold may be decreased from such factors as childbirth which stretches the tissues in the vagina and weakens the muscles and connective tissue in the pelvis.  Other conditions decreasing the continence threshold include certain medications such as alpha blockers, estrogen deficiency as seen in post-menopausal women, obesity, chronic coughing, and nerve disorders as occasionally seen in women with diabetes.

High impact exercising also predispose women to leak.  With jumping or running, the bladder has to accept over 25 pounds of force from the abdominal organs slamming down against the bladder and the urethra which can exceed the continence threshold and result in incontinence.

There is also evidence that loss of collagen in the connective tissues may be responsible for the loss of urine in women who lose urine during exercise.  As women get older there is a loss of collagen and this may be responsible for some of the incontinence that occurs in women during exercise.

Are women who exercise at risk for clinically significant incontinence later in life?  Probably not.  A study that questioned female Olympians who competed 20-30 years ago, found that those who participated in high impact sports (gymnastics and track and field) were not more likely to have more severe incontinence today than women who competed in lower impact exercises such as swimming.

Solutions to exercise incontinence

Most importantly, women should not stop exercising.  This is especially important as a women reaches middle age and can easily become overweight.  Being overweight is definitely associated with urinary incontinence so women can get into a vicious cycle if they stop exercising as they can become more overweight and have even more incontinence.   Some women may cope with the use of pads used during exercise, others can change from high-impact to lower impact exercises such as swimming.  There are also pelvic muscle strengthening drills that can stop or cut down leakage during exercises.  Now there are inserts containing a small, single use liquid covered with silicone that can be inserted into the urethra and conforms to the urethra creating a seal and preventing the loss of urine during exercise.  The insert is removed during regular bathroom visits where it is discarded and replaced with a fresh insert.  Finally, for women whose quality of life is impaired by the incontinence, surgery can alleviate incontinence in most women.

Bottom line:  Help is available for those who suffer from incontinence during exercise.  If you want to explore the various treatment options you should discuss them with your doctor

No-Scalpel Vasectomy-Almost Painless Male Contraception

Vasectomy is the process of dividing the vas (the tube that delivers the sperm from the testis to the prostate) in order to prevent conception. It is the most common method of male contraception in this country where about 500,000 vasectomies are done each year. Since vasectomy simply interrupts the delivery of the sperm, it does not change the hormonal function of the testis and sexual drive and ability remain intact. Since most of the semen is composed of fluid from the prostate, the semen will look the same. Vasectomy is thought to be free of known long term side effects, and is considered to be the safest and most reliable method of permanent male sterilization.

The technique of the No-scalpel Vasectomy was developed in 1974 by a Chinese physician, Dr. Li Shunqiang, and has been performed on over eight million men in China.

After injecting the scrotal skin and each vas with a local anesthetic, we use a special vas-fixation clamp to encircle and firmly secure the vas without penetrating the skin. One blade of a sharp forceps or clamp is then used to penetrate the scrotal skin. The tips of the forceps are spread, opening the skin much like spreading apart the weaves of fabric. The vas is thus exposed and then lifted out and occluded by any of the standard techniques, such as cautery or sutures. The second vas is then brought through the same opening and occluded in a similar fashion. The skin wound contracts to a few millimeters and usually does not require suturing.

Compared to the traditional incisional technique, the No-Scalpel Vasectomy usually takes less time, causes less discomfort and may have lower rates of bleeding and infection. Recovery following the procedure is usually complete in two to three days. Hard work or straining (athletic pursuits or heavy lifting) is not recommended for seven days. Most patients should wait to have intercourse for a week after the procedure (You should feel no discomfort).
Common reasons given for having a vasectomy.

1. You want to enjoy sex without worrying about pregnancy.
2. You do not want to have more children than you can care for.
3. Your partner has health problems that might make pregnancy difficult.
4. You do not want to risk passing on a hereditary disease or disability.
5. You and your partner don’t want to or can’t use other kinds of birth control.
6. You want to save your partner from the surgery involved in having her tubes tied and you want to save the expense.

COMMON QUESTIONS ASKED AND ANSWERED ABOUT NO-SCALPEL VASECTOMY
How can I be sure that I want a vasectomy?
You must be absolutely sure that you don’t want to father a child under any circumstances. You must talk to your partner and it certainly is a good idea to make this decision together, consider other kinds of birth control and talk to friends or relatives who may have had a vasectomy. Think about how you would feel if your partner had an unplanned pregnancy. Talk to your doctor, nurse, or family planning counselor.

A vasectomy might not be right for you if you are very young, if your current relationship is not permanent, if you are having a vasectomy just to please your partner and you do not really want it, you are under a lot of stress or you are counting on being able to reverse the procedure at a later time.

How does the vasectomy prevent pregnancy?
Sperm is made in the man’s testicles. The sperm then travels from the testicle through a tube called the vas into the body where it enters the prostate gland. In the prostate, the semen is made and here the sperm mixes with the semen. The prostate is connected to the channel in the penis and hence the sperm and semen are ejaculated. In a vasectomy, the vas or tube is blocked so that sperm cannot reach the prostate to mix with the semen. Without sperm in the semen a man cannot make his partner pregnant.

What is different about a no-scalpel vasectomy?
No scalpel-vasectomy is different from a conventional vasectomy in the way that we get to the tubes or vas to block them from passing sperm out of the testicles. An improved method of anesthesia helps make the procedure less painful. In a conventional vasectomy, the physician may make one or two small cuts in the skin with a knife, and the doctor would then use sutures or stitches to close these cuts at the end of the procedure. In the no-scalpel vasectomy, instead of making two incisions, the doctor makes only one tiny puncture into the skin with a special instrument. This same instrument is used to gently stretch the skin opening so that the tubes can be reached easily. The tubes are then blocked, using the same methods as conventional vasectomy, but because of the lack of scalpel technique there is very little bleeding and no stitches are needed to close the tiny opening. This opening will heal quickly with little or no scarring. No-scalpel vasectomy was introduced in the United States in 1988 and is now used by many doctors in this country who have mastered the technique.

Reasons for having a no-scalpel vasectomy as compared to conventional vasectomy

1. No incision with a scalpel–only a small puncture with a sharp probe
2. Usually no stitches
3. Usually a faster procedure
4. Usually a faster recovery
5. Usually less chance of bleeding and other complications
6. Usually less discomfort
7. Just as effective as regular vasectomy

Will it hurt?
When the local anesthetic is injected into the skin of the scrotum, vou will feel some discomfort, but as soon as it takes effect you should feel no pain or discomfort. Afterwards, you will be sore for a couple of days and may want to take a mild pain killer such as Tylenol, but the discomfort is usually less with the no-scalpel technique because of less trauma or injury~ to the scrotum and tissues. Also, there are no stitches in most cases. We will provide you with complete instructions about what to do after surgery.

How soon can I go back to work?
You should be able to do routine physical work within 48 hours after your vasectomy, and will be able to do heavy physical labor and exercise within a week.

Will the vasectomy change me sexually?
The only thing that will change is that you will not be able to make your partner pregnant. Your body will continue to produce the same hormones that give you your sex drive and maleness. You will make the same amount of semen. Vasectomy will not change your beard, muscles, sex drive, erections, climaxes or your voice. Some men say that without the worry of accidental pregnancy and the bother of other birth control methods, sex is more relaxed and enjoyable than before.

Will I be sterile right away?
No. After a vasectomy there are some active sperm left in your system. It may take a dozen to two dozen ejaculations to clear the sperm out downstream from where the vasectomy is performed. You and your partner should use other forms of birth control until we have had a chance to check your semen specimens at least twice to make sure that they are free of sperm.

Is the no-scalpel vasectomy safe?
Vasectomy in general is safe and simple. Vasectomy is an operation and all surgery has some risk such as bleeding, infection and pain, but serious problems are unusual. There is always a small chance of the tubes rejoining themselves, and this is the reason that sperm checks are necessary. There have been some controversies in the past about the long-term effects of vasectomy, but to our knowledge there are no long-term risks to vasectomy.

How long will the no-scalpel vasectomy take?
It depends on the surgeon, but on average, the operation lasts between fifteen to thirty minutes.

When can I start having sex again?
As a rule, we suggest waiting a week before having intercourse. Remember, however, that the vasectomy only divides the vas and has no effect on the sperm that are already beyond that point. IT IS IMPORTANT NOT TO HAVE UNPROTECTED INTERCOURSE UNTIL THE ABSENCE OF SPERM FROM THE EJACULATE HAS BEEN CONFIRMED WITH TWO (2) NEGATIVE SPERM CHECKS TWO WEEKS APART.

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Bladder Control-You Can Do It

Self-Care
You can take these steps to help improve control of your bladder:

• Behavior modification. This may involve timed urination — going to the bathroom according to the clock rather than waiting for the need to go. You may start off urinating every hour or so and then build up to a longer interval.

• Pelvic floor exercises (Kegels). These exercises involve learning how to contract and release your pelvic floor muscles in order to strengthen those muscles. These are the internal muscles you contract to stop the flow while you’re urinating. If you have problems doing the exercises, biofeedback may help you learn how to control your pelvic floor muscles. In biofeedback, a monitor helps you see the strength of your contractions and if you’ve contracted the right muscles. For incontinence that isn’t caused by nerve damage, these exercises may bring noticeable improvement in 8 to 12 weeks. If you’re a woman, you can use a vaginal cone to improve muscle strength. You insert a tampon-shaped cone into your vagina and hold it there by contracting your pelvic floor muscles. Holding the cone and contracting pelvic floor muscles may increase muscle strength. As your muscles grow stronger, you increase the weight of the cone.

• Diet. Avoiding certain foods and drinks may improve incontinence in some people. Alcohol and caffeine relax the sphincter muscle and are mild diuretics. Carbonated drinks, citrus fruits and juices, spicy food, chocolate or artificial sweeteners may irritate your bladder. Drinking less liquid before bedtime also may help.

• Hygiene. Problems with urine leakage may require you to take extra care to keep your skin clean and free of irritation. Frequent wiping with a cloth and use of moisturizers and creams may help with cleanliness. Deodorizing tablets may eliminate urine odor. A variety of pads, pants, shields and other devices is available to control urine leakage. Many women find absorbent pads made for urine leakage much less irritating than menstrual pads. Ask your doctor which devices to control urine leakage might work best for you.

Sex and the Senior Citizen

Just because a person is aged, confined to bed, or even has Alzheimer’s Disease does not mean that they do not wish to be sexual. My elderly mother is in a nursing home and I have seen several men having a physical relationship with the women. This is often as minimal as handholding but the desire for intimacy is still ever-present. Supreme Court Justice Sandra Day O’Conner even gave permission for her husband with Alzheimer’s disease to have a physical relationship with another woman in his nursing home. So what can people expect about sexuality in their advancing years?

As we grow older there are expected and normal changes that take place that causes some alternations in the ability to be sexually intimate. These changes take place in both men and women. There are some women who enjoy sex more as they get older. The fear of pregnancy or the anxiety of having youngsters enter the room during sexual intimacy is no longer an issue. Now they may feel freer to enjoy sex.

As women age there are normal changes in the woman’s vagina especially after menopause. The vagina does not lubricate as easily and as quickly and the vagina may shorten making sexual intimacy painful. However, with the assistance of lubrication, most of these issues can be resolved.

With aging a man often notices that he has difficulty obtaining and maintaining an erection. An erection may require more genital stimulation and the erection is not as rigid as in former years. This can often be remedied by longer periods of foreplay. Men will also notice that the force and volume of the ejaculate decreases with age and the erection will subside in seconds after ejaculation occurs. Erection problems are more common in men with high blood pressure, heart disease, and diabetes.

There are large numbers of drugs that can decrease the libido or sex drive in both men and women. Drugs used to treat depression such as the Selective serotonin reuptake inhibitors (SSRls) are an example of medications that may affect the libido in both sexes. Also medications used to treat high blood pressure, antihistamines, tranquilizers, appetite suppressants, diabetes drugs, and some ulcer drugs like ranitidine can diminish a man’s erection. If you are taking one or several of these medications, check first with your doctor before you discontinue the medication as the doctor can often adjust the dosage or change to another class of medication

that won’t cause sexual problems.

Help is available

There are several things you can do on your own to keep an active sexual life. Remember that sex does not have to include intercourse. Make your partner a high priority. Pay attention to his or her needs and wants. Take time to understand the changes you both are facing. Try different positions and new times, like having sex in the morning when you both may have more energy. Don’t hurry-you or your partner may need to spend more time touching to become fully aroused. Masturbation is a sexual activity that some older people, especially unmarried, widowed, or divorced people and those whose partners are ill or away, may find satisfying.

If you do seem to have a problem that affects your sex life, talk to your doctor. The most common problem that affects women is painful intercourse. For most women, lubrication can be provided with creams or jellies. If the problem is estrogen deficiency, this can be supplied with topical estrogen creams or oral estrogens if there are no contraindications such as estrogen receptor positive breast cancer.

If a man complains of a loss of libido, the problem may be related to testosterone deficiency that can be replaced with injections, topical jells or the insertion of testosterone pellets. If impotence is the problem, it can often be treated with oral medications such as Viagra, Levitra, or Cialis. If the medications are not successful then injections, vacuum devices, or surgical implants can be performed.

Bottom line: Just because a man or women enters their senior years does not mean that sexual intimacy has to cease. Older men and women can and do enjoy intimacy.

5 Fast Facts About ED Every Man (And Woman) Should Know

Erectile dysfunction (ED) is defined as the inability of the male to achieve and/or maintain an erection adequate for satisfactory sexual activity. Here are 5 facts that everyone should know about this common problem.

1) If you have experienced ED, you are not alone.

ED affects about 30 million men in the United States. In fact, it is one of the most corninon chronic medical disorders in men over the age of 40.

2) ED is not all-or-nothing.

A man doesn’t have to experience ED during every sexual encounter in order to be diagnosed with ED. In fact, the majority of men with ED say that they have it only some of the time.

3) ED may be a sign ofa more serious, but treatable medical condition.

ED is sometimes a symptom of more serious medical conditions, such as heart disease, high blood pressure, diabetes, or depression. When diagnosed by a doctor or other healthcare professional, all of these conditions can be treated.

4) ED is not “all in your head.”

Many people still believe the old notion that ED is mostly a psychological problem. That’s simply not true. It is now understood that the great majority of cases of ED have a physical, not a psychological, cause.

5) ED is treatable.

ED can be effectively treated with a variety of methods. More treatments are available today than we have ever had before. In the majority of cases, these treatments work regardless of age or the presence of other medical problems. .

If you have ED, your doctor or other healthcare provider can help decide which treatment is right for you.