Placing The Patient At Center Of The Doctor-Patient Relationship

The Patient Centered Practice

Today the patient is far different than the patient of a few decades ago. Patients can find healthcare information just as easily as a physician and many patients are taking a greater role in their healthcare and want to be involved in the decision making and work with the doctor as a team with the doctor being the captain of the healthcare ship. This new attitude has been referred to as patient-centered healthcare. Patient centered care occurs when the processes and culture (attitude and behaviors) of the care givers address the wants and needs of the patient.

Patient-centered primary care is beginning to take root. The Institute
of Medicine (IOM) includes patient-centered care as 1 of 6 domains of
quality. Yet, the IOM also notes that a chasm exists between the kind
of care that patients receive and the kind of care they should have,
and calls for fundamental change in the system of care. It further
argues that these changes would both be better for patients and make
the provision of care more satisfying for clinicians.

Here are a few examples of how you can put patients into center of the equation of the doctor-patient relationship.

How would you like to hear the results of your test, E-mail, phone
call, automated lab results telephone contact, or written report? The days of “no news from the doctor is good news” is no longer applicable in the age of putting the patient at the center of care. Today every patient should receive a communication regarding every test result, even if the results are normal. It is recommended that you put in place a policy that if patients don’t hear from the doctor’s practice about the test results, the patient should contact the office. It is likely that patients will have a favorite method of being informed and you won’t know unless you ask.

Which arm would you like to have your injection? Right-handed patients may want the injection in their left arm. Patients who participate in sports may want the injection in the buttocks and not in either arm. Patients appreciate having a choice where they want to receive their injections and what arm they would like to have their blood drawn.

Would like to see the x-rays? Now with the use of picture archiving and communication system (PACS), it is very easy to show the radiographic results on your computer. Many patients are now very interested in seeing the pathology of the findings of their radiographic studies.

Can I show you a diagram of your problem and what we will do to treat
the problem? There are a number of programs available on the computer that show nice graphics that allow you to draw and discuss the details of the findings and the plan of action. I use a free program, DrawMD (www.drawmd.com) on my iPad to demonstrate procedures and the pertinent anatomy.

Use the patient’s name. The most important word in the human language to each an every one of us, is the sound of our own name. We all like to be called by our names and the receptionist, the nurse, and the doctor need to refer to the patient by their name at least twice during the office visit.

Use social progress notes. Patients like to be thought of as more than a condition, illness, or diseased organ system. It is a nice to acknowledge patient’s accomplishments, hobbies, or life events such as birthdays or anniversaries. I call these social progress notes and these notes can be placed in the patient’s chart or in the EMR and the staff and doctor can refer to these personal topics before launching into the patient’s medical problem.

Would you like this prescription electronically sent to the pharmacy
or would you like to have the paper prescription? Not everyone wants to use e-prescribing and patients will usually opt for the new technology but appreciate the choice.

There are four options for treating your medical condition. Let me
describe the possible options and then you can select the one that
is best for you and your situation. This patient centered approach applies to treating many other medical conditions when one option does not apply to everyone.

Would you like some educational material on your condition? There are so many ways to educate patients today on their medical problems. Not everyone has a DVD player and giving the patient a DVD may not be the only method of providing educational material.

Can I provide you with a list of websites that have credible
Information on your condition? Healthcare is the second most commonly searched topic on the Internet (you guessed it, number one is pornography) and patients will often stumble on non-credible websites. You can do your patients a service by providing them with a list of websites that have accurate medical information.

Would you like a generic prescription, which has a few more side
effects, or would you like a brand name medication which has fewer
side effects but is more expensive? Not everyone can afford the newer brand name products. It is such a nice gesture to offer the patients a choice.

Would you like to complete the health questionnaire and several forms for your records in the office or in your home and bring it with you to the office? If you have the receptionist recommend that the patient visit the website and complete the health questionnaire at home before they come to the office the visit will be expedited. If the patient doesn’t have access to the Internet, they can fill out the necessary forms in the office but that they need to arrive 15-20 minutes earlier than their appointment time to complete the necessary paper work. This will improve your workflow and improve the efficiency of your practice.

Do you have any other questions that you would like for me to answer regarding your visit? This question puts the patient at the center of their visit to your office and should be asked to nearly every patient before the encounter comes to a conclusion.

Bottom Line: Patients want and need to take a greater role in their medical care. Using a few techniques like those listed above is a cost-effective method of developing a patient-centered medical practice.

Dr. Neil Baum is a physician in New Orleans and the author of Marketing Your Clinical Practice-Ethically, Effectively, and Economically (Jones and Bartless, 2009, 4th edition). He blogs at Dr. Neil Baum’s Urology Blog <https://neilbaum.wordpress.com/

To Lie Or Not To Lie-When Telling A Lie Might Be Appropriate

I was in practice about five years and was about to do a radical nephrectomy on a patient. I met with the patient and his son in my office and the son informed me that he and his father were Jehovah’s Witnesses and that he didn’t want his father to receive any blood or blood products before, during, or after surgery. I asked the father if that was his wish and he sheepishly agreed that it was his decision as well. I had him sign a consent form, with the appropriate documentation, that would absolve me of any negligence if he should require a blood transfusion and didn’t receive it.

The night before surgery, I met with the patient alone in his room. He confided in me that he was not as “religious” as his son — if he needed blood, he wanted to receive it. However, he requested that I shouldn’t tell him or his son if he received a transfusion.

I thought that was a prudent plan of action, and I documented our discussion in the patient’s chart. I then made calls to the laboratory and the blood bank, to type and hold several units of packed cells.

The surgery was a little more difficult than I anticipated and the patient lost several units of blood — he had signs of hypovolemia in the immediate post-operative period. At the end of the procedure I ordered that the blood be given to the patient in the recovery room. I told the nurses not to allow any family members into the recovery room while the transfusions were being given. I also had the nurses change the IV tubing after the transfusions were given so that there would be no tell-tale signs of blood in the IV tubing that could be seen by the family. I thought I had covered all of my bases.

I then walked out to meet with the family in the family lounge. The son asked me about the surgery and I told him about the difficulty of the operation but that his father was stable and doing well in the recovery room. The son then asked me, “Did my father receive any transfusions or any blood products?” Pow! I know I had the look of a deer stunned by the headlights. There were so many thoughts that raced through my mind in the interval between his questions and my response.

I responded, “Why do you ask?” as I was hoping to have just a few more seconds to gather my thoughts. The son said that someone from the blood bank had come into the family lounge during the surgery and asked if anyone in the family would consider donating blood, as their father was going to receive blood. I thought I had taken care of everything but I didn’t give the blood bank a heads up on my agreement with the patient. I thought, do I tell the truth and risk rupturing rapport between the father and the son and/or between the patient and myself? To give an adult patient blood against their will or wishes could be considered an assault with battery. I was truly scared about the legal ramifications the truth would subject me to. Or do I lie and protect the patient? I decided that my responsibility was to the patient and that the patient deserved that I protect his wishes and preserve his relationship with his son.

I said, “There must have been a mistake as your father did not receive any blood.” The son gave a sigh of relief and I know that inside I, too, was also relieved that the rapport was not blown between the patient and me, or between the patient and his son.

I ask, if you were the doctor in this situation, what would you have done? Would you be perfectly honest and tell the son about your discussion with the father the night before? Or would you do as I did, and lie to the son in order to protect your patient, his father?

We have all taken the Hippocratic Oath, which admonishes us “To do no harm.” I believe this dictum refers to more than just clinical harm to the patient, but also to psychological harm. I believe that had I been forthright about the transfusions, I would have harmed the patient — the lie protected the patient.

A certain moral goodness is expected in physicians, and if goodness is not present, education probably will not create it. Superior moral reasoning can enhance moral behavior, and we only have to look at the lessons of the great physicians who preceded us for the answers and the advice that can guide us in the practice of our profession.

This was one of the scariest days in my professional life and I believe, to this day, that I behaved in the best interest of my patient.

Addendum: I have researched this issue and the legal implications associated with blood transfusions in Jehovah’s Witness patients. The advice is that “medical providers should take care that each patient presenting as one of Jehovah’s Witnesses has ample opportunity to express their personal preferences of treatment outside the presence of any other member of the faith, including close family members.” And that is exactly what I did.

Dr. Neil Baum is a practicing urologist in New Orleans, Louisiana and the author of “Marketing Your Clinical Practice: Ethically, Effectively, and Economically,” (4th edition) Jones and Bartlett, 2009. He blogs at https://neilbaum.wordpress.com/

Erectile Dysfunction-Use It Or Lose It

Having intercourse more often may help prevent the development of erectile dysfunction (ED). Men who had intercourse more often are less likely to develop ED.

Analyzing a five-year study of 989 men aged 55 to 75 years from Finland, the investigators observed that men reporting intercourse less than once per week at baseline had twice the incidence of erectile dysfunction compared with those reporting intercourse once per week. Further, the risk of erectile dysfunction was inversely related to the frequency of intercourse.
Other factors that may affect the incidence of ED, such as age, chronic medical conditions (diabetes, heart disease, hypertension, cerebrovascular disease and depression), body mass index and smoking were included in the analysis of the data.
Erectile dysfunction incidence was 79 cases per 1000 in men who had reported sexual intercourse less than once per week, dropping to 32 cases per 1000 in men reporting intercourse once per week and falling further to 16 per 1000 in those reporting intercourse 3 or more times per week.
In addition, the frequency of morning erections predicted the development of complete erectile dysfunction, with an approximate 2.5-fold risk among those with less than 1 morning erection per week compared with 2 to 3 morning erections per week
Regular intercourse has an important role in preserving erectile function among elderly men. Continued sexual activity decreases the incidence of erectile dysfunction in direct proportion to coital frequency.

Bottom Line: Regular intercourse protects men from the development of erectile dysfunction, which may, in turn, impacts general health and quality of life. Isn’t that a good reason to have sexual intimacy?

A Grapefruit May Be The New Apple-But Be Careful

For generations we have been encouraged to eat an apple-a-day in order to stay healthy and keep the doctor at bay. Today, the new apple may just be the grapefruit.
Let’s look at the benefits of grapefruit:

Appetite Loss: Grapefruit reduces the feeling of hunger. This is the reason why people include grapefruit in their weight loss programs. High fiber contained by this fruit can satisfy hunger and thus may avoid any overeating temptation. Grapefruit juice, if combined with water, can quench the thirst.

Fatigue: Grapefruit is beneficial in the treatment of fatigue. It helps to dispel fatigue and general tiredness. It can bring about a refreshing feeling in you when you drink equal amount of grapefruit juice and lemon juice.

Acidity: The fresh grapefruit juice has alkaline reaction after digestion. The citric acid increases the effect of the alkalinity reaction after digestion. The juice extracted from the grapefruit is beneficial in preventing the acid formation and many other diseases that arise due to the presence of acidity in the body.

Indigestion: Grapefruit is useful for solving the problem of indigestion. It is very light as compared to other food articles and thus, acts immediately on indigestion by easing the heat and irritation caused in the stomach. It improves the flow of digestive juices, thereby improving the digestive systems.

Insomnia: A simple glass of grapefruit juice, if drunk before going to bed, can promote healthy and sweet sleep and thus, alleviates insomnia.

Constipation: A glass full of fresh squeezed grapefruit in the morning is the best remedy to control the constipation. Grapefruits are high in fiber and they result best in stimulating the colon and other parts of the body.

Urinary Disorders: Grapefruit juice is quite rich in potassium and vitamin C and thus, works as the best medicine in the case of recurrent urinary tract infections.

Lowers Cholesterol: The Journal of Agricultural and Food Chemistry shows that consumption of grapefruit can reduce LDL (“bad”) cholesterol, as well as triglycerides.

Caveats on grapefruit
As with any medication, there are considerations about the use of grapefruit with medications. More than 50 prescription and over-the-counter drugs are affected by grapefruit juice, including some of the most commonly prescribed medications. This list includes a number of medications used to treat high cholesterol, high blood pressure, depression, pain, erectile dysfunction, and allergies.

Grapefruit contains a substance that inhibits the enzyme called CYP3A4. This powerful enzyme breaks down numerous medications such as the cholesterol-lowering drug, Lipitor. Patients who take Lipitor, or some antidepressant medication, and eat grapefruit, can have toxic levels of the medications because the grapefruit inhibits CYP34A.

So what are patients to do? Check with your healthcare provider or pharmacist to find out about your specific drug. All new medications are tested for drug interactions, including grapefruit juice, before they are approved by the U.S. Food and Drug Administration (FDA). When you order medications in the mail or pick them up at your local pharmacy, you should receive a patient information sheet, which will let you know if your drug is affected by grapefruit juice. Some pharmacies may also put a warning label on your medication bottle. If you are not sure, ask the pharmacist.

Bottom Line: Grapefruit juice may be helpful for many conditions and improve overall health. However, there are precautions about using grapefruit because of interactions with certain medications. If you have any questions, check with your doctor or your pharmacist.

Don’t Want To Die? Avoid Going to the Hospital in July

You are to have elective surgery or you need to go to the hospital for a procedure. You may want to consider deferring this decision the month of July or in early August. Why? Conventional wisdom has long held that the quality of care in hospitals plummets during the month of July. But now a new study published in the Annals of Internal Medicine on July 11 confirms that suspicion.

Most newly minted doctors, interns, residents, fellows, and nurses graduate in June and begin working in hospitals on July 1. Teaching hospitals where doctors and nurses train have little experience caring for patients, often aren’t well supervised and don’t yet know the hospital system. As a result, patients remain in the hospital longer, and risk of complications and even death are higher in early July than the rest of the year. This finding is designated the “July Effect” in medical circles.

As a group, these physicians-in-training are supervised by fully trained doctors but from day one these new doctors are writing medication orders and doing certain procedures and diagnostic tests with relatively little direct supervision, so there’s always an opportunity for something to slip through the cracks and mistakes can be made.

Because on or around July 1, fresh, inexperienced interns, residents, nurses and other new health care workers first report to work at many of the nation’s hospitals, eager to start practicing medicine — on you.

In medical circles it’s known as the “July effect.” The new study reviewed data from 39 previous studies that tracked health results in teaching hospitals — including death rates and complications from medical procedures. The best designed and largest studies, the authors found, showed mortality rates increase 4 to 12 percent in July and revealed that many patients remain in the hospital longer, spend more time in surgery and have higher hospital charges in July than in other months. After analyzing more than 62 million death certificates issued across the country from 1979 to 2006, researchers found that fatal medication errors consistently spiked in July by about 10 percent — but only in U.S. counties with many teaching hospitals — and then subsided in August to levels on par with other months. Yet there was no measurable increase in counties with facilities that don’t employ residents, such as community hospitals.

How protect yourself from the July Effect

• Bring your own health records (including a “Personal Medication Record”).
• Ask a friend, relative or other health advocate to stay with you.
• To lessen the chance of mix-ups, state your name to anyone providing you with care.
• Know the name of the doctor who is ultimately in charge of your care.
• Ask your doctor who will be doing the surgery or the procedure and consider asking him\her if they will promise to do it and have the new doctor serve as an assistant

Bottom Line: All surgery and all medical procedures have risks and complications but you can reduce these risks by avoiding a teaching hospital the month of July and early August.

This article was excerpted from “Why? New doctors and nurses report to work for the first time, eager to ‘practice’ medicine on you”
by: Sid Kirchheimer

http://www.aarp.org/health/doctors-hospitals/info-06-2010/why_you_should_avoid_the_hospital_in_july.3.html

It’s Safe To Turn On Your Cell Phone-You Won’t Get a Brain Tumor

There’s been a lot of media attention about the risk of developing a brain tumor if you excessively use a cell phone. The Danes have come to relieve our anxiety about the use of cell phones. A study of more than 2.8 million Danish adults found that those who’d used a cell phone for 11 to 15 years were no more likely than newer users or non-users to develop an acoustic neuroma which are slow-growing tumors that from the nerves in the inner ear to the brain. The symptoms of an acoustic nueroma incude ringing in the ears, dizziness and balance problems; in a small number of cases, they can grow large enough to press against the brain and become life-threatening.
Acoustic neuromas grow in the area of the brain where greater energy emitted from the cell phones is absorbed, compared to other areas of the brain.
Doctors might expect that if cell phones were a cause of brain tumors, people who’ve used them for a long time might have an increased risk of acoustic neuroma — especially on the side where they typically hold their phone. But the study reported in the recent issue of Journal of Epidemiology did not bear out this assumption. Among the nearly three million Danish adults for whom they had data, just over 800 were diagnosed with acoustic neuroma between 1998 and 2006. And those who’d used cell phones the longest — at least 11 years — had no greater risk than shorter-term users or non-users.
Also there was no indication that long-term cell users had larger-than-expected tumors. Nor did they have a tendency to develop acoustic neuromas on the right side, where most held their phone. Many researchers believe that the radiofrequency waves from cell phones are not capable of causing tumors.
Bottom Line: The jury is out on the relationship between cell phone use and brain tumors. I plan to continue using mine on a regular basis. I’ll let you if I have trouble hearing or ringing in my ears!

Advice From a Landscaper-John Florios

I received this blog from Dr. Neil Neimark (How can I pass up a blog from a man named Neil?) and I would like to share it with you.

What Is Your Passion?

Developing a passion for doing good in the world is one of the keys to living a vital and healthy life.

But just how do we go about doing that? And just what does it mean to be passionate?

To answer this question, let’s look at the meaning of the word, “passion.” The Latin root for the word “passion” means “to suffer.”

In this sense, true passion means that in pursuing our own fullness of expression, we may suffer (by experiencing failure, rejection, loss or pain).

But, really, who among us wants to suffer?

No one really, but the key is this: It is only in our willingness to suffer (struggle) in pursuit of our values and dreams, that we unlock the hidden strength and vitality that helps us find meaning and fulfillment beyond our suffering.

Let me illustrate for you the healing power of living passionately with an inspiring story told by Bernie Siegel M.D., in his book Peace, Love & Healing.

It was late February when a patient named John Florios was referred to Dr. Siegel for a rapidly spreading stomach cancer. Dr. Siegel advised John to have surgery immediately. John looked at Dr. Siegel and said, “You’re forgetting something.” “What did I forget?” asked Dr. Siegel. “It’s springtime,” said John, “and I’m a landscape gardener and I want to make the world beautiful. I’ll come back later for the surgery. That way if I survive it’s a gift. If not, I will have left a beautiful world.”

With that comment, the patient left the office, not to be heard from again, until about a month later, when he returned to Dr. Siegel’s’ office saying “The world is beautiful now. I’m ready.” Surgery was performed and the first night after the operation, John looked great with no pain or discomfort, however the pathology report revealed significant cancer had spread to the lymph nodes and to the margin of resection. Dr. Siegel advised John to have chemotherapy and radiation. Once again, John replied, “You forgot something.” “What did I forget this time?” asked Dr. Siegel. “It’s still spring. I don’t have time for all that.” The patient was at peace with his decision to have no further treatment. He recovered rapidly from the surgery and left the hospital ahead of schedule.

Two weeks later, John returned to the office complaining of stomach pain, but it turned out to be a virus. Four years later, as Dr. Siegel was pulling a chart from a patient’s room, he found the name “John Florios” on it. “You must have the wrong chart,” he said to his nurse. “No that’s the right one,” she replied. “Then there must be two John Florios,” puzzled Dr. Siegel, quite certain that, based on the pathology report, the “other” John was long gone.

When Dr. Siegel walked in the room he couldn’t believe his eyes. “Why are you here?” he asked. John said, “I’d like to know what I can eat after a stomach operation.” “Four years after! Anything!” said Dr. Siegel, “But why are you here?” “I got a hernia from lifting boulders in my landscape business,” retorted John. In his usual style, John refused admission to the hospital and had the hernia repaired under local in the office.

Six years after his surgery, John was 83 and doing well. We don’t know what’s happened to his cancer. It may still be there, but John is alive and well.

THE MORAL OF THE STORY

We cannot help but be moved by John’s determination to follow his heart and to make the world a more beautiful place, in spite of the seriousness of his disease. His refusal to be defeated by his diagnosis is a forceful illustration of how passionate living can help activate our healing system.

But please understand that the greatest healing happens when we combine the best of medical science with the best of the human spirit. So please DON’T postpone surgery for a life threatening condition. Please DON’T refuse radiation and chemotherapy. Please DON’T avoid visiting your doctor for serious medical problems. Please DON’T ignore your doctor’s advice and recommendations.

Please DO those things that give your life meaning and purpose. Please DO those things that help make the world a more beautiful place. Please DO those things that bring you and others a deeper, richer sense of what is good and meaningful in life. Please DO follow your own inner sense of what is right and true. Please DO remember that even in the face of our own personal tragedies, we can help to make the world a more beautiful place.

Be well. In body and soul,

Neil F. Neimark, M.D.

Neil F Neimark MD Inc

4980 Barranca Pkwy, Suite 207
Irvine, CA
92604
US

The best diagnostic medical device is right in your own home

Dr. George Lundberg, M.D., who was the previous editor of the prestigious Journal of the American Medical Association wrote this blog and I think it is certainly worth passing along to my friends and followers.

What is the year 2011′s best diagnostic and therapeutic medical device?

Is it the PET scan with special bells and whistles to detect early Alzheimer’s?

Is it the robotic surgery that reams out the worst prostate cancers remotely?

Is it the Total Genomic Analysis that predicts what your genetic future holds?

Is it the GI endoscope that checks out your innards from stem to stern?

Is it the latest drug-eluting stent that promises to keep your clogged arteries clear in perpetuity?

Is it the light or electron microscope?

Is it the stethoscope?

Is it the contrast MRI that paints in vivid detail the artistic nuances of your bones, ligaments, and joints?

Is it the Proton Beam Machine to zap your cancer from 100 yards?

Is it a CT total body scanner that purports to find so many iddy biddy diseases so early you can fix them?

Is it the ordinary x-ray machine that can both diagnose and treat so many conditions?

Is it the health Internet from which you can access all recognized medical knowledge?

No, it is none of those basic or advanced technologies, all of which may be wondrous inventions, but have little effect on the totality of American life and death.

The best diagnostic and therapeutic device, by far, is the cheapest and easiest to use of all — the bathroom scale!

Everyone needs to use it in the privacy of their home every day and recognize and use the actionable results, thereby changing their life and their health for the better, at almost no cost to themselves, the government, or their health insurance company.

Proper use of the bathroom scale can help prevent obesity and with that, heart disease, congestive heart failure, diabetes, sleep apnea, stroke, hypertension, osteoarthritis, GERD, various cancers, depression, even erectile dysfunction.

What a deal. A real medical miracle machine. Use it … every day. And don’t let your number rise.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Generic Drugs-Buyer Beware!

Drug costs are spiraling out of control and out of reach for many Americans.  As a result many patients are turning to generic drugs and drugs manufactured in India and China.  In 2002, the U.S. imported $331million of pharmaceutical products from China.  In 2010, the U.S. imported more than $1.7 billion and there doesn’t appear to be an end to this outsourcing of medications to China and India. 

All that glitters is not gold

In 2007 a tainted heparin was brought to the U.S. from China and it was directly responsible for 149 deaths of American patients. Baxter Healthcare, the company that imported the heparin said that the drug was tested for efficacy but the tests did not detect the contaminant that caused the fatal allergic reaction. 

Another drug, Neoral, which is used to prevent rejection of transplanted kidneys, and is manufactured in China resulted in a unacceptable 10% rejection rate.

The French have identified that the chemotherapy drug, Taxotere, did not meet approved specifications and as a result the efficacy of the drug may be affected. 

In China poor oversight, weak governmental regulation and occasional gross negligence are likely to persist in compromising drug quality.  The Chinese drug regulation system has a daunting task in overseeing a huge industry.  Our government through the FDA has established an office in China and is increasing investigations of the plants that export to the U.S., but the agency is understaffed.  At the moment and with the existing staff, the agency can assess each site only once every 13 years.  The best we can hope for is that the FDA pressure the Chinese authorities to test what is on the market and remove any substandard products that are identified. 

Bottom Line: Those generic drugs from China and India may be available at a steep discount but the price you pay may be affecting your health.

Vaginal Dryness-Another “VD” You Don’t Want To Have

For most women sex is fun and enjoyable.  However, if there isn’t enough lubrication and the vagina is dry like the desert, sexual intimacy can be excruciatingly painful with fun placed on the back burner.   It’s especially frustrating when the natural vaginal lubrication a woman is used to “dries up,” making it so much more difficult to enjoy what is one of life’s greatest pleasures— sex after 50!   In spite of the list of physical changes from aging, studies have shown that sexual satisfaction increases, rather than decreases, as women grow older. This article will provide suggestions to fix the problem and help restore vaginal lubrication to its former friction free status that makes intimacy something to look forward to rather than to avoid.

Why women experience vaginal dryness

Menopause is results in a loss of estrogens and this can create more than hot flashes.  This condition that affects every woman in her late forties and early fifties also results in less natural lubrication as the woman ages, resulting in vaginal dryness and dyspareunia, a medical term for post-menopausal thinning of your vaginal walls resulting in painful intercourse.  You are not alone as one in four post-menopausal women experiences pain, either before, during and after sexual intercourse. Unfortunately, many are embarrassed to discuss female dryness and intercourse pain, either with each other or with their gynecologist. It’s time to get over that fear. Every woman experiencing intercourse pain after 50 should seek a doctor who is skilled in vaginal examinations, and one who isn’t afraid to ask you everything you need to know to help you address this pain.

The solution isn’t always at the tip of a pen with a prescription written by your primary care doctor or your gynecologist.  There are several over the counter remedies that will put the slippery back into the bedroom activities.

Liquid Silk is topical cream used by many postmenopausal women for overcoming vaginal dryness.  Another is Carrageenan, which has no smell or taste.  A popular solution is Replens, which is a unique, estrogen-free vaginal moisturizer. It has the advantage of being long-lasting as one application can last three days and women can use it two or three times per week. As a result there is more spontaneity with sexual intimacy and the woman need not excuse herself to apply the cream when the opportunity presents itself. Astroglide’s name says it all as it does make things glide and slide.  Women find this topical gel a nice companion to their toys and accessories.  A little dab and a little water works just great.   OH! Is the name of a product which can fuel the fire down there in a gentle, sensual way.  And finally, don’t over look the ol’ standby, K-Y Jelly, mother of all vaginal lubricants.  It’s inexpensive, effective, and now comes with more exciting names such as Silk-E and His and Hers. For those women who are reticient about requesting these products at the local drug store, you can buy them online at: GoodVibrations.com, A-Womans-Touch.com, or TabuToys.com.

Getting started.  Suppose you may have purchased vaginal lubrication, or you may tried several out and found one that fits your fancy, how do you present this option to your partner.  Two suggestions: First, invite your partner to apply the lubricant. Seeing how it works will probably turn him on, too, and encourage him to make it part of your sex play.  Second is to try using some of the cream or ointment on him during foreplay. The way your hands will slide should make a believer out of him. If he is still resistant and I doubt he will be, try putting some lube on your inner lips of your vagina when you are planning to have sexual intimacy.

First line therapy consists of the vaginal lubricants just described.  However, if lubrication isn’t enough, there are other options usually consisting of vaginal estrogen therapy, which I will discuss in greater detail in a following blog.

Bottom line:  While female dryness which develops at the time of menopause can result in painful intercourse, the good news is that effective treatments exist for vaginal dryness and dyspareunia.