Sex and Aging

There is a common myth that as one ages they become less interested in sex. This is false. Pleasure and interest don’t diminish with age. It is true though that as our bodies age, sex life is affected. In women this change is brought on mostly by menopause. Menopause is the natural and permanent stopping of the monthly female reproductive cycles. After menopause, estrogen and androgen levels drop, causing physical changes. Most of women, about 81%, reported menopausal symptoms. Nearly 60% of those women noted vaginal symptoms, such as vaginal dryness, pain during sex, vaginal narrowing, vaginal shrinkage. Advances in medicine, and improved nutrition and healthcare, for men and women, are helping to keep sexual relationships strong.
While the desire for sex is still strong for older women, one older women pointed out her different view on sex as she aged--“When one is young, love and lust have an urgency and sometimes feel like the most important part of a relationship. As you get older the sexual act becomes more comfortable, less urgent but in many ways more passionate. You don't worry about pregnancy, or such things you just enjoy the closeness with another human being.” Although the sexual relationship of a couple may change as they age, it does not mean the change is negative. It may just become a different type of closeness.

The Pap Test

A Pap test is done to look for changes in the cells of the cervix. During a Pap test, a small sample of cells from the surface of the cervix is collected by your health professional. The sample is then spread on a slide (Pap smear) or mixed in a liquid fixative (liquid-based cytology) and sent to a lab for examination under a microscope. The cells are examined for abnormalities that may indicate abnormal cell changes, such as dysplasia or cervical cancer.

It is important to have your first Pap test within 3 years of having sex for the first time or by age 21. You may be able to stop having regular Pap tests after you are 65 to 70 years of age, if you have had 3 normal Pap tests in a row, you do not have a high risk of cervical cancer, and you have not had any new sex partners over the last 3 years. If you do not have a uterus, you don’t need a Pap test as long as cervical dysplasia or cervical cancer was not the reason your uterus was removed. You may need more frequent Pap tests if you have had an abnormal Pap test in the past. Talk with your health professional about how often you should have Pap test.

Before a Pap test:

• Try to schedule the test when you are not having your period, since blood can interfere with the results of the test. If your bleeding is light, you may still be able to have a Pap test.


• If you have symptoms such as bleeding after intercourse, get a Pap test as soon as you are able to schedule one.


• Do not use douches, tampons, vaginal medicines, sprays, or powders for at least 24 hours before having a Pap test.

Birth Control

Women are capable of becoming pregnant in their teens until well into their 40s.
About 50% of all pregnancies are unplanned (ACOG, 2002).
Women have many choices today when it comes to contraception.
The 100% effective way to prevent pregnancy is continuous abstinence.

Fertility Awareness-Based Methods

Basal Body Temperature method – based on the fact that most women experience a decrease in BBT, followed by a slight, but detectable increase in BBT just after ovulation.

Calendar Method (“Rhythm Method”) - In order for this method to work, a woman must keep a record of the length of each cycle (the start of one period to the start of another period) for at least 8 consecutive months.
This method is based on the fact that the interval from ovulation until the beginning of the next period is always 14 days, regardless of cycle lengths.

Cervical Mucus method - prediction of ovulation is based on daily changes in the amount, consistency, and color of the cervical mucus.
As ovulation approaches, the mucus changes from cloudy and thick to clear and thin (raw egg whites), and suddenly increases in amount for 1 or 2 days (peak).

Barrier Methods

Diaphragm - soft rubber cup-like device (with a flexible, spring rim) that is inserted into the vagina to cover the cervix.

Cervical Cap - small, thimble-shaped rubber cap covers the cervix like a mini-diaphragm.

Sponge – soft absorptive sponge inserted into vagina to cover cervix

Male Condom - sheath that fits over a man’s erect penis, acts by preventing the sperm from entering the uterus (best protection against STDs)

Female Condom - 2 flexible diaphragm-like rings at either end of a soft, loose-fitting polyurethane sheath.

Foam, Cream, Jelly, Suppositories, & Film - these products contain spermicides.

Intrauterine Device/Intrauterine System

IUD/IUS must be inserted into the uterus the last 2 days of a menstrual cycle to ensure lack of pregnancy; must be inserted by a clinician.

Hormonal Contraception

Seasonale – birth control pill taken for 84 days straight, then 7 days off = only 4 periods a year!

The shot (Lunelle) contains both estrogen and progesterone similar to what the body makes.

The ring (NuvaRing) is a small, flexible ring which is inserted deep into the vagina.

The patch (Ortho Evra) is a thin plastic patch that is placed on the skin of the buttocks, stomach, upper outer arm, or upper torso once a week for 3 weeks.

Progestin-only Methods

The “mini” pill contains progesterone only thus making it safe to use during breast-feeding.

The shot (Depo-Provera) is a long-acting form of progesterone that is injected every 12 weeks.

Contraceptive implants (Norplant) has received much attention due to their controversial nature.

Other Methods

Post-coital Contraception - "morning after" pill or emergency IUD insertion

Sterilization - woman (tubal litigation) or male (vasectomy)

Essure System - small metallic implant placed in fallopian tubes, causes scar tissue to form, blocking fallopian tube, thus preventing pregnancy

Continuous Breastfeeding of LAM (Lactational Amenorrhea Method) - woman cannot have had a period, breastfeeds at least 6 times a day on both breasts, and wakes for night feedings.

Basis Female Anatomy

Pictures say a thousand words... in this case body parts.

Menstruation

Averages 28 days in length.
During menstruation, the endometrial lining of the uterus is shed, thus the discharge of blood and tissue.
On average, women lose about ¼ cup of blood each month.
Day 1 of the menstrual cycle is the first day of bleeding.
Menstruation is considered an endocrine process, meaning it is controlled by hormones.

During the first half of the cycle, FSH is released causing the maturation of the egg in one of the ovaries prior to ovulation.
The egg is located in a special part of the ovary called a follicle, which secretes estrogen.
Each month, estrogen stimulates the growth of a new endometrial lining where the fertilized egg can implant.

Ovulation

Half way through the cycle, LH causes the release of the egg from the follicle. This is ovulation, and may cause a brief, sharp pain on one side of the abdomen.
Increased vaginal mucus or spotting may occur at or near the time of ovulation.
In a 28 day cycle, ovulation occurs on day 14 (the days before and after ovulation are the most fertile days).

After ovulation (2nd half of cycle), there is an increase in estrogen and progesterone, which may be responsible for premenstrual tension.
After releasing the egg, the follicle is now called a corpus luteum, which continues to secrete hormones.
The egg enters the fallopian tube, waiting to be fertilized (it takes 6 days for the egg to get to the uterus).
At the end of the cycle, the corpus luteum stops producing estrogen and progesterone if pregnancy has not occurred.
This decrease in hormones causes the blood to stop nourishing the uterine lining, and menstrual bleeding begins.
The low production of estrogen stimulates the pituitary gland to produce FSH, thus beginning the next menstrual cycle.

Fertilization

Fertilization occurs with the union of the male sperm and the female egg in the fallopian tube.
It takes about 6 days to travel down the fallopian tube where it is then implanted in the uterine wall.
With the implantation about a week after ovulation, the placenta begins to develop.
The placenta then begins to produce the HCG hormone, which prevents menstruation from occurring.
HCG also stimulates the corpus luteum to continue producing estrogen and progesterone for the first 3 months of life, after which production is taken over by the placenta.

Self Esteem and Sexual Health

Research has shown that youth who are discriminated against and have problems with self-esteem are more likely to behave in risky sexual behaviors. Advocates for Youth did some research, and wrote a paper discussing this problem in youth today.

The Problem

Youth who face prejudices by virtue of their identity, life experience, or family circumstances disproportionately experience teen pregnancy and sexually transmitted infections (STIs), including HIV. Research often focuses on the socioeconomic factors—such as poverty, family distress, and access to health care—which contribute to teenage sexual risks. Little research, however, focuses on the effect on young people of discrimination based on their age, race/ethnicity, gender, class, and/or sexual orientation.

The Paper

The paper encourages those who work with youth to understand the impact of prejudice and discrimination on vulnerable adolescents, to assess and address their needs, and to build on their assets. In prevention programming, it is essential to empower young participants by involving them in all aspects of designing and running programs for youth. It is equally essential to provide culturally appropriate interventions, with culturally competent adult and youth staff.

We must Understand the Impact of Prejudice and Discrimination on Young People:

1. The historical and cultural context of reproductive and sexual rights, especially for women of color and low-income women, is one of persistent inequality.
2. Prejudice and discrimination have strongly negative impacts on the health of young people.
3. Young people face barriers and obstacles in sexual and reproductive health programs.
4. Teens who experience prejudice and discrimination may have less self-esteem and fewer resources and skills to meet the challenges that all teens face.
5. Media strongly influence adolescents' self-perceptions and self-concept.

Programs must recognize and deal with the broad social, economic, and political framework within which teens live.

(Davis, Laura – 2003 – Advocates for Youth)

Religion and Sex

Sexual health can be a controversial topic. It is important for women to understand their bodies, but it is even more important for the sacredness of sex and related topics to be respected. This post will give some insight into the views of respected and inspired leaders of The Church of Jesus Christ of Latter-day Saints on the topic of sex and sex education.

The Eternal Purpose of Sex

It is important to teach children that Heavenly Father did not intend sex to be something evil and corrupt. Rather sex has two basic purposes: first, to enable us to have children to fulfill God’s command to “be fruitful, and multiply” (Genesis 1:28), and second, to express that special kind of love shared between a husband and a wife. When a husband and a wife use sex properly in their marriage, the Lord will bless them. However, when people abuse this divine gift, they please only Satan and his followers. President Spencer W. Kimball has clearly stated: “We strongly warn all our people from childhood to old age to beware of the chains of bondage, suffering, and remorse which come from improper use of the body.

The human body is the sacred home of the spirit child of God, and unwarranted tampering with or defilement of this sacred tabernacle can bring only remorse and regret. We urge: stay clean, uncontaminated, undefiled.” (In Conference Report, Apr. 1974, p. 8; or Ensign, May 1974, p. 7.)

We should teach our children that self-gratification inside or outside of marriage will not fulfill the eternal purpose of sex. Sex is to establish eternal families and to unify a husband and wife. When viewed in this way, sex is an uplifting influence.

("Teaching About Procreation and Chastity" - Gospel Lobrary - Support Materials - Family)

Questions and Answers

Some definitions by the World Health Organization—

What is sex?
Sex refers to the “biological characteristics that define humans as female or male. While these sets of biological characteristics are not mutually exclusive, as there are individuals who possess both, they tend to differentiate humans as males and females.”

What is sexuality?
Sexuality is a “central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious and spiritual factors.”

What is sexual health?
The World Health Organization defines sexual health as “state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.”

What are sexual rights?
Sexual rights “embrace human rights that are already recognized in national laws, international human rights documents and other consensus statements. They include the right of all persons, free of coercion, discrimination and violence, to:

• the highest attainable standard of sexual health, including access to sexual and reproductive health care services;


• seek, receive and impart information related to sexuality;


• sexuality education;


• respect for bodily integrity;


• choose their partner;


• decide to be sexually active or not;


• consensual sexual relations;


• consensual marriage;


• decide whether or not, and when, to have children;


• and pursue a satisfying, safe and pleasurable sexual life.”

Where and how long does it take for the sperm to reach the egg?
Fertilization happens in one of the fallopian tubes, which carries an egg from an ovary to the uterus. It can take up to seven days after intercourse for sperm and egg to join and become a fertilized egg. Usually, it's because the sperm gets into the fallopian tube before the egg is released.

Should I be worried if I have very heavy bleeding on my period?
Menstrual flow varies from woman to woman. Most women’s flow is around 6 to 8 ounces over the course of a few days. Menorrhagia is the medical term used for excessively heavy periods. Some signs of menorrhagia include:

• menstrual flow that soaks through at least one sanitary pad or tampon per hour


• having to change pads or tampons overnight


• a period that lasts longer than seven days


• menstrual flow that includes blood clots


• menstrual flow that interferes with your routine

Usually menorrhagia is a symptom of a hormonal imbalance or uterine fibroids. Visit your gynecologist if you are concerned.

What effect do intense workouts have on my period?
Increased exercise regimen can cause lack of menstruation. The absence of menstrual periods for three or more consecutive months is known as amenorrhea. When women involved in sports lose their period, the condition may be termed "athletic amenorrhea." Although the exact mechanism is not known for sure, and may vary from person to person, amenorrhea is associated with one or more of the following:

• low body weight


• low body fat


• physical stress


• nutritional inadequacy


• hormonal changes


• high intensity training


• long duration training

What’s the difference between a STD and STI?
STD stands for Sexually Transmitted Disease. It is an illness that has a significant probability of transmission between humans or animals by means of sexual contact. STI stands for Sexually Transmitted Infection. It has a broader meaning; a person may be infected, and may potentially infect others, without showing signs of disease.

What’s a gynecologist?
Specialist that deals with health of the female reproductive system (uterus, vagina, and ovaries). Literally means “the science of women.”

What tests are done by gynecologists?
Breast exam
Doctor will feel for lumps or anything irregular.
Pelvic exam
Checks vaginal area for signs of irritation, discharge, warts, or anything irregular.
Speculum is used to hold vagina open so the doctor can see the cervix.
Will collect some fluid for a Pap test.
Internal Organs
Two fingers in vagina and press on abdomen with other hand.
Feel internal organs (uterus, fallopian tubes, ovaries) to make sure they’re free of
fibroids, cysts, and tumors, and they’ll check the size, shape, and position of uterus.

What are some types of birth control?
These will be gone over in further detail in an upcoming post, but some important ones to note:
Abstinence
Fertility Awareness Method: Natural Family Planning
Barrier Methods: Devices
Hormonal Methods
Withdrawal & Sterilization

What are long-term effects of birth control?
The only birth control to have long-term effects would be those that alter the hormone levels in the body (ie hormonal methods). A study published in January 2006 in the Journal of Sexual Medicine claims that women who use birth control pills may suffer from long term side effects. Possible side effects include decreased desire and arousal, decreased lubrication, and increased sex-related pain.

What are good sources of information on sexual health?
Online Sources Include:
Medline Plus – National Institutes of Health
http://www.nlm.nih.gov/medlineplus/sexualhealth.html
World Health Organization
http://www.who.int/reproductive-health/gender/sexualhealth.html
Centers for Disease Control and Prevention
http://www.cdc.gov/sexualhealth/
Also Local Organizations:
Planned Parenthood of Utah
www.plannedparenthood.org
1842 S Columbia Ln
Orem, UT 84097
(801) 226-5246
Utah County Health Department
151 S University Ave.
Provo, UT 84604
(801) 851-7000