Doctor's Advice - A mature woman's sex life

Q. I am a woman who has a very good sex life. I have been married twice, and although my second husband died four years ago, I have now resumed dating, and am pleased to say that my body still seems to be in great shape, and that sex is still very enjoyable. However, one of my friends has told me that my body "is certain to change a lot as I get older". She hinted that the female sex organs tend to 'shrivel up' as the years go by. And she told me that very few 50-year-olds still have a good sex life.  Is this all true, doctor? If so, it sounds pretty depressing!

A. No, it is not true. What your friend is saying is ridiculous. It may be the case that 100 years ago, women 'gave up' on sex at around 50, but that is definitely not true today.

I have a few female patients who are over 50, and are leading exciting and fulfilling sex lives. I even know a few patients who are over the age of 80 and are still making love occasionally.

One trend that is very noticeable these days is that a surprising number of women find that they become 'multi-orgasmic' when they reach middle age. In other words, they are able to climax repeatedly in a single evening. However, this ability depends to a large extent on whether they have a loving, romantic and skilled partner!

It has to be admitted that as we get older, various parts of our bodies do show some signs of 'wear and tear'. That is true of the genital organs.

However, the changes in the sex organs are not very great. And these days, if there is any problem with lovemaking, then modern medical treatment can often put everything right!

The changes that occur in the female body has been studied extensively by American researchers, and particularly by the famous sexologist Masters and Johnson. Some of the changes which are likely to occur in the sexual parts of a woman:

The breasts: In older women, their nipples become erect in response to sexual excitement, just the same way as it does in younger women. But there is one change which occurs as one grows older. Often, when the breast is stimulated, it does not increase in size as it used to.

The clitoris: In many older women, the clitoris does not enlarge as much as it once did during sexual stimulation. However, it should 'works' equally well. Skilled, gentle stimulation of it will still produce intense pleasure, and orgasms.

The labia majora (the outer lips). These tend to lose a certain amount of fatty tissue over the age of 50. Only a few women are concerned by this slight change in appearance. If absolutely necessary, it can be reversed by cosmetic surgery.

The labia minora (the inner lips). As you are probably aware, in young women the inner lips change colour during sexual excitement - becoming red as an orgasm approaches. In women over 60, this colour change is sometimes not so marked.

The vagina: In the years after menopause, the walls of the vagina have a tendency to become slightly less elastic and 'cushioned'. But if this is a problem, it can easily be corrected by the use of a vaginal hormone cream, prescribed by a doctor.

Lubrication: Quite often, natural vaginal lubrication takes longer to occur in the older women. But taking more time for foreplay will often correct that. Also, there are now many very good vaginal lubricants which are available from pharmacies and online. And if these preparations do not work, a small dose of a vaginal hormone cream or pessary (vaginal tablet) will soon restore lubrication to satisfactory levels.

So there is no reason why a woman over the age of 50 should not continue to have a very good sex life if she wants to. Masters and Johnson pointed out that many women enjoy what might be termed a 'second honeymoon' during that part of their life!

Q. I am a businessman, and last month while I was on a trip to Negril, I had sex with a young woman there.  Now I experience pain when I urinate and a slight discharge. I realise that this means that I have picked up an infection from her. But could I have given it to my wife?

A. Your symptoms suggest that you have a chlamydia infection, or possibly gonorrhoea. So you must get some tests done and start receiving treatment immediately. Sounds like you had sex with your wife after you came home from the trip. If so, then you will most likely have given the infection to her. So she, too, needs tests and treatment, even if she has no symptoms.

Both you and your wife must see a doctor - fast. Organising this without upsetting your spouse will require considerable diplomacy on your part. Incidentally, you should also try to contact the young woman and tell her that she needs medical advice.

Q. I am 34, and have been having very bad menstrual pain. My doctor says she thinks it is endometriosis. What is that?

A.  Endometriosis is a common condition among women in their 30s. It's a disorder in which little pieces of womb lining somehow turn up in the wrong place, like on the ovaries or just behind the womb.

During their monthly cycle, these little bits of tissue try to menstruate. But because they are in a confined place, they can't do so. And the result is very painful. You need to see a gynaecologist to confirm the diagnosis. You may have to do an operation, but often the condition can be managed by medication alone. I assure you: the outlook is good.

Q. I am a 48-year-old man and I have just discovered a little lump in my testicle. Is this a cancer?

A. In Jamaica, testicular cancer at the age of 48 is pretty rare. Nevertheless, a lump in the testicles always needs urgent checking by a doctor. You will probably have to have an ultrasound scan of the testicles. But my bet is that all will be well.

Q. My husband says that I do not need to go on the Pill because he will always 'pull out' at the last minute. Can I depend upon him doing this?

A. I don't think so. Men have a terrible tendency to give 'just one more thrust'. Very often, the result is that sperms get into the vagina. Your spouse's technique of contraception, which is called coitus interruptus, is better than nothing. But I feel you should insist on a more reliable method.

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