What Women Want to Know

I am 36 and my husband wants to have sex a lot more than I do. Sometimes I pretend I’m sleeping because I don’t have the energy anymore after a full day with the kids. Is this awful?

Great question- this is such a common situation, that I get this type of question all the time.

I always start out with this question: when you are on vacation and have a night or two to catch up on sleep - how is your romance and sex life then? (I know many of us never get this opportunity to go on vacation and rest, but try to think back to this time or even imagine). For many, once they are away from all the stress and responsibilities and are no longer sleep deprived, the sex comes back and is nice again.

The good news is there are easy ways to improve it. First, it would be great to talk with your partner at some point when it is not immediately relevant. Sometimes even starting in an observational way like, “I know we haven’t been connecting intimately like we used to. I miss that and it is important to me, and I wanted to check in to see how you were feeling about this.” You’ll be amazed, how often they are so relieved to be able to discuss this and know it is important to you too.

Then you can brainstorm ways to change little things in your lives to improve the situation. Sometimes it can be simple changes like scheduling a “date”, or trying to connect in the morning or day, when you are often less exhausted than at night. Scheduling this date also gives you both something to look forward to and sometimes the anticipation and even courting before hand can add some excitement and set the tone. If your planned date is at the end of the night once the work is done and kids are down, anticipating it allows you and your partner to work together to get all of the tasks done and may reduce your load and exhaustion and help with desire. Laura Berman, a famous sex therapist, feels that foreplay starts often days before for women, by having a husband help with everyday chores and responsibilities that are meaningful and helpful to you. Once you make it a priority, it is amazing how you will find opportunities to work together for intimacy which is so good for the relationship in so many ways.

It is also helpful to think about what you would each like in terms of frequency, and work towards it just like we do with exercise or other life goals. The saying “use it or lose it” actually has some relevance here. For women, the more often you have sex, the more desirable it becomes and also there is increased blood flow to the area which means more lubrication, less pain, less dryness and muscle tension, and more orgasms. [click to continue…]

Two studies just released in the British Medical Journal both found ways to effectively treat and prevent postpartum depression without antidepressant medications. One study found that patients who received counseling from a trained nurse had significantly less postpartum depression at 6 months postpartum than the group that did not receive any special counseling. In the second study, new moms who received phone calls from women who previously had postpartum depression were significantly less likely to develop postpartum depression at 3 months. The author states that their research is consistent with other studies that link depressive symptoms with “smaller social networks, fewer close relationships…” in society.1 Take home message: those having symptoms of postpartum depression or at high risk should seek prompt evaluation from their provider, and may consider using trained counseling and support groups in conjunction with conventional evaluation, with or without medications.

References:
1. MedPage Today 2009
2. Morrell C, et al. “Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women: pragmatic cluster randomized trial in primary care”. BMJ 2009.

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I am 34 and we’ve been trying to get pregnant for about 6 months and I’m not sure whether to be worried. I had an early miscarriage 3 years ago and have a healthy 2 year old at home. Both times I got pregnant right away. Should I be concerned?

I can imagine your concern over the situation but I am optimistic for you given the information I have. You easily conceived a healthy child, a reassuring sign of your proven fertility. Even for those who have never had a baby, remember that the odds are on often your side. It can often take 6 months or longer to conceive — 85% of couples will conceive in 1 year. After that, 50% of the remaining couples will get pregnant on their own over the next 36 months, and the remaining 7% have a lower chance of conceiving naturally. Infertility is defined as 12 months of frequent intercourse without conception.  Everyone has friends who tell you that they got pregnant each time on their first try. These may be the same people who eat whatever they want and never gain weight. Don’t worry about their stories. People exaggerate, and comparing notes can add to your stress. Find a few supportive people whom you trust and confide in them. 

We typically recommend seeing your gynecologist after 6 months of trying to conceive for women age 35 and older and after 12 months for women under 35. For those over 40, you can go in right away. If you’re not ovulating or not having regular menstrual cycles, if you have significant pain or bleeding, have a known history of large fibroids, endometriosis, or had a history of prior infertility, it is worth seeing your doctor sooner.  When you see your doctor, it is helpful to bring your menstrual calendar and ovulation charting. She will get a detailed history, check blood tests, do a pelvic ultrasound and/or an HSG (tubal dye study) to check the tubes and anatomy, and usually request a semen analysis on your partner. Usually after the initial workup, you will get a referral to a reproductive endocrinologist (REI) for a consultation. Even if you know that you never want to do fertility treatments, it can be helpful to have even one visit to get their expert assessment on what the issues might be and what the options are. Be sure to find someone with a good bedside manner and excellent referrals from your doctor and any friends or nurses.

To maximize your chances at home, [click to continue…]

Finding time to exercise and establishing a regular exercise routine is a challenge for many of us. Even though we can lose weight on a diet without exercise, for optimal health, regular exercise, even walking, at least 5 days a week should be the goal. I have found that for my patients and myself, the key to a consistent exercise routine is finding something that you love and is easy to do. Some may love the social aspect of group activities and classes while others may prefer individual activities as a time to recharge. For many busy moms, attending classes is not always practical, but sometimes getting a good exercise DVD or stroller walking with your iPod or a buddy can steal you away from reality for 30 minutes, and you will emerge healthier and more energetic.

I love the book “Five Factor Fitness” by Harley Pasternak who is best known for being the fitness trainer of the Hollywood stars. When I looked into it, I figured looking even half as amazing as Halle Barry couldn’t be too shabby! Pasternak’s program suggests varying your exercise routine and working the major muscle groups at once to reduce the amount of time you need to work out and have a maximum impact. He has 20 minute workouts that you can even do at home or at the park with kids (I’ve done it) and they are great for every fitness level. You can add more cardio at the end if you want a longer workout. There is a five factor website where you can get a weekly fitness and diet plan with shopping lists for a fee and the book is often on sale for under $10.

If you are expecting [click to continue…]

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A study in the New England Journal of Medicine found that elective repeat cesarean delivery before 39 weeks increases the risks to the newborn. Risks can include respiratory problems, infection, low blood sugar, and prolonged hospitalizations. The good news is that the current standard of care is not to schedule elective cesarean deliveries before 39 weeks so this should not be an issue at many major medical centers.

Tita ATN, et al “Timing of elective repeat Cesarean delivery at term and neonatal outcomes”.   New England Journal of Medicine 2009.

Researchers found an association with sleeping less than 7 hours a night and an almost 3 times risk of catching the common cold virus than those who slept 8 hours or more. Those who slept less and had poorer sleep quality had the highest risk. Sleep may play a role in the body’s response to fighting infections among numerous other benefits.

Cohen S, et al “Sleep habits and susceptibility to the common cold“.  Archives of Internal Medicine 2009.

Women with preterm labor who were given intravenous magnesium sulfate were found to have newborns with a lower rate of cerebral palsy. Fortunately, magnesium sulfate is a commonly used medication in the U.S. to stop preterm labor in hospitalized patients, and this is a promising finding.

Doyle LW, et al “Magnesium sulfate for women at risk of preterm birth for neuroprotection of the fetus”. Cochrane Database of Systematic Reviews 2009.

Question: What is the deal with HPV? Am I doomed to get cancer someday since I was  told I have it on my Pap? I don’t smoke or anything and am married but am so stressed and not sure what to do? 

Human papilloma virus (HPV) is a virus spread through direct skin to skin contact. The good news is that most people who are sexually active are exposed to HPV and are absolutely fine in the long run if they are followed closely, so first I want you to know that although it feels scary, it should be alright. 

Short of being a nun it is almost impossible to avoid exposure to HPV if sexually active even with using a condom since condoms unfortunately don’t fully protect against HPV.  It is estimated that 75% of sexually active adults will get an HPV infection in their lifetime.(1) There are over 100 strains of the virus, and for the most part, you must have the virus to get cervical cancer but most people who have the virus never get cancer.  Some of the strains cause genital warts, which are a nuisance, but these are the low risk strains of the virus and having warts doesn’t mean you have abnormal cells of the cervix.  There is an HPV vaccine to prevent cases for women ages 9-26 years old which is helpful in preventing warts and abnormal cells in those who have not been exposed to HPV.  

The riskier strains and abnormal cells are only detected when you get your Pap smear.  Usually it takes at least several years to develop cervical cancer from the time HPV infects the cervix and causes the abnormal cells to form, so if you are getting regular Pap tests you usually have time for it to be detected and treated before it ever progresses to cancer.  If any abnormal cells or persistent HPV are found on the Pap test your doctor can [click to continue…]