Q My wife and I are in our seventies. We have been together for more than 50 years and have always enjoyed a good sex life but, for some months now, my wife has been unable to reach orgasm, which she finds tiring and extremely disappointing. We are both completely open to ideas — we have indulged in erotic literature and videos. My wife had a small stroke eight years ago and she is now on a range of medication but requests to the doctor for help have not progressed beyond “in due course something will be produced for women”. We are keen to find something now.
A Your doctor’s reluctance to engage in any kind of meaningful discussion about possible causes and solutions for you and your wife is, I am afraid to say, pretty typical. Too many doctors allow ten-minute appointment slots to dictate a policy of “don’t ask, don’t tell” and, as a result, very few women who encounter sexual difficulties after the age of 50 are brave enough to seek help. This conspiracy of silence makes it exceptionally difficult for older couples to resolve sexual problems.
Although society is loath to acknowledge the fact that people in their sixties (73 per cent), seventies (53 per cent) and eighties (26 per cent) are still having sex, it is a very short-sighted attitude. Most of us will suffer from one or more of the chronic conditions that afflict your wife. For example, the risk of arteriosclerosis, which occurs when fatty deposits narrow the arteries, interfering with blood flow and thus having a direct effect on sexual function, increases dramatically with age. Why shouldn’t the elderly have access to sexual help and support if, and when, they need it?
Given your wife’s medical history, your GP should have automatically referred her to a specialist in sexual function. The person I would recommend is Dr David Goldmeier. He is a globally respected expert in this field and he treats patients on the NHS at the Jane Wadsworth Clinic at St Mary’s Hospital in London. I have already spoken to him about your wife and he is happy to see her (David.Goldmeier @imperial.nhs.uk). Although Dr Goldmeier does not recommend interfering with your wife’s medication, he does think that she needs a very careful medical assessment in a unit such as his, before any decisions about treatment options for her anorgasmia are made. The two options that he intuitively thinks might be worth exploring are a local oestrogen cream to help with blood flow and/or, possibly, a small dose of Viagra for the same reason.
Although Viagra should not be prescribed within six months of a mild stroke and should never be prescribed to anyone taking nitrates, if your wife is a suitable candidate, a low dose of the famous blue lozenge might improve genital blood flow and engorgement in the pelvic area. It won’t have any effect on your wife’s desire for sex, but the sensation of fullness that it provides can enhance arousal and encourage orgasm. Mind you, factor in the placebo effect and there is at least a 30 per cent chance that her desire for sex might improve too.
Your wife, and you, should also work on strengthening your pubococcygeal (PC) muscles. You can find a good guide to the exercises for men and women if you type kegel exercises and your gender into the search engine at www.mayoclinic.com. Stronger PC muscles will prevent incontinence, improve circulation, aid firmer and longer-lasting erections and help to increase the ease and intensity of orgasm for your wife. Although the root cause of her problem is almost certainly physical, the fact that, as you say in the full version of your letter, she has also suffered from anxiety and depression in the past, means she would almost certainly benefit from a course of mindfulness-based sex therapy. She can access this through the Jane Wadsworth Clinic as well. Good luck to you both and congratulations on an inspirational 50 happy years together.
Some additional information with regard to your wifes medication….
Although antidepressants are known to interfere with female libido, your wife takes the old fashioned Monoamine Oxidase Inhibitors (MAOI) which have been around for forty years or so. Like all drugs they have their drawbacks, but Dr Goldmeier says that the brands your wife takes (Phenelzine and Chlordiazepoxide ) don’t have the kind of negative effect on libido that is associated with newer selective Serotonin Reuptake Inhibitors (SSRI) such as Prozac. On the downside, the other drugs she is on are more problematic. The anti epileptic (Tegretol) for example, is associated with sexual dysfunction in both men and women.
The rest of your wife’s prescription suggests arteriosclerosis, or narrrowing of the blood vessels. This occurs when fatty material, such as cholesterol, is deposited along the walls of the arteries obstructing normal blood flow, and it too can interfere with orgasm. The drugs she is on for this condition (Ezetrol, Clopidogrel, and Olmetec) should regulate cholesterol, blood pressure and platelet stickiness, but her condition may have deteriorated so her medication may need to be altered.
Testosterone gel – usual dose for women is 10g daily
Oestrogel – 2 – 4 pumps daily
Zumenon (oestradiol) 2 mg daily (added for me but most women would not need this as well)
DHEA 25mg 2 times daily
Omega 7 oil capsulesI have regular blood tests to monitor my hormone levels and in fact take rather higher dosages than this because I seem to metabolise everything very fast. I think the real secret is the testosterone. My levels used to be zero (and maybe this is not untypical of a post-menopausal woman) but once the testosterone rates improved everything started to get better.I was so miserable and now I am happy. If possible, would you pass this plan onto the couple as a suggestion? You are welcome to forward this e mail on to them if you wish.