Sex Therapy Clinics for Mid-Aged Women Goes Mainstream

IN SEARCH OF THEIR OWN ELIXIR OF LOVE
By Michael Winerip
New York Times
November 29, 2009

http://www.nytimes.com/2009/11/29/fashion/29genb.html

PHILADELPHIA – Charlotte McLaughlin was married for 35 wonderful years. “He
was the only partner in my life, a terrific guy,” said Ms. McLaughlin, a
retired cosmetics consultant. But in 2001, her husband, Bill, died of heart
disease at 60, and to help cope with the loss, Ms. McLaughlin, who was in
her 50s, began taking an antidepressant.

Then in 2004 she met another terrific guy, a 65-year-old widower named
Sanford, and felt an attraction, though she worried about keeping up.
Antidepressants can inhibit sex drive. “I was afraid of pain at my age,
after three or four years of not having … you know, relations.”

So Ms. McLaughlin did what a lot of middle-aged women here do when they are
not ready to give up on sex. She visited the Pelvic and Sexual Health
Institute, which treats about 200 women a week, mostly from the
Philadelphia-New York City corridor, but some from as far away as Canada,
South America and Britain. Half the patients seen by the staff of 20 are
boomer women. A lot have husbands and boyfriends who’ve been given a
recharge via Viagra or even a penile implant, and, as Ms. McLaughlin said,
“We need something, too.”

Ms. McLaughlin first had a pelvic exam with the medical director, Dr.
Kristene Whitmore, a urologist, and then a sexual medicine consultation with
Susan Kellogg, who has a doctorate in human sexuality and is a nurse
practitioner. Dr. Kellogg told her about antidepressants with fewer side
effects and gave her a topical oil for heightening sexual arousal.

“Oh yes, it worked, absolutely,” said Ms. McLaughlin, who reports that for
the next three years, she and Sanford enjoyed a healthy sex life. That is,
until 2007, when at 68, Sanford died of a brain tumor.

By then Ms. McLaughlin had reached 60, but she was not yet ready to be
alone. Two months ago she was at a funeral and met an old girlfriend who set
her up with a guy — now a widower — they’d known in high school. Ms.
McLaughlin and her new man have been going out for six weeks, and things,
she reports, are clicking. So Ms. McLaughlin made a recent return visit to
Dr. Whitmore and Dr. Kellogg. “In case I need — I don’t know if I need
anything,” she said. “To tell you the truth, it’s been pretty hot.”

Ms. McLaughlin counts herself lucky, and statistically she’s right. Several
studies, including one published in 1999 in The Journal of the American
Medical Association, have indicated that sexual dysfunction is more common
in women (43 percent) than men (31 percent). And it’s worse for middle-aged
women. A survey of 31,581 women published in 2008 in Obstetrics & Gynecology
found 44.6 percent of those age 45 to 64 reported a problem with desire,
arousal or orgasm, compared with 27.2 percent of women age 18 to 44.

Since 1998, men have had Viagra, and for many years, doctors prescribed
hormone replacement therapy for women to ease menopause symptoms and improve
sex drive. But in 2002, hormone therapy was linked to small increases in
breast cancer, heart attacks and strokes. Since then, Dr. Kellogg said,
“We’ve had to be more creative.”

The typical boomer patient they see, she said, “is a woman 52 to 54, a year
or two after menopause, and she’s saying, ‘I can’t do it, I can’t keep up.’
” Dr. Kellogg said 10 to 15 percent point to Viagra.

“Viagra has brought women out of the closet on this,” Dr. Whitmore said.
“It’s given them a way to talk about it. Suddenly he’s got a sex life again
and she’s crying in pain. No one’s talked about the impact Viagra would have
on her, which is why it’s important to work with the couple. She needs to
understand what she’s going through is normal.” Their practice includes six
sex therapists and a psychologist who often wind up seeing both partners.

Originally, Dr. Kellogg and Dr. Whitmore had separate practices and referred
patients to each other. They estimate that in 50 percent of cases, there’s
an overlap between pelvic-area health problems and sexual dysfunction, which
led them to merge their practices 15 years ago.

Dr. Owen Montgomery, chairman of obstetrics and gynecology at Drexel
University medical school, said that the treatment model Dr. Kellogg and Dr.
Whitmore have created for women — a combination of sophisticated pelvic and
urinary care along with sexual medicine and therapy all under one roof — is
one of just a few in the country. “They’re on the cutting edge of a new
field,” he said. “I used to have a gynecologist partner and if a middle-aged
woman asked him about sex, he’d say, ‘I don’t talk about sex.’ Thankfully,
that’s changing.”

Patty Maisano, 50, a nurse who’s been married to her second husband for 13
years, first visited the office with pain problems that required a
hysterectomy and urinary surgery. But once these issues were addressed, she
said, she continued to have pain during sex. Dr. Kellogg and her team
offered a variety of medications, injections, lubricants, sprays and
exercises over the next few years, which Ms. Maisano said made only
“moderate improvements” in her sex life. What finally worked, she said, was
a nonhormonal topical product called Zestra, made from botanical oils and
meant to heighten sensitivity to touch. “This last month, I feel like I’m
back in my 20s,” Ms. Maisano said. “My husband is just thrilled that we can
be intimate and both get pleasure out of it. I can see a sigh of relief that
I’m not in pain.”

“So many women give up,” she added. “That’s a shame. It’s so important. You
marry your best friend, but intimacy is what makes a marriage work.”

Zestra is a favorite of the center’s patients, said Dr. Kellogg, who has
worked as a paid consultant for Semprae Laboratories, which makes the
product. But she cautions that even if a product helps arousal, that is not
the same as desire, and rekindling desire is the most complex challenge in
her work.

To date, there has been no elixir for Sue, 49, a paralegal who’s been
married 26 years, and asked that her last name not be used. She first came
to the office in 2005 with health-related pain issues that required surgery.
“A year later,” she said, “I was feeling better, but had no sexual desire.”
She also used Zestra and said she found it improved her sex life for a
while. “But now I’m going through the same situation again — no sex drive,”
she said. “My husband does occasionally have to take the Viagra. He’ll say,
‘Please, please, please.’ I’m like, ‘All right, all right, all right.’ His
drive’s stronger than mine and he’s 73.”

“So I’m going back to see Dr. Kellogg,” she said.

Dr. Kellogg has patients who somehow have decided that 58 is the age it’s
permissible to stop having sex. “I just had one today,” she said. “She told
me 58 is when partners start sleeping in separate beds. I said some do, many
do not. She said her partner’s O.K. with it. I said, ‘Are you sure?’ She’s
going to bring him in and we’re going to verify that. We’ll see what happens
next visit.”

Ms. McLaughlin, the 60-something who is dating again and still going strong,
counts her blessings. “I’m very fortunate, very blessed, very thankful,” she
said. “I have great faith. Every day I go to Mass and thank God that I am
just full of life.”