Aging Below the Belt

Valerie Altman, ARNP, has been practicing in the state of Florida for 33 years and caring for patients at the Citrus County Health Department since 1997. She sees many patients with concerns about changes in their reproductive health as they age. One of the

“One of the major annoyances is incontinence. The pelvic floor weakens, and the bladder can drop. Who wants, at any age, to worry about urine leakage?” says Altman. Many women experience weakening of the pelvic floor muscles over time, whether from aging, childbirth or weight gain. Because these muscles support the uterus, bowels and bladder, women may experience incontinence or decreased sensation during sex as they age and the muscles weaken. Common signs of a pelvic floor issue include accidentally leaking urine when laughing, coughing, sneezing or jumping; feeling a sudden urgency to go; or not making it to the bathroom in time at all. And, of course, there’s menopause. Although some women don’t experience the discomfort from symptoms, there are solutions.

“They may get changes in the vagina, which can get less lubricating and less elastic, so sex becomes uncomfortable,” says Alice Carlisle, ARNP, Ph.D., who has practiced in Ocala for 21 years. “Sometimes if they’re not experiencing hot flashes but just experiencing trouble with the vagina, I recommend lubricants over the counter. The next step would be a topical hormone, either a cream, a small pill or a ring. Those are all very lowdose, so they don’t carry many of the risks often associated with hormone replacement therapy.”

Another aging concern is painful sex, or dyspareunia, which a ects a startling 25 to 45 percent of postmenopausal women.

“As for dyspareunia, that’s usually due to dryness and fragile tissue. It can get little tears and cause pain. And Viagra created a bit of a problem,” Carlisle laughs. “It means men can get an erection and have sex again, when maybe the woman hasn’t been having sex for a few years. The vagina shrinks from non-use. I encourage them to use a lube and take it slow.”

Just the Two of Us (And Our Viruses)

The most common sexually transmitted disease in Marion County is chlamydia, a ecting 419.5 per 100,000 people. Altman’s advice to avoid those particular cooties?

“Always get tested before you start a new relationship.”

What could be more romantic than a joint appointment at your local clinic? Not much, if it means two healthy people who know their status.