Category Medicine

Sex After 40

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By: Dr. Stacey Naito – Physician and IFBB Pro

The Shifting Tide

Those of you about to turn the corner and enter the 40 and over zone may be concerned about the impact that getting older will have on your sex life. You may have questions about whether you must resign yourself to becoming a dried-up old lady, with no fun to be had in the bedroom. Thankfully, the reality is that you can have more fulfilling and enjoyable sex than you had in your 20’s or 30’s.

What’s more, society has gotten wind of the idea that people want to live completely fulfilled lives into their advanced years. It’s true that 40 has become the new 20, and the concept is supported by empowered celebrities like J. Lo proclaiming their eternal youth and sexual vitality without shame. So instead of allowing the aging process to shut you down, it’s time to look forward to a new and more sexually fulfilling chapter in your life.

Why Getting Older Is Great For Your Sex Life

I don’t know about you, but I wouldn’t trade the knowledge and life experience I obtained over my 52 years on the planet to return to my 20’s, because aging has positively impacted every aspect of my life, including what happens behind closed doors. With age comes acceptance of who we are, body flaws and all. Let’s face it, we accumulate stretch marks, cellulite, scars, etc. over time, all of which could send us into a meltdown if we stressed out about them. We have become more comfortable with who we are, which translates to greater body confidence. That body confidence works to our advantage in the bedroom, because we no longer feel uneasy or ashamed of how we look sans clothing. When we are comfortable naked, we can finally relax and enjoy intimate encounters to the fullest.

A woman in her 40’s or 50’s is less likely to take desperate measures to entice her man, such as dressing up in sexy but uncomfortable lingerie, or wearing a pair of high heels guaranteed to aggravate her plantar fasciitis or her bad back. In contrast, it seems there are plenty of women in younger age brackets who follow ridiculous wardrobe guidelines to garner the attention of potential sex partners or followers on social media channels. A woman in her 40’s of beyond doesn’t have the inclination to make a fool out of herself to guarantee a romp in the bedroom. She is older, wiser, and doesn’t have time for such nonsense. She doesn’t feel like she needs to try so hard to win her partner’s favor. Her attitude tends to be more along the lines of, “This is what I got, take it or leave it.” Besides, I am willing to bet that such an attitude is far sexier to a man these days. In addition, most men tend to be more excited about the notion of getting you naked, and once you are in the buff, they aren’t scrutinizing your body for flaws.

Older women are also less selfish in bed, and bolder about declaring what they want. They know their bodies, their likes and dislikes. If single, they are more discerning about how they procure partners, so they are less likely to engage in risky activities which expose them to sexually transmitted diseases. For older women in a relationship, there is a greater likelihood that they have been with the same partner for many years, and have developed a level of intimacy which only comes from a longer term committed relationship. A 40-something woman is usually confident enough to turn to her partner and say, “I really like it when you use your hands on me more”, and not fret about whether her partner will accept her sexual preferences.

Chances are that for older women, there are far fewer household distractions which can impede the natural progression of an afternoon of flirting into a full-blown lovemaking session. Such interludes are pretty much impossible if a baby is crying, or young children are demanding attention. Once children have become old enough to be relatively independent, say from pre-teens on, there may be more opportunities to roll around in the sheets with your partner without any interruptions. That kind of freedom can result in more spontaneous sexual encounters and greater satisfaction.

For those past menopause, Aunt Flo’s monthly visit no longer interferes with any amorous advances. Furthermore, there is no concern about getting pregnant and having an unplanned family addition. It’s incredibly liberating.

Sexual Issues and Aging

Though I have painted a rosy picture of the sex life of older women, there are some issues which can interfere with optimal sexual activity. However, this doesn’t mean that all women over 40 will experience sexual dysfunction. As geriatric psychiatrist and Caring.com senior editor Ken Robbins states, “Impaired sexuality and sexual function aren’t normal consequences of aging.” (https://www.caring.com/articles/sexless-after-40).

Women can experience symptoms of perimenopause as early as 35, and the diminishing estrogen and progesterone levels can result in vaginal dryness and thinning of the vaginal mucosa, both of which can make intercourse painful. If this occurs, make sure to obtain a pelvic exam with a physician who can diagnose and treat the condition. In many cases, a lubricant is sufficient, but hormone replacement therapy may be offered as an option as well.

Some women may experience a decrease in sexual desire as they age, but many others experience a surge in libido from the increased testosterone to estrogen ratio, which increases as estrogen levels continue to diminish. The sexual benefits of testosterone are also enhanced by regular weight training, which naturally boosts testosterone levels in the body. However, the ebb and flow of sexual desire often fluctuates more in women over the age of 40, a result of associated dips and surges in hormonal levels. In addition, the hot flashes, night sweats, and mood swings associated with plummeting progesterone levels don’t exactly make a woman feel amorous.

If you are a woman over 40 who is experiencing symptoms of perimenopause, such as hot flashes, and they are frequent enough to disrupt your daily life, seek the advice of a physician. During your visit, you may ask if the addition of hormonal support supplements like maca or dihydroepiandrosterone (DHEA) would be helpful in decreasing the symptoms you are experiencing.
Most importantly, reduce stress in your daily life, get plenty of rest, and communicate with your partner about any sexual concerns you may have.

Ham, Cheese and Pickles

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During a recent urgent care shift, I encountered a man in his mid-50’s who had presented to the center with complaints of sinus pressure and cough. After I gathered more history and conducted a physical exam, the patient went on a tangent, asking me numerous questions about healthy foods. A commercial construction foreman, he was accustomed to being on site during the day, and insisted that his daily lunch was quite healthy and acceptable. As he prepared to tell me about this daily meal, he beamed with pride. What was it? Several slices of ham from the refrigerated section of the supermarket, a few slices of cheese, and a handful of pickles. He truly believed that the meal he consumed daily was incredibly healthy and nutritious. He even stated that he was consuming a high protein meal with produce (the pickle). The patient went on to tell me that when he was done with work, he often stopped at Arby’s to pick up a sandwich for dinner, and felt that the animal protein from these sandwiches wasn’t harmful in the least.

I shake my head in amazement when I encounter patients who have completely convinced themselves that somehow, their eating habits are completely clean and healthy, when they are actually abysmally deficient in nutritional value. What is more surprising is how insistent these people are on continuing their unhealthy habits, even when they ask for advice. The patient I mentioned above listened to me discuss the power of food as fuel, as sustenance, and nodded when I suggested he visit the fresh produce section of local grocery stores, select uncured meats, and avoid frequenting fast food establishments like Arby’s. I also mentioned that his blood pressure readings of 181/125, 179/127, and 185/122 (non-symptomatic) were rather alarming, especially since he stated that he had “forgotten” to take his blood pressure medications that morning. Was it fair to shake him out of his fog and inform him that with malignant hypertension, and a diet sure to compound the problem, he was on a short course to an unfavorable event like a stroke or heart attack? Did he even care if he was at high risk?

This is the kind of situation which I as a physician must often dance around. I have to determine how receptive a patient is to advice, and I also have to figure out the best way to speak to the patient without offending or discouraging him or her. It can be very tricky to reason with someone who has most likely gone through his entire life somehow believing that ham, cheese and pickles constitute an acceptable daily meal in anyone’s life!

Stacking The Deck

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“So…what do you DO?”

This question is incredibly annoying to me, and I cringe every time I hear it. I resent the fact that many people are so quick to assess someone on the basis of what they “do” for a living, as if there are no other dimensions which should be taken into account.

I completely resent the demand to pick one career that defines me. To add insult to injury, when people find out that I am a medical doctor, they struggle with the stereotype of what they expect doctors to be like, in other words, very conservative in dress and demeanor, and without any flavor or personality. Well, I’ve got news for you. I will NEVER be a typical doctor. And please don’t doubt my credentials or schooling. I am NOT a nurse (not that there is anything wrong with this highly respected profession). I am a fully licensed and board certified physician.

However, I do not consider myself to be ONLY one thing, “only” a physician. Yes, I am a board certified physician. But I am also a degreed (Bachelor’s) fitness professional, professional athlete (IFBB Pro), certified nutrition coach, writer, model, brand ambassador and contest prep coach. If that’s too much for one to process, too bad. Because I am ALL of those things, and then some. I am just as much about fitness, bodybuilding and wellness as I am about medicine, and I shouldn’t have to choose one over the others. I am damned proud of what I have accomplished in bodybuilding, especially because I was in my forties when I took things to the next level, not when I was a young whipper-snapper, and I was already established in my medical career. I will not apologize to people who are confused by the sampler plate philosophy by which I live and who don’t believe that it’s possible to be more than one thing. Truth is, I live as what Marci Alboher describes in her book One Person Multiple Careers as a Slash, and I am proud of it. I know it’s unusual, but why is that so hard for people to grasp? I mean, here I am, doing all that I do, switching gears constantly, and sending a message to the world that no one should have to be one-dimensional and boring.

I am honest. I have sass, and I speak my mind. I will NOT hide parts of myself which some overly judgmental people may have a problem with. I am NOT going to apologize for having a sense of humor, for using cuss words here and there (though I don’t use them while seeing patients). I am not going to paint a false picture of who I am. If you don’t like what I am doing, no worries. Move on.

Here’s a message to you if you find that you are someone who is compromising your own vision, dreams, or goals, because you perceive a need to choose one thing to define you. Perhaps you need to re-examine why you are allowing that to occur. If you subscribe to a no limits philosophy, then you would never even consider pulling the reins back. I will always encourage driven people to go for whatever they want, and if it doesn’t fit in with the conventions of one of their chosen careers or hobbies, even better. Break stereotypes and show people what you are made of! Don’t hide all the facets which make you who you are!

Natural Antidepressant Combinations I Recommend

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Despite the fact that I was trained in the traditional ways of medicine, I prefer to utilize natural supplements and foods to treat conditions, only turning to prescription medications as a last resort for my patients. I have a particular aversion to prescribing antidepressant medications, and honestly believe that such meds only serve as a bandage for the root cause, which almost invariably is a combination of hormonal imbalance and malnutrition.

When a patient comes to me complaining of symptoms of depression, I always recommend the following three supplements as part of the patient’s daily regimen:

Vitamin D
Folate 800 mcg
B-Complex

Once my patients are on this daily regimen for a few weeks, I have them visit for a follow-up to see if their symptoms have improved. If the improvement is marginal, I add SAMe and 5-HTP to the regimen, both of which are great for treating pain issues. As the patient treatment progresses, I order hormonal assays, checking the thyroid, adrenal glands, DHEA, IGF-1, testosterone, progesterone, and estradiol. If anything is off balance (and in most cases, something is), I will treat the imbalance directly with organ support compounds and bioidentical hormone replacement therapy.

In addition to natural supplements, I also recommend that patients consume whole foods, and avoid processed foods at all costs. I encourage them to find balance in their daily lives, and often demonstrate breathing exercises or discuss meditation with them. I also remind them to stop and enjoy what they have in their lives, to be grateful for what they have instead of dwelling on what they lack.

Rather than turn to SSRI’s, please consider the natural approach first if you are dealing with depression!

If you are in the Los Angeles area, and you would like to schedule an exam, please call Urban Med at (213) 406-8055 to make an appointment.

Yes I Write Prescriptions. No I Won’t Write One For Your Brother.

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As a fully licensed, board-certified physician, I have written my share of prescriptions over the years for medications, imaging studies, etc. I recognize that it is an incredible honor and privilege to be able to write scripts, and I never take advantage of it. However, there are people out there who think nothing of asking me to write prescriptions for them, simply because I am a fully credentialed physician conveniently standing there in front of them. What is especially irritating is when people dare to ask me to conduct curbside consultations or write prescriptions for their family members or loved ones who not only aren’t there with them to be examined, but who are complete strangers to me. Tell me, how in the world am I supposed to conduct a medical evaluation on a complete stranger, sight unseen? These same individuals also tend to get offended when I kindly tell them that their loved one needs to be seen in person by a qualified medical professional who can assess their condition and administer the appropriate treatment.

So if you are the kind of person who is in the habit of asking doctors to do similar favors for you or your family, please understand that your requests are unreasonable and inappropriate. If your husband, sister, son, cousin, or best friend needs medical attention, do the responsible thing and either tell that person to go see a doctor, or take that person to the doctor.

Of Orifices and Zero Freedom

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As a physician, I have had the incredible honor and privilege of studying every part of the human body, to the most minute detail. I have hovered over cadavers which were fileted and displayed for they eyes of inquisitive medical students, and scrubbed in on colon resections, open heart surgery, neurosurgery, cataract removal, etc. During my first month of internship as a newly minted physician, I massaged a dying heart with my gloved hands (no, the patient didn’t survive). I have also delivered over 40 infants via vaginal and Cesarean methods, and have pronounced the demise of patients in the wards. In fact, there are many stories I have collected over the years, some incredibly sad, some disgusting, some frightening, and some infuriating, but all true, and all part of my experience as a doctor.

I knew full well that by signing up for an education in medicine, I would be subjected to disgusting, morbid, frightening things, and that I would face mortality on a regular basis. However, after several years of working in family practice, I began to notice that I wasn’t thrilled with the fact that I examined orifices of every kind on a very regular basis. Whether it was a nostril, a mouth, an ear canal, an anus, a urethral meatus (layman’s term pee-hole), or vagina I had to examine, I was never thrilled about it, and the orifices below the belt were certainly much more bothersome to address. My intense dislike of such examinations, combined with the tedium of primary care and the low insurance reimbursement for services and procedures provided, caused me to retreat from primary care and focus more on the areas I had more interest in, namely, physical medicine, cosmetic dermatology, and anti-aging medicine, all of which are much cleaner and which do not require me to conduct examinations on private parts.

Another feature of primary care which made me cringe was the intense demand on a practitioner’s time. The only time it ever seemed reasonable for me to literally lose sleep night after night as a physician was when I was in training. At this point, there is no way you could convince me that such a thing is healthy, and I refuse to sign up for that. I won’t give up weekends to take on three stacked 12-hour work shifts, and I will not give up the few holidays I celebrate (Thanksgiving, Christmas Eve, Christmas Day, New Year’s Eve, and New Year’s Day) in order to work. As it is, I give up other major holidays to work, but since the work I perform on those holidays is in bodybuilding and fitness, I don’t mind it at all.

I love being a physician, and I find it incredibly rewarding to make a positive impact on my patients. However, I will not sacrifice balance in my life, or the freedom to pursue my other interests, in order to prove to society what a good physician I am. I don’t believe for a second that running oneself into the ground working as a physician ever sends a positive message to others. I don’t ever want to be the kind of doctor who is saddled with so many chart notes to write that an entire weekend is devoted to completing them. Not for me.

Lasty, I think it’s so strange that society still assumes that doctors are supposed to give their time and knowledge at a moment’s notice, on demand, yet I don’t see those same demands placed on people in other industries. I can’t tell you how many times I have been in a brief conversation with a complete stranger, who dares to ask me a medical question as soon as my profession is revealed. I swear, one of these days I am going to get a t-shirt made that says, “THE DOCTOR IS OFF-DUTY RIGHT NOW…NO MEDICAL QUESTIONS PLEASE”!

When Your Joints Rebel: How To Modify Your Lifting Regimen So You Can Train With Joint Issues

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You are a beast in the gym…that is, until a joint injury or flare-up from arthritis, bursitis or sprain threatens to deflate your motivation as a result of the pain. While it is always important to take preventative measures to protect the joints, such as warming up the surrounding soft tissues properly, using proper form during exercises, and taking supplements which promote joint health, there may be times when joint discomfort is so significant that a little TLC needs to be added to the regimen. The recommendation of complete rest usually falls on deaf ears when a fitness fanatic is the one suffering from joint woes, because the general mindset for such an individual is to push through the pain and continue training. However, in most cases, the pain and inflammation will throw a wrench in the works by adversely affecting range of motion and strength. As long as the joint pain isn’t severe, and is not caused by direct, acute injury to the joint, exercises can usually be modified to alleviate load stress on the affected area.

There are a number of exercise modifications which can be made to weightlifting exercises to minimize the loading on affected joints while still effectively training surrounding muscle groups. Bear in mind that you might not be able to perform certain exercises at all, even with a modified grip or stance. The most important thing is to pay attention to your body and stop doing anything which exacerbates the joint discomfort.

SAVE YOUR SHOULDERS AND ARMS

Since shoulder joint issues are relatively common, most of the suggestions made in this article for exercise modifications for the upper body will take this into account. Depending on the degree and location of shoulder pain, you might still be able to perform shoulder presses, but do not perform them behind the neck as they can cause impingement. Incidentally, you will also need to avoid pulling the bar behind your head when doing lat pulldowns. To perform overhead presses, use a straight bar with a grip slightly wider than shoulder width apart, or use dumbbells, and use a light weight. Another exercise which should be modified when shoulder pain is an issue is the bench press. Chest presses should be avoided on an incline bench due to increased abduction and a corresponding increased shear stress and strain on the glenohumeral joint.

Shoulder joint pain can also interfere with lower body barbell exercises like the back squat and lunges. Since the barbell must be stabilized across the back, the shoulder must remain in an externally rotated and abducted position. Even barbell deadlifts force the shoulder into a gravitational load in extension which can be enough to aggravate shoulder joint issues if a heavy weight is used. Modifications to these exercises include performing front squats while holding onto a kettlebell or dumbbell, and switching to dumbbells when performing lunges and deadlifts.

Most cases of shoulder pain from joint instability or arthritis can make it impossible to perform a plank for an extended period of time due to the superior-posterior stress across the shoulder joint complex, but this is easily remedied by modifying the plank so that you rest on your forearms instead of your hands, thus shortening the lever arm and decreasing the stress load.

If you have issues with your elbows, it is wise to avoid pullups, pushups, mountain climbers, overhead tricep extensions and planks, but bicep curls may also be difficult to do, especially as you supinate and flex the elbow. The elbow joint is a tricky one to train around, and the best approach is to completely avoid any direct movements which involve the elbow flexors if the pain is severe. If the pain is minimal, regular dumbbell bicep curls, hammer curls and cable tricep extensions can be performed with light weights. Using a false grip on dumbbells (in which the thumb is not engaged in opposition around the bar), using a cuff around the arm with a cable assembly, or switching to weight plates with a neutral (palms in) grip can also be helpful in minimizing the strain on the elbow stabilizers during delt training routines.

Wrist pain can often be eradicated by using lifting gloves which have wrist support to counteract some of the stress. Since bench dips can aggravate sore wrists, they should be avoided and replaced with cable tricep extensions, which can be performed without extending the wrist. Traditional pushups also force the wrists into a hyperextended position, but a simple switch in hand position, in which the fingers point out to the sides, with hands at least shoulder width apart, will minimize joint stress during the down phase of the movement.

WEIGHT BEARING JOINTS

If you have issues with the joints in your lower extremities (hips, knees, ankles, feet), ballistic movements, such as the ones performed in plyometrics and calisthenics, should be avoided. Unfortunately, exercises which are considered staples in a weightlifter’s regimen, such as squats, lunges and leg presses, can also wreak havoc on achy hips and creaky knees, especially if poor form and heavy weights are used. It’s best to trade these in, at least for a while, and instead turn to leg lifts on all fours, wall sits, front leg raises against a wall, and single leg deadlifts, all of which decrease the load on the hips and knees while still providing good isolation.

Since ankles and feet take the brunt of weight bearing, they should be babied when flare-ups occur, which means that calf raises, leg presses, and squats should be avoided and replaced with moves which do not require excessive joint motion under a loading force. Foot stance should be maintained at shoulder width to maintain the ankle position in a neutral plane and avoid any inversion or eversion. Mat exercises are also an excellent alternative to hardcore standard weight machines when dealing with joint flare-ups in the ankle or foot.

OHHHHH MY BACK

The incidence of low back pain is extremely high, especially among fitness devotees. Since it is usually triggered by extreme positions of flexion or extension, something as simple as standing with your heels on two weight plates and dropping the amount of weight lifted can be enough to maintain a more upright position and avoid the excessive lumbar flexion often seen with back squats. Another modification which spares the low back as well as the knee is performing Bulgarian squats, which keep the upper body in a vertical plane.

If you experience joint pain in your neck or upper back, you should avoid exercises mentioned earlier such as behind the head lat pulldowns and military presses, both of which cause excessive flexion in the cervical spine. In some cases, you will need to omit exercises which involve the use of a barbell behind the neck since this type of load increases flexion stress. You can modify these movements by using dumbbells or by switching to a machine, for example, switching from barbell squats to hack squats.

The most important thing to remember is to listen to your body and stop any movement if you feel sudden pain. By training wisely and making necessary modifications while your joints are inflamed, you will be able to bypass injury and continue to make gains at the gym.

Anti-Inflammatory Meds and Muscle Growth

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NOTE: This was originally written for Oxygen Mag digital version.

There has been a heated debate over many years within the bodybuilding community about whether anti-inflammatory medications like ibuprofen (Advil, Motrin) and naproxen sodium hinder muscle growth. These medications inhibit the synthesis of prostaglandins, which also play a role in muscle synthesis. All it took was one clinical study published in the Journal of Clinical Endocrinology and Metabolism to put bodybuilders into a panic about reduced protein synthesis, and it didn’t matter that such results were found in laboratory rats. While there is some evidence to suggest that the anabolic signal is shut off when anti-inflammatories circulate in the bloodstream, nothing is absolutely conclusive, and what might be seen in the rat model might not necessarily be the case for humans.

While I will never advocate chronic use of painkillers and anti-inflammatory agents, I think they definitely serve a purpose when acute injury is present. When I find myself in the middle of disputes with bodybuilders who INSIST that a few days on such medications will completely destroy all their efforts in the gym, I simply shake my head in frustration. If you are injured and your lifting is adversely affected by the injury, whether it be a muscle strain, a ligament tear, or a minor disc herniation, you need to be aware that training through that injury, especially when it deranges your form and causes other body parts to compensate for the injury, will end up really messing you up over time. I honestly think that a minimal decrease in muscle mass over the course of a few days is preferable to the imbalance and asymmetry which usually occur when a bodybuilder foolishly pushes through heavy workouts despite an injury which has a domino effect on the body.

Common sense, and medical expertise, dictate that the inflammation must be removed from the area, most commonly through short term administration of anti-inflammatory agents, ice, and rest. Trust me, if you follow a regimen like this, you won’t lose all the muscle you have built over the years. Be sure to take these medications with food, and if you have any history of gastric ulcers. bleeding disorders, or kidney dysfunction, avoid taking them.

Remember that I am talking about DAYS, not weeks or months. This is one time when eating constantly has its benefits, since bodybuilders and fitness people can pretty easily fit in their medication administration with one of their meals. I know it’s difficult to back off from training, but if you truly want to HEAL, you must give the injured area time to repair itself. If you insist on continuing to train through the injury, especially, without any medications or other interventions on board, you can count on the injury either lingering or worsening over time.