You’re not divorced, you’re re-singled

An FOF expert–and divorcée–explains why divorce may just be the best thing to ever happen to you.

Lee Block is a post-divorce coach, but she’s never worked with anyone who’s been divorced. Instead, Lee tells her clients to think of themselves as “re-singled,” a term that portrays the opportunity she sees in the dissolution of a marriage, rather than the defeat and loss so many of us fear. Lee would know. Six years ago, she herself was re-singled. Lee worked hard to make her life happy and prosperous again, and in the process, discovered she had a talent for helping others do the same. Now she runs a flourishing business, coaching her clients to see the light at the end of the tunnel – and even the light behind them. “I thank my ex all the time,” she says, illustrating one of her key lessons. “He gave me my children.”

We talked with Lee about the challenges that FOFs face after marriages break up, and some of her strategies for moving on.

  • Do middle-aged couples divorce for different reasons than younger couples do?
    • The biggest difference is that [divorce for middle-aged couples] often involve some type of midlife crisis. Sometimes there’s a moment where the person thinks, ‘My children are grown – what am I doing? There’s something I’m missing–something better.’ You thought everything was fine, and all of a sudden your spouse says ‘I’m leaving you.’ The next thing you know, you’re divorced. And there’s seemingly no reason for it. I attribute that to the midlife crisis issue.
  • It can be that abrupt?
    • I had a female client whose husband left her and she had no idea why. They had no issues. He just checked out. They were in therapy for years. He just didn’t want to be married. He actually told her he wanted something better. Has he found something better? Who knows. My guess is he’s still chasing whatever he thought he was missing in the marriage.
  • Was there nothing she could do to save the marirage?
    • It takes two to make it work. If one person doesn’t want to make it work there’s nothing you can do. It doesn’t matter how much counseling you have.
  • How did your client handle that?
    • She was devastated. She thought they had a good marriage and that his issues revolved around work and the economy. It’s been difficult for her to come to terms with the idea that there’s no good reason for him leaving. There’s no real closure. No way to move forward.
  • How did you help her?
    • She and I have worked on finding her own opportunities to grow by coming up with a list of things that were missing, from her perspective. She thought her marriage was perfect, but as we’ve gotten into it, we’ve realized there were aspects that she wasn’t happy with either. That she just ignored.
  • Is that usually the case – that both people had issues in a marriage?
    • It takes two to make it work; it takes two to make it fall apart. Unless mental or physical abuse is involved, somehow, somewhere, both parties have responsibility for a marriage falling apart. One of the stages of recovery is admitting that you had a part in the breakup. It could be something as simple as ‘I devoted my whole life to my children and was so focused on them, I didn’t pay enough attention to my marriage.’
  • Do any clients refuse to do that?Image
    • Yes, I know some women who are so angry, that they don’t move on. It ruins their lives. ‘He left me for another woman. He left me with no money. He’s out there living the high life, traveling, doing all these things I can’t afford.’ They cannot get past it, and they don’t want to. Some people play the victim. You can’t do anything for those people.
  • It seems important to try to look at divorce as an opportunity to do something new and different, as opposed to something irretrievably lost.
    • Absolutely. It’s an opportunity to become who you wanted to be before you got married. Maybe you were in the middle of getting a degree. Maybe you were just starting a new career and then got pregnant. It’s your opportunity to make your life whatever you want it to be.
  • What if you can’t figure out what you want?
    • Well, when you’re married, you mesh everything. It’s like you become a unit. You forget who you are. I’ve had clients, where I say to them, ‘Tell me what you love.’ And they say, ‘I don’t know.’ Part of the process if figuring out what you like and need.
  • You mentioned children. How is their role in divorce different if the couple is older?
    • The children are affected no matter what. Even if they’re grown and out of the house, it’s still very upsetting when parents get divorced. What makes it easier for the parents is that they don’t have to think about child support and custody. Less things you have to work out.
  • That must benefit the post-divorce relationship.
    • In general, people that get divorced older have better post-divorce relationships than people who divorce younger. They have less to fight over. They know each other better. In many cases, they’ve already transitioned from lovers to friends, in the marriage. They maintain that friendship.
  • What is one of the biggest challenges your middle-aged, female clients face?
    • All of a sudden, you have to take care of yourself. I have had women who have never paid a bill, don’t know how to balance a checkbook or never worked. They dropped out of college and got married. They were homemakers. They don’t have any idea what to do. The reality of, ‘I have to pay my own bills and support myself’ is a huge deal when you’re 50, 60 years old and have never done it before.
  • That sounds very daunting. Where do you start?
    • I help them financially set everything up. [I show them] how to get a credit card, get your bank account in order, pay the bills. Then we start looking at what strengths they can translate into a paying job. Everyone has some talent.
  • How long does it typically take a boomer to get through a divorce, and back to her normal self?
    • Everybody heals at a different rate. Some boomers take less time because they know themselves better, which makes it easier to heal. If you don’t know yourself very well, it takes a lot longer. I find that people that divorce in their 50s and 60s stay single a lot longer than younger people, who generally jump right back in.
  • Why is that?
    • They want companionship, they want to date, but once they love themselves again, they find they like having their space. They like having someone to go do things with, but they don’t feel the need to be married.
  • Is the dating scene tougher for post-divorce female boomers?
    • In a way it’s easier, because the dating pool is more tailored. It’s not just divorced people but also widows. It’s easier to find a nice companion who’s looking for the same thing you’re looking for. On the other hand, it can be tough because you haven’t been in the dating world for 20 or 30 years.
  • Do you have a lot of clients who come to you devastated but in the end feel they’re in a better place than ever?
    • Yes, generally that’s the case. After three to six months, they feel like they’re in such a better place, that they can’t believe they ever allowed themselves to stay in the marriage.
  • It seems like so many people stay in unhealthy or unsatisfying marriages.
    • There’s a stigma about divorce to this day, which is ridiculous. People don’t want to be around divorced people, like it’s a disease. ‘I might catch it.’ Or, ‘I don’t want to invite her to this party with all these married people around – what if she tries to steal one of our husbands?’ They don’t understand. We don’t want your husbands. We just got rid of our own.
  • It’s almost like Mad Men, the way you describe it.
    • It is, I know. That’s why I tell people not to call yourself divorced; call yourself re-singled. All divorce means is you’re not married anymore. You weren’t married before you were married. Now you’re just not married again.
  • If only everyone looked at it that way.
    • Look, nobody wants to get divorced. It’s devastating in so many ways, especially if you have children. But being divorced isn’t the worst thing. Fifty percent of people in the country have been divorced. So can you imagine if you couldn’t get anything positive out of it? People would be going postal all over the place. It would be terrible.
Lee Block
Post-divorce coachLee Block is a post-divorce coach, author of The Post-Divorce Chronicles and founder of a new, online post-divorce dating community,

My libido is gone. Should I care?

Is low sex drive a cause for concern, or a natural part of aging? FOF investigates.

“FOF patients come to me all the time complaining of low sex drive,” says Dr. Holly Thacker, Director of the Center for Specialized Women’s Health at The Cleveland Clinic. In fact, 50 percent of the FOF women we surveyed reported a loss of sexual desire as they aged.

But what’s behind this lacking libido? Is it menopause? Is it a physical problem that requires medical treatment? Or is it just a natural part of aging? Here, Dr. Thacker explains how to suss out the origin of your sexual dilemmas.

  • Is loss of libido an inevitable part of aging?
    • For most women, some loss of sex drive with aging is inevitable. The purpose of a sex drive is to reproduce, so if a woman is past reproductive age, she’s not going to have the constant sexual thoughts that she might have had when she was younger–and that her male partner may have.
  • What’s the connection between menopause and libido?
    • Loss of estrogen following menopause can lead to changes in a woman’s sexual functioning. Menopausal women may notice that they are not as easily aroused, and may be less sensitive to touching and stroking, which can result in decreased interest in sex.
    • Further, the emotional changes that often accompany menopause–including anxiety and depression–can add to a woman’s loss of interest in sex and/or inability to become aroused. In addition, lower levels of estrogen can cause the vagina to be thin, pale, and dry. The lower one-third of the vagina can shrink, leading to painful sexual intercourse.
  • Is this something women should learn to accept, or can these problems be fixed?
    • There are many options for women and ways to improve sexual function, and some problems, such as vaginal pain and dryness, are absolutely medical issues. Figuring out the causes of the problem are key to know how and if it should be treated.
  • How do you treat vaginal pain and dryness associated with loss of estrogen?
    • Vaginal atrophy happens to at least 80 percent of women after menopause if they’re not on hormone therapy. The vagina gets thin and delicate and goes into a pre-pubertal state. Obviously, sexual activity can become painful if not impossible. That’s very easily treated. We have estrogen creams, tablets, and even a small estrogen ring called the Estring. For women who can’t or won’t take vaginal estrogen because they have a history of uterine cancer or blood clots, we mix up compounded vaginal DHEA in a little suppository that’s put in the vagina. All of these improve sensation, lubrication and sexual function.
  • Are these creams something you use just before you want to have sex?
    • No, they’re used as maintenance to keep the tissue healthy. Estrogen cream is not a lubricant. Whether or not you’re actually having intercourse, we still want you to have a healthy vagina so you don’t end up with other infections.
  • Speaking of lubricants . . . can those help as well?
    • ImageVaginal dryness during sex is a common complaint among menopausal women. You can use water-soluble lubricants such as Astroglide® or K-Y Jelly®, and that can help a lot. There is also an over-the-counter “feminine arousal fluid” called Zestra that’s available without a prescription. A small, randomized trial showed that when women applied Zestra to the genitals–versus some other over-the-counter oil–they had better sensation and slightly better ability to climax.
  • What is the active ingredient in Zestra? Is it an estrogen product?
    • No. It’s a botanical oil that contains Evening Primrose Oil, thought to improve blood flow.
  • When should you consider menopausal hormone therapy to treat sexual dysfunction?
    • If you have good sexual function before menopause and then it deteriorates suddenly after menopause, or if you have other serious menopausal symptoms such as hot flashes, bone loss, etc. But you have to make sure it’s not just a partner issue. The vast majority of women who come to be complaining about sexual dysfunction . . . a lot of times they’re not attracted to their partner or they have other relationship issues. That will not be fixed by hormones or medication.
  • What if you’ve been attracted to your partner, but then you lose your libido from menopause and you think, ‘I’m just not attracted to this man any more.” How do you know what’s your partner and what’s biological?
    • Well, that’s not so much that case usually…most patients are able to identify if they’re attracted or neutral or repulsed by another person. Often a woman is sexually functional, she just has less of a sex drive than her partner. For example, she may have spontaneous sexual drive twice a month, and her partner has the drive twice a week or even twice a day. So she may be having sex more than once a week–to appease her partner–and therefore never feeling her spontaneous drive. It’s sort of like, if you ate a little before every meal, you’d never feel very hungry for the meal itself!
  • So to some extent, your sense of your libido has to do with your expectation of what it should be.
    • Exactly, a lot of women come in complaining of low sex drive, but when you get into their history they have a good relationship, they’re able to climax some of the time, they don’t have pain with sex, and it’s enjoyable–they just don’t have the same drive to be as active as they were when they were younger. That’s not a disease or a problem, that’s just the natural state.
  • Do you think some women come to you wanting permission to not care about sex anymore?
    • Some want permission to feel that there’s not something wrong with them, especially if they’re getting their information from the media–movies, TV–which tells them they should constantly want to be having sex. Some women never feel that way or they can identify wanting that only in their 20s or 30s. Once women understand that their sex drive isn’t meant to be what it was in their 20s and 30s, they feel better about how they’re feeling.


  • So what do you do if you’re not particularly motivated to have sex, but your partner is?
    • One question I always ask women is, ‘Once you get involved in sex, do you enjoy it? And they say, ‘yeah,’ and i say, ‘Well, it’s like exercise.’ Most people aren’t addicted to exercise–they have to force themselves to do it. But once they start exercising, they enjoy it and feel good and they think ‘Why don’t i do this more often?!.’
  • I’ve read that men also experience loss of sexual drive and ability with age. But, they have Viagra! Is there a similar pill for women?
    • Doctors are studying whether a combination of estrogen and testosterone may be helpful in creating sex drive in women; however, there aren’t currently any drugs available in America to treat sexual problems in women.
  • Why is that? Viagra has been around forever…
    • Women’s sexual function is a lot more complicated to evaluate and study than male sexual dysfunction. I also think we have a very paternalistic FDA. For example, in Europe and Canada, the testosterone patch is approved for low sexual desire and female sexual dysfunction, and in America it’s not, and I think that’s a shame.
  • So there’s no way to get testosterone in the US?
    • We are forced to use compounded testosterone for women who have low testosterone or have had their ovaries removed. There are some ongoing studies with a testosterone gel, but it has not reached the market. The company that was developing a pill for low sexual desire in pre-menopausal women have unfortunately stopped studying the drug–Flibanserin–based on the feedback they have received from the FDA.
  • What happens if a woman uses Viagra?
    • Even though we don’t have a female Viagra, we will use off-label Viagra in certain circumstances, for example women who are on anti-depressant drugs, who are interested in sex but have difficulty climaxing. In those cases, sometimes the use of Viagra does allow them to climax. Or sometimes we change their antidepressant medication to something call Wellbutrin or Bupropion which can help them climax more easily. Sexual dysfunction and loss of libido can be a side effect of some medications, so it’s important to visit your doctor with a complete list of medicines you’re taking.
  • Even if you can’t medically increase your libido, are there non-prescription ways to get in the mood?
    • The most important thing is to educate yourself about your physical anatomy. A lot of women just don’t understand their bodies–they don’t understand what their erogenous zone is. For some women it’s the clitoris and for some women it’s the g-spot, which is the interior lower one third of the vaginal wall, and some women just need to be educated and given permission to explore their bodies.
  • ImageThat can be easier said than done. How do you get a woman who’s over fifty to suddenly start exploring her sexual self?
    • I might send her to a sex therapist who can give her very specific exercises or help her work out a communication issue with her partner. For women who can not climax, there is one very specific, FDA approved device called the EROS which is a vibrator that also pulls more blood into the clitoris.
    • For other women it’s using erotic materials such as books and videos. It can be helpful to try physically stimulating activity that does not include intercourse, such as sensual massage or even exercise.
    • While overall libido may decrease, many women understand their bodies and are more comfortable with themselves and actually are more orgasmic after the childbearing phase.
  • NOTE: Want to learn more about this topic? Dr. Thacker recommends two “excellent” resources:

    This Article is created in partnership of with Speaking of Women’s Health, a national women’s health education program from the Cleveland Clinic Center for Specialized Women’s Health.

    Subscribe today to Speaking of Women’s Health e-newsletter to receive health articles, recipes, quizzes and more in your inbox monthly at

    Dr. Thacker
    Cleveland Clinic CenterDr. Holly Thacker, MD, FACP is the director of the Cleveland Clinic Center for Specialized Women’s Health, one of the world’s foremost clinics for women. She has authored two outstanding books on menopause and hormones and is a recipient of the “Lila Wallis Women’s Health Award” in recognition of her lifetime achievement in the field. She’s also a straight talker and a totally FOF woman.

    My Story: My Daughter is Bipolar

    FOF Christina Daniels’ daughter, *Sophie, was diagnosed with bipolar disorder when she was just six years old. Here, Daniels describes the experience of battling this devastating disease–and the stigma it still carries.

    “Up until she was six, my daughter was a little fairy princess,” says FOF Christina Daniels, 48. “She was a happy, smart child–she never even went through the terrible twos.” That year, Sophie Daniels exhibited the first “truly obvious” signs of mental illness, and, Christina says, their lives have never been the same.

    Bipolar disorder (also known as manic depression) causes mood swings that range from the lows of severe depression to the highs of mania. Though often controlled with medication, bipolar disorder is a traumatic disease that lasts a lifetime–with no known cure and a high rate of psychiatric hospitalization and suicide.

    For FOFs like Christina, caring for a child with bipolar disorder can become a life-long labor of love.

    • When did you start noticing that something was wrong with Sophie?
      • When she was about six, her father and I started going through a divorce, and she began having bouts of extreme crying–I mean, uncontrollably, for hours. She would talk and write things about wanting to die and kill herself.
    • Did she actually hurt herself?
      • The first incident of self harm I can recall was when she was six. We’d had a snow storm, and one evening while I was cooking dinner, she walked outside to the end of driveway with no coat, just a dress, and lay down in the snow. She was there for fifteen minutes before my son saw and ran out to get her. We went to the hospital, and she was treated for hypothermia.
    • Did you think she had a mental illness at that point?
      • At first I thought, maybe she saw a friend outside, or left a sleigh outside, and went to retrieve it, or something like that. But that wasn’t the case. She ‘didn’t want to be here anymore,’ and that’s why she’d walked out in the snow and laid down. That was really the first real strong indication that something wrong.
    • How was she diagnosed?
      • When we first started seeing all the psychologists and psychiatrists, the condition du jour was ADHD. So first, she was diagnosed as ADHD and put on Ritalin. After the meds didn’t work, an I kept pushing, her doctor looked closer and realized that she had an extensive family history of bipolar disorder on her father’s side. They finally got on the right course after about 18 months. She’s 13 now.
    • Has she continued to have problems?
      • Yes–she’s been on many combinations of medication and therapy, but there hasn’t been an ‘easy’ fix for her. Her depressive stages have been the most significant and hardest to deal with. She would lock herself in her room; she would hurt herself; she would bang her head against the wall. She refused to go to school–or would go and then just sit in the bathroom and cry. As she got older, the depression would manifest itself in different ways–suicidal thoughts, overeating to compensate for a lack of self-esteem. By the time she was 12 years old she’d gone up to 200 pounds and been hospitalized six times.


  • How did you two get along during this time?
    • The depression made her isolate herself, but it also made her extremely, extremely attached to me, to the point where I couldn’t move or breath without her right there. Then, around 11 or 12, she became violent–destructive. She had bouts of uncontrolled rage. She became physically abusive towards me. I think she knew that I loved her and I wasn’t going anywhere, so she could take her frustration out on me.
  • Were you ever seriously concerned for your physical safety?
    • Yes. I’m a small person–5’1”. When she was younger, I could restrain her, but it got to the point where she outweighed me by 70 pounds. I had to start calling 911. The police came to the house 13 times in 6 months. After the police come, it’s always the same: You go to a crisis center, sit there for 6 hours, and by the time you see the clinician, the child has calmed down and they send you home.
  • Was there anyone you could turn to for help–protection?
    • Eventually, she injured me so many times, I had to press charges. So here we are with an 11 year old kid, charged with assault. It was one of the hardest things I’ve ever had to do. And the judge is chastising me: ‘How can you do this–press charges against your child?!’ But after going through all this, for so many years, I said, basically, ‘I’ve been advised that the only way she’s going to get help is to not let her get away with it.’
    • Unfortunately, there’s no set of instructions for this.
  • You said you were getting divorced when this began. How is you ex-husband—Sophie’s father–involved in all this?
    • I have been solely responsible for my daughter’s care, and she lives with me full-time. She does, however, have a relationship with her father. Although he does not get involved in treatment and medical care, he tries very hard to maintain a positive relationship and keep informed. The ‘history of mental illness’ in his family is something he has had to deal with all of his life, and he has a difficult time coping with his daughter’s condition. I came to terms with that a long time ago.
  • Have you been supporting your children this whole time as well?
    • Yes. I had a steady employment history until my daughter was diagnosed, but then things got very difficult. There aren’t many employers out there who understand that you need to leave twice a week to go to a therapist, and to a psychiatrist twice a month, and to group therapy sessions. On top of that, you also have to be ‘on call’ for incidents at school, daycare…the list goes on. I lost my job in 2008, unexpectedly. I was performing way above standard and way above my goals, but it didn’t matter–they needed me to be in the office from 8:30am to 5pm every day, and that’s it. I was rehired by another company, and they seemed to understand my situation, but then my daughter had to be hospitalized for two weeks. Daily visits to the hospital again cut into work time, and my employer began taking away my responsibilities saying I probably couldn’t handle it and should ‘concentrate on things at home.’
  • That sounds incredibly stressful? How did you cope?
    • I didn’t–I really went into a tailspin. I thought I had things under control: I’m supermom; I have it all together; I can multi-task like nobody’s business. But you never know when that one thing can come along be the proverbial last straw. I started having panic attacks and instances of anxiety when I couldn’t leave the house. Through the years, I was so focused on helping my daughter, that I did not help me. It’s so important, as a caretaker, to take care of yourself.
  • I can’t imagine being depressed while taking care of a depressed person.
    • That was eye opening for me. Taking care of my daughter over the years, I felt stress and sadness and anxiety and so many emotions. But this was the first time I was really able to relate to some of the feelings that this child was dealing with. We all get the blues sometimes, but when you actually get depressed it’s very different. You have no control. I can’t imagine being a 6, 7 ,8, 9…13, 14 year old child trying to cope with this. It gave me a whole new understanding and appreciation of what she goes through.
  • How do you feel about the possibility of being your daughter’s caretaker for the rest of your life?
    • There are many people who are bipolar and become very high-functioning adults. That’s my goal for her, but I’m aware she may not reach that level. So caring for her is something I’m planning for emotionally and hopefully financially. Is it a scary proposition? No. I’m used to caring for my daughter. I’ve been a mom for 26 years. This past year she’s actually been in a residential treatment facility–somewhere she can get round-the clock care. It’s been the first time in 26 years I haven’t had any kids to take care of. And I really miss it–I like being a caretaker. I do understand, however, that the prospect of caring for an adult child comes with a whole different set of challenges.
  • What about your personal life–your love life? Is there time for that?
    • Actually, I just got engaged.
  • Congratualtions!
    • Thank you. After I’d been divorced for a few years, I did have a 5-year relationship with a man who was aware of my daughter’s condition. But when we moved in with him, it got to the point where he couldn’t take it anymore. She was so attached to me and possessive of my time–that was hard for him.
    • Three years ago I met another man–this time through my freelance marketing business–and he has personal experience with children who have issues. He really understood my situation. We can be a support system for dealing with each other and our children.
  • How is your daughter doing now?
    • Right now, my daughter still struggles with depression. She’s been at a live-in treatment center for about a year, and I’ve seen some dramatic improvement. She’s no longer violent. She’s still cutting, and, at the moment, she’s obsessed with body piercing so she’s tried to pierce her lip and belly button herself. But she’s in a very controlled environment. She’s lost 70 pounds–and she does feel better about herself because she accomplished that. She’s also gotten involved with sports and won 5 gold medals in the Special Olympics.
    • When she got there she was on four different meds–Lexapro, Abilify, lithium, Tenex–and now she’s down to two.
    • The hardest thing is that there’s still a stigma. People just don’t understand that this is a disease. The only time you hear about mental illness is when someone does something crazy–like shoots a congresswoman. And my daughter is a 13 year old girl–being a teenager is hard enough without having to deal with that on top of it.
    • My daughter is a smart, beautiful, wonderful girl who just happens to have some problems that she can’t really help. The goal is, that with love, ongoing treatment and a strong family support network, she can develop the coping skills that will allow her to survive and, hopefully, thrive.
  • *A pseudonym

    Christina Daniels
    Marketing and communications consultantChristina Daniels is a marketing and communications consultant and the mother of three. She lives in New Jersey.

    My Story: My Husband Has Prostate Cancer

    In October 2010, FOF Linda Cohen’s husband of thirty years, Spencer, was diagnosed with prostate cancer, the most common non-skin cancer in America. That day, Linda joined the ranks of millions of FOFs across America who have been forced to navigate the rules of this relatively new epidemic. “Spencer was young, athletic and healthy. This was a shock,” Linda says.

    Prostate cancer affects 1 in 6 American men. It rarely affects men under 40, which means most FOF women are likely to have a husband, brother, father or friend with the disease.

    Linda coped by tapping into her network of FOFriends, many of whom had supported their own husbands or boyfriends though prostate cancer. At each step of her husband’s six-month long battle, Linda found solace in their stories and advice. Linda’s FOFriends steered her and Spencer to the “right” surgeon and helped calm Linda’s nerves in the waiting room while he underwent surgery. They also listened to her most intimate concerns: “I asked them, ‘Will we have a normal sex life again? Will he regain control of his bladder?’” Linda remembers.

    “Once you start confiding, you realize how strong women are,” says Linda. “Men don’t always talk to other men about these things. We are really the ones who get the information. I bonded with so many women over this.”

    Thankful for all the support she received from her FOFriends, Linda wants to make sure every FOF who is supporting a man through prostate cancer, is supported herself. Here she shares her story:

    • Did your husband have any symptoms before his diagnosis?
      • He noticed a little blood in his sperm. He had been told this could be normal and overall he was feeling well. My husband is a very healthy person — he’s an athlete and eats well. So, the diagnosis was a shock.
    • Tell me about the diagnosis.
      • My husband is 57. Every year, for the past five years he has been going for a PSA, a test for prostate cancer. It’s like the male version of a mammogram. It went from 2.75 to 3.2 to 3.75. Then last year it went up to 4.35, a cause for concern.
    • Did the result of the PSA mean he had prostate cancer?
      • Not necessarily. But, it meant he had to have a biopsy. From that, they come up with something called a Gleason score. It’s a number that grades the biopsy based on the appearance of the cancer tissue. He had a Gleason score of 7. A Gleason score of 6 means they might not operate. But, he had a Gleason score of 7 — broken down to a 3 and a 4. Basically, when you get that score, you have cancer and you have to do something.
    • How was he feeling at the time of the diagnosis?
      • He was shocked and depressed even though he tried to keep his spirits and sense of humor up. I think he was angry, like, ‘how could this happen to me?’ He was also scared the cancer may have spread, which thankfully wasn’t the case.
    • What were his options for treatment?
      • The options were either radiation therapies or surgical removal. Due to his youth and good health, for his case they suggested robotic surgery. It’s less-invasive with a faster, more complete recovery rate. There’s also a better chance that the cancer won’t return.
    • What did you do?
      • I contacted about five different women I knew whose husbands had prostate cancer. They shared what they went through. The same name kept coming up in my conversations–Dr. Samadi. Dr. Samadi has treated thousands of patients using robotics and goes all over the world to teach this treatment. We got three different opinions, but when we met with Dr. Samadi, we knew we were going with him.
    • What are the risks of robotics?
      • After removal of the prostate, you can’t produce sperm. There’s a risk of sexual dysfunction and urinary incontinence. The robotic surgery decreases the chance of incontinence and sexual dysfunction.
    • How long after his diagnosis was the treatment?
      • He was diagnosed in October and had surgery in January.
    • How did you support him during this time?
      • Before he went to the surgery he needed to do Kiegel exercises to control help strengthen his urinary sphincter. I would help by reminding him to do his exercises.
    • Tell me about the surgery.
      • Spencer took ten days off of work. He had just started a new job. The surgery lasts about three and a half hours and you can stay [in the hospital] one or two days. We stayed one day. They remove the prostate and lymph-nodes through fix or six quarter-sized holes incised in his abdomen. The waiting room where I stayed was like a hotel lobby. I was with about eight different women, and all their husbands were there going through the same thing. While he had the surgery, I bonded with them.
    • What happened after the surgery?
      • The surgery went well. The surgeon said that the cancer was more pronounced than the biopsy had showed but that they got it all. He will continue to have regular check ups to make sure his PSA remains at 0. You don’t immediately know if he will be incontinent or impotent.
      • He had a catheter for about a week and after that he wore Depends. During the day, he would leak. It was embarrassing to him, especially when he went back to work. He tried to minimize the amount of liquids he drank. He continued doing Kiegels to regain urinary control.
    • How did you support him through his recovery?
      • I’d ask him, ‘Did you do your Kiegels?’ and I’d say, ‘You’re doing great.’ I’d take walks with him because he couldn’t exercise during that time. I would take out a chess board even though we haven’t played chess in years, to get his mind off things. I’d make him laugh when he was embarrassed about leaking by saying, “You’re really packed down there.” He made fun of himself by telling me not to make him laugh because he’d squirt.
    • Did it help?
      • Sometimes. I tried not to take things personally. When he said he wanted to be left alone, I left him alone — he really needed his space through the recovery.
    • Did he ever regain control of his bladder?
      • Yes. He’d talk to other men who said, ‘I had control within two months’ or ‘I was back to work within a week.’ Everyone heals differently. For him, it took 6 months. He lived in Depends during that time and it progressively got better.
    • What about your sex life?
      • After the prostate removal, you can’t produce sperm but you may be able to have an erection and orgasms. . They prescribed him Viagra six weeks after the surgery to assist with an erection and an orgasm. Fortunately after about four weeks he was able to have an erection. It’s been six months and now we have a normal sex life again both with and without medication.
    • Did you pray?
      • Yes, of course. I prayed every day, but I always felt he would be fine. He started practicing meditation and yoga with me. We spoke to our Rabbi about it. Spiritually, it brought us together — it made us more aware that life is short and helped us learn where we want to put our priorities at this point.
    • What was the hardest part?
      • To see your husband or someone you love hurting is difficult in any situation. Seeing a man wearing what he felt was a diaper — I just felt such compassion for him. There was shame associated with it, and I really had to make him feel important in other ways.
    • How did you keep your own sanity through it all?
      • I kept busy. I kept balanced. I was there when he needed me but I gave him space and continued my life.
    Linda Cohen
    Fashion merchandising consultant
    FOF Linda Cohen is a fashion merchandising consultant from New York. Her husband, Spencer, was diagnosed with prostate cancer in 2010.

    Cheat or Let Your Sex Life Fizzle? You don’t have to choose

    FOF sex expert Pamela Madsen recharged her sex life while keeping her wedding vows intact. And she says you can, too. But, is her solution for everyone?

    A few months ago, FOF published “The Case for Sleeping Around,” an interview with two psychologists that argue monogamy is against our biology. Comments on the article flooded in, with some FOFs in staunch disagreement. “It’s easy to excuse all kinds of selfish behavior as being based on our ‘biology.’ What about discipline, self-sacrifice, commitment?” commented one FOF. Others thought the article was right on point. “I totally agree. it is the lies that end marriages not sex outside of the commitment,” wrote another FOF.

    Enter FOF Pamela Madsen. Pamela, a nationally-known expert on fertility and sexuality, believes its normal to feel sexually restless as an FOF. But, she says sleeping around isn’t the answer. Her new best-selling memoir, Shameless, chronicles her own journey to fulfill her sexual yearning while keeping her marriage intact. Here, she shares just how she successfully did it…

    • Why do many woman begin to feel sexually restless as they approach menopause?
      • Well, in my coaching practice I see women from age 27 to age 75. It happens all across the board. But, I do see a majority of women who are what I call “the shift before the shift.”
    • What do you mean by that?
      • It’s the things that happen before menopause. In our 40s, we’ve established our careers, our marital status is where it is, we’ve figured out if we are not having kids or already had them. And if we have kids, they’re becoming more independent. So, then all of a sudden we’re like, ‘Ohmigod…is that all there is?’ Sexuality becomes really big for some woman and for others it’s gone. We start looking for a way to really understand who we are, especially as erotic creatures. We want to make peace with our bodies.
    • You write that many of your friends who were feeling sexually restless started having affairs in their 40s. You don’t believe that’s the solution . . .
      • I believe that to ditch your marriage because you have the need to explore something around your sexuality is really a shame.
    • A few years ago you set out on a journey to fulfill your own sexual yearning while staying faithful to your husband. Tell me about that.
      • When I first started out on this crazy journey I felt completely alone and isolated. But, I knew that if I didn’t figure this out, I was going to ruin my life. So, I went searching for a sexy adventure that would keep my marriage vows intact. I found out about sexy massages with gay male masseuses, which is what I thought I wanted. I literally cruised gay male websites which led me to Marcus, my first sexual healer–a paid, hands-on practitioner. I worked with Marcus for a year and he introduced me to other people in this world. I was 43 then; now I’m 50 and that industry has changed a lot. It’s much more above ground now.
    • What does a sexual healer do?
      • ImageIn my book, you can read detailed accounts about my sessions with sexual healers, but generally they have helped me explore my sexuality. They don’t engage with me. They don’t show up as my lover, and there is no sexual intercourse or oral sex. They are usually clothed. It’s not about two-way touch. Of course there is some interactivity, they are not a prop, but the focus is about me and about my body and experimenting with my own sexuality. I got to discover who I was as an erotic creature, but I was able to do it really safely because there were boundaries that I knew were being held for me.
    • All these discoveries didn’t make you want to cheat more?
      • No, it fed me. It was enough. It definitely helped my marriage and my sex life. It worked things up at home.
    • And your husband was okay with all of this? He didn’t see it as cheating?
      • Yes, after he got over the initial shock. He went for two sessions. One session is in the book–it’s a very funny chapter. He got to find out what this was and what this wasn’t. He felt safe. These practitioners aren’t interested in cheating with you. They are professionals. This is what they do for a living. They are not interested in converting you into a relationship.
    • How do you find a legitimate sexual healer?
      • There’s an association for people who do this work. They’re called Sexological Body Workers and they’re certified in the state of California. They go to school, they have a business license, they have to adhere to a code of ethics….
    • Why explore your sexuality on your own or with a paid practitioner if the ultimate goal is sexual fulfillment with your partner?
      • Who says that’s the ultimate goal? For me, the goal was living my life in full. That’s really the crux of my story, learning how to fall in love with me, but not in a cliche way. I was finally able to do that. I lost 7 dress sizes, and I wasn’t dieting. I found true pleasure in my body and my life.
      • There stopped being free-floating anger and anxiety in my life. That’s what I want for other women. I want them to find their desire and their pleasure and it may not be through the path that I’ve taken.
    • So you’re saying sexual healers aren’t the answer for everyone?
      • No, we all have different sexual agreements in our marriage. My sexual agreement with my husband may not be someone else’s. It’s more about how we create the space so we can stay married and figure out who we are as individual sexual beings in a way we both feel safe…It’s expanded monogamy. I see a lot of women who aren’t working with sexual healers but are looking for their own ways to find embodiment. For some, that could be starting with a couples workshop. For others, it can be exploring pornography.
    • What if you and your husband don’t have the same feelings on what is ‘safe’?
      • If the partners are not agreeing, that is a recipe for being shut down sexually. That’s a recipe for divorce or an unhappy life. If they’re really committed to each other, then it has to be more than one conversation. They may need to work with an outside person or a sex therapist on how to come together as two unique sexual beings.
    • You mentioned ‘expanded monogamy,’ can you explain?
      • I think its really difficult to be completely fed in all areas in your marriage. Why do we think that we have exactly the same erotic needs as our partners? Why is it a realistic expectation that we can fulfill everything for each other? Sometimes people cheat because they feel trapped. What happens to a flame when there is no oxygen? It goes out. If you can let a little air in, then the flame in a long-term marriage can survive. I’m a huge supporter of marriage. My husband and I have sexual agreements and we trust and love each other enough to hold them. Our sexual agreement is that I don’t have affairs and I don’t. Am I monogamous? According to the rules of my marriage I am. But, I’ll leave that up for you to decide.
    Pamela MadsenPamela Madsen is the founder of the American Fertility Association and one of the nation’s most outspoken fertility and sexuality educators and advocates. Her blog posts on have attracted 300,000 readers and her new memoir SHAMELESS: How I Ditched The Diet, Got Naked, Found True Pleasure and Somehow Got Home In Time To Cook Dinner is #1 on Amazon’s “Hot New Releases in Sexual Therapy.”

    Fix That Leak!

    There’s no need to suffer incontinence in silence. FOF gets the scoop on new procedures that get rid of it for good.

    In our mother’s generation, urinary incontinence was considered an unfortunate but inevitable part of getting older. A woman who experienced “leakage” kept her problem to herself and her bathroom cabinet stocked with Depends. Today, things are very different. If you’re one of the 20 million women who suffers from occasional, uncontrollable loss of urine, there are incredibly effective treatments that don’t involve the adult diaper aisle.

    Unfortunately, this still isn’t a widely discussed topic (there’s no “walk for a cure” when it comes to incontinence) so many women don’t know how to get the best treatment. Fear not–we’ve done your homework for you. Last week, FOF met with Dr. Alan Garely, MD, one of the world’s leading experts on urinary incontinence and the Director of Urogynecology and Pelvic Reconstructive Surgery at Mount Sinai Hospital in New York. Dr. Garely answered every question–even the really embarrassing ones.

    • What exactly is incontinence?
      • There are two main kinds. Stress incontinence is defined as uncontrollable loss of urine when you exert yourself–cough, laugh or sneeze, for example. Urge incontinence is when you feel like you have a sudden urge to go, and you can’t hold it, so you leak.
    • What causes it? Why is it more common for FOF women?
      • Both women and men can become incontinent from neurological injury, birth defects, stroke, multiple sclerosis and physical problems associated with aging. As we age, the connective tissue in our bodies weakens and the muscles of the bladder and urethra start to stretch. Then we get leakage. Lack of estrogen may have a role in muscle weakness but that’s not definitive.
    • Are some women at more risk than others?
      • You are at higher risk if you…
      • …had children vaginally. The more kids you have, the more risk you have, but one kid can do it.
      • …have a chronic cough, like asthma or smokers cough.
      • …have a genetic predisposition. if you have a family history of hernia, you have an increased chance of developing incontinence. Also, certain ethnicities are more prone, such as Irish, Northern European and Jewish.
    •  How do you treat it?
      • Stress incontinence is almost always treatable with surgery, and there’s almost no non-surgical method that can treat it completely. You can do pelvic strengthening exercises, but that rarely cures the problem.
      • Urge incontinence is usually treatable with medication, unless the vagina is prolapsing. Then, all the medication in the world won’t help you. A lot of people come into our office and say, “I have an overactive bladder problem but the medication isn’t helping…” and you examine them and you see the vagina is prolapsing.
    • What is prolapse?
      • It’s when the vagina begins to drop out of place. The best way to picture vaginal prolapse is to put your hand in your pocket and pull your pocket inside out–that’s prolapse. It’s similar to a hernia.
    • How do you know if you have it?
      • You need to have an exam, but most people notice a bulge coming out of the vagina. They feel pressure, or if they strain to have a bowel movement they feel like there’s something down there–a mass.
    • Okay, so let’s assume I don’t have prolapse. I have stress incontinence and I leak when I laugh, cough, etc. What’s the treatment?
      • As I said, surgery is pretty much the only way to fix it. There are a few approaches. The simplest would be injections–the doctor injects collagen around the opening of the urethra so that the urethra constricts and gets tight. That procedure is not very effective as a cure, and usually has to be repeated on a yearly or twice-yearly basis. The gold-standard of treatment for incontinence is called ‘a sling.’
    • What’s that?Image
      • A little piece of surgical mesh–made of a porous material called polypropylene–that’s inserted under the urethra so that it has support and you don’t have leakage. It’s placed under the skin–you don’t see it or feel it.
    • You have to have surgery to put it in?
      • Yes. The surgery is minimally invasive and takes about 10 to 15 minutes. The anesthesia is light–the same thing you’d get with a colonoscopy. There are two ways to do the surgery–one involves two tiny cuts right above the pubic bone and one in the vagina (called a TVT sling). The other involves two little cuts in the groin (called a TOT sling). The type you get just depends on your specific case. Both have a 90% cure rate.
    • What’s the recovery time?
      • Most people are continent immediately after the surgery. You can return to work within a few days…you just can’t lift a weight of more than 10 pounds for 8 weeks.
    • How long has this surgery been available?
      • It was first introduced in the United States in the late 1990s–it’s relatively new.
    • I’ve heard there are risks to using mesh….is that true?
      • The TVT and TOT sling surgeries I’ve described are very safe and effective. The FDA has issued a warning on all mesh procedures in the vagina. Unfortunately, they’ve lumped TVT and TOT together with a more risky surgery that’s used for vaginal prolapse. It involves a much bigger piece of mesh that can cause complications in about 15 percent of patients. What’s important to know is that TVT and TOT use only a small piece if mesh and their complication rates are very low.
    • Okay, so what do I do if I have vaginal prolapse?
      • We push the prolapse up, and the bladder leakage will clear itself up. That can be done with surgery or something called a pessary–a little ring that goes inside the vagina. Prolapse surgery involves a larger piece of mesh and can be done vaginally or abdominally. The complication rate for the prolapse surgery that’s done through the vagina–the risky one I mentioned before–is 45 in 300. The complication rate for the abdominal procedure is 1 in 300.
    • Why would anybody opt for the prolapse procedure with the high complication rate?
      • Because patients are under the belief that they want to avoid an abdominal incision at any cost. That’s not necessarily smart, but that’s their belief and sometimes it’s hard to convince people against their beliefs. Also, there are not many doctors who are trained to do the abdominal prolapse surgery–they may not even mention it as an option to their patients.
    • You’ve said that the success of these incontinence surgeries has a lot to do with the skill of the surgeon. How do you choose a surgeon that you can trust?
      • The one thing that has been proven to determine success rate more than anything else is the number of surgeries that doctor has done. The more surgeries, the better the outcome. Now, it’s hard to determine what someone’s numbers are unless they tell you, but you can always ask. It’s also important that your surgeon has done a three-year fellowship specifically in urogynecologic surgery.
      • The American Urogynecological Society’s website, has a list of society members, and that’s a good place to start.
    Dr. Alan D. Garely, MDDr. Alan D. Garely, MD, FACOG, FACS, is the Director of Urogynecology and Pelvic Reconstructive Surgery at   

    The Mount Sinai School of Medicine in New York.


    Where Will Your Parents Live?

    FOF Roberta Satow is a psychotherapist and sociology professor at Brooklyn College. Her book, Doing the Right Thing: Taking Care of Your Elderly Parents Even if The Didn’t Take Care of You, chronicles her experience caring for her own mother, as well as the experiences of 50 other family caretakers across the country.

    Roberta believes that the period of transitioning your parents from independence to dependence can be an incredible time of healing, growth and bonding–if you know how to handle it. Here, she talks about choosing the best living arrangement for your parents, without making them–or you–crazy.

    • When you start to notice your parents having difficulty taking care of themselves, what’s the first thing you should do?
      • In the beginning, minor changes may be enough. For example, your father may have difficulty shoveling the snow. Then you can suggest he hire someone to shovel the snow and he might be quite receptive. The problem arises when your father doesn’t want to hire someone, and insists on doing it himself.
    • How do you approach that stubbornness?
      • The question is, how intrusive do you get, and where do you set the limits? Ask yourself, is this issue dangerous? If your parent is becoming an unsafe driver, for example, you have to intervene, otherwise you’re taking your parent’s life and other peoples’ lives into your hands.
    • Sure–and that’s pretty clear. But what about the shoveling, where you know your elderly father has a heart condition, and it could be a medical risk, but he’s risking his own life, not someone else’s.
      • When you’re trying to get an elderly person to do something for his or her own good, you have to remember that they have a tremendous investment in being alright. There’s a huge loss if you confront them head-on with “You can’t do this.” The likelihood of a positive resolution is greatly enhanced if you can somehow distract from the bigger issue of physical decline. For example, give your father a snow blower for Christmas. Or arrange with a neighbor to offer to shovel the walk. Try to do it in a way that involves the lease loss of self-esteem
    • What if your parent is belligerent and angry no matter how delicate you try to be?
      • There may be someone better suited to have the conversation with him or her. Perhaps your dad has a friend, priest, minister or rabbi who he trusts. There may be another sibling who’s just better at dealing with dad than you are. If you’ve tried everything humanly possible, then it may be a cognitive problem that he or she is having. In that case, take you parent to a geriatric specialist, because there are drugs like Aricept and antidepressants which can really help.
    • Okay, so once you’re at the point where you know it’s not safe for your parent to live alone, what do you do?
      • There are three main options: hire full-time help to live with your parent, move your parent into your home, or put your parent in an institution. Obviously, financial concerns weigh into that, but my expertise is more psychological.
    • How realistic is it to have your parent move in with you?
      • Some people just know right away that there’s no way they could possibly have their parents live with them without their marriage falling apart or something equally stressful. Those people have to accept that it’s not an option and figure out what they need to make sure their elderly parent gets what he or she needs, but not under their roof. There are other people who want to have their elderly parents live in their home, but find that they can’t set boundaries and it ends up having a negative effect that they didn’t expect.
    • When is it successful?
      • I’ve found it has a lot to do with your cultural background. African American families are more likely to keep their elderly parents at home–even if they have dementia–often because that parent was integral in raising their own children. Hispanic people have similar attitudes. I went to a talk by a Puerto Rican geriatric doctor and when he and his wife got married, the first thing they did was get a house with two separate apartments because from the beginning they accepted that their parents were going to come live with them at some point.
    • So how do you know if you’re a good candidate to do this–apart for your ethnic background?
      • First of all, you have to have space–enough room in your home that you can have some privacy and your parent can have some privacy. Putting grandma in the room with her granddaughter is not a good idea. Second, your family needs to sit down and talk about this decision and have reasonable expectations. For example, it’s usually the woman who ends up becoming the caretaker, even if it’s her husband’s parent. So talk to you husband about what responsibilities each of you will take on.
    • Can you expect everyone to shoulder part of the responsibility?
      • Yes, as long as everyone is comfortable setting boundaries. It’s okay to expect your son to drive grandma to the mall on Sundays, but you don’t want to teach him to be a masochist. If the mall interferes with something he loves–like a regular baseball game–that might not be okay for him. Here’s a case that worked: A woman in my book had a two-family house and her widowed father lived downstairs. In the beginning, he made the family pasta fagiolo and was home when the kids returned from school. As he got less and less capable, they would bring in some outside help for him, but by that point he was such a part of their family that his care had been integrated into family life. The kids made him breakfast on the weekends, mom took him for walks, etc.
    • So if you’re not a good candidate for that, or if, perhaps, your parent has just become too much to handle in a home environment, then what?
      • Start researching what kinds of institutions there are in your area that might be possibilities. I personally like Continuum of Care facilities, where you have an apartment and you can cook for yourself or you can go down to the dining hall. As you start needing more help, they can provide more help. When you get to the point where you can’t live alone, there’s a nursing home. It’s all in the same area, so the people that you know from the beginning can come visit you, and there’s a sense of community–we’re all in this together. Also, make sure the place is close enough that visiting isn’t a hassle.
    • How do you introduce the idea of a “home” if you know your parent is resistant?
      • With my own mother, we asked her if she’d like to go to lunch with us at one of the places. We fully expected her to throw a fit, but when she got there, she had a very different reaction. She felt like the place was a hotel, and she was thrilled at the idea that someone was going to cook for her and take care of her. She’d also been fairly isolated, so she liked the feeling of people around her. In some cases, your parent will have an idea of these places that doesn’t fit with reality, and they end up being pleasantly surprised.
    • But what if it doesn’t work out that way, any your parent refuses?
      • At some point you might have to have a serious discussion and say, ‘this is untenable, we can’t do this anymore.’ They may have to do something that they don’t like, and it’s very unpleasant. But you have to have confidence that this is what your parent needs, and you have to bite the bullet. If you’re controlled solely by what the elderly person wants, you may be putting everyones’ physical and mental health in jeopardy.
    • Finally, what if you’re questioning your own decision? What if you’re not confident that you’re making the right decisions?
      • When you start taking care of your parents, you can really regress psychologically. Issues crop up that have been dormant for years–anger, resentment, etc. Accept that you will feel ambivalent about a lot of these decisions. This is a great time to consider outside help. There are geriatric social workers who can help you find solutions and talk through whatever issues you may be having. You also may want to start seeing a therapist or counselor on your own. It’s a fertile time if you want to work out these old issues that have been left unresolved.
    Roberta Satow
    Professor, Psychoanalyst

    Roberta Satow is a Professor in the Department of Sociology at Brooklyn College and a practicing psychoanalyst in New York City. She has written numerous articles on sociological and psychoanalytic subjects that have appeared in journals and magazines such as Partisan Review and Psychology Today. Her latest book, Doing the Right Thing: Taking Care of Your Elderly Parents Even if They Didn’t Take Care of You, was published by Jeremy Tarcher Publishers in 2006.

    FOFs in Toyland

    Two FOF doctors (and friends) buzz about the tools every FOF woman really needs to put the spring back in her sex life.

    Dr. Patricia Allen and Dr. Hilda Hutcherson are two of the most esteemed women’s sex and health experts in the United States. They’re also two of the funniest, realest FOFs we know. Here, they dish about the FOF sex aids that really work: vibrators, lube and of course, jewelry.

    • FOF: So let’s start with the most common toy—a vibrator . . .
      • Dr. Pat Allen: Well, first of all, if you’re a woman who no longer has estrogen because you’ve gone through menopause, do not decide that you’ve read an erotic book or had a sex talk with your girlfriends, and now you’re ready to start using a vibrator. Because if you use it on an un-estrogen-ized clitoris—well, honey, that might cause some discomfort—the opposite of what you want!
    • FOF: (laughing) So what’s the solution?
      • Dr. A: Preparation. To restore health—pinkness and plumpness–to genital tissue, we begin with the use of high-dose vitamin D for three weeks. Then a woman can choose to use vaginal estrogen, which generally in two forms—a cream (Estrase and Premarin are the two most common) and a pill called Vagifem a tablet that’s inserted twice a week.
    • FOF: What about dangers of estrogen treatments?
      • Dr. A: Vagifem is designed to limit its absorption in to the blood vessels, however there is a black box warning on it and all estrogen products noting that some small amount of the estrogen many enter the blood stream and could increase the risk of breast and endometrial cancer. Hilda, would you agree that is the general party line?
      • Dr. Hutcherson: I would agree.
      • Dr. A: We have to say it, you have to write it, but it’s thought to be extremely low risk.
    • FOF: How much Vitamin D and how much estrogen cream?
      • Dr. A: After 3 weeks of high-dose vitamin D (5,000 IU of vitamin D every day for three weeks), one can add the Vagifem. The first week, it should be every other night and then twice a week. A woman will decide, depending on how her genital tissue feels, if she needs a little estrogen cream on the outside. I tell patients that they shouldn’t use estrogen cream on the same night as the vaginal pill. And they’re to use a lima bean amount— which is a very tiny amount for those of you who did not grow up on a farm.
      • Dr. H: I don’t recommend as much preparation because I’m just so pro-toy. I tell women to start off with something mild first and work up to something stronger. Start out with a small, gentle “finger vibe” and lots of lube.
      • Dr. A: Yes, some women can use that. But if they’re several years past menopause, I suggest that they first get the tissue prepared. When their tissue is atrophic and thin and it itches and burns and cracks, first it has to heal.
    • FOF: Which vibrator do you like best?
      • Image
        The “Pebble” vibrator was designed
        by Japanese sculptor Mari-Ruth Oda.
        Dr. Pat likes it because it
        “doesn’t look like a vibrator.”

        Dr. A: I recommend one from MYLA called the pebble, and the reason that I like is that the maid can find it and not know what it is. I like a vibrator to not look like a vibrator.

      • Dr. H: The finger vibe. It’s discreet, but it’s probably enough to get you where you want to go.
      • Dr. A: Is there somewhere to go other than orgasm?
      • Dr. H : (Laughing.) Well, no.
      • Dr. A: I just wanted to make sure I hadn’t missed something or that there wasn’t something beyond orgasm besides jewelry.

      • Image
        Dr. Hutcherson recommends starting out
        with a “gentle fingervibe” and lots of lube.
        Pictured: Adam & Eve Finger Vibe,
        available at

        Dr. H: I also like the Pocket Rocket and The Bullet. Or for a woman with a great deal of experience, she could even choose something called The Rabbit.

      • Dr. A: That probably has multiple prongs…I can’t imagine.
    • What about lubricant. Is there one you recommend?
      • Dr. H: KY intrigue is a silicone-based product that’s especially good for women who are many years past menopause and have chosen not to use an estrogen product.
      • Image
        KY Intrigue is “especially good
        for women who are many years
        past menopause and have chosen
        not to use an estrogen product.”

        Dr. A: For women who are allergic to the propylene glycol found in some of these products, plain old mineral oil is a wonderful lubricant. However, no man can sustain an erection if presented with a one-quart, tin bottle of mineral oil, so do decant it into something pretty and pink. Now, mineral oil would not work with a condom–you must use a water-based lube with a condom. Many of my patients like Astroglide–a water-based lube.

      • Dr. A: Some women don’t want their partners to know that they’re not getting lubricated. For that, KY ovules, used twice a week, on a regular basis, could be enough to keep you lubricated when the time comes. However, a seductive FOF woman can certainly have fun using lube as a part of foreplay.
      • Dr. H: That’s certainly a way to put foreplay back into sex. Also, KY Intense is an arousal gel for women who like to have their clitoris warmed up.
      • Dr. A: A hot, relaxing bath is another great way to warm up and have some genital and clitoral engorgement.
    • What about erotica? Is there certain visual or written erotica that you think is good?
      • Dr. H: Eve’s Garden ( has great erotica–books and videos with women-centered stories.
      • Dr. A: If it doesn’t come in a blue box wrapped in a white ribbon, than it’s not erotica for me. You’ll have to go with Hilda’s advice on that one. . .

    Want to hear more about the sex life of women in midlife? Check out these titillating topics at Women’s Voices for Change:

    A History of the Vibrator
    Sex Diary of a Satisfied 62-Year-Old Woman

    Patricia Yarberry Allen, MD & Dr. Hilda Hutcherson, MD,Patricia Yarberry Allen, MD, director of the New York Menopause Center, is a gynecologist affiliated with New York-Presbyterian Hospital and a board- certified fellow of the American College of Obstetrics and Gynecology. She is a spokesperson on women’s health, and the publisher of Women’s Voices for Change.

    Dr. Hilda Hutcherson, MD, is presently a Clinical Professor of Obstetrics and Gynecology and Associate Dean for Diversity and Minority Affairs at Columbia University’s College of Physicians and Surgeons. She is also the author of What Your Mother Never Told You About Sex and Pleasure: A Woman’s Guide to Getting the Sex You Want, Need and Deserve.

    DIY Marriage Counseling

    Expert Laurie Puhn insists you don’t need couples therapy, you need to roll up your sleeves and fix it yourself.

    ImageDivorce lawyer and mediator Laurie Puhn sees a lot of fighting couples–and she wouldn’t have it any other way. “Not only are fights inevitable, they’re good,” says Laurie. In her new book, Fight Less, Love More: 5-Minute Conversations to Change Your Relationship without Blowing Up or Giving In, Laurie teaches couples how to fight effectively. “You and your partner don’t need to talk more, you need to talk better,” she says. She sat down with FOF to discuss this revolutionary concept and shared 5 quick-fixes for common communication blunders.

    • FOF: In your book, you say couples usually don’t need therapy. This is pretty radical…Are you saying people can and should take marriage counseling into their own hands?
      • That’s right. I’d say therapy is helpful if there’s a mental health issue or if you’re the type of couple that wants to sit down in a room and talk and talk and talk. The couples I see don’t want to talk; they are sick of talking about their problems. They don’t want to spend ten years in therapy; they want solutions that will work in a week.
    • FOF: We all want instant gratification. Your book promises changes in 5 minutes but doesn’t it take more time than that to unlearn bad habits and alter expectations?
      • You can have an awakening in the course of one conversation. For instance, you might be having an argument about a decision that doesn’t need to be made for a few months. Instead of fighting you might realize ‘Hey I don’t need to argue this,’ and say to your partner ‘We are going to have more information before we really need to make a decision. Let’s hold off.” In that instant you went from having a fight to having an awakening. It takes is a little bit of wisdom to have a happier life.
    • FOF: Is it possible after being in a relationship for many years to get the butterflies and new romance feelings back?
      • ImageYour knees aren’t going to buckle like they might have on the fifth date, but doing something new and exciting together — going for a weekend getaway or trying a new restaurant or hobby – can stimulate you as if you were with a new person. You have to be honest with each other and say, “Our life got boring. What can we do together that would be exciting for both of us?” You can’t ignore the issue or it’s going to blow up in your face. You need to check for intimacy, for passion, for praise. Most people are good people, they just get into a routine.
    • FOF: How do you break out of these routines?
      • You need to date each other again. You need to go back to the praise and the kindness and the ‘Good morning’ and the ‘How are you doing today?’ You need to listen to each other and ask ‘How did your doctor appointment go?’ and ‘How’s your mother doing?’ You need to care about what’s going on in your partners life.
    • FOF: In your book you mention ineffective or conflict-provoking phrases you hear over again in relationships and offer quick-fix alternatives. Let’s discuss a few.
    • Instead of: “Can we talk?”
      You suggest: “Honey, can we have a 5-minute conversation?”

      • When people know the conversation is going to be short, they are willing to fully engage. If you say, ‘Can we talk?,’ your partner may fear that he won’t be dismissed for a few hours. He won’t want to contribute because it only makes the conversation go longer. If you say and promise five minutes, you’ll get full attention for five minutes.
    • Instead of: “I love you”
      You suggest: “I love you for…”

      • ImageThe “for” reminds you to look for something to love. It reminds you that every day he’s doing things that benefit you. Even if it’s something that doesn’t benefit you, it can be worthy of praise. Maybe your brother-in-law had issues and your husband is helping him. That’s your spot to say, “I love you for being a great brother.” Who else is going to say that besides you?
    • Instead of waking up and saying: “This is what we have to do today…”
      You suggest waking up and saying: “Good morning.”

      • What does good morning mean? It means, ‘it’s a good morning because you’re here, I’m here and we’re healthy and together.’ Or if we are not healthy, we are here to help each other. Sometimes we stop saying it to each other because we get stuck in a ‘roommate routine.’
    • Instead of: “Whatever.” (When your partner asks your opinion)
      You suggest saying: “Honey, can you give me a minute to think about that.”

      • When someone says “whatever,” it sends the message that they are a spectator in the relationship. If you don’t have an answer, just say, “Let me have a minute to think about it.” Then come up with an answer and be flexible. When you contribute ideas, you’ll have a more open and exciting relationship.
    • Instead of: “I told you so.”
      You suggest saying: “I’m sorry that happened.”

      • This is what I call moving from a fight line to a love line. For example, your husband gets sunburned. You want to say “I told you to wear sunscreen,” but it doesn’t affect you and it already happened. It’s the perfect opportunity to offer compassion instead of criticism.
    • FOF: What if your partner isn’t on board, continues to fight, is negative, places blame and engages in other ineffective forms of communication?
      • It takes two people to start an argument and one person to end it. You can make changes with our without your partners help. If you want to see your relationship improve, change yourself first. You have complete control of that. Then let the cards fall. I guarantee that if you start speaking differently, you are going to get a different reaction. He won’t even know what happened to him and you’ll both be much happier.
    Laurie Puhn, JD
    Divorce lawyer/mediatorLaurie Puhn, JD, is a Harvard-educated family and divorce lawyer/mediator with a private practice in Manhattan. She is the author of “Fight Less, Love More: 5 Minute Conversations to Change Your Relationship without Blowing Up or Giving In.” She has appeared on local and national media, including Fox & Friends, Weekend Today, 20/20, Good Day New York, and CNN, and her communication and relationship advice has appeared in Good Housekeeping, Real Simple, Redbook, and the New York Times. She also conducts empowering relationship communication seminars and workshops nationwide. Her website is:

    Is cheating a dealbreaker?

    He Strayed. Now What?

    Dr. Lucena argues that after adultery, your emotional side will want to be in control, but your rational side should still have the final say.

    Every infidelity may be different, but the effects are always the same–pain, turmoil and a lot of questions. The trust may be broken, but does that mean the relationship is? Can marriage survive an infidelity?

    Sex therapist Dr. Williams Lucena thinks it can, and every effort should be made to see that it does. While there’s no changing events from the past, they don’t have to define your relationship’s future.

    • FOF: What advice can you give women who find out that their husbands have cheated on them?
      • Dr. Williams Lucena: My advice is always to work out the relationship. Look into couples therapy and get some help. See what’s going on between the two of you.
    • FOF: You don’t think cheating is a dealbreaker?
      • Just one time? No, I don’t think it has to be that way. If she really wants to work out the relationship, she needs clear awareness — what’s more important to me, my desires or my anger? Can there be a solution?
    • FOF: What kind of solution?
      • In every relationship, both parties are responsible — not guilty, but responsible. Probably as a woman I’m doing something wrong or I’m not communicating something. As a man, probably I’m not communicating something, or I’m doing something wrong. Both parties share the responsibility.
    • ImageFOF: How does a woman live with a man through that period, when she knows that he’s cheated?
      • Everyone has to understand that she has to express her anger, and that she has the right to express her anger.
    • FOF: Most women would want to throw the man out.
      • That’s just feeling anger. It’s normal to feel pain, but you have to see if you can work out the relationship. It’s wrong to make a decision based on anger. You don’t need to throw everything out. You need to think before you decide. You need to talk. What is he missing?
    • FOF: Some people feel very rejected, like the partner has committed the worst sin and can’t get past it.
      • True, it’s difficult for people to go through this, or to forgive. But you know, it’s better at least to try to understand what’s going on and for what reason. Maybe it’s about something that happened in childhood. Those wounds — perhaps feelings of rejection, or not feeling completely loved — may have never been totally cured. Then they’re re-opened by the infidelity and carry the same hurt feelings, so it’s hard sometimes to get into the healing process. My recommendation is always try psychotherapy. Many times people don’t always understand what happened, and they really need somebody else to do an intervention.
    • FOF: For some people the intervention can take years. They can forgive but not forget, and it’s rough to live under those circumstances.
      • You may have to take a rest. But if you believe in the relationship and see it as something you can save, you need to be clear. You need someone from the outside who’s capable of listening and understanding the dynamic — one side and then the other side. Then you can both say “look at what happened here.”
    • ImageFOF: How can couples therapy help?
      • We create tasks to see if the couple really wants to fix things. Is it a painful process? It can be, but there’s often a good outcome. That outcome isn’t necessarily just going back together. Sometimes the outcome is the ability to decide, with a healthy mind, “You know what, this just isn’t going to work.” But that decision isn’t made with anger. That decision is made with a thought process, rather than an emotional process. Even though it may be painful, at least you’re more clear.
    Dr. Williams Lucena
    Physician and PsychiatristDr. Williams Lucena is a physician and psychiatrist in Venezuela and a Florida Licensed Mental Health Counselor (LMHC). He has worked in the mental health field for 22 years and received his certification in sex therapy at the Sex Therapy Training Institute in Miami, Florida.

    Dr. Lucena has experience in Transactional Analysis, Psycho-Corporal Techniques and other Psycho-Dynamic approaches and works with individuals, couples and group and family therapies. He headed the Prior Authorization Adult Department at the Miami Behavioral Health Center and was Clinical Administrator at Royal Coast Mental Health Center, Miami, Florida.

    Williams also provides consulting services for various mental health facilities. He is currently the President of the Brain & Behavioral Institute of South Florida,