When we talk about safe sex, we are usually referring to using condoms. That's a good start, but it is much more than that.
Safe sex truly means reducing your risk of contracting a STI (sexually transmissible infection). Although condoms can greatly reduce the risk, they are not 100% reliable, as they can break, tear, or fall off. Plus, they must be used for all encounters that involve vaginal, anal, and oral sex. Condoms that are latex or polyurethane are best, since lambskin condoms do not prevent all STI's.
Let's go through the many considerations.
First of all, can you still get pregnant? Many women who are peri-menopausal may still be fertile. Using adequate birth control is recommended for one year after the last menstrual period. See Measuring Menopause.
But, if your are at this website, you may have reached menopause and don't have to worry about pregnancy. Many women may find themselves considering having sex after a divorce or loss of a spouse, and the rules have changed since they last entered into a new relationship.
The first rule is: Know your sexual partner. Many adults over the age of 50 have had multiple sexual partners. An honest discussion regarding a history of previous partners, whether there is a known STD and whether it has been treated, and if there is a history of having sex with individuals at high risk is mandatory. High risk behaviors include IV drug use, anal sex, having sex with prostitutes, having sex with individuals who are at high risk, and a man who is also having sex with other men. Some STI's are not curable. They include HIV, HPV, and herpes. Condoms can prevent contact with secretions that transmit HIV, but HPV and herpes are spread by skin contact, and some areas of skin are not covered by a condom.
Rule number two is: Get tested. Before entering into a new sexual relationship, ask your partner to be tested. You should be tested, too. This is OK! Sometimes these discussions can be difficult, but if you accept that this is so important to your health, you will be protecting both yourself and your partner. A visit to a primary care physician or gynecologist will include vaginal swabs and blood tests to determine if there is an STI present. See Understanding Sexually transmitted infections.
The next rule which was already discussed is: Use Condoms. Condoms should be used for vaginal, anal and oral sex. Condoms should be used with lubricants, as dryness increases the risk of a condom breaking or tearing. Plus, breaks in the skin, which can occur with intercourse that causes a vaginal tear or abrasion, increases the risk that an STI can get into the bloodstream. This is an important reason for menopausal women to use lubricants or perhaps, vaginal estrogen to improve the integrity of the vaginal tissue. Lubricants that are water or silicone based are less likely to cause deterioration of a condom, therefore, oil based lubricants are not recommended.
If sex toys are used, they should be carefully cleaned after use. There are usually instructions about proper cleaning that will be included in the product literature.
There are now several drugs that can be used for prevention. Antivirals can be used by a person with herpes, to reduce outbreaks and also the risk of shedding the virus during sexual encounters. There is also a medication for pre-exposure prevention of HIV. This drug, if taken in a population at high risk of contracting HIV, will greatly reduce the possibility of infection.
It is generally recommended that condoms be used for six months after the onset of sexual activity with a new partner. It can take up to six months for a person who is infected with HIV to test positive. Retesting is recommended, and then if the relationship is consistently monogamous, condoms can be stopped.
The safest sex is a mutually monogamous relationship. If your are exposed to multiple partners, it is best to know the symptoms of STI's and to be tested frequently.
Following the suggestions discussed can prevent avoidable diseases and a lot of grief!
The Journal of the American Heart Association published an article in October, 2016, that indicated that use of calcium supplements may increase the incidence of coronary artery calcifications. This wasn't the first study that questioned whether use of calcium supplements actually helped your bones, which was the purpose, or ended up in unwanted places like the vessels of the heart or in the kidney as stones. The article received significant press coverage, and many patients stopped their calcium supplements.
After studying many articles, I realize the controversy has been going on for a decade or more. Some studies actually found that those who took the highest dose of calcium in both food and supplements had the lowest risk of cardiovascular disease.
My search led me to a presentation by Dr. Andrea Singer from Georgetown who looked at the studies and put them in perspective. She evaluated the literature since 2008 and noted some problems with trying to get data. Studies on dietary supplements are difficult when looking at diseases that take a very long time to develop, such as heart disease and osteoporosis. The studies showed conflicting data, with some studies demonstrating a benefit, and others, an increased risk of cardiac disease. Interesting, is that women noted to have a lower bone density also had an increased risk of cardiovascular disease. So maybe the calcium supplement matters not at all.
Finally, the National Osteoporosis Foundation and the American Society for Preventive Cardiology came together to produce this policy statement:
“There is moderate-quality evidence (B level) that calcium with or without vitamin D intake from food or supplements has no relationship (beneficial or harmful) to the risk for cardiovascular and cerebrovascular disease, mortality, or all-cause mortality in generally healthy adults.” • “In light of the evidence available to date, calcium intake from food and supplements that does not exceed the tolerable upper level of intake (defined by the National Academy of Medicine as 2000 to 2500 mg/d) should be considered safe from the cardiovascular standpoint."
Obtaining calcium from food sources is preferred. • Supplemental calcium can be safely used to make up any shortfall in dietary intake. • Discontinuation of supplemental calcium for safety reasons is not necessary and may be detrimental to bone health in situations where intake from food is suboptimal • Aim to reach, but not exceed, recommended intakes.
The recommended dose for women <50 is 1000 mg per day, >50 is 1200 mg/day.
For a more complete discussion of the effects of calcium in the body, and a list of foods that contain calcium, look for the tab "Calcium" in the MORE section of this site.
M. Jerome, MD
Have you heard of designer estrogens? They are not really estrogens at all, but chemical compounds that may act like estrogen in some parts of the body, but an anti-estrogen in another part of the body.
Many women experience depressive symptoms during the menopausal transition. The psychiatric community has criteria that define a major depressive disorder. These criteria include depressed mood or lack of interest in daily activities for more than two weeks.
The mood disorder should be a change from the person’s typical baseline. During a period of depression, a person will demonstrate impaired function with social, occupational, or educational activities. Additional symptoms include at least 5 of the following, present nearly every day:
Anxiety symptoms that are severe including irrational worrying, feeling tense or fearful, and trouble with relaxation may be a part of a depressive disorder.
An evaluation of a patient with these symptoms should include looking for causes that may contribute such as substance abuse, medical illnesses, bereavement that includes marked functional impairment, and other psychiatric disorders.
A previous history of a major depressive episode is an important factor since those with depression will often have recurrences. A physician must also consider the degree of functional impairment that the person is experiencing. Functional impairment involving personal relationships, school or work, relationships with peers, the degree of stress or anxiety, and concerns regarding suicidal ideation or self-harm are important factors to assess.
Many women going through menopause will experience mood changes. Depressive symptoms of menopause vs. a clinical depression are important to differentiate, because the treatments may be very different. Hormone therapy may be helpful for depressive symptoms, but clinical depressions should be treated with anti-depressants, therapy, and other modalities.