Cara and John were a fifty-something couple who presented to my office with a relationship dilemma. It was no secret that with her stressful job, two adolescent children and a new house under construction, Cara’s sexual desire had headed south since their wedding ten years earlier. John’s had remained the same and this was starting to become a big issue for them.
So after much discussion and frustration on both parts, they decided together that perhaps they should open up the relationship. They made an AGREEMENT. Cara and John agreed that he was free to seek sex outside of their marriage as long as he lived by a few rules:
- Cara did not want to know about it at all.
- John was at all costs to practice safe sex.
- They would only have sex if Cara initiated.
John agreed as he noticed that with a lack of sex in their relationship, he was becoming irritable and lonely. He needed to have sex. This arrangement was seemingly working for them until Cara noticed a provocative picture that a woman sent to John on his phone and as John states, "Cara blew a gasket." This prompted them to get some help for their sexless marriage.
When I see patients in my clinical practice, I always cover some background information prior to getting to the problem:
- Are you sexually active?
- Have you ever experienced sexual trauma or abuse as a child or an adult?
- Are there any physical medical problems?
- Is the patient/patients on any medication?
- Is there a history of anxiety/depression or another psychiatric disorder?
- Any previous treatments for your sexual issues?
In Cara’s case, she stated that she was experiencing some menopausal symptoms which she felt was what sent this whole venture to the dark side. Cara was experiencing night sweats, hot flashes, mood swings, irregular periods and vaginal dryness. She said the last time she had had sex with John it was so painful, she could not bear it. She had never told John this detail, which is not uncommon.
According to the Clarifying Vaginal Atrophy's Impact on Sex and Relationships (CLOSER) survey: emotional and physical impact of vaginal discomfort on North American postmenopausal women and their partners revealed:
- Vaginal discomfort caused most surveyed North American women to avoid intimacy (58%)
- 64% experienced loss of libido due to vaginal dryness
- 64% of those with vaginal dryness experience painful sex
- 78% of men surveyed believed that vaginal discomfort caused their partners to avoid intimacy and
- approximately 30% of North American women and men cited vaginal discomfort as the reason they ceased having sex altogether.
John was shocked as his wife sat there sobbing. She felt she had ruined her marriage and could not believe she had agreed to an open relationship. She had deep regret. She had no idea that she would feel so badly knowing another woman wanted her man which can sometimes increase a woman's sexual desire.
Perhaps it was time to treat Cara’s vaginal dryness and menopausal symptoms with the use of a personal moisturizer such as RepaGyn, a hormone-free ovule that is inserted into the vagina once daily for 2-3 weeks, then every other day as maintenance or as directed by one's healthcare professional. It may also be time to end the “agreement” as it was clear this was not as easily handled by Cara, a woman whose moods were labile during her menopausal years.
This was a place to begin, I explained to both John and Cara. With a bit of help for her physical and emotional health, my work had only just begun to get John and Cara backtothebedroom .....with each other. Stay tuned.