]Sexy Saturdays are back! WVFC’s favorite, most candidly outspoken gynecologists have returned with another round of freewheeling conversations about sex, sexuality, and the pleasures of life before, during, and after menopause. Here, Dr. Pat and Dr. Hilda start out by exploring the pros and cons—and what to watch out for—in living the single life.

Dr. Pat:  When we left off on our conversation last spring, one of the things we wanted to get back to was, How do you initiate that important dialogue with a new sexual partner? What points do you need to clarify with somebody you’re starting out with? What kind of tests do you need to show them? What kind of tests do they need to show you? How does a non-monogamous, post-menopausal, recently divorced, or always-single woman get back into the game, but safely?

Dr. Hilda: I see that quite frequently in my practice—women in their 50s who suddenly find themselves single after many years of what they thought was a happy marriage. And now they’re out as single women meeting men and trying to make good decisions about their health and their sexuality. And they often come to me and say, “Well, what tests do I need to have done?  And how do I broach that topic of condoms?” Because for those of us in our 50s, when we first became sexually active, it was a free-for-all, right?

Dr. Pat:  Everyone either had the IUD or the pill, and men never used condoms.

Dr. Hilda: And herpes was the worst possible thing you could get, and most people didn’t get herpes, so you just didn’t worry about it. It wasn’t something that was on most women’s radar when we first became sexually active. So if you’ve been with a partner for a long time, and suddenly you’re single, it can be very difficult because now you have to learn, the way our daughters are learning right now, how to have that conversation with a man. Or with a woman, if your partner is female. And that can be quite difficult.

Dr. Pat: And of course it’s even harder in midlife because the man may not be used to these kinds of conversations. Often these men over 50 who are available sexual partners feel that they are somehow a great gift. You know, there are fewer of them, so they can set the rules. “You want to use a condom?  Well, honey, I don’t do that.” I mean, it takes a great deal of self-possession to bring that up, let’s face it. I think women have to carry condoms. I think they have to practice the conversation with their girlfriends. I tell young women, and now I tell older women, I never have a physical relationship unless I have an emotional connection. This gives both people an opportunity to know the other person better. After all, condoms do not protect against all sexually transmitted diseases. It would be reassuring at least to know something of the person’s character. Otherwise, the price may be too high.

Dr. Hilda: I don’t necessarily agree.  I think that if a woman goes out on a date and she’s in her 50s or 60s, and this man turns her on, she should go for it.  Life is short.

Dr. Pat: She could make it shorter. [Laughter]

Dr. Hilda: I think she has to be smart. But I think she should go for it—have the sex, have the orgasm, enjoy it, and have no guilt the next day whether he calls you or not.

Dr. Pat: It’s not about that.

Dr. Hilda: Have a good time, but—

Dr. Pat: But take care of yourself.

Dr. Hilda: But, yes, be safe. Safety’s important.

Dr. Pat: I’m saying it’s easier if you have some kind of emotional connection with another adult where you can talk about safety. You know, a sexual relationship is brief—a romantic encounter is going to be brief. But the sexually transmitted diseases can stay with you forever. We are going to be seeing head and neck cancer in women in increasing numbers, because it’s routine for women to think that giving someone a blow job is not really sex. I mean, men have been telling us that oral sex is not really sex for a very long time! But it is sex, and we know that a man can have HPV [human papillomavirus], because what is it? 80 percent of sexually active heterosexual women, by the time they’re 50, have been exposed to HPV. No one has done a study testing men for HPV, but if that’s the percentage for women, we can assume that it’s approximately the same for men.

Dr. Hilda: But people don’t commonly have oral sex with a condom on the penis.

Dr. Pat: So who’s going to suffer from HPV and oral cancer? Women. So the only kind of sexual activity you can have is mutual masturbation, or you can have a condom on a penis and have intercourse. Nothing wrong with either one of those. But I would not advise patients to give a blow job to someone they don’t know well.

Dr. Hilda: But even if you know them well, they can still be carrying HPV, and that’s just my point. Are you going to go through life never having oral sex?

Dr. Pat: Well, there is a physician in New York, Dr. Alan Kling, who does check men for HPV. And I think if I were going to begin a new sexual relationship and it was going to involve oral sex, I would send the guy to Dr. Kling, or a specialist like him in other cities. Dr. Kling will dip the man’s penis in vinegar, then look at it with microscopic lens to determine if he has HPV. He’s a specialist in evaluating men for HPV, but I would also want to know that the man is HIV-negative. And really, one would be smart enough, I hope, to try to engage him in a conversation about how many partners, and where. To begin sort of gently: “Tell me, what’s the most fun sex you ever had?”

Dr. Hilda: What kind of partners, as well.

Dr. Pat: Right. Try, “Have you ever had sex with a prostitute?  Oh, my God, you certainly have had lots of fun. Tell me more!” Or “Bachelor parties in Vegas? Did you ever try a sex club?” What you’re trying to do is get information.

Dr. Hilda: And “Have you ever had sex with a man?”

Dr. Pat: That’s a hard one. How many men are going to tell you the truth, and how many men are going to like have sex with you after that one? But an HIV test is crucial. I’ve said it before and I’ll say it again—women tell me that they didn’t ask for any documentation of sexually transmitted diseases before buying the house. No inspector was hired, no one came to look at the roof, the house, or the foundation.  They just bought the house. Because the man said to them, “Well, you know I give blood every two months, and they don’t allow us to give blood unless we’re free of diseases.”

Dr. Hilda: Oh, yeah, I’ve heard that one before.

Dr. Pat: And I say to patients if all the men in New York who claim to have given blood had actually done so, the streets of New York would be like the Red Sea. It’s hard to meet someone and have impulsive sex unless all you do is sex with a condom.

Dr. Hilda: Yes. And I think that women should ask for an HIV test. The mistake that some women make, though, is they’ll ask for a test once, and then they think that’s it. I would tell a woman to get a test herself at the same time, so the two of them are being tested. Then continue to use a condom. She needs to be sure that he is monogamous and having sex only with her, with a condom. And then they get tested again three months later.

Dr. Pat: And then six months later.

Dr. Hilda: And then six months later. I think it’s important to have more than one test.

Dr. Pat: You’re absolutely right. It is not just the moment. We don’t know if the night before, he had sex with a man. Dating in midlife is a minefield, not just because you get your heart broken. You might die.

Dr. Hilda: Oh!  That’s very sad!

Dr. Pat: Well, you tell me if it’s not true.

Dr. Hilda: Who would want to have sex after that?

Dr. Pat: Well, then tell me it’s not true.

Dr. Hilda: But I don’t like looking at only the negative aspects.

Dr. Pat:  Have we looked at only the negative aspects?

Dr. Hilda: No. I think midlife sex is amazing. I always thought that I was having great sex when I was in my 30s. I thought that was it. But in my 50s, it’s incredible. I don’t have fears of pregnancy. I know my body completely. I know where all my erogenous zones are. I know how they need to be stroked. I know how fast, how hard, I know everything about my body, and I’m comfortable with my body. I don’t have any issues. I’ve been with my partner for 25 years. We know each other very well. So sex is great because I can just be free, you know?

Dr. Pat: But we’re talking about a different situation here. We’re talking about being with someone about whom we know nothing, and we have to be comfortable enough to teach him how, how long, where, when.

Dr Hilda: But you know, the other thing, too, Pat—let’s stretch our boundaries here a little bit. We are still talking about a woman who’s been non-monogamous or recently divorced and who’s trying to settle down with somebody new in a new relationship. What if she just wants a series of lovers?

Dr. Pat: Then she should use a condom and have intercourse, or she should accept the risk that there is a growing body of evidence that HPV transmitted from a penis or vagina to a woman’s mouth could give her throat cancer.  Like it or not.

Dr. Hilda: Well, the other side, I think, is that the risks are still small. They’re not zero, but presently they’re still small.

Dr. Pat: The data is small. The data is small.

Dr. Hilda: Right. What I say to my patients is, “There is definitely a risk of contracting HPV, and you can contract it in your vagina, your vulva, your anus, and your throat, of course. I think it’s important that you be selective about who you’re sleeping with, although that doesn’t necessarily mean anything.”

Dr. Pat: Especially if you are having a few drinks, and you meet someone great at a party, and you go home and you have a wonderful time. You know, that’s what we’re talking about. Women who don’t have children at home, and women who want to experiment sexually, they’re not often thinking with the left side of their brain. They are thinking with the right side of their brain, which is essentially emotional impulsivity.  I think I must have an overly developed part of my left brain. Sometimes I say to myself, “What disease could you give me?”  [Laughter]

Dr. Hilda: I’m so fortunate that I’m married because if I were not, I think that I would be having a very active sex life—

Dr. Pat: —And you’re not now?

Dr. Hilda: —with multiple men. I’m over 50, and if I were single and I saw someone across the room who caught my attention, I would have no problem whatsoever walking up to him and talking to him, and if I was interested, hitting on him. No problem at all.

Dr. Pat: That’s part of the joy of being in your 50s.

Dr. Hilda: Absolutely. At this point in my life, I should be able to make adult decisions for myself without guilt, shame, or fear about what others will think.

Dr. Pat: Right, including getting HPV of the throat.

Dr. Hilda: There’s a risk in everything that you do.  And you measure the risk versus the benefits.  There’s a small risk. I tell women to be careful—

Dr. Pat: Right. But what does that mean?

In the next Sex Talk: More on having fun, being careful, and why those new Japanese condoms are the essential don’t-leave-home-without-it.

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