In this installment of the ongoing conversation, Dr. Pat and Dr. Hilda talk about feeling sexy, attitudes that can get in the way, and how to get past them.

Dr. Pat: Hilda, you asked some interesting questions about women who don’t like their bodies or body parts as they age. And one of them is about a woman who has large breasts. Those breasts are perhaps no longer as perky as they once were, and she feels uncomfortable because she has large, pendulous, sagging breasts. And a question is, how can a woman feel better about herself so that she will feel sexier? Because when we’re constantly judging how we look in the act of lovemaking, it certainly will impede the capacity to have an orgasm, and it certainly would have a big impact on libido.

I think the answer to that is that, we live in a time when there is absolutely fabulous lingerie that’s fun for any woman to wear, fun for her to have on in bed. And they make wonderful lingerie for the full-busted woman. I think that’s a great way of turning what she is feeling ashamed of into an asset.

Dr. Hilda: Certainly, bras now not only lift, but separate [laughter] pendulous breasts, and they’re beautiful. So you can find bras for a full-breasted woman that are absolutely gorgeous, and  that she can feel confident and comfortable in when she goes to bed with her partner. And I often tell my patients to put on sexy negligees with the bras built in them—

Dr. Pat: Yes, they’re wonderful.

Dr. Hilda: —and wear that to bed. If that makes her feel sexy, then that’s something she should do. The other thing I tell them is that when a man gets to that point where he has you in bed, he’s not worried about your sagging breasts, your midriff bulge, or the dimples in your thighs. Men have a way of focusing on—

Dr. Pat: What’s to come.

Dr. Hilda: [laughter] —what’s to come.

Dr. Pat: And when I’ve talked to men about this issue, they say that they don’t really focus on parts. They focus on the totality of the experience. They’re interested in a woman sexually not just for how she looks by any means, but, you know, is she a lot of fun? Does she have a great personality?

Dr. Hilda: And does she like sex. [laughter]

Dr. Pat: Does she like sex!

Dr. Hilda: Exactly. Enjoying sex is the most important thing.

Dr. Pat: Many women focus on the change in their skin, the muscle loss, the less taut abdomen and begin to resist going to bed naked, resist making love with the lights on, and worry that they will not be seen by their partners as sexually desirable. The partner, one assumes, is in the same age range and is very likely to have a paunch, less hair on the head, and visual changes to his genital tissue as well.  Men get droopy down there as they age too, you know.

I suggest that women be realistic about some bodily change and create an action plan for changing what can be changed. Start an exercise program if you are not in one. Focus on toning and developing aerobic endurance exercise, as long as there are no contraindications to a more vigorous exercise program. Start slow and build on this. It is well known that exercise improves the blood flow to the brain, the skin, and all those other parts. Feeling in charge of one’s own body is itself invigorating. And always remember that sexy lingerie makes most women feel good, and most men are delighted that their partner made the effort to “dress for the occasion.”

Dr. Hilda: I think one of the things that things that makes women feel uncomfortable with their bodies is their worries or concerns about how other people view them—how men view them, how their partners view them. And that’s why I spend time trying to convince them that he’s not so worried about your breasts, so you can just push that out of your mind. If that affects how you see yourself, then let’s try to deal with that issue. And then you also need to work on how you view yourself and why you see yourself in a negative way.

Dr. Pat: But you know, there’s a limit. As gynecologists who are interested in sex therapy, there’s a limit to what we can do or should do. I’m not a relationship expert. I’m not a psychologist. So I do discuss the basics. I try to provide information and cheerleading. But if the issue is unresolved unhappiness about body change as a woman is growing older—

Dr. Hilda: You certainly can give tips, right?

Dr. Pat: Oh, many tips.

Dr. Hilda: One is lingerie . . .

Dr. Pat: Right.

Dr. Hilda: Another is choosing positions. If your breasts are your biggest concern, and you’re worried about how your breasts look, then you might not do the woman-on-top position because that gives a fuller view of your breasts. Or if you are going to do woman-on-top, you’re going to keep your little nightie—a little see-through teddy with a formed bra inside—on when you’re on top, if that position makes you uncomfortable and you can’t get that out of your head.

Dr. Pat: And also there’s the side entry, where the man and woman, usually from the rear—

Dr. Hilda: Yes, from the rear. Rear-entry positions might make you feel a little bit more comfortable.

Dr. Pat: And men like that because they get to hold and caress the breasts.

Dr. Hilda: Exactly. So you might choose positions in which you feel that you’re not being exposed as much. It’s little tricks that people can do to make themselves . . .

Dr. Pat: Information from older friends who have remained sexual is so empowering. Patients who are still very sexual in their 60s, 70s and 80s have made it a priority. They also learned to get past the change in their bodies. But the truth is many of these women do work hard at looking sexy, acting sexy, and staying sexy. Ignorance about how you might feel about body change is a bad choice. Ignorance about how the body changes in each life stage is avoidable. You know, it’s like when I found out about having my first period. Believe me, it was a shock because nobody told me what to expect. I was absolutely appalled. There is nothing about menopause that appalled me nearly as much [laughter] as growing up in the South and having—

Dr. Hilda: [laughing, nodding] —in the South and having nobody tell you …

Dr. Pat: —nobody tell you anything about what’s to come. So at some point, you just have to make peace with it, and have some common sense. I mean, when so many people we know lose their breasts completely because of breast cancer or disease, the fact that somebody has healthy breasts is already a plus. You know, looking at the positive, if you have generally good health and you have someone with whom you might share your sexual self, these are already fabulous gifts.

Dr. Hilda: But I think it goes beyond breasts for most women. Breasts are one part. But I see women who worry that their belly’s not as flat as it used to be. They’ve got stretch marks because they’ve had kids. Or now they’ve got fat on their hips that they didn’t have when they were 18. Or they’re 20 pounds heavier than they would like to be. They don’t look like the models in the catalogues. They’re overweight.

Dr. Pat: But may we point out that their husbands don’t, either.

Dr. Hilda: Well, most of them—

Dr. Pat: You know, men age as well.

Dr. Hilda: Most women just don’t think about that, though. [Laughs]  They really don’t. They don’t think about the fact that he doesn’t look the way he looked 20 years ago, either. And he’s not usually focusing on his quote-unquote “imperfections” in the same way that we do. We’re a lot more critical of our bodies and how we look and less accepting of aging. Men don’t spend a billion dollars on Botox and fillers in the same way that—

Dr. Pat: Some do.  [Laughs]

Dr. Hilda: Well, a few. But most of them don’t do that, or hair pieces, or any of the things that we do. But most of my patients don’t think about that part of the equation.

Dr. Pat: But I do bring that up. I say, “Excuse me. Does he look just the way he did?”

Dr. Hilda: Well, certainly we do that. We bring that up when we’re talking to our patients. But they don’t usually think about it. And there are so many issues. We’re very, very hard on ourselves. The whole issue of weight. Now, I’m a woman who’s overweight but I don’t feel that I’m not sexy. I feel very sexy. Yes, I’d like to be 20 pounds lighter than I am right now. But I feel that I’m sexy, and I don’t hide in the bedroom.

Dr. Pat: And you don’t hide in clothes.

Dr. Hilda: No. And I talk to my patients about that. Just because you don’t fit that stereotypical mold that we have in this country about what is beautiful, it doesn’t mean that you’re not sexy. And that has to do with how you feel inside. And so you have to change those messages that you’ve received from whatever—the media, or wherever you’ve received them. You have to change them into positive ones and find the things that make you feel good about yourself.

In the next Sex Talk: Stretching and fitness for the post-menopausal vagina.

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