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Coping with a Divorce or Relationship Breakup:

When you lose a close friend or love relationship, you are likely to feel great sorrow and heartache. Even when a bad relationship ends, there can be deep pain and grief. Coping with a divorce or relationship breakup of any kind can be very painful, and most people go through this experience at some point in their lives. But the challenges posed by such a deep loss can be turned into opportunities, enabling you to not only survive, but also thrive. Learn to understand your feelings and develop tools to cope with your relationship breakup or divorce.

Relationship breakup is one of life’s most painful experiences

Breaking up a relationship is difficult – especially if it’s not your choice. Grief can be experienced even when an unfulfilling relationship ends, because, at the very least, you have lost the emotional investment you made in that relationship. There may be a sense of failure, hopelessness, loss, despair, fear, or desperation. In many cases, the length of the relationship compounds the pain of loss – a divorce after half a lifetime together can seem like the end of the world. Partly, it depends on how much you had vested, spiritually, emotionally and financially. But even short-term relationships can involve an investment in fantasy and in hopes for the future, and their loss can be similarly heart-wrenching.

The loss of a partner through death is an obvious source of grief, but relationships end for many other reasons. Couples grow apart in general because they:

• don’t care about or want the same things – differing values and interests
• don’t know how to sustain a mutually fulfilling relationship – not surprising if you haven’t experienced positive role models
• have problems that the other can’t abide – compulsive or abusive behavior or illnesses that severely limit the relationship

Loss in relationship breakups and divorce is experienced both physically and emotionally

Why do relationship breakups hurt so much, even when the relationship is no longer good? Whatever the reason for a breakup or divorce, coping can be a challenge, because even a disappointing relationship starts out with an emotional investment in what could be. Serious relationships begin on a high note of excitement and hope for the future. People invest time, energy, plans, dreams and hope for the future in love relationships. When these relationships fail, we experience profound disappointment, as well as grieve the physical loss of someone important in our lives.

Grief is the outcome of loss that includes:

• loss of companionship and shared experiences – which may or may not have been consistently pleasurable
• loss of a hoped for dream – can be even more painful than practical losses
• loss of needed support – financial, intellectual or emotional

Early life memories can also contribute to the pain of relationship breakups and divorce.

Past relationships can make current breakups more painful

Sometimes the end of a love relationship can bring up powerful, even frightening memories of earlier separation or loss. Whatever the trigger – from the childhood memory of a last hug and kiss before Mommy or Daddy left for work, to first-hand recovery from a painful divorce – the current crisis you are experiencing can prove more difficult as that earlier fear surfaces. To read more about early life developmental trauma, see related articles below,

Childhood wounding can complicate the pain of a breakup
Abandonment:	Death of a loved one early in life Absentee or alcoholic parent(s) Being deserted somewhere when you were supposed to be picked up
Rejection	Adoption or other separation at birth Conception was an ‘accident’ or frowned upon by others Not being the gender wanted by one or both parents
Shaming	Being told you were too fat, too skinny, etc. Being teased or made fun of mercilessly by other kids or siblings Getting blamed for others’ mistakes
Abuse	Physical: bruises, welts, isolation or starvation Sexual: exposed to sexually explicit material or touched inappropriately Mental: lies and mind games; no personal privacy

In crisis there is opportunity. Although your current breakup can trigger unresolved memories that add to your pain and grief, the availability of raw memories gives you an opportunity to revisit unresolved past hurts, reevaluate and heal them.

Grieving a relationship loss may lead to depression

Grief is a normal and healthy response to loss, not an illness. Its symptoms are painful, but they serve an adaptive purpose. Most grief runs its course with the support of friends and family. But sometimes grief can trigger depression or even unresolved past trauma.

When grief triggers depression, the sadness can be unrelenting and overwhelming. Some people describe it as “living in a black hole” or having a feeling of impending doom – that is never interrupted by moments of pleasure. Even when participating in activities you used to enjoy, you feel as if you are just “going through the motions.” You may also feel numb, lifeless and empty.

Additional symptoms of depression may include
Appetite or weight changes	Significant weight loss or weight gain – a change of more than 5% of body weight in a month.
Sleep changes	Insomnia or oversleeping (also known as hypersomnia).
Psychomotor agitation or retardation	“Keyed up,” unable to sit still, anxious, restless or sluggish, slow speech and body movements, lack of responsiveness.
Fatigue or loss of energy	Physically drained. Even small tasks are exhausting. Can't do things as quickly as you used to.
Self-loathing	Strong feelings of worthlessness or guilt. Harsh criticism of perceived faults and mistakes.
Concentration problems	Inability to focus. Difficulty making decisions. Can’t “think straight.” Memory problems.
Aches and pains	Depression can cause or exacerbate many physical symptoms, including headaches, backaches, diarrhea or constipation, abdominal pain, and aching joints.

Easing the pain of relationship breakups and divorce

How do you heal from devastating losses? There is no one answer to this question, but two things that can provide support during the grieving process are:

• Experiencing your emotions in your body. Numbing or avoiding painful feelings can interrupt healing. And going over and over the details of what happened, why it happened, what you could have done to prevent it from happening is also not productive. To gain a greater ability to experience and manage your emotions see Helpguide’s Quick Course in Raising Emotional Intelligence
• Having the support of other people. Even if you aren’t comfortable talking about your feelings under normal circumstances, it’s important to talk about them when you’re grieving. Knowing that others are aware of your feelings and understand your grief will make you feel better, less alone with your pain, and will help you heal. Support from others can also be found in a divorce recovery group or a twelve-step program

A note about repeating your story to others

After a while repeating your story in its entirety can grow tedious for you and for others who have listened repeatedly to the same story. But this doesn’t mean that you have to pretend. You can briefly express your feelings to a good friend without having to explain further: “I’m still not my old self,” “I still miss him or her,” “I still feel sad, angry,” etc. Not having to be dishonest helps you feel better. Friends will also benefit from the good feelings they get from seeing that they have helped you – just by listening.

Additional ways to take good care of yourself

• Eat regular, balanced meals – Letting yourself get run down physically makes you feel even worse.
• Exercise daily – more than once a day if possible. Even if you have to force yourself to do it, exercise releases endorphins that will fill you with positive feelings.
• Avoid alcohol and other mind-altering chemicals. Blocking you feelings won’t make them go away and will only prolong suffering.
• Consider having a divorce ceremony or other ritual. Rituals help some people create meaningful symbolic ends to their relationships.

Consider Professional support if

• Feelings of isolation and loneliness persist – even though you are getting helpful information and support from others.
• The intensity of your grief seems not to be diminishing – for example, if you continue to have trouble with eating and/or sleeping, persistent feelings of guilt, or impairment of ordinary life functioning, you need professional assistance.
• You are experiencing physical symptoms that include: chest pains, sweating or shortness of breath, nausea or lightheadedness, dramatic changes in weight or physical appearance, or sleep disturbances.

Gaining strength from facing the challenge of a breakup

You can use divorce or breakup to engage in healing and empowering processes of self discovery. What matters in the healing process is your ability to make sense of your divorce or breakup. Challenges faced are opportunities to:

• Learn more about your beliefs, habits and needs.
• Build more powerful and effective interpersonal skills.
• Acknowledge past losses and recover from them, as well as your current loss.
  

The work of grief is to let the emotions flow, not attempt to block or judge them. Acceptance of the reality of current circumstances can lead to a renewed hope for the future, even though it is different from the one you used to imagine.

Through this opportunity, you are free to focus on other pursuits:

• Your friendships (and children if you have them).
• Helping others in need.
• Doing the things you've always wanted to do, but didn’t because your partner was not supportive.

Resolving practical challenges

Breaking up may involve practical matters that require your attention. Even those who weren’t married might own property together or have children. Perhaps you and your ex work at the same office or belong to the same gym. You probably have friends in common, or may own pets. So who gets what in the aftermath of your breakup?

• Belongings: Two commonly recognized difficulties are hoarding and disputing. Eventually you will have to deal with each other’s personal belongings. An exception might be mementos that would be meaningful to someone else, such as love letters or wedding pictures for your children to view once they’re grown.
• Legal matters: If you try to make important decisions when your emotions are flaring up, you might end up having regrets later on. Instead, if your partner is reasonable and willing, explore alternatives to costly and emotionally draining litigation, such as conflict mediation or arbitration.
• Parenting: While its important to express feelings such as anger, frustration or deep sadness with a trusted adult or a support group, confiding in your child can be damaging. Strive to use constructive language about your ex (not put-downs or complaints) in front of your children. Communicate directly with your ex, instead of passing messages through children. Also, keep your children’s routines as normal as possible.
• Friends: When a couple has friends in common, those people often are put in the difficult position of “choosing sides.” You can make it easier on yourself and everyone else by being aware of the problem and understanding it from your friends’ point of view. If possible, talk to them about it. Try not to pressure your friends to go against your former partner, and don’t hold it against them if they attempt to maintain friendships with both of you.

Related links for Coping with Divorce

Coping with Separation and Divorce - Tips to help in going through separation or divorce. (Mental Health America)

Separation and Divorce - Things you can do to get emotional support in separation or divorce. (Canadian Mental Health Association)

Jaelline Jaffe, Ph.D., Robert Segal, M.A. and Jeanne Segal, Ph.D. contributed to this article. Last modified on: 9/28/07.

Suicide Prevention

Understanding and Helping a Suicidal Person

A suicidal person may not ask for help, but that doesn't mean that help isn't wanted. Most people who commit suicide don't want to die - they just want to stop hurting. Suicide prevention starts with recognizing the warning signs and taking them seriously.

If you think a friend or family member is considering suicide, you might be afraid to bring up the subject. But talking openly about suicidal thoughts and feelings can save a life. Speak up if you're concerned and seek professional help immediately! Through understanding, reassurance, and support, you can help your loved one overcome thoughts of suicide.

Understanding and preventing suicide

The World Health Organization estimates that approximately 1 million people die each year from suicide. What drives so many individuals to take their own lives? To those not in the grips of suicidal depression and despair, it's difficult to understand. But a suicidal person is in so much pain that he or she can see no other option.

Suicide is a desperate attempt to escape suffering that has become unbearable. Blinded by feelings of self-loathing, hopelessness, and isolation, a suicidal person can't see any way of finding relief except through death. But despite their desire for the pain to stop, most suicidal people are deeply conflicted about ending their own lives. They wish there was an alternative to committing suicide, but they just can't see one.

Because of their ambivalence about dying, suicidal individuals usually give warning signs or signals of their intentions. The best way to prevent suicide is to know and watch for these warning signs and to get involved if you spot them. If you believe that a friend or family member is suicidal, you can play a role in suicide prevention by pointing out the alternatives, showing that you care, and getting a doctor or psychologist involved.

Common Misconceptions about Suicide

FALSE: People who talk about suicide won't really do it.
Almost everyone who commits or attempts suicide has given some clue or warning. Do not ignore suicide threats. Statements like "you'll be sorry when I'm dead," "I can't see any way out," -- no matter how casually or jokingly said may indicate serious suicidal feelings.

FALSE: Anyone who tries to kill him/herself must be crazy.
Most suicidal people are not psychotic or insane. They must be upset, grief-stricken, depressed or despairing, but extreme distress and emotional pain are not necessarily signs of mental illness.

FALSE: If a person is determined to kill him/herself, nothing is going to stop him/her.
Even the most severely depressed person has mixed feelings about death, wavering until the very last moment between wanting to live and wanting to die. Most suicidal people do not want death; they want the pain to stop. The impulse to end it all, however overpowering, does not last forever.

FALSE: People who commit suicide are people who were unwilling to seek help .
Studies of suicide victims have shown that more then half had sought medical help within six month before their deaths.

FALSE: Talking about suicide may give someone the idea.
You don't give a suicidal person morbid ideas by talking about suicide. The opposite is true --bringing up the subject of suicide and discussing it openly is one of the most helpful things you can do.

Warning signs of suicide

Suicide prevention begins with an awareness of the warning signs of suicidal thoughts and feelings. Major warning signs for suicide include talking about killing or harming oneself, talking or writing a lot about death or dying, and seeking out things that could be used in a suicide attempt, such as weapons and drugs.

A more subtle but equally dangerous warning sign of suicide is hopelessness. Studies have found that hopelessness is a strong predictor of suicide. People who feel hopeless may talk about "unbearable" feelings, predict a bleak future, and state that they have nothing to look forward to.

Other warning signs that point to a suicidal mind frame include dramatic mood swings or sudden personality changes, such as going from outgoing to withdrawn or well-behaved to rebellious. A suicidal person may also lose interest in day-to-day activities, neglect his or her appearance, and show big changes in eating or sleeping habits.

Suicide Warning Signs

Talking about suicide	Any talk about suicide, dying, or self-harm. Includes statements such as "I wish I hadn't been born," "If I see you again...," "I want out," and "I'd be better off dead."
Seeking out lethal means	Looking for ways to commit suicide. Seeking access to guns, pills, knives, or other objects that could be used in a suicide attempt.
Preoccupation with death	Unusual focus on death, dying, or violence. Writing poems or stories about death.
No hope for the future	Feelings of helplessness, hopelessness, and being trapped ("There's no way out"). Belief that things will never get better or change.
Self-loathing, self-hatred	Feelings of worthlessness, guilt, shame, and self-hatred. Feeling like a burden ("Everyone would be better off without me").
Getting affairs in order	Making out a will. Giving away prized possessions. Making arrangements for family members.
Saying goodbye	Unusual or unexpected visits or calls to family and friends. Saying goodbye to people as if they won't be seen again.
Withdrawing from others	Withdrawing from friends and family. Increasing social isolation. Desire to be left alone.
Self-destructive behavior	Increased alcohol or drug use, reckless driving, unsafe sex. Taking unnecessary risks as if they have a "death wish".
Sudden sense of calm	A sudden sense of calm and happiness after being extremely depressed can mean that the person has made a decision to commit suicide.

Suicide prevention tip #1: Speak up if you’re worried

If you spot the warning signs of suicide in someone you care about, you may wonder if it’s a good idea to say anything. What if you’re wrong? What if the person gets angry? Even worse, what if you plant the idea in your friend or family member’s head? In such situations, it's natural to feel uncomfortable or afraid. But anyone who talks about suicide or shows other warning signs needs immediate help—the sooner the better.

Talking to a person about suicide

If you're unsure whether someone is suicidal, the best way to find out is to ask. You can't make a person suicidal by showing that you care. In fact, giving the individual the opportunity to express his or her feelings may prevent a suicide attempt. The person may even be relieved that you brought up the issue.

Here are some questions you can ask:

• Have you ever thought that you'd be better off dead or that if you died, it wouldn't matter?
• Have you thought about harming yourself?
• Are you thinking about suicide?

Suicide prevention tip #2: Respond quickly in a crisis

If a friend or family member tells you that he or she is thinking about death or suicide, it's important to evaluate the immediate danger the person is in. Those at the highest risk for committing suicide in the near future have a specific suicide plan, the means to carry out the plan, a time schedule for doing it, and an intention to do it.

The following questions can help you assess the immediate risk for suicide:

• Do you have a suicide plan?
• Do you have what you need to carry out your plan (pills, gun, etc.)?
• Do you know when you would do it?
• Do you intend to commit suicide?

If a suicide attempt seems imminent, call a local crisis center, dial 911, or take the person to an emergency room. Do not, under any circumstances, leave a suicidal person alone.

It's also wise to remove guns, drugs, knives, and other potentially lethal objects from the vicinity. In some cases, involuntary hospitalization may be necessary to keep the person safe and prevent a suicide attempt.

Level of Suicide Risk
Low — Some suicidal thoughts. No suicide plan. Says he or she won't commit suicide.
Moderate — Suicidal thoughts. Vague plan that isn't very lethal. Says he or she won't commit suicide.
High — Suicidal thoughts. Specific plan that is highly lethal. Says he or she won't commit suicide.
Severe — Suicidal thoughts. Specific plan that is highly lethal. Says he or she will commit suicide.

Suicide prevention tip #3: Offer help and support

If a friend or family member is suicidal, the best way to help is by offering an empathetic, listening ear. Let your loved one know that he or she is not alone and that you care. Don't take responsibility, however, for making your loved one well. You can offer support, but you can't get better for a suicidal person. He or she has to make a personal commitment to recovery.

As you're helping a suicidal person, don't forget to take care of yourself. Find someone that you trust—a friend, family member, clergyman, or counselor—to talk to about your feelings and get support of your own.

Helping a suicidal person:

• Listen without judgment — Let a suicidal person express his or her feelings and accept those feelings without judging or discounting them. Don't act shocked, lecture on the value of life, or say that suicide is wrong.
• Offer hope — Reassure the person that help is available and that the suicidal feelings are temporary. Don't dismiss the pain he or she feels, but talk about the alternatives to suicide and let the person know that his or her life is important to you.
• Don't promise confidentiality — Refuse to be sworn to secrecy. A life is at stake and you may need to speak to a mental health professional in order to keep the suicidal person safe. If you promise to keep your discussions secret, you may have to break your word.
• Get professional help — Do everything in your power to get a suicidal person the help he or she needs. Call a crisis line for advice and referrals. Encourage the person to see a mental health professional, help locate a treatment facility, or take them to a doctor's appointment.
• Make a plan for life — Help the person develop a "Plan for Life," a set of steps he or she promises to follow during a suicidal crisis. It should include contact numbers for the person's doctor or therapist, as well as friends and family members who will help in an emergency.

Risk factors for suicide

According to the U.S. Department of Health and Human Services, at least 90 percent of all people who commit suicide suffer from depression, alcoholism, or a combination of mental disorders. Depression in particular plays a large role in suicide. The difficulty suicidal people have imagining a solution to their suffering is due in part to the distorted thinking caused by depression.

Common suicide risk factors include:

• Mental illness
• Alcoholism or drug abuse
• Previous suicide attempts
• Family history of suicide
• Terminal illness or chronic pain
• Recent loss or stressful life event
• Social isolation and loneliness
• History of trauma or abuse

Antidepressants and Suicide

Overall, the risk of suicide is lower in people taking antidepressants for depression. But for some, depression medication causes an increase—rather than a decrease—in depression and suicidal thoughts and feelings. Because of this risk, the FDA advises that anyone on antidepressants should be watched for increases in suicidal thoughts and behaviors. Monitoring is especially important if this is the person's first time on depression medication or if the dose has recently been changed. The risk of suicide is the greatest during the first two months of antidepressant treatment.

Suicide in teens and older adults

In addition to the general risk factors for suicide, both teenagers and older adults are at a higher risk of suicide.

Suicide in Teens

Teenage suicide is a serious and growing problem. The teenage years can be emotionally turbulent and stressful. Teenagers face pressures to succeed and fit in. They may struggle with self-esteem issues, self-doubt, and feelings of alienation. For some, this leads to suicide. Depression is also a major risk factor for teen suicide.

Other risk factors for teenage suicide include:

Childhood abuse Recent traumatic event Lack of a support network

Availability of a gun Hostile social or school environment Exposure to other teen suicides

Suicide in the Elderly

The highest suicide rates of any age group occur among persons aged 65 years and older. One contributing factor is depression in the elderly that is undiagnosed and untreated.

Other risk factors for suicide in the elderly include:

• Recent death of a loved one
• Physical illness, disability, or pain
• Isolation and loneliness
  
• Major life changes, such as retirement
• Loss of independence
• Loss of sense of purpose

Related links for suicide prevention and help

General information about suicide prevention

Understanding Suicidal Thinking — Learn what to do when someone is suicidal. Features advice on preventing suicide attempts and offering help and support. (Depression and Bipolar Support Alliance)

Frequently Asked Questions About Suicide — Find answers to common questions about suicide, including who is at the highest risk and how to help. (National Institute of Mental Health)

Understanding and Helping the Suicidal Person — Covers the warning signs of suicidal thoughts, suicide prevention tips, and advice on getting help. (The American Association of Suicidology)

Suicide and Mental Illness — Article on the link between suicide and mental illnesses such as depression, substance abuse, schizophrenia, and bipolar disorder. (StopaSuicide.org)

Helping a suicidal person

What Can I Do To Help Someone Who Might be Suicidal? — Discusses possible warning signs of suicidal thoughts and ways to prevent suicide attempts. (Metanoia)

Suicide: Learn More, Learn to Help — Suicide prevention fact sheet that includes questions to ask to find out if someone is suicidal. (The National Alliance for the Mentally Ill).

When You Fear Someone May Take Their Own Life — Overview of what to do when someone is suicidal, including preventing suicide in an acute crisis. (American Foundation for Suicide Prevention)

Handling a Call From a Suicidal Person — Advice on how to handle a phone call from a friend or family member who is suicidal. Features tips on what to say and how to help. (Metanoia)

Suicide hotlines and crisis support

National Suicide Prevention Lifeline - Suicide prevention telephone hotline funded by the U.S. government. Provides free, 24-hour assistance. 1-800-273-TALK (8255).

National Hopeline Network - Toll-free telephone number offering 24-hour suicide crisis support. 1-800-SUICIDE (784-2433)

State Prevention Programs — Browse through a database of suicide prevention programs, organized by state. (National Strategy for Suicide Prevention)

Crisis Centers in Canada — Locate suicide crisis centers in Canada by province. (Centre For Suicide Prevention)

Befrienders Worldwide — International suicide prevention organization connects people to crisis hotlines in their country.

Teen suicide

Facts for Families: Teen Suicide — Learn about teen suicide, including risk factors, warning signs, and how to prevent it. (American Academy of Child Adolescent Psychiatry)

Suicide Prevention Resource Center: Teens — Guide to suicide in teenagers. Includes advice for helping yourself or a friend. (Suicide Prevention Resource Center)

Suicide in the elderly

Older Adults: Depression and Suicide Facts — Overview of the problem of depression and suicide in the elderly, including how to get help. (National Institute of Mental Health)

Suicide and the Elderly: Warning Signs and How to Help — Article on suicide in the elderly covers the risk factors, warning signs, and how to provide help. (University of Florida)

Melinda Smith, M.A., and Jaelline Jaffe, Ph.D., contributed to this article. Reviewed by Jeanne Segal, Ph.D. Last modified on: 3/20/08

Lifelong Sexuality

Sex is good for older adults. In both men and women, good sex appears to: prompt the release of substances that bolster the immune system; release endorphins that act as painkillers and reduce anxiety; benefit the heart and lungs by increasing breathing and circulation; help us relax and feel good about ourselves.

Sexuality and sensuality are an important part of the aging process. Most people want and need to be close to other people. We want to touch and be touched, both physically and emotionally. As we grow older, some of us become more attuned to our sensuality—our ability to be fully present in each moment and to notice the smells, textures, and sounds that enhance our lives. How sensual you are plays a key role in your overall ability to derive pleasure from life.

Physical closeness and companionship are important to most seniors. Just being physically near is important, but many of us also want to continue an active, satisfying sex life as we grow older.

Is sex only for the young?

As people age they often worry about their sexual performance. Some may feel that at a certain age sex is no longer appropriate—that sex is for the young. Others are embarrassed about their lack of sexual "performance" and begin to back away from regular sexual encounters. Sometimes illness or loss of a partner interferes with sexuality. Without appropriate information, and sometimes professional help, a temporary situation can often turn into a permanent one.

However, given good health and a willing partner, studies show that both men and women can enjoy sex for as long as they wish. All it takes is a willingness to learn and compensate for some of the normal changes of aging, and to ask for professional help when needed. With proper information and support, your midlife and later years can be an exciting time to explore the emotional and sensual aspects of your sexuality.

How does our sexuality change as we age?

oung men and women often find that although the physical aspects of their sexuality are strong, they have difficulty with timing and frequency of desire. Research has shown that the typical young male sexual cycle builds quickly and climaxes quickly, while a women's sexual arousal tends to build more slowly. Additionally, young male sexuality tends to be more physically based, while women want more of an emotional connection during their lovemaking. As we age, however, the relationship aspects of our sexuality often become a more important aspect of our sexual expression. As physical sexuality changes, couples can explore new ways to stimulate each other by being more intentional about creating a romantic atmosphere for lovemaking with candles, romantic music, sensual massages etc. They may wish to explore new aspects of their sexuality through erotic reading, sex toys, or videos. For couples with families, the later years provide the time and freedom to cultivate "love nests", something that might not have been possible in a house ruled by young children, carpools, sports schedules and the many other demands of raising a family.

Being informed about the normal changes of aging and the many options for supporting our sexuality is much easier than it was a generation ago. More information is available on the Internet, in books, and from the medical community. Also, more middle-aged and older adults feel freer to discuss sexuality with their friends and learn from and support each other. Openly discussing your sexual needs and desires, particularly with your spouse or partner, becomes even more important as you age. Several physiological changes of aging can affect your sexuality, as outlined below.

Women

The major changes that women experience during midlife are related to diminishing hormonal production. This accounts for the symptoms of perimenopause (the time when monthly periods begin to change) and menopause (after monthly periods cease) experienced by many women. Common symptoms include:

• Lower libido and/or slowing of sexual arousal
• Hot flashes and/or night sweats
• Sleep disturbances
• Emotional changes such as irritability, mood swings or depression
• Vaginal dryness and itching
• Increased sensitivity to sounds
• Dry skin
• Weight gain and/or food cravings

Several excellent websites can provide you with more information about this important time of life and tips for adjusting to your body's changes (see References and resources).

Men

Men often find that it takes them longer to have an erection as they get older. They also find that their erection doesn't last as long, and that it takes longer for them to have another erection once they climax. Men who do not know that this is normal become overly concerned, leading to even more "dysfunction" from the increased anxiety.

What can be done to compensate for these changes?

Women

If you are experiencing any of the symptoms related to menopause, it is important to educate yourself. Sometimes women feel like they are the only ones "going crazy", or that they should be able to get through these things by themselves. Fortunately there is more information available to us today than there was a generation ago, and you can learn a lot from internet research, books, magazines, and open discussions with female friends.

Using a water-based lubricant during sex can usually help one of the most common sexual problems related to menopause, vaginal dryness. Additionally, hormone replacement therapy (HRT, available in pills, patches, creams or vaginal rings) can help many women decrease vaginal dryness and other menopause related symptoms. However, with the latest research showing HRT to be associated with higher risks of heart attack, stroke, breast cancer, and gall bladder problems; many women are reluctant to take estrogen. You may want to explore one or more of the many alternative or complementary health care supplements now available. Talk to your doctor about the best approach for your particular symptoms and feelings.

If you feel that your low libido may be related to stress, anxiety, depression, past traumas or other emotional issues, this may be a good time to see a mental health professional. Be sure to let the person know that you are dealing with sexual issues and ascertain whether they have expertise in this area of psychotherapy. You may also find that exploring other interests and activities, like taking a dance class, learning how to meditate, or doing yoga can have a positive effect on mood and help enhance your sexuality and sensuality. Some women have found that a medical provider who specializes in female sexual dysfunctions can be helpful.

Men

As men age, they need more direct physical stimulation to get an erection. Often taking more time during lovemaking, exploring new ways of expressing love, and not focusing on "performance" are enough to break the cycle of tension and allow men to enjoy lovemaking again. Considering lifestyle changes, such as increasing physical exercise, eating a more nutritious, well-balanced diet, stopping smoking, decreasing alcohol intake, and reducing stress can enhance sexuality.

When more frequent problems arise, or when a man is unable to get or maintain an erection, medical intervention may be helpful. Men sometimes think the problem is their fault, or have been told that the problem is psychological. We now know that over 80% of the time impotence or erectile dysfunction (ED) is caused by a physical problem.

If you are having trouble maintaining your erection, you are not alone. It is estimated that 5% of 40-year-old men and 15-25% of 65-year-old-men are experiencing erectile dysfunction. To explore solutions, it is important to not only talk openly with your partner, but also to seek help from your health care provider. A physical exam and lab tests can help pinpoint the cause of your ED, and help determine the best way to help. The now very well known drug Viagra and other similar medications are helpful to 60-75% of the men who try them. Mechanical devices and surgeries are other options to discuss with your physician.

Sometimes illnesses and the drugs used to treat them can also interfere with sexual functioning. Open discussions with your physician can lead to changes in your medical regime that can mitigate these effects.

Medical conditions that affect sexuality

In addition to the normal changes of aging, illnesses and other conditions can contribute to sexual problems. These include:

Medical Conditions that Affect Sexuality
Medications Surgeries, especially ones that can effect how a person views himself or herself like hysterectomies, mastectomies, and prostatectomies. Cancers, especially in the genital area such as prostate cancer Illnesses effecting the vascular system, such as diabetes, heart disease and stroke	Neurological conditions Traumas Chronic pain

In addition, women sometimes experience a loss of bladder control. It is important to discuss any physical condition with your medical provider if it is interfering with your sexuality. Many times these problems can be overcome by changing medications, or by effectively treating the medical problem.

How will cancer affect my sexuality?

Understandably, many cancer patients have a difficult time thinking about their sexuality while undergoing treatment. During a time of so many changes, it can be very disappointing to realize that the cancer and treatments also negatively affect your sex life. The Cancer Care sites listed in References and resources can help answer some of your questions and concerns about how cancer and cancer treatments for cancer might affect your sexuality, as well as suggestions for coping with the changes.

Am I too old to worry about safe sex?

As women get closer to menopause they may not have their period for many months and think they can no longer get pregnant. However, until you have missed 12 months in a row, you may still be ovulating and you may still get pregnant. Therefore birth control is still needed. A more important problem, however, can be sexually transmitted diseases.

Although young people are most at risk for these diseases (including syphilis, gonorrhea, chlamydial infection, genital herpes, hepatitis B, genital warts, and trichomoniasis), older sexually-active people can still get them as well. Anyone who is sexually active is also at risk for being infected with HIV, the virus that causes AIDS. Many people do not realize that the number of older people with HIV/AIDS is growing. One out of every 10 people diagnosed with AIDS in the United States is over age 50. You are at risk if you have more than one sexual partner or you have started dating and having unprotected sex again. Always use a latex condom during sex, and talk to your doctor about ways to protect yourself from all sexually transmitted diseases.

Does living in an institution mean my sex life is over?

For many seniors, institutional living marks the end of sexual freedom: no locks on doors, shared rooms, single beds, segregation of male and female residents, no provision for couples to room together. Combined with insufficient knowledge about aging and sexuality, and negative attitudes on the part of staff and family, seniors may find themselves in a sexual desert. Expressions of sexuality and intimacy are often treated as behavior problems, if not actively discouraged. For some seniors, negative attitudes toward sexuality in general are compounded by homophobia: whether living in the community or in a retirement residence or institution, gay men and lesbians can face significant barriers to healthy expression of their sexuality. If you find yourself or a friend or relative in this situation, it is important not to ignore the importance of sensual, and if possible sexual expression. Love, caring, and touching should be acceptable in any setting. Some institutions even allow for privacy among consenting adults for "intimate relations". However, the opportunity for sexual expression in these settings is often very limited, and much more education of staff and family members is often needed for institutionalized older adults to have appropriate expressions of their sexuality.

How do emotions affect your sexuality?

Sexuality is often a delicate balance of emotional and physical issues. How you feel may affect what you are able to do. For example, men may fear that once they have had a sexual "failure" they are less manly, and become overly concerned about their sexual prowess. This worry can actually cause enough stress to trigger further erectile dysfunction. A woman who is worried about how her looks are changing as she ages may think her partner will no longer find her attractive. This focus on youthful physical beauty may get in the way of her enjoyment of sex. Older couples also face the same daily stresses that affect people of any age. But they may also have the added concerns of illness, retirement and other lifestyle changes. These worries can be cause depression and anxiety and affect sexual functioning as well.

Emotional health is important to having a healthy and fulfilling sex life. It is important to address emotional issues as they surface. For more information on passionate feelings and emotions in marriage and other intimate relationships, see Helpguide's relationship series, Building and Preserving Joy and Excitement in Adult Relationships. Open communication with your partner is vital, but if you are sensitive about the subject matter, a therapist specializing in sexual issues might also be helpful. Talking about your concerns and actively addressing them is the only way to overcome them. You may find that expressing your worries and anxieties can help you see them in perspective or reveal ways that you can work to correct them.

Improving our sex life

Recognizing that most couples have difficulty with their sexuality sometime during their relationship and not taking it personally can be a very helpful first step. Next, it is essential that you and your partner develop ways to talk about the problem. First, choose a time when you are both able to give full attention to the conversation, and aren't feeling particularly stressed. Focus on the positive, (your love for your partner and your desire to work things out together). Objectively describe your feelings and perceptions of the problem without being judgmental. Ask open-ended questions, such as "What can I do to make things better for you?" or "What are your concerns about talking with your doctor?". Take time to create a romantic atmosphere and add more playfulness, laughter, and foreplay to your lovemaking. Explore other options, such as sex toys, oral sex, mutual masturbation etc. that do not require an erect penis to obtain sexual satisfaction. This is also a great time to explore doing more sensual things together, such as giving each other a gentle, loving massage, taking dance classes, or exploring Tantra yoga together. And finally, don't be afraid or embarrassed to get professional help when it is needed. Life is too short to deprive yourself of one of life's greatest pleasures.

Kegel exercises, also known as pelvic floor exercises, are overwhelming recommended by doctors for women (and men!) to improve and enhance sexuality. The exercises are simple to do and can be inconspicuously done anytime and anywhere. Strengthening the pelvic floor area should result in heightened feeling and sensitivity, and hopefully, better sex. See References and resources for information about how to do Kegel exercises.

References and resources on sexuality and aging

Sex Over Sixty – Offers a readable and comprehensive overview of sexuality over 60. (Canadian Bulletin of the National Advisory Council on Aging)

Sexuality in Later Life – Provides suggestions for overcoming some common physical problems that affect sexuality. (National Institute on Aging)

Women's Health

Project Aware – Offers an excellent overview of perimenopause and menopause, including a list of common symptoms. (Association of Women for the Advancement of Research and Education)

Perimenopause – Provides recommendations for seven common perimenopausal symptoms from three leading women's health experts. (Discovery Health Online)

Women's Sexual Health Foundation – A nonprofit corporation, offers pamphlets on a variety of women's sexual issues. (The Women's Sexual Health Foundation (TWSHF))

Menopause – Offers an excellent overview of menopause, with good links to other relevant websites. (National Institute on Aging)

Instructions for Kegel Exercises – Provides information on how to do Kegel exercises and why they are beneficial for both men and women. (Midwest Institute of Sexology)

Men's Health

Erectile Dysfunction or Impotence – Features a short video explaining the physiology of an erection and information about causes, diagnosis, and treatment of erectile dysfunction. (Urology Channel)

Erectile Dysfunction – Provides a list of commonly asked questions concerning the causes, diagnosis, and treatments of erectile dysfunction. Includes a list of additional organizations to seek information and help. (National Kidney and Urologic Diseases Information Clearinghouse)

Holly Kiger, R.N., and Gina Kemp, M.A., contributed to this article. Last modified on: 2/09/07.

Tips for Getting Better Sleep

Do you have trouble falling asleep, or toss and turn in the middle of the night? Awaken too early, or find yourself not feeling refreshed in the morning? You are not alone: millions of people struggle with falling and staying asleep.

Unless you’re suffering from a serious sleep disorder, simply improving your daytime habits and creating a better sleep environment can set the stage for good sleep. By developing a good bedtime routine and designing a plan that works with your individual needs, you can avoid common pitfalls and make simple changes that bring you consistently better sleep.

I: Improving your daytime habits

How can what you do during the day affect your sleep at night? Better sleep starts with good daytime habits, from when (and how often) you exercise to what you eat and drink.

Regular day exercise can help sleep....

Regular exercise, aside from many other wonderful health benefits, usually makes it easier to fall asleep and sleep better. You don’t have to be a star athlete to reap the benefits-- as little as twenty to thirty minutes of activity helps. And you don’t need to do all 30 minutes in one session: break it up into five minutes here, ten minutes there. A brisk walk, a bicycle ride or a run is time well spent. However, be sure to schedule your exercise in the morning or early afternoon. Exercising too late in the day actually stimulates the body, raising its temperature. That’s the opposite of what you want near bedtime, because a cooler body temperature is associated with sleep. Don’t feel glued to the couch in the evening, though. Exercise such as relaxation yoga or simple stretching shouldn’t hurt.

Get some light to set your body clock

We all have an internal body clock that helps regulate sleep. This clock is sensitive to light and dark. Light tells your body clock to move to the active daytime phase. When you get up, open the shades or go outside to get some sunlight. If that’s not possible, turn on the lights to make your environment bright.

Napping can interfere with sleep

Perhaps the English had the right idea in having teatime in the late afternoon when you naturally get sleepy. Some people can take a short afternoon nap and still sleep well at night. However, if you are having trouble sleeping at night, try to eliminate napping. If you must nap, do it in the early afternoon, and sleep no longer than about thirty minutes.

Alcohol, caffeine, smoking

• Alcohol reduces overall quality of sleep. Many people think that a nightcap before bed will help them sleep. While it may make you fall asleep faster, alcohol reduces your sleep quality, waking you up later in the night. To avoid this effect, stay away from alcohol in the last few hours before bed.
• Caffeine. You might be surprised to know that caffeine can cause sleep problems up to ten to twelve hours after drinking it! If you rely on coffee, tea or caffeinated soda to keep you going during the day, consider eliminating caffeine after lunch or cutting back your overall intake.
• Smoking. Smoking causes sleep troubles in numerous ways. Nicotine is a stimulant, which disrupts sleep. Additionally, smokers actually experience nicotine withdrawal as the night progresses, making it hard to sleep.

II: Creating a better sleep environment

The key to better sleep might be as simple as making some minor changes to your bedroom. Take a careful look around your sleep environment to see what might be disrupting your sleep.

Your Bed

• Is your bed large enough? Do you have enough room to stretch and turn comfortably in bed, or are you cramped? Having a bedmate makes this even more important- both of you should have plenty of room to stretch out. Consider getting a larger bed if you don’t have enough space.
• Your mattress, pillows and bedding. Waking up with a cramp in your back or a sore neck? You may want to experiment with different levels of mattress firmness and pillows that provide more support. If your mattress is too hard, you can add a foam topper for additional softness. Experiment with different types of pillows – feather, synthetic, and special pillows for side, back or stomach sleepers. Consider your bedding—scratchy sheets might be making you uncomfortable in the middle of the night, or your comforter might not be keeping you warm enough. Consider soft, breathable cotton sheets. Flannel sheets may be cozy for the winter months.

Your Room

Ideally, to maximize sleep, your room should be quiet, dark and at a comfortable temperature and ventilation.

• Keep the noise level down. Too much noise- loud outside conversations, televisions blaring, traffic noise - can make it difficult to sleep well. When the source of outside noise can’t be eliminated, sometimes it can be masked. A fan or white noise machine can help block outside noise. Some people enjoy recordings of soothing sounds such as waves, waterfalls or rain. Earplugs may also help, although you want to make sure they don’t block out important noises like an alarm clock if you use one.

• Keep your room dark during sleep hours. Early morning light can send your body clock the wrong signal that it is time to wake up. Or perhaps there is a streetlamp shining right in your window at night. Heavy shades can help block light from windows, or you can try an eye mask to cover your eyes.
• Room temperature and ventilation. Who can sleep in a hot stuffy room? Or for that matter, a cold drafty one? If you can, experiment with the room temperature. Most people sleep best in a slightly cooler room. Make sure that you have adequate ventilation as well - a fan can help keep the air moving. You also might want to check your windows and doors to make sure that drafts are not interfering with sleep.
• Reserve your bed for sleeping. Do you sometimes balance your checkbook propped up on your pillows? Or jot down some notes for tomorrow’s meeting? It might feel relaxing to do tasks like these on a comfortable bed. However, if you associate your bed with events like work or errands, it will only make it harder to wind down at night. Use your bed only for sleep and sex.

III: Preparing for Sleep

Keep a regular bedtime schedule, including weekends

Time of day serves as a powerful cue to your body clock that it is time to sleep and awaken. Go to bed and wake up at the same time each day, and it will be easier and easier to fall asleep. However tempting it may be, try not to break this routine on weekends when you may want to stay up much later or sleep in. Your overall sleep will be better if you don’t.

In setting your bedtime, pay attention to the cues your body is giving you. When do you feel sleepy? Set your bedtime for when you normally feel tired, within reason – you may not want to make your bedtime 2am if you have to work at 8am! If you regularly go to bed when you don’t feel sleepy, not only is it harder to fall asleep, but you may start worrying about not sleeping, which can end up keeping you up longer! If you want to change your bedtime, try doing it in small daily increments, such as 15 minutes earlier or later each day.

Foods that help you sleep

Maybe a rich, hearty dinner, topped off with a big slice of chocolate cake might seem like the perfect way to end the day, but it’s wise not to eat a large meal within two hours of bed. Try to make dinnertime earlier in the evening, and avoid heavy, rich foods as bedtime snacks.

However, a light snack before bed, especially one which contains the amino acid tryptophan, can help promote sleep. When you pair tryptophan-containing foods with carbohydrates, it helps calm the brain and allow you to sleep better. For even better sleep, add some calcium to your dinner or nighttime snack. Calcium helps the brain use and process tryptophan. On the other hand, you might want to avoid eating too much protein before bedtime - protein-rich foods contain tyrosine, an amino acid that stimulates brain activity. Experiment with your food habits to determine your optimum evening meals and snacks.

Some bedtime snacks to help you sleep:

• Glass of warm milk and half a turkey or peanut butter sandwich
• Whole-grain, low-sugar cereal or granola with low-fat milk or yogurt
• A banana and a cup of hot chamomile tea

Foods that can interfere with sleep

Some food and drinks that can interfere with your sleep, including:

• Too much food, especially fatty, rich food. These take a lot of work for your stomach to digest and may keep you up. Spicy or acidic foods in the evening can cause stomach trouble and heartburn, which worsens as you are laying down
• Too much liquid. Drinking lots of fluid may result in frequent bathroom trips throughout the night.
• Alcohol. Although it may initially make you feel sleepy, alcohol can interfere with sleep and cause frequent awakenings. Also some people are also sensitive to tyrosine, found in certain red wines
• Caffeine. Avoid food and drinks that contain caffeine, and that doesn’t just mean coffee. Hidden sources of caffeine include chocolate, caffeinated sodas, and teas.

If you suspect a food or drink is keeping you up, try eliminating it for a few days to see if sleep improves.

Develop a relaxing bedtime routine

A consistent, relaxing routine before bed sends a signal to your brain that it is time to wind down, making it easier to fall asleep.

Start by keeping a consistent bedtime as much as possible. Then, think about what relaxes you. It might be a warm bath, soft music or some quiet reading. Relaxation techniques, such as yoga, visualization or muscle relaxation not only tell your body it is time for sleep but also help relieve anxiety.

Avoid bright light or activities which cause stress and anxiety.

Ideas to help prepare for sleep

Reading a light, entertaining book or magazine Visualization/meditation Listening to soft music or radio broadcast A light bedtime snack or a glass of warm milk Hobbies such as knitting or jigsaw puzzles Listening to books on tape Worry, Anxiety and Sleep With busy schedules and family lives, it’s hard to leave the worries of daily life behind when it is time to sleep. Worrying and anxiety trigger the “fight or flight” mechanism in the body, releasing chemicals that prepare us to be alert and ready for action. That not only makes it difficult to fall asleep, but can wake you up frequently in the night as well. Stop stress and worry from disrupting your rest by: Making the time before sleep a time of peace and quiet. As much as possible, avoid things that may trigger worry or anxiety before bed, like upsetting news or gory television shows. Quiet your mind. There are many things you can do to help your brain wind down and prepare for sleep. Relaxation techniques set the stage for quieting the mind. Make some simple preparations for the next day, like a to-do list or laying out the next day’s clothes and shoes. Some people find jotting down a list of worries makes them more manageable. Tips IV: Getting back to sleep, television and sleep medications Getting back to sleep It’s normal to wake briefly during the night- a good sleeper won’t even remember it. However, there are times when you may wake during the night and not be able to fall back asleep. You may get more and more frustrated about not being able to sleep, which raises your anxiety level, ironically making it even harder to achieve the sleep you crave! Stay relaxed: The key to getting back to bed is continuing to cue your body for sleep. Some relaxation techniques, such as visualization and meditation, can be done without even getting out of bed. The time honored technique of “counting sheep” works by engaging the brain in a repetitive, non-stimulating activity, helping you wind down. Do a quiet, non-stimulating activity if you can’t sleep: If you’ve been awake for more than 15 minutes, try getting out of bed and doing a quiet activity. Keep the lights dim so as not to cue your body clock that it’s time to wake up. A light snack or herbal tea might help relax you, but be careful not to eat so much that your body begins to expect a meal at that time of the day. Television Many people use the television to fall asleep or relax at the end of the day. You may even have a television in your bedroom. However, it’s best to get rid of the television, or related activities like video games, for several reasons. First, television programming is frequently stimulating rather than calming. Late night news or prime time shows frequently have disturbing, violent material. Even non-violent programming can have commercials which are jarring and louder than the actual program. Remember, commercials want to get your attention! Processing this type of material is a stimulating activity, the opposite of what you want to help you sleep. In addition, the light coming from the TV (or a computer screen) can interfere with the body’s clock, which is sensitive to any light. Television is also noisy, which can disturb sleep if the set is accidentally left on. Take the TV out of the bedroom - The optimum setup for better sleep is to have your bedroom reserved for sleeping. So if you watch TV in bed, even if you don’t fall asleep watching it, you are unconsciously associating another activity with the area you use to sleep. It’s best to remove the TV from the bedroom entirely, saving your viewing for the living room or den. Trouble falling asleep without the TV - You may be so used to falling asleep with the TV that you have trouble without it. Be patient. It takes time to develop new habits. If you miss the noise, try turning on soft music or a fan. If your favorite show is on late at night, record it for viewing earlier in the day. Although the first few days might be difficult, better sleep pays off in the long run. Medications and sleep If only sleeplessness could be completely cured by a simple pill! There are certainly plenty of over-the-counter sleep aids. However, these medications are not meant for long term use. They can cause side effects and even rebound insomnia, where your sleep ends up worse than before. Prescription medications are no magic pill, either. If you must take sleep prescription medications, work carefully with your healthcare professional.