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RECLAIMING MENTAL AND SEXUAL HEALTH AFTER A CARDIAC INCIDENT

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RECLAIMING MENTAL AND SEXUAL HEALTH AFTER A CARDIAC INCIDENT Dr Marelize Swart Psychologist and Sex Therapist Helderberg Medi-Clinic – PowerPoint PPT presentation

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Title: RECLAIMING MENTAL AND SEXUAL HEALTH AFTER A CARDIAC INCIDENT


1
RECLAIMING MENTAL AND SEXUAL HEALTH AFTER A
CARDIAC INCIDENT
  • Dr Marelize Swart
  • Psychologist and Sex Therapist
  • Helderberg Medi-Clinic

2
WELCOME HELDERBERG CARDIAC SUPPORT GROUP!
3
(No Transcript)
4
How do I reclaim my sexual self after a cardiac
incident?
  • Sexual activity is a major quality of life issue
    for men and women with cardiovascular disease and
    their partners.
  • Sexuality, including sexual function and the
    psychological aspects of sexual health, are
    affected in almost everyone who has had a cardiac
    incident.
  • Expect that your bodys response to arousal and
    stimulation will have changed.

5
How do I reclaim my sexual self after a cardiac
incident?
  • Sexual activity frequency and satisfaction often
    decline because of anxiety on the part of the
    patient or partner that sexual activity will
    worsen the underlying cardiac condition or cause
    death.
  • Changes in sexual activity after a cardiac event
    may impair the patient's quality of life,
    negatively affect psychological health, and
    strain marital or other important intimate
    relationships, which in turn may lead to
    depression and anxiety.
  • The resultant depression may be an important
    contributing cause of ED in men and of female
    sexual problems, including decreased libido,
    difficulty with arousal and orgasm, and
    dyspareunia.

6
How do I reclaim my sexual self after a cardiac
incident?
  • After a diagnosis of cardiovascular disease, it
    is reasonable for patients to be evaluated by
    their physician or healthcare provider before
    resuming sexual activity.
  • Patients should be assessed to see if their
    sexual dysfunction is related to underlying
    vascular or cardiac disease, anxiety, depression
    or other factors.

7
RECLAIMING SEXUAL HEALTH (cont)
  • Patients with severe heart disease who have
    symptoms with minimal activity or while at rest
    should not be sexually active until their
    cardiovascular disease symptoms are stabilized
    with appropriate treatment.

8
SEX AND INTIMACY AFTER CARDIAC INCIDENT
  • The insecurity, fear and doubt that can arise
    from this can throw even the most open and loving
    couples into a tangled web of conflicting
    emotions.
  • The most common concern for survivors and
    caregivers alike is fear of causing another
    cardiac incident.
  • Experts agreed that research indicates that it is
    very unlikely that lovemaking will cause another
    cardiac incident.

9
RECLAIMING SEXUAL HEALTH (cont)
  • The absolute rate of cardiovascular events during
    sexual activity, such as heart attacks or chest
    pain caused by heart disease, is miniscule
    because sexual activity is usually for a short
    time.

10
RECLAIMING SEXUAL HEALTH (cont)
  • It is often the partner of the person who had a
    myocardial infarction who is worried about having
    sex and causing another MI.  

11
RECLAIMING SEXUAL HEALTH
  • - Decreased sexual activity and function are
    common in patients with cardiac incidents and are
    often interrelated to anxiety and depression.

12
  • Cardiovascular events such as heart attacks or
    chest pain caused by heart disease rarely occur
    during sexual activity, because sexual activity
    is usually for a short time.
  • Some patients will postpone sexual activity when
    it is actually relatively safe for them to engage
    in it.
  • On the other hand, there are some patients for
    whom it may be reasonable to defer sexual
    activity until theyre assessed and stabilized.

13
RECLAIMING SEXUAL HEALTH (cont)
  • As long as someone can walk two flights of stairs
    and has the okay from the doctor they are good to
    go for having sex.
  • Men and women with stable CVD who have no or
    minimal symptoms during routine activities can
    engage in sexual activity.

14
SEXUALITY
  • According to a new scientific statement issued by
    the American Heart Association, it is probably
    safe to have sex if your cardiovascular disease
    has stabilized.

15
SEX AND INTIMACY AFTER CARDIAC INCIDENT
  • Sex is a sensitive subject amongst cardiac
    patients and their partners as it can cause big
    changes in the lives of couples who are sexually
    active.
  • Cardiac related physiological and psychological
    changes may affect both sexual desire and
    performance.
  • When to have sex? Neither partner should force
    the issue. You will know when you are ready.

16
WHAT HAPPENED TO DESIRE
  • Many survivors find that they dont have much
    desire for sex because they are so involved in
    their recovery process.
  • Or erection difficulties. A number of
    anti-depressants and blood pressure medicines can
    reduce libido (sexual desire) and performance
    (ED).

17
WHAT ABOUT DEPRESSION
  • Depression often reduces libido, and drugs for
    depression may also reduce libido.
  • Careful grooming and attractive clothes can help
    you feel good about yourself. While this may take
    extra effort at first, youll feel attractive.

18
THE IMPORTANCE OF INTIMACY
  • Intimacy is very important and we need to get
    away from the model of heterocentric penis-vagina
    penetration.
  • Men with heart problems may have difficulty with
    erections both due to problems like
    artherosclerosis and high blood pressure, and the
    meds used to treat them.  
  • They need to hear that they can still be intimate
    and not to get discouraged if they are having
    difficulty with erections.  It's common, talk to
    doctor.

19
Grieve changes as often as you need to
  • You will want to take time and grieve
  • 1) changes in how your body feels functions,
  • 2) changes in your energy, and
  • 3) changes in your desire, arousal and sensation.
  • Let go of how you were, and embrace how you are
    now - a new normal.

20
Re-Connect with your Body
  • Get a manicure or pedicure
  • Get a full body massage
  • Move breathe and eat mindfully, noticing every
    sensation
  • Connect consciously with the things you love
    about your body
  • Find clothing or lingerie that is comfortable and
    makes you feel sexy and attractive
  • Learn what feels good now and what kind of touch
    works best for you.
  • Do something physical (yoga, walking, sitting in
    the sunshine and focus on how your body feels as
    you do it.

21
Communicate with your partner
  • Sometimes it takes something as life-altering as
    a cardiac incident to help one realize how
    important it is to have clear and loving
    communication in order to keep intimate
    relationships healthy.

22
FATIGUE
  • Fatigue is a common problem for survivors and
    partners. The best time for sex may be after
    resting or in the early morning.
  • Perhaps, just to reestablish the relationship,
    couples should spend time together cuddling and
    sleeping quietly.

23
Die Burger front page article today
  • A survey by Pharma Dynamics in South Africa
    reported that the average man in SA has sex 52
    times per year versus 100 in other countries.
  • 22 of the men reported that they only had sex
    every 3 months.
  • 16 reported that they were in a sexless (no sex)
    relationship.
  • The majority of the men that took part in this
    survey stated that they had experienced erectile
    disorder for the previous 5 years without getting
    treatment for it. ED can be a sign of cardiac
    problems, high blood pressure, diabetes, etc.

24
  • YOU HAVE A CHOICE TO BE MORE INTIMATE THAN EVER
    BEFORE--

25
MOVING FORWARD INTIMACY TIPS
  • Take the time and do some work to make sure that
    youre both fully communicating with each other
    talk, listen, and intentionally move through life
    together as a team.
  • Grieve the changes together.
  • Help your partner get to know your body as it is
    now as s/he might be afraid too ask.

26
MOVING FORWARD INTIMACY TIPS
  • Get to know each other again
  • Ask what s/he loves about you, mind, body and
    spirit.
  • Move forward together and further develop your
    sense of being a team in this life.
  • Make time for intimate closeness even if you
    dont have the energy for sex.

27
MOVING FORWARD INTIMACY TIPS
  • Take some time with your partner to cuddle,
    touch, and be close in intimate, but not
    necessarily sexual, ways when you dont have
    energy for sex.
  • This will keep your bond strong, and provide
    healing touch and comfort for both of you.

28
Permission for self-pleasure
  • If you are feeling less sexual than your partner,
    its important to give your partner permission to
    enjoy self-pleasure as part of him or her life.
  • It is not your responsibility to provide sexual
    opportunities or release for your partner but is
    is helpful for to to explicitly give permission
    for her or him to maintain their own wellness
    through orgasm and self-pleasure

29
Permission for self-pleasure
  • One way to provide this kind of permission is to
    give your partner a pleasure toy, or an erotic
    book or DVD, with instructions to PS Enjoy
    yourself, with love.
  • There will be a time when you will want to
    explore you own pleasure, alone, as you learn how
    your body has changed and what feels good now, so
    setting the stage early for healthy self-pleasure
    can make that more comfortable when its your
    turn.

30
Get to know your sexual new normal
  • Because a cardiac incident can change how your
    body responds to touch and stimulation, once you
    feel reunited with your body, it is time for you
    to explore to see how it works, what feels good,
    what is not-so-pleasurable, and what kind of
    touch and mental stimulation work best for sexual
    arousal and sensation.

31
Be Loving
  • As a couple you need to be patient, loving and
    keep humour in the relationship. It is good to
    set aside a special time for intimacy and sex. Do
    things that make both of you feel sexy and
    attractive. Create a loving atmosphere with
    music, soft lights, candles and by giving
    compliments to each other.
  • Having sex is not just about vaginal penetration
    as much as touching, caressing, kissing, and just
    showing appreciation for your mate.

32
TALK WITH EACH OTHER
  • When do you have the energy for sex?
  • If you have pain or discomfort, what do you need
    to accommodate that?
  • What does it take to have an orgasm now?
  • Take time to explore with yourself so you can
    share what you learn with your partner.
  • Create a pleasure map for your partner (and have
    him/her do the same for you) showing what kind of
    touch you like and where, and showing where the
    no go zones are now.

33
Practice communicating and negotiating around sex 
  • Its always a good idea to be able to communicate
    explicitly about what you like and want but
    after a cardiac incident it is even more
    important to do so.
  • Practice asking for what you want, planning
    together to enjoy intimacy at times when you have
    the most energy and interest.
  • Make conscious sex dates so intimate play
    doesnt get left out of your life altogether.

34
Explore new ways to make love
  • It wont be the same as it was before, and with
    some creativity and learning, it can be even
    better and more intimate than before the cancer.
  • Pleasure each other without having intercourse.
  • In stead, become accustomed to Outercourse.
  • Enjoy the sensations. Take your time. Be less
    goal-oriented. Get creative and experiment with
    new positions and places.

35
Use tools and enhancements when you need them 
  • Lubricant
  • Vibrator for helping with arousal, sensation and
    orgasm
  • Vibrating massage wand for vaginal health and
    renewal
  • Kegel exercises to help keep your pelvic floor
    strong and flexible
  • Penile rehabilitation devices for erectile
    dysfunction

36
Facts about Intercourse
  • Cultural attitudes have led most people to think
    of intercourse -- ending in orgasms for all
    parties -- as the be-all-and-end-all of sexual
    activity, in spite of the fact that most women
    cant orgasm through that method alone.
  • This leaves many people who are unable to
    participate in that activity feeling cheated or
    downright defective because they cannot provide
    what is viewed by many as the ultimate act of
    love and pleasure. It also negates the intimacy
    non-penetrative acts provide.

37
Outercourse
  • Fortunately, for couples who cannot have
    intercourse, whether its caused by health
    issues, like erectile dysfunction or painful sex,
    , there are plenty of alternative activities that
    simulate the feel and closeness of intercourse.
  • We call that Outercourse.

38
Outercourse -- What is it?
  • Outercourse is creative sex play that is not
    limited to, or focused on intercourse. It can
    include any sexual activities you and your
    partner enjoy, and can lead to anything you both
    agree to. It can be the first course, the last
    course, the main course, or the only course!

39
Outercourse a good choice if you or your partner
  • has trouble maintaining an erection
  • has pain with penetration, or do not enjoy
    penetration
  • has trouble reaching orgasm/ejaculating during
    intercourse
  • has performance anxiety
  • want to postpone intercourse, and still enjoy
    intimate play together .

40
GETTING STARTED
  • Start slowly, perhaps just be being close and
    cuddling. Explore what feels good to you now.
    Tell your mate what pleases you he or she
    cannot read your mind.
  • Intercourse may not happen at first, so just
    relax and focus on the intimacy that you are
    building together
  • Add intercourse only if and when you both feel
    ready.

41
  • A playful attitude and adventurous spirit are the
    best assets you have when it comes to sex, second
    only to a genuine affection for your partner. The
    right attitude can make any activity or technique
    full of pleasure and fun.

42
  • Sex can easily become serious business if you see
    it as a race to the finish line, or a performance
    that must play out in a particular way each time.
  • We all experience busy or stressful times,
    illnesses, and other circumstances that force
    changes in intimacy or physical response.
  • Flexibility and a sense of humor can help you
    weather these changes.

43
  • Broadening your idea of what good sex consists
    of, and exploring ways to create as much pleasure
    as possible for you and your partner, will take
    the focus off of what you cant, or choose not to
    do.

44
  • Instead you can keep your attention on creating
    pleasure and deepening your intimate connection
    with each other. As an added benefit, expanding
    your sexual repertoire will increase the fun you
    can enjoy during sex play.

45
Getting Started and Building Anticipation
  • Agree that neither of you will aim for orgasm
    your only goals will be giving/receiving pleasure
    and having fun together.
  • You can decide some activities are off-limits, or
    set no limits, but DONT set orgasm as the end
    point.
  • One or both of you may have an orgasm, but its
    not required. This can relieve performance
    pressure while allowing you to explore activities
    you might have otherwise missed, If you enjoy
    this, you can make try it whenever you want to
    build your connection and anticipation.

46
Getting Started and Building Anticipation
  • Make out during a movie with no pressure to go
    any further, or skip the movie and revisit heavy
    petting on the couch.
  • Keep your clothes on much longer than you want
    to, or keep them on all evening.
  • See how much fun you can have undressing slowly
    when the time comes, or touching each other
    through your clothing.

47
Add some more advanced communication skills
  • Try asking your partner for permission before
    every action or touch. Only touch when and where
    your partner allows.
  • After asking "may I touch your...?Follow it up
    with Did you like that? Would you like me to do
    it some more?" If so, try May I kiss your...?".

48
Hand or Foot Massage
  • Another version is to give a hand or foot massage
    but only touch in the exact manner your partner
    requests. Your goal is that you are both able to
    ask for specific kinds of touch in specific
    places. Then youre ready to move on to other
    erogenous zones.

49
Communicate more about intimacy
  • Practice talking about intimate play more often,
    explicitly asking for what you want as well as
    asking your partner what she or he would enjoy
    doing.

50
  • By improving your non-sexual intimacy hugging,
    laughing, having fun can really improve your
    sexual intimacy
  • It is important to focus on what you have, not
    what you have lost.

51
Become more creative
  • Start a date by meeting in the produce department
    of your local grocery store. If you are tempted
    by fruit, what body part would taste nice with
    raspberries on it? Peaches? Whipped cream?
    Champagne?

52
More ideas for increased intimacy
  • Find out how much fun a man can have without an
    erection, or without engaging in penetration of
    his partner.
  • Buy a nice lubricant (or compare several) and try
    stimulating him with a variety of different parts
    of your body.
  • Some ideas hands, mouth, breasts, or between the
    thighs. Try a masturbation sleeve if your skin is
    not up for the contact. Remember that men can
    have orgasms without ever having erections, so
    keep going even if he isnt hard.

53
More ideas
  • Find a movie or book on erotic massage, and try
    out the techniques. There are books and movies on
    vulva massage, penis massage, and whole body
    erotic massage.
  • You can also explore touch using feathers, silk
    scarves, strands of pearls or fur, and get
    creative with some of the kitchen
    utensils/gadgets.

54
Be creative
  • See if you can discover some erogenous zones you
    didnt know about before by observing your
    partners responses carefully and experimenting
    with different areas and different strokes and
    touches. Explore everywhere, not just the
    genitals.

55
More things to try
  • Try sexy phone talk, or explicit notes via email,
    SMS, or sexy notes tucked into pockets or lunch
    bags.
  • You can tease, tempt, and arouse your partner all
    day long from a distance.
  • Anticipation can make your next date extra-spicy.

56
Mutual self-stimulation
  • Mutual self-stimulation in its many forms is both
    sexy and safe.
  • It can be extremely arousing to watch a partner
    pleasure him or herself to orgasm.
  • Settle yourselves into comfy positions and decide
    if you want to take turns, go solo, or stimulate
    yourselves simultaneously.
  • You can impose rules like You cant touch me" or
    let your partner play a supporting role in your
    pleasure, e.g. by putting his arm around you
    whilst you are lying on your bed.

57
KISSING
  • Many people enjoy giving and receiving pleasure
    of all kinds with their mouths.
  • If you love kissing, devote some time to it
    rather than seeing it as just an appetizer.
  • You can take kissing to another level by
    exploring your partners entire body with your
    mouth.

58
SELF-PLEASURING
  • Self-pleasuring is healthy. Studies have found
    that orgasms boost your immune system and help
    fight depression. Plus, the more orgasms you
    have, the easier it will be for you to orgasm in
    the future.
  • Orgasms are one of the most effective ways of
    strengthening your pelvic floor muscles, which
    can reduce the risk of urinary incontinence.
  • Self-pleasure is also the best way to learn what
    you like so you can teach these techniques to
    your partner. For many women, it is easier to
    have an orgasm with a partner after having
    discovered what works by themselves.

59
NEW TO ORAL PLEASURE??
  • If stimulating your partners genitals with your
    mouth is new to you, consider rending an
    instructional movie or book on oral sex to debunk
    myths and offer sexy tips, or just dive in and
    enjoy discovering what you and your partner both
    enjoy.

60
ORAL PLEASURE
  • If you are experienced in giving and receiving
    oral pleasure, experiment with using flavors or
    ice, and explore different positions, adding
    additional stimulation with your hands or a
    vibrator.

61
Focus your attention tips
  • Take turns focusing attention on one another. One
    day, have a date thats all about pleasing your
    partner.
  • The next day, switch places.
  • Sometimes knowing you wont be reciprocating
    right away can allow you to relax at a deeper
    level and sink into the sensations youre
    experiencing.

62
Schedule time
  • If you have trouble finding time for being
    intimate in your busy lives, make a date and put
    it on the calendar.
  • Turn off the phone.
  • If youll be distracted by your to-do list during
    a date at home, get a motel room.

63
Go on a date
  • Pack a romantic picnic, or order in. Even if all
    you can manage is a an hour or two, you can have
    a lot of fun in that time, and anticipating the
    upcoming date can help get you both through the
    week.

64
Sit closer and touch more
  • If youre overwhelmed with stress, try sitting on
    your partners lap while you catch up on the
    days events and see if the mood shifts.
  • Or allow yourselves to begin gently touching and
    pleasuring each other, and follow the sensations.
  • If you become more aroused, you can pursue more
    intense touch. If not, enjoy the contact and
    intimacy.

65
Above all, have fun!
  • There are so many ways to enjoy intimacy without
    ever engaging in intercourse or penetrative sex
    play.
  • Start with the ones weve listed here, and then
    expand your list to whatever you wish to add to
    your repertoire.
  • You have nothing to lose, and a lot of pleasure
    and closeness to gain.

66
Thumbs up for the new normal!
  • Remember to take time for pleasure and intimacy,
    and know that while things will not be the same
    as they were, they may be even better!

67
Ask for professional help from a therapist if you
need it
  • Sometimes its just too hard to deal with it all
    on your own pace. Find someone youre comfortable
    working with and ask for the help you need, as an
    individual or as a couple.

68
MALE PENILE RINGS
69
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70
SEX AND INTIMACY AFTER CARDIAC INCIDENT
71
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72
HOW TO SPICE UP YOUR LOVE LIFE
73
HOW TO SPICE UP YOUR LOVE LIFE
  • 1. Make a conscience effort to be more sensual
    and more sexual (if unsure, look on internet for
    sexual flirting tips)
  • Set aside time for date and /or sex nights
  • Devise sexual games to play together
  • Arrange an out of town trip at east twice a year
  • Be adventurous and change! Hair style, clothing,
    make-up, cologne/perfume

74
HOW TO SPICE UP YOUR LOVE LIFE
  • Have fun with personal hygiene have a shower or
    bath together
  • Update or change your wardrobe (out with the
    granny panties and in with a few new sexy
    items. If you want your partner to look at you in
    a more sexual light, you have to give him/her
    something more/different
  • Change your bedroom new paint, artwork, statues,
    candles and new bed linens.

75
HOW TO SPICE UP YOUR LOVE LIFE
  • Engage in erotic entertainment. Watch an erotic
    soft-core porn movie.
  • Read erotic literature either read that
    together as a couple or alone. They can often
    spur the imagination even better than films
  • Experiment with sex toys (can be purchased in
    adult shop or on internet)
  • Attend or visit a clothing optional resort or a
    nudist beach (Sandy Bay!).

76
MEDICATIONS AND SIDE EFFECTS
77
MEDICATIONS AND SIDE EFFECTS
  • Some medications that cardiac patients are on may
    change the way that your body functions sexually.
  • Statins have erectile dysfunction as a possible
    side effect (small, but reported frequently
    enough that it needs acknowledging) and beta
    blockers slow down sexual arousal and response so
    that orgasm is harder (or impossible) to attain.
  • This means you may need to adapt your sexual
    interaction style to find intimate activities
    that are rewarding and pleasurable in the absence
    of one or both of these events

78
MEDICATIONS AND SIDE EFFECTS
  • In addition to medication effects, coronary
    artery disease can affect the blood vessels in
    the penis and clitoris that fill with blood to
    create the penile and clitoral erections.

79
MEDICATIONS AND SIDE EFFECTS
  • Rehabilitation activities should help reverse
    some of this damage, but the person with the
    cardiac incident should understand that arousal
    may take longer, erections may or may not happen
    and be full, and that it may well take more time
    to achieve orgasm because of the length of time
    it takes to become fully engorged and aroused.

80
MEDICATIONS AND SIDE EFFECTS
  • Vibration will help this process for both men and
    women, as it facilitates blood flow directly to
    the appropriate vessels.
  • PDE-5 inhibitors may or may not be safe for the
    person to use, depending on what other
    medications they are on and their risk factors.

81
MEDICATIONS
  • It is reasonable for post-menopausal women with
    cardiovascular disease to use estrogen thats
    topically or vaginally inserted for the treatment
    of painful intercourse.

82
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83
Erection Dysfunction Treatment
  • Vacuum device therapy (suction pressure)
  • Penile stimulation ring (i.e. Pixie)
  • Constrictor band (a round elastic device that
    help trap the blood flow in the penis once an
    erection is obtained. Especially for those that
    have difficulty maintaining their erection.
    Should only be worn for a max of 30 mins
  • Masturbation accessories.

84
Erection Dysfunction Treatment
  • PDE5 inhibitors
  • Intracavernosal Injections self-injection
    therapy
  • MUSE (very small pellet of prostaglandin is
    inserted into urethra and erection occurs within
    15 to 30 minutes).

85
MEDICATIONS
  • Women with cardiovascular disease should be
    counselled on the safety and advisability of
    contraceptive methods and pregnancy based on
    their patient profile.

86
RECLAIMING SEXUAL HEALTH (cont)
  • Cardiac rehabilitation and regular physical
    activity can reduce the risk of cardiovascular
    complications related to sexual activity in
    people who have had heart failure or a heart
    attack.

87
MEDICATIONS
  • Drugs that can improve cardiovascular symptoms or
    survival should not be withheld due to concerns
    that such drugs may impact sexual function.

88
MEDICATIONS
  • Drugs to treat erectile dysfunction are generally
    safe for men who have stable cardiovascular
    disease.
  • These drugs should not be used in patients
    receiving nitrate therapy for chest pains due to
    coronary artery disease (blockages in the
    arteries that supply the heart with blood), and
    nitrates should not be administered to patients
    within 24-48 hours of using an erectile
    dysfunction drug (depending on the drug used).

89
TOYS AND ACCESSORIESMagic Wand, Water Sprite,
Liquid Silk
90
MALE STIMULATION SLEEVE
91
BOOKS PARTY GAME
92
AND FINALLY,
  • THE HUMAN SEXUAL RESPONSE SLOWS DOWN WITH AGE,
    BUT IT NEVER COMPLETELY DISAPPEARS.

93
THANK YOU!
  • Dr. Marelize Swart
  • swartm8_at_gmail.com
  • Tel 060 737 8837
  • www.femalethoughts.com
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