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Why Women Need to Talk About Midlife Sex — A Lot

Here's how to elevate the conversation

Woman's hands holding a megaphone

Getty Images

Ever since The Graduate, there's been this Hollywood-spawned trope about women hitting their sexual stride later in life. But it turns out, even Anne Bancroft is no match for the libido-stealing power of menopause.

Exiting the reproductive stage of your life as a woman can have a profound emotional and physical impact on sexual desire, says Barb DePree, M.D., an ob-gyn who specializes in menopause care. But it's still under-recognized, both by health care providers and by women themselves.


"Women are two to three times more likely than men to experience a reduction in desire as they age,” says DePree. Many times, this decrease in drive — what medical professionals call hypoactive sexual desire disorder, marked by persistent, recurring loss of desire — has a hormonal basis, but women don't always associate it with menopause. After all, there is no shortage of libido killers for most modern women: kids, jobs, impossible body image standards, housework, cargo shorts.

The lack of openness surrounding women's sexual health doesn't help. You can't watch a YouTube video without seeing at least one ad for treating erectile dysfunction, but how often does vaginal dryness or labial atrophy come up in conversation?

The answer is, far too infrequently — even between women and their doctors. “Interestingly,” says DePree, “surveys suggest that 78 percent of women have never discussed sexual health with a provider, at any age. For this population of women, who are so assertive and proactive and well-informed in so many areas of their lives, this is one area where that's lacking."

With 6,000 American women “going menopausal" every day (DePree's term, and one that sounds, maybe not coincidentally, like “going postal"), it's a problem that's not going away. The good news is, while the majority of women will experience menopause-fueled changes to their sex lives, there are really effective treatment options. “We can almost always restore sexual function,” DePree says. But to do so, “Women really have to own their sexual health the way they do their physical, emotional and mental health.”

Ch-Ch-Ch-Changes

It's common to associate menopause, the time when your body stops cranking out estrogen and progesterone, with hot flashes, sleep disruptions and general moodiness. But the one place in the female body with more estrogen receptors than anywhere else is the genitals, and losing those hormones takes a significant toll on them.

"From around age 12 to 50, most of us take it for granted that our vaginas are functional and comfortable,” says DePree. “In the absence of estrogen, however, women can lose up to 8 percent of the volume down there.” Tissues shrink and become less elastic. Natural lubrication dries up. Restrictions to blood flow can make it more difficult to get aroused or orgasm. And emotionally, women just may not have as much desire for sex as they once did.

"Loss of desire and uncomfortable intercourse is a really bad combination,” says DePree. “A lot of women will just avoid sex altogether in response.” And, she points out, unlike other aspects of our health, sexual health is often a shared experience, so you may not be the only one affected. The rise of ED meds has put pressure on people to extend their sex lives longer, to the delight of some people and the horror of others.

If you fall into the former camp, whether or not you're partnered at the moment, you can't be passive about it and just wait for desire to strike. Lust, like just about everything else these days, is a mindful experience. Women need to be intentional, opt in (or maybe “lean in” is more appropriate in this case?) and choose horniness. DePree encourages the liberal use of lube (see below), and adding a vibrator or other toy to the bedroom for additional stimulation when climax seems elusive. “When your vision deteriorates, you pick up readers,” DePree says. “The same goes for orgasm. A lot of women don't give themselves permission to do some of those things."

The very first step should be finding a provider you're comfortable with. It doesn't have to be a gynecologist — if you feel better discussing it with your primary care physician, that's a great place to start, says DePree. It might mean finding a different care provider, though, since many still don't have adequate training in sexual health and arousal.

If you're struggling to bring it up, you can always get things started by printing out some info, handing it to your doctor and saying, “Hey I read this, can we talk about it?” DePree launched her website, MiddlesexMD, for this very purpose. “I wanted to give women the language to talk about it and take some action on their own,” she says. Another good starting point is to note any major change in your sexual desire or function that you're concerned about. “Sexual health is often the canary in the coal mine,” DePree says. It might be a symptom of a bigger underlying issue. For those reasons, she says, “We need to elevate the conversation. Sexual health is an important part of general health.”

Slick Deals

Not all sexual lubricants are created equal. Here are a few that stand out.

Good Clean Love Restore Vaginal Moisturizer

This is the line's most popular product for women 45 and older. In addition to being free from parabens, fragrances and other potential irritants, it is formulated with lactic acid, which has been shown to supports healthy bacterial growth in the vagina.

Pjur Med Premium Glide

This silicone-based lube isn't absorbed by skin, so it stays on the surface and lasts as long as you need it to. It's preservative-free and compatible with sensitive skin and, like most silicon-based lubes, condoms.

Aloe Cadabra

This natural lube (every product in the line is made with food-grade ingredients) is certified organic, is 95 percent aloe so it's safe to use with condoms, doesn't contain silicone, and absorbs into your skin to moisturize even after playtime.

Foria Awaken

This “natural arousal oil” is pricey, likely because it's infused with CBD. Fans say it helps lessen pelvic inflammation or tenderness, and some research indicates that compounds in cannabis, including CBD, may boost libido.

Woo More Play

Sinking estrogen levels as you age can affect not only vaginal dryness but pH as well, making you more susceptible to certain infections. This lube's primary ingredient, coconut oil, is a natural antifungal, which may help prevent yeast overgrowth, but can degrade latex condoms.

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