5 Reasons Women Need to Talk About Midlife Sex

I grew up in the Midwest, where there’s not all that much talk about sex generally. I’ve seen some awkwardness when I explain to people what I do — I’m an obstetrician and gynecologist currently specializing in menopause care. And I’ve noted that sex in the popular culture seems to be reserved for the young: Older people having sex is simply not part of our shared reality,  except in the world of advertising for erectile dysfunction medications.

I regularly see women in my practice who are surprised by the changes that come with menopause. They aren’t aware that simple steps and new routines can keep sex not only comfortable but pleasurable for years to come. They assume — because no one’s telling them otherwise — that “that part of life is over.” Whether they want it to be or not.

And health care providers get mixed grades on addressing sexual health, according to a University of Chicago study. While over 60 percent of OB/GYNs asked whether their patients are sexually active, only 40 percent asked if there were any problems. Even fewer (less than a third) asked whether sex was still satisfying.

It’s time for women to change all that. There are more of us over 50 than ever before, and sex remains a vital part of our physical, emotional, and even spiritual lives. Here are five reasons women need to speak up:

1. We can deepen our relationships. I hear a lot of stories from patients and their partners, friends and colleagues, casual acquaintances — and the occasional stranger on the street who sees the HOTFLAS vanity plate on my car. A consistent theme is a lack of communication: Beyond “not tonight, honey,” couples often haven’t talked about what’s changing physically and emotionally for women experiencing menopause even if they haven’t had sex in a year.

Men, I find, are often even more surprised by menopause than their partners. When they understand what’s happening, though, they’ve been just as supportive as when a sink clogs or a tire goes flat. I exchanged emails with a man who was looking for solutions to his wife’s painful sex; while she had given up, he had not. It wasn’t just self-interest: He could see that she was mourning the loss of what they’d once shared.

A particular topic I recommend for conversation is foreplay. Many women I’ve talked to acknowledge that while going “straight for the finish line” worked for them earlier in their lives and relationships, their needs have changed. As estrogen declines, tissues become more fragile, and there’s less circulation, if we don’t “warm up,” we hurt. Nothing shuts down desire like pain. And yet, many of us are shy about telling our partners that we’d like to linger in the intimacy before intercourse.

2. We can get information that helps us manage our sexual health. If doctors don’t ask about sex, we women need to bring it up. There are a number of tools available to mitigate some of the changes menopause brings — just as there are reading glasses for when our eyesight begins to dim.

I often recommend lubricants, vibrators, dilators and other products that can be purchased without prescriptions. We doctors have also gotten a lot smarter about hormone therapies (localized as well as systemic) and there are some new prescription drugs available, too. If you’re having symptoms that interfere with the sex life you want, don’t be shy: Your doctor can be a resource.

And, if along the way we change doctors’ perceptions about midlife — and older — women, so much the better.

3. We can feel more confident and empowered. I see women who are embarrassed by their loss of sexual desire or response, or interpret the pain they feel during intercourse as a personal shortcoming rather than a common effect of diminished hormones. On the other hand, I hear from women that satisfying sex makes them feel like they rule the world — or at least their worlds.

The natural effects of reaching a certain age shouldn’t make us embarrassed or ashamed. We are still women, and we can still roar. It’s time we are heard.

4. We can learn from each other. Since most of my workdays are filled with talking about sex and “lady parts,” I have a distorted view of how uncommon that kind of conversation is. I have to read studies and ask friends to get a more realistic view. What I learn is that somehow, comparing notes about sexual experience declines as we grow older. While we might have dished with girlfriends all night long during college, somehow, after marriage and certainly after midlife, we’re less likely to make anything but a passing reference to our sex lives.

Part of that I understand and support. None of us wants to expose all the intimate details we share with our partners. But surely, if we can talk about our knee replacements and gall bladder surgery, we can also talk about vaginal dryness, a condition most of us experience.

5. We can make “the change” easier to navigate for our sisters, our nieces, and our daughters. We can decide that we’re reluctant to talk about sex for ourselves. I wouldn’t endorse that choice, but I understand it: It’s hard to swim against the cultural current. But as the mother of three daughters, I hope we’ll make the effort. My hope is that the next generation of women will be well-informed enough to take menopause in stride, adapt as required, and keep living the lives they choose.