I am in my forties and not that interested in sex, it that normal?

Perimenopause is the time period your body transitions, hormonally, physically and emotionally into menopause. Every woman’s experience is different and can last up to 10 years prior to getting into full blown menopause which accounts for women/people in their 40’s.  If you have irregular and heavy periods, emotional ups and downs, night sweats and insomnia you should not be surprised that you are also not that interested in sex. Your hormones, including estrogen and testosterone, are erratic which effects your interest in having sex. This is very common and completely normal.

 

Can I take testosterone to help boost my sex drive?

Testosterone therapy may be helpful for low libido. It’s best to first get your testosterone levels checked by your healthcare provider to see if there is a hormonal explanation for your low sex drive. Even if your levels are normal, testosterone therapy has been shown to improve your sex drive in perimenopause and menopause. 

Testosterone replacement therapy can also improve bothersome symptoms of aging and the menopause transition. Testosterone replacement not only improves libido but can also help with fatigue, muscle tone and stamina, mood disorders, sleep issues, cognitive functioning, bone strength and heart health.

 

Now that I am in menopause, I have no interest in sex, am I a freak?

When you enter the next chapter of life, called menopause, your estrogen and testosterone levels both drop affecting your desire to be sexually and intimate.  Over 60% of women will report losing their libido.  You are being bombarded with physical and emotional symptoms that directly affect your mood in the bedroom. This can create a lot of disruption in a relationship since over 30% of women stop having sex all together.   Treatment options include hormone replacement therapy-both oral and vaginal, Addyi (the “pink” pill for women), testosterone therapy, lubricates, self-awareness and education that can ease this normal hormonal cycle.

Why is sex so painful in Menopause?

Menopause typically occurs around the age of 51year. When you transition into menopause and decide not to be on hormone replacement therapy, use estrogen or DHEA vaginally, the vagina can suffer dramatically. Often, the hot flashes will improve over time but vaginal dryness only worsens.  In the vagina specifically, estrogen increases blood flow to the tissue, thickens the vaginal walls and helps with overall lubrication.   With menopause and the loss of estrogen stimulation in the vagina, the tissue becomes dry, thin and pale.  The medical term for this is genitourinary syndrome of menopause (GSM).  As a result, intercourse and other forms of vaginal contact become painful and, often, impossible. Tears in the vaginal opening are common which can lead to bleeding and pain. There are many treatment options including vaginal estrogen or DHEA, internal moisturizers, lubricants, hormone replacement therapy and vaginal lasers that can help with these common symptoms of menopause that can ruin your sexual experiences.

Why is estrogen helpful for sex?

Estrogen plays a critical role in our female sexual response especially in peri-menopause and menopause. Estrogen is responsible for our vaginal tissue sensitivity, elasticity, secretion, pH balance, establishing healthy microorganisms in the vagina, urinary continence, pelvic muscle tone and joint mobility. All of these affect our female sexual functioning. In perimenopause and menopause, estrogen levels are erratic or go away all together. Using oral or vaginal estrogen can help maintain all the helpful qualities that estrogen provides us for a healthy sexual response.

Why there are still so many taboo about sex in midlife and beyond?

Aging, in general, is not embraced by our culture. Women don’t want to admit they are in menopause knowing the eye of the storm is in the near future. The conversation of aging alone is a taboo along with the negative effects of what happens in the bedroom.  

When you enter the next chapter of life, called menopause, your estrogen and testosterone levels both drop affecting your desire to be sexually and intimate.  Over 60% of women will report losing their libido.  You are being bombarded with physical and emotional symptoms that directly affect your mood in the bedroom. Many women do the laundry than having sex with their partner.  This can create a lot of disruption in a relationship since over 30% of women stop having sex all together.  Menopause is derailing to the sexual wellness and the vagina for women.

These topics have been taboo for way too long. The time is now to bring them out in the open and continue the conversation so women can continue to live their best lives even with aging.

The bottom line is that quality of life, especially in the bedroom, is incredibly important and should be a priority.  Expect the unexpected as your body to transition into menopauses. Menopause is a natural process and everyone goes through it differently.  Take good care of yourself through diet and exercise.  Communicate openly with your partner so they know what you are going through.  

 

How can we be more sexually confident at this age?

When you transition into menopause and decide not to be on hormone replacement therapy the vagina suffers dramatically. Often, the hot flashes will improve over time but vulva-vaginal atrophy only worsens.  In the vagina specifically, estrogen increases blood flow to the tissue, thickens the vaginal walls and helps with overall lubrication.   With menopause and the loss of estrogen stimulation in the vagina, the tissue becomes dry and pale.  The medical term for this is vulva-vaginal atrophy (VVA) or genitourinary syndrome of menopause (GSM) since the bladder is also affected.  As a result, intercourse and other forms of vaginal contact become painful and often impossible. There are many treatment options including hormone therapy, vaginal laser, and lubricants that can help with GSM. Ideally you want to be using vaginal estrogen twice weekly to increase blood flow, improve lubrication and moisture inside this sensitive area of the body. Lubricants are a bandaid to the delicate vaginal tissue during vaginal penetration in menopause. Taking care of the vulva and vagina decades before menopause is the most helpful remedy for menopausal effects on the vagina. 

Women’s sexual health has to be made a priority in life. Despite life’s expected obstacles and hormonal challenges, a sexual and intimate life reminds you that your body deserves to be celebrated and pleasure may be within an arm’s reach. Hydrating and moisturizing your Lady Parts in your early in life will be your best defense for GSM.

What can I do if I haven’t had sex in years and my vaginal opening is small?

During menopause and perimenopause, the vaginal opening can become tighter because the skin loses its elasticity-it’s stretchability! If you are haven’t infrequent penetration with penises, fingers, or sex toys the “tightness” factor worsens.  Infrequent penetration and a lack of estrogen-systemically and vaginally, both make painful penetration worse.

Using vaginal dilators can help with this very problem! The goal of using vaginal dilators is to increase the vaginal opening comfortably to retain, expand, and gently stretch the entrance and canal of the vagina for additional comfort and pleasure. When you can insert one size of a dilator completely without any discomfort, then you should start using the next size up. The goal is to insert the largest size dilator without any discomfort. Using vaginal dilators weekly can also be done in between sexual activity to make any penetration comfortable and painless.

Kegels & Sex

I heard doing Kegel exercises during vaginal penetration can help me orgasm, it that true?

The one thing I would definitely mention and agree with you is how great Kegel exercises are for sexually pleasure for both men and women! When women do their Kegel exercises and strengthen these pelvic floor muscles it is win-win for her and for him.  For women, if they do Kegels while trying to orgasm it can actually enhance your orgasm (who doesn’t love that?).  And when a woman Kegel’s during vaginal intercourse, the pelvic floor muscles contract on the penis enhancing his sexual experience.  For all these reasons, Kegel exercises should be a permanent part of your daily routine.

What is a lube, why would I need it? 

A lubricant, aka lube, is a liquid, made of silicone, water or oil, used during sexual activity, whether solo or with a partner. Sexual lubricants are especially helpful if you suffer from vaginal dryness with sexual activity. The majority of people love bringing a lubricant into the bedroom to make sexual activity more enjoyable and reduce pain during vaginal penetration.

What are the best lubes to use with sex?

 

The most commonly used lubes tend to be water, silicone or oil based, which will not disrupt the vagina’s delicate pH balance and cause infection or irritation. Water-based lubricants feel smooth, “silky” and slippery to the touch. There is no clumping effect and can be used safely with condoms and sex toys. Water-based lubricants are cost friendly and easy to wash off sheets and body parts.

 

Silicone based lubricants are equally as wet and slippery as water-based lubes. Silicone based lubes tend to be thicker, last longer with more staying-power, but need soap and water to rinse off after sexual activity. This lubricant can be used with a condom. Silicone based lubes should probably not be used with silicone sex toys as they may break down the material.  Silicone lubricants tend to be preferred for anal play since it’s thicker, slippery and doesn’t absorb into the body so it lasts longer than other lubes.

 

My skin is super sensitive and I can’t use a lube with sex, what do you suggest?

Oil based lubricants, such as coconut oil, is a natural, preservative free, cost and vagina friendly alternative. For people with skin sensitivities, it has a benefit of not causing any allergic reactions or vaginal infection. Coconut oil is anti-fungal so it will not increase your risk of a yeast infection. It also has a thicker and more long-lasting affect during sexual activity. Oil-based lubes can break down the integrity of latex condoms and dentals dams, increasing the risk of STI’s and pregnancy. Oil-based lubes may affect the sperm’s integrity, making it not the lube of choice when trying to conceive. 

Is it okay to use Vaseline as lube?

Not all lubes are created equal! A perfect lube should be slippery, safe for the tissue, long lasting and not increase your risk for any vaginal infections. Vaseline was not created to be used as a vaginal lubricant.  Vaseline, which contains petroleum, was not created to be used as a vaginal lubricant.  It’s ideal for chapped lips and dry skin but tends to be thick, sticky and gummy as a vaginal lubricant.  Using Vaseline can also increase the risk of a bacterial infection and break down latex condoms.

 

What is a “natural” sexual lubricant?

Natural and organic lubes can mean many things depending on the store where it is being sold.  It can definitely be confusing to the user.

Generally, natural lubricates do not contain extra additives including synthetic chemicals, dyes, preservatives, artificial fragrances, and other toxins. Avoiding parabens, petroleum, glycerin, and other sugars would also be considered natural.

The fewer the ingredients, the more natural the lube would be.

 

Can Coconut Oil be used as a lubricant?

Extra virgin coconut oil can be considered a safe natural or organic lube since it doesn’t disrupt the pH balance of the vagina. It’s a great moisturizer and considered a natural lube with no harmful additives. The price is right and it has anti-fungal properties. The downside is it cannot be used with condoms and can stain the sheets.

Can Olive Oil use used as a lubricant?

In the modern age, olive oil is still used as a viable and popular sexual lubricant.  It’s natural and lasts longer than water-based lubricants.  Silicone-based lubricants are also an option and last the longest during sexual intercourse compared to olive oil and water-based lubes.

Olive oil is a great alternative, but it cannot be used with latex barriers such as a condom or dental dam since it can break these commonly used STI or pregnancy protectors. If you use olive oil as a lubricant, you will have to use a polyurethane or synthetic condom.

Some women and men notice more skin irritation including rashes and hives when using olive oil. If you are prone to skin sensitivities or yeast infections, oil olive may not be your best option.

 

What ingredients should I avoid in a lube?

Ingredients you want to avoid include parabens, glycerin, petroleum, artificial fragrances, colors or flavors, synthetic chemicals, dyes, preservatives or other harmful toxins.

How do I know the best lube for me?

Lubricants are a very personal decision, whether you are having solo or partner play. Trial and error with experimentation, is always my recommendation to know which lubricants work best for you, or you and your partner, with vaginal and anal play. 

 

A topic completely under discussed and inconsistently practiced, safe sex means condom use during vaginal or anal intercourse and oral sex. When was the last time you gave someone a blow job with a condom on? Or was given oral sex with a dental dam?  99.9% of women and men would answer “never”! Many women and men have never even heard of a dental dam but they are meant to be used during oral sex. And if there isn’t a dental dam in grabbing distance, plastic wrap or a cut condom will do the trick. It’s important to know that when giving oral sex to a man or women, HPV, Chlamydia, Gonorrhea and Syphilis can be transmitted.  This is so important to understand since there is an increased incidence of cancers involving the throat. 

Who needs to worry about safe sex?

Everyone needs to be concerned about practicing safe sex. Prevention is the best defense against STI’s. Male and female condoms are the only dual protection methods available to help reduce the risk of common STI’s including HPV, Chlamydia, Gonorrhea, Syphilis and HIV. Women and men of all ages and regardless of your sexual orientation are at risk for STI’s and need to incorporate dual protection methods when having sex.

 

How do you suggest bringing up the topic of safe sex with a partner?

It’s important to have this completely awkward conversation with a new partner before finding yourself in that uncontrollable passionate moment under the sheets. I’d suggest having this conversation before you have a couple of drinks and before you’ve strewn your clothes around the room. Have it on a date or during dinner if you feel the relationship is heading towards sexual intimacy.  Discuss your STI history and the importance of safe sex before taking those next steps. 

 

What are some common mistakes you see people making when it comes to safe sex?

The most common mistake women and men make when it comes to safe sex is how common it is to transmit STI’s you are unaware that you have.  HPV is the best example. HPV is contracted through skin-to-skin contract typically during sexual contact. It’s often best to avoid any sexual partner that has genital warts or a known history of HPV. The problem is that most people are unaware that they carry HPV, especially men. Men do not have an equivalent to the PAP smear for women that allows detection of HPV. Unless men have warts or a history of them, they have no way of detecting this epidemic virus. Another frustration for women is that the condom does not provide complete protection against HPV. HPV may live at the base of the penis or in other exposed areas that can pass HPV to the woman during sexual intercourse. This includes penetration with the penis, vaginal or anally, oral sex and hand-to-genital contact. Straight and same-sex couples are equally high risk to HPV exposure and transmission. Other STI’s you may be unaware you have included Chlamydia, Gonorrhea and Syphilis.

 

How long should my partner and I practice safe sex?

Another common mistake people make in practicing safe sex is being consistent about enforcing this practice.  Typically, a condom is used during vaginal penetration the first few times a couple has sex.  With time and comfort with your partner, the practice of safe sex is not consistently enforced. Since you don’t have active signs of infection you think the coast is clear when in fact you can become infected and not show any signs of infections with any of these contagious STI’s.

Protecting each other against STI’s, especially HPV and Herpes, should always be a top priority. Until there’s a ring on your finger or have proclaimed a committed relationship, practicing safe sex is recommended.

 

Do I need to worry about STI’s over 50year?

STIs in women and men over 50 occur for the same reason they occur at any age, exposure to an infected partner. STI rates have more than doubled among U.S. adults 65+ in the last decade; chlamydia cases tripled, gonorrhea increased sixfold, and syphilis nearly tenfold between 2010–2023. The Drivers for this include greater sexual activity in older adults, including in senior-living facilities, very low condom use (about 3% in those over 60yr), limited STI knowledge, and partner imbalances from longer female life expectancy.

There are also several age-specific factors increase risk and make diagnosis more likely including thinning, drier vaginal tissue after menopause (vaginal atrophy) which reduces the natural mucosal barrier and lubrication, making transmission easier and symptoms more likely. Lower estrogen can impair local immune defenses, increasing susceptibility. Changes in genital microbiome or community inside the vagina that may change the protection against harmful bacteria.

Plus, there is an increase in new or multiple sexual partners after divorce, widowhood, or re-entering the dating scene. We know there is less frequent condom use and many older adults underestimate the STI risk and don’t use barrier protection (condoms).

Unfortunately, there is less awareness among patients and healthcare providers not routinely asking about sexual activity or screening older women for STIs. Symptoms can be subtle or mistaken for menopausal changes (vaginal dryness, itching), delaying diagnosis and treatment.

As a result, some infections (e.g., HIV) can have higher transmission risk and worse outcomes because of the mucosal changes and late diagnosis.

Discuss your risk or concerns with your healthcare provider if you are single and ready to mingle!