As the medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause, a Chicago-based clinic that treats the physical, hormonal and medical aspects of sexual response, I have become an expert when it comes to solutions for problems that result from midlife plummeting hormones. My center is a safe space to tackle those hard-to-discuss taboo topics (like why your sex life is a distant memory), so I hear it all. If you have a nonexistent libido, pain with penetration, or the ability to orgasm goes under the heading of wishful thinking — then I’m your person. Here are a few of my favorite tips.
- All lubes are not created equal.
It’s tempting to grab the first product you see and then buy 20 things you don’t need to hide the fact that lubricant is the only thing on your shopping list. Most popular water-based lubes are not vagina-friendly and can damage or even dehydrate the tissue. Look for a silicone-based lube or a low-osmolality water-based lube. For a list of super slippery lubricants and more vaginal dryness solutions, check out my book Slip Sliding Away: Turning Back the Clock on Your Vagina (A Gynecologist’s Guide to Eliminating Post-Menopause Dryness and Pain). Your vagina will thank you.
- Your diabetes may be getting in the way of your ability to have an orgasm.
I am betting your doctor asked about decreased sensation in your feet but didn’t mention that your clitoris might also be a little numb from vascular or neurologic changes that commonly occur with diabetes. A little estrogen cream (you will need a prescription!) applied directly to the clitoris a few times a week will increase blood flow and sensation. Be sure to take your time rubbing it in.
- Change your estrogen to boost your libido.
Postmenopause estrogen therapy is a known libido booster. But it turns out that transdermal estrogen — absorbed through the skin as a patch, spray or gel — has a more favorable impact on libido than oral estrogen. Here’s why: Estrogen pills increase sex hormone-binding globulin (SHBG), a protein that binds testosterone (essential for libido!). A high SHBG reduces the amount of active testosterone and reduces your desire for sex. So if you are taking oral estrogen therapy and have a lagging libido, you may want to talk to your doctor about switching to a transdermal option. The details are in Hot Flash Hell: A Gynecologist’s Guide to Turning Down the Heat.
- HPV vaccines are not just for teens.
If you are single and dating, fear of getting a sexually transmitted infection is a major libido killer. Human papillomavirus (HPV), the most common sexually transmitted infection, is responsible not only for genital warts but also for cervical, vaginal, vulvar, anal and oropharyngeal cancers. Gardasil, the vaccine that guards against the most common types of HPV, was originally only approved for women younger than 26. In 2018, the FDA extended its approval to men and women over age 45, but a lot of women never got the memo.
Getting a vaccine reduces your risk of acquiring an HPV infection by a whopping 90 percent! If you are in the over-45 crowd, know that Gardasil, is not FDA-approved — not because it is ineffective or dangerous, but because the FDA has determined that the “cost benefit” is not enough to make it worthwhile. Your doctor may be willing to vaccinate you (I vaccinate anyone who asks), but you will need to stick out your checkbook along with your arm, since insurance won’t cover the cost.
- That “gotta go” feeling may be because your urethra needs a little estrogen.
Tired of that seemingly constant mad dash to the bathroom? It’s hard to be “in the moment” when you are worried about peeing on your partner. Lack of estrogen is not just about the changes that occur in the vagina. Postmenopause changes in the urinary tract result in several tissue alterations, including drying and inflammation of the urethra. Women who are constantly dealing with a sudden, irresistible urge to void usually have no idea that recurrent urinary tract infections and urinary urgency is sometimes a direct result of menopause. A dab of prescription vaginal estrogen cream applied to the urethra a couple of times a week often eliminates the need to spend more time in your bathroom than in your bed.
- If the only thing that vibrates is your cellphone, it’s time to go shopping.
If nerve endings are not as responsive as they used to be due to aging or medical conditions, many postmenopausal women find that achieving an orgasm becomes more difficult, if not impossible. External stimulation with a vibrator is a necessity, as opposed to an enhancement. It’s no surprise that a 2009 Indiana University study not only found that 52 percent of women reported having used a vibrator but also that women over 45 had increased sexual satisfaction. And far from being something that is used only for solo play, vibrators were used by couples 80 percent of the time.