Sex in the Middle Ages.

Dr. Tracey Fein M.D.

Board Certified, Obstetrics-Gynecology

Over 20 years in clinical practice

Sex is a funny thing. Sometimes its ha-ha funny but most of the time its funny like strange or unexpected funny. Take sex in the middle ages, or middle age sex if you prefer; with the exception of Viagra commercials, it doesn’t exist as a cultural meme. Kind of off the radar screen kind of thing. Men retain sexual vibrancy even if it comes from a pill but women sort of disappear from the sex scene unless they’re the younger companions of older men. Funny, no? Because what makes it funny-strange is the truth of the real world is worlds apart from the truth the media gives us. Here’s a quickie news flash; women like sex even if they’re in the forties, fifties, sixties, seventies and eighties right up to the end of life. With only one hitch, they must retain their mojo, which is a different kind of mojo from the kind men enjoy.

When men get older their ability to preform sexually is a matter of blood flow to their private parts. Due to the effects of aging this process may not work as efficiently as when they were younger. That’s what all the erectile dysfunction medications address, increasing blood flow to the penis resulting in an erection. Compared to women’s sexuality it’s a more direct process and a simpler problem to address when things go south.

Unlike men, women become sexually dysfunctional for completely different reasons having nothing to do with blood flow or circulation. With women, the problem is hormonal. The hormone estrogen ceases to be produced beginning as early as forty years old. The result on a cellular level is progressive deterioration and eventual atrophy. In other words, a woman’s vagina after menopause starts to self-destruct. The tissue structures that once created soft, moist skin become dry and thin, making sex difficult, painful and eventually impossible. This process is gradual and subtle with its symptoms frequently attributed to yeast infections or temporary dryness. As the experience of sex becomes increasingly uncomfortable and orgasms harder to achieve, desire for sex diminishes because there is no longer any pleasure in it. Left untreated the end result of vaginal atrophy is a complete loss of sexual function and a vagina that becomes increasingly prone to infection.

Alright so you’re asking where’s the funny in this? Well, the funny strange part is that the men are getting pills for erections on demand and their wives and girlfriends can’t keep up. Female Viagra doesn’t exist. Women need healthy vaginas for sex to be both pleasurable and desirable. Therefore, retaining a healthy sex drive means retaining a healthy vagina regardless of age. Treating the inevitable advance of vaginal atrophy needs to be at the core of every woman’s menopause plan. The deterioration of vaginal health begins as early as forty years old and will continue to progress through the senior years. It’s a silent menace and it needs to be treated as early as possible and continue for as long as practical. Vaginal health, like dental health has no end date. Vaginal atrophy is progressive and it begins with the onset of menopause. If a woman has hot flashes, she already has vaginal atrophy.

The funny-odd-really-strange-thing is that sexual dysfunction in women with the loss of sexual vibrancy is completely preventable. If vaginal atrophy has already occurred it can be treated effectively and safely with a range of new treatments including laser rejuvenation like the kind used for facial rejuvenation resulting in the kind of skin found in younger women. There may be no female Viagra but there is a way for physician menopause specialists to help patients keep their mojo in the first place, or get it back if its gone missing.

Why aren’t we hearing more about this from the media? From doctor’s themselves? Because middle age women who want to have sex are not really on the radar screen of the culture. Women’s roles in Hollywood and TV go from babe to Mom to Grandma in a heartbeat leaving little room outside of that. Women in middle age desiring sex fall into the cliché of “Cougar” not the real-life image of loving, wives, girlfriends and partners who wish to express physical intimacy. Those real-life women are largely absent from the cultural radar screen. And regarding doctors, they may have other priorities during an annual examination and like all other people, may find sex difficult to talk about, especially if the patient is their mother’s age. Which if you saw it on a sit-com would really be pretty funny. Imagine Betty White explaining to Dr. Doogie Howser that she has trouble having orgasms and that sexual intercourse has become very difficult for her, “Tell me Dr. Doogie what should I do?” Funny no?

The North American Menopause Society (NAMS) has a list of certified menopause specialists that can help women make a plan for effective treatment of menopausal symptoms. Or ask your regular doctor for a referral.

#monalisatouch #drtraceyfein #sexproblems #menopause