Sex After Fifty

Dr. Tracey Fein, M.D., Board Certified, Obstetrics-Gynecology

Senior Attending Physician, Lenox Hill Hospital, NYC

Over 20 years in Clinical Practice

Things have certainly changed a lot since the time my Grandmother was a fifty year old woman. Back in the day there was an unspoken agreement in the culture that women at a certain point in their lives stopped being sexual people. This is reflected in the movies and TV shows of the time, there came an age when women went from being babes to mothers to Grandmas and their role was defined as nurturers of the family unit. Few other portrayals of fifty year old women were available for women to utilize as role models.

In our time however, the dynamic has changed radically. For many women aging gracefully and being sexually vibrant is something they take for granted. Their conception of themselves is that they will remain sexually active and a vibrant player in the dramas of life until they attain quite old age. This is a universally sought after goal and is also universally difficult to achieve. In contrast to women’s experience, sex for fifty year old men is a fairly straight forward thing compared to that for women. Men only require a circulatory system in good enough health to allow increased blood flow to the penis. This is what the Viagra and Cialis medications do, they increase blood flow to men’s genitals resulting in an erection. For men sexual vibrancy can come in a pill regardless of their age.

Women have a whole different thing going on when it comes to sex. For a woman to have sexual feelings, her body needs to go through a much more complex series of maneuvers than popping a pill to jumpstart the body’s reluctance to turn on. Having a pleasurable experience of sex for women relies on a healthy vagina. A strong, healthy vagina has moist, soft skin, features bumps and folds and has a characteristic of elasticity. When women begin menopause, starting with the first missed period, the essential hormone estrogen begins to decline in production. Without estrogen a woman’s vaginal tissues become dry, thin, inelastic and smooth. This type of tissue makes sex difficult or painful, increases the chances of vaginal and bladder infections and if left untreated will result in complete sexual dysfunction. This silent menace of menopause is called vaginal atrophy and if a woman has hot flashes, she already has vaginal atrophy. There is no pill to treat this.

The complicated nature of treating menopause is why most Grandmas gave up sex after a certain point. Their vaginas simply couldn’t handle intercourse. The other dynamic that has gone largely unnoticed is that as vaginal atrophy takes hold and asserts itself, the nerve endings that weave through vaginal skin also atrophies. Fewer nerve endings means reduced sexual signals to the brain that cause arousal, stimulation and climax. In other words, as atrophy spreads, the ability to have sexual feelings and achieve orgasms, diminishes or goes away entirely. Therefore for women to remain sexually vibrant, vaginal atrophy must be prevented and if already established, properly treated .

My Doctor’s Best Advice is that women need to have a Menopause Plan. Menopause can begin as early as forty years old and continues until the most senior of years. Symptoms such as hot flashes, skipped periods, insomnia and so on are all treatable with a wide range of remedies some herbal and some medicinal. Different treatments will prove more effective for some women than others and many treatments will work for a time and then need to be adjusted. As menopause advances and symptoms of sexual dysfunction become evident, there is now a laser rejuvenation method called the Mona Lisa Touch that reverses vaginal atrophy and has helped many women.

The important thing about a Menopause Plan is that it addresses a woman’s need for a continuum of care that lasts over decades. The type of treatments a woman needs must be individualized or her. No two women are alike and their experience of menopause will be unique. Therefore it is vital for women to think of menopause as a process that will require different levels of treatment over many years as their bodies react to the depletion of estrogen.

Remaining sexually vibrant over the age of fifty means treating vaginal atrophy. The traditional symptoms of menopause are in fact temporary and usually easily treated. The progression of vaginal atrophy however starts early in menopause and continues until the most senior of years. Vaginal atrophy is the longest lasting and worst effect of menopause and its end result is sexual dysfunction. This is true for all women.

Women of previous generations did not have the ability to retain their sexual vibrancy as they aged. Neither physicians nor patients back in the day knew about the need for healthy vaginal tissues to have healthy nerve endings for the sex signals to be strong enough to trigger pleasurable responses in the brain. No one suspected everything was so interconnected and if they did there were no real treatments to keep fifty year old women sexually vibrant. In our day that is no longer true. Women with the help of a menopause specialist can remain sexually active as long as they wish and for women who are not sexually active, physicians now have techniques to keep their vaginal tissues healthy.

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.

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