How Your Doctor Can Help Women Manage their Sexual Health

Why sexual health is so important

Women's sexual health is not only important for reproduction, but it contributes to overall emotional wellbeing by contributing to women's sexual drive and a sex life that is pleasurable and satisfying. It can also impact overall health because it can lead to lowered blood pressure, improved immune system and heart health, better sleep, improved mental wellbeing and stress reduction. 

Read on to learn about the different types of female sexual dysfunctions, how sexual health changes as you age, how increasing your sexual health can support your overall health and how to maintain your sexual health for a vibrant and fulfilling quality of life, especially in your later years.

What is sexual health?

Sexual health encompasses emotional, physical, psychological, social and interpersonal aspects that combine for a woman to achieve a healthy and satisfying sex life. Getting fulfillment and pleasure from sexual activity is important to achieve positive sexual well-being and can be especially helpful for sex after 50.

Why is sexual health hard to talk about?

The many societal stigmas, myths and taboos around sex have led to women feeling embarrassed or reluctant to talk about sex and sexual wellbeing. These stigmas often worsen later in life, when societal misconceptions lead people to believe that sex stops entirely. Talking about sex – like our desires, wants, needs, likes, dislikes and boundaries – can make women of all ages feel vulnerable or uncomfortable. This discomfort is often magnified when it comes to discussing topics deemed by many to be especially taboo, including masturbation, the use of pornography, sexual orientation and sexual preferences, and any sexual practices that are considered “unconventional.”

Sex is generally considered to be the most intimate act between people. When sex is experienced in safe, healthy and fulfilling ways, it is an integral, life-affirming, joyous and natural part of living – and it is vital to a good quality of life for most women and men.

How sexual health impacts your overall health

Decades of research have found that positive sexual health has many potential health benefits, from increased heart health to improved mental health. A 2016 study found that the risk of cardiac events later in life was lower for women who were sexually active with a regular partner. The study also found that women who reported that they were satisfied with their sex lives had lower blood pressure.

 Studies also show that positive sexual health may be beneficial for boosting the immune system. The same research reported that women who had sex at least once a week had higher levels of the antibody immunoglobulin, a key component of our immune system, that thrives in mucosal tissue, including vaginal tissue, and salivary glands. While more research is needed, studies have also shown that sexually active women's immune systems are better able to kill infectious pathogens during the menstrual cycle.

There is a strong connection between mental health and sexual health. Mental health struggles can potentially lower your sexual health and vice versa: poor sexual health (physical, emotional and social) can cause or exacerbate mental health issues including anxiety, depression and more severe mental health disorders, including psychosis.

This is because the brain is key to sexual health. Neurotransmitters (primarily epinephrine, dopamine and serotonin) and neuropeptides (including oxytocin) along with endocrine factors, including estrogen, cortisol and pheromones, play an integral part in influencing sexual desire, sexual confidence and the ability to perform and enjoy sex.

Anxiety and depression can cause worries and distractions that overshadow the ability to relax and get pleasure from sex, or make people feel undeserving of attention and affection. Women are especially susceptible to major depressive episodes — impacting 10.3% of adult women compared to 6.2% of adult men — which can severely impair sexual functioning.

What it means for women to have sexual health dysfunction

Female sexual dysfunction is medically defined as any sexual problem that causes physical or emotional distress at least 75% of the time during a six- month time period. These sexual problems fall into four categories:

• Sexual interest and desire 
• Arousal
• Orgasm 
• Sexual pain

Common causes include:

Physical: 

• Hormone imbalances 
• Cancer
• Cardiovascular diseases
• Diabetes and other chronic diseases
• Pregnancy and breastfeeding 
• Menopause
• Neurological disorders
• Medication side effects, in particular antidepressant drugs 
• Alcoholism
• Substance abuse

Psychological:

• Anxiety
• Stress
• Depression
• Sexual abuse or trauma
• Poor body image
• Lack of sexual self-confidence
• Sexual performance anxiety

Common female sexual dysfunction (FSDs) include: 

• Female sexual interest/arousal disorder (FSIAD) - the inability to become actively and physically aroused - including vaginal swelling, lubrication and tingling sensations - even when sex is desired.
•  Female orgasmic disorder - when a woman experiences delay, difficulty or is unable to achieve orgasm despite sufficient arousal.
• Genito-pelvic pain or penetration disorder - involves painful contraction of the vaginal muscles and/or other vaginal pain during penetration.
• Vaginismus - involuntary tensing of the vagina causing painful intercourse (dyspareunia).

Fast facts/stats

• Research shows 46.2% of all women report they've suffered female sexual dysfunction; for women aged 40 to 50, it increases to 75.7%.
• Female sexual dysfunction is most commonly related to arousal (37.5%), problems with orgasm (44.5%), and/or pain (42.5%).
• Low libido, medical termed hypoactive sexual desire disorder (HSDD), is the moist common female sexual dysfunction. 
• John Hopkins Medicine reports that 50% of women in their 50s and 27% of women in their 70s continue to be sexually active.
• More than 30% of women in menopause or perimenopause say they suffer from lack of libido difficult reaching orgasm and other sexual difficulties including painful sex after menopause.

How sexual health changes as you age

There are many age-related factors that affect sexual health for women. One of the biggest is menopause, which has a significant influence on the ability to want and enjoy sex due to both physical and psychological changes.

Physical Changes

Menopause and its effects on sexual function

During menopause, the ovaries stop making estrogen, resulting in reduced vaginal elasticity and muscle tone as the vaginal lining gets thinner, less lubrication produced, a decrease in vaginal muscle tone, and more time needed to become aroused. These physical changes can lead to a lack of libido, vaginal dryness that causes pain with penetration, and difficulties achieving orgasm for satisfactory climax.

Hormonal shifts and their impact on libido

Throughout a woman's menstrual cycle, estrogen production fluctuates, with the highest levels resulting in the strongest libido. Estrogen levels drop to their lowest levels during menopause, which tends to negatively impact libido and sexual desire. Decreases in production of other hormones can also cause plummeting libido, including dehydroepiandrosterone (DHEA) and testosterone, which commonly is low after undergoing a hysterectomy.

Vaginal dryness and its implications

Vaginal dryness commonly occurs when the vaginal wall gets thinner or is otherwise unhealthy or not well-lubricated. The biggest culprit and cause is low estrogen levels, which decrease as a woman ages. As a result, vaginal dryness can cause pain during intercourse and a higher occurrence of vaginal yeast infections and urinary tract infections (UTIs), both of which are more common in women over 70.

Natural remedies for vaginal dryness include coconut oil, aloe vera, jojoba and vitamin E suppositories which stimulate vaginal mucosa that naturally lubricate the vagina. There are many over-the-counter vaginal moisturizers available that typically come as a cream or vaginal suppository. Ask your doctor if any of these solutions could be a good option for you.

Psychological and Emotional Impacts

The natural aging process and increase in susceptibility to age-related health issues, as well as other chronic diseases, can physically and psychologically impact a woman’s sexual health as she advances in years. As our bodies change with age, women tend to experience lower libido, lack of sexual confidence and worsened body image, as well as an increase in medications. All of these have a negative impact on a woman’s desire and ability to function sexually. The key to sexual health and a satisfying sex life in our later years is to make it a priority. Research shows that women 40 to 65 who place importance on sex are more sexually active and sexually healthy as they age into their 70s and beyond.

Treatment

Lifestyle changes

Focusing on eating a healthy balanced diet, maintaining a healthy weight, exercising including weight training to maintain muscle strength and stamina, and performing Kegels regularly – aka pelvic floor muscle training exercises – are all equally important for sexual health.

Medication

Cancer treatments, medications for cardiovascular and other diseases including diabetes and mental health disorders can all have major side effects that negatively impact sexual health, in particular libido and the ability to feel aroused and achieve orgasm. Talk to your doctor about the potential sexual side effects of your current medications — especially if you are taking antidepressant drugs that commonly cause female sexual dysfunction, most notably selective serotonin reuptake inhibitors (SSRIs) — and discuss potential options for changing your medications to reduce these symptoms.

Strategies for boosting libido post-menopause

Boosting your libido requires focus and action. The North American Menopause Society recommends the following:

• Prioritize thinking about sex - your brain is your most important sex organ.
• Communicate - speak up and don't be shy about discussing your changing sexual needs and concerns with your partner. In addition, consider consulting with a sex counselor or therapist if talking to a healthcare provider educated in sexual health feels more comfortable. 
• Make intimate appointments - spontaneity is great but if you rely on it for sex, it might never happen. Schedule time for intimacy and sexual encounters with your partner and/or yourself. 
• Consider erotic moments beyond intercourse - try oral sex, manual stimulation, sensuous baths and massages or just caressing.
• Go shopping - as we age, the need for vaginal lubricants, moisturizers and sexual enhancement creams (including those with taste and smell) may increase. Talk to your partner about introducing lubricants, massage oils or toys into your sex life. 
• Maintain a healthy lifestyle - get quality sleep, reduce stress, eat healthily and exercise. 
• Learn to love your body (easier said than done, but possible.) 

Communication

Communication is critical component of good sexual health. The ability to maintain an open dialog in which you can candidly discuss your desires, wants and needs with your partner is vital to fighting stigma and normalizing conversation about sex. 

How your primary care doctor can help you manage your sexual health

To get the best care and start feeling better, be open with your physician about your sexual health-related symptoms you're experiencing. Discuss any health problems or medication side effects that may be affecting your sexual health and be open to medication changes and new treatments. The key is to be honest and transparent with your doctor so he or she can guide you to your goal. 

Be completely honest with your doctor

Sometimes, it's tempting to be less than truthful with our doctors, especially when it comes to intimate topics like your sex life. American society does not have a strong history of encouraging open dialogue around sex and sexual health, so it's common to find it difficult to talk about sex with your doctor. It's understandable and common to feel embarrassed or even ashamed if you're struggling with issues related to your sexual health. 

But your doctor has seen it all: You won't be their first patient to struggle with vaginal dryness, low libido or other sexual health issues. You can also communicate to your doctor that you are anxious or embarrassed about these topics and that you could use reassurance. 

Make a list of your questions and concerns. 

It's easy to forget important questions at the doctor, especially if your appointment is short or rushed. A simple solution is to write out your questions and concerns ahead of time. You could even keep a list in your phone or a pocket notebook and add to it whenever you think of something else you want to bring up.

If you are planning to make (or have already made) major lifestyle changes, it's recommended that you check with your doctor to ensure these changes are safe and appropriate for you. Good general questions to ask include: 

• What steps do you recommend in managing my symptoms?
• Are there any sexual health-related test you recommend for me, like testing my hormonal levels? 
• Do you have patients who successfully reversed their low libido, vaginal dryness or other sexual dysfunctions?
• Is there any medication I should try?
• Are there female sexual health books, podcasts or literature I should check out? 
• What lifestyle changes do you recommend?

Bring a spouse or trusted friend. 

Not everyone knows that you are allowed to bring someone with you when you go to the doctor. Having a confidante by your side can make you feel more secure and help you remember what you want to talk about with your doctor. It also shows your doctor that you have a strong support system and research has shown that strong social and emotional support are associated with better health. 

Take notes

Doctor's appointments can be overwhelming. In order to remember your doctor's recommendations, it can be helpful to take notes during your appointment. If you bring someone with you, you can ask them ahead of time to take notes for you. You should also get a visit summary from your doctor after each appointment. If you are not sure how to access this summary, ask your doctor or a member of their front desk staff. 

Conclusion

Discomfort and shame is common for both individuals and society at large when it comes to discussing sexual health, especially as we age past 50. But positive sexual health - physically, psychologically, emotionally and socially - is an important part of achieving quality of life throughout life but in particular in our older years. Focus on making it a priority and discuss any concerns with your doctor or healthcare provider. 

FAQ About Women's Sexual Health

Does breast cancer hurt?

The answer is sometimes but now always. Breast pain can be a symptom of the cancer itself and a side effect of treatments. 

Why am I dry down there all of a sudden?

Vaginal dryness or vaginal atrophy - thinning, drying and inflammation of the vaginal walls - is most often caused by a decrease in estrogen hormone levels, medications or breastfeeding.

What is the best lubricant for vaginal dryness?

It depends on many factors including personal preference and whether vaginal dryness is experienced before or after menopause. Many gynecologists recommend Replens, Uberlube and coconut oil.

At what age does a woman stop being sexually active? 

There is no set age for the end of sexual activity, which can continue well into your 70s and beyond if it remains physically comfortable and pleasurable. About half of women in their 50s and 23% of women in their 70s report an active sex life. 

What is sexual dysfunction? 

Anything that prevents you from experiencing satisfying and pleasurable sex for 75% of the time for a six month period is considered sexual dysfunction. Causes include emotional or mental health disorders, medication side effects and chronic illness or disorders that impact desire, arousal and orgasm. 

Does Viagra work for women? 

While Viagra is not FDA-approved for use by women (only for sexual dysfunction in men), some studies show that for women with female sexual arousal disorder (FSAD) it may improve lubrication, sexual arousal sensation and orgasm.