We've Gotta Have it
4 Trends That are Improving Sex after Midlife
From new products made by women to research, things are getting better
Now and then I get discouraged in my role as a menopause care specialist because there aren’t enough tools in my toolbox for treatment and there’s not enough solid research on women’s general health, let alone on women’s sexual health — especially on the components of desire and arousal. Many doctors confess to feeling ill-equipped to address women’s sexual health questions, and women admit they’re reluctant to raise the topic of sex after midlife with their doctors. Even when we women talk to each other, we could be more affirming of the individuality of sexual history, experience, preferences, and choices.
And yet, I feel more hopeful now than at any other time in my 30 years as an Ob/gyn, or since 2010 when I launched MiddlesexMD as a resource for women. Why?
Pharmaceuticals are breaking through
There are lots of helpful products women can buy over the counter to improve their sex lives.
Today I’m as likely to recommend a lubricant or a vibrator as I am to pull out my prescription pad. For some patients, though, only a prescription drug will get them past the pain, discomfort, or lack of desire that’s frustrating them and challenging their relationships.
It was flibanserin (called Pink Viagra in the press and commercialized as Addyi) that paved the way through FDA approval for drugs for women’s sexual function, with the first review in 2010 and approval in 2015. While flibanserin was between reviews, Osphena was approved in 2013 and Intrarosa in 2017, both as nonhormonal treatments to counter the effects of menopause on vaginal tissue.
There’s another drug for hypoactive sexual desire disorder now under review; if approved, bremelanotide could more accurately be called Pink Viagra, since it’s taken before a sexual encounter instead of on a daily basis.
None of these drugs will be a silver bullet for every woman. But as a practitioner looking to help women be as sexually active as they choose to be, it’s awfully good to know I have some options to consider and the prospect of more options in the future.
There’s more women’s sexual research across categories
The pharmaceutical companies, of course, rely on research to develop their products, but they’re not the only ones looking to learn more about what works, what doesn’t, and why.
I’m grateful to — and hopeful because of — organizations like The North American Menopause Society (NAMS) and the International Society for the Study of Women’s Sexual Health, which publish research reports and recommendations for care with such regularity that I’ll never run out of reading material.
There’s more fact-based information about over-the-counter products like lubricants, which previously women would need to test themselves.
Research presented at a recent NAMS conference points to pH value between 3.8 and 4.5, osmolality (a complex concept that determines whether one molecule gives or takes moisture from molecules next to it), and harmful additives like glycols, parabens, and preservatives. Michelle Robson and the Mayo Clinic (through SkinSAFE) analyze products for ingredients that can irritate or trigger allergies and share all the results.
I’m not sure it’s ever been easier to find products that can help without hurting.
Women are talking about sexual issues
Of course, I see the downside of pharma advertising. It adds to the cost of drugs, and it sometimes convinces women that there’s magic for them if their doctor would only prescribe a certain product.
The silver lining, though, is that advertising encourages conversation. Women may not only talk to their doctors about what they’ve seen in an ad in Oprah, but they may also talk to their sisters or their friends about vaginal dryness or sex after menopause.
Flipping through magazines, our daughters may see headlines that I hope make the realities of menopause less surprising than they’ve been for women of my generation.
And, you know, after a couple of decades of erectile dysfunction advertising, it could be time for men to have a little awkward education about the realities of sexual issues for midlife women.
Women are making their own products
We have a product shop at MiddlesexMD, so my team and I keep our ears to the ground for new products.
Some of our favorite new items were conceived (no pun intended) and developed by women, for women. I remember meeting Rebecca Posten, who has both a medical degree and an MBA, at a conference for physicians. She (and her team) developed PrevaLeaf products because too many “intimate” products didn’t meet her standards for natural and gentle ingredients.
Dame Products is another company where women are working for women. Founders Alexandra Fine (a social worker specializing in marriage counseling and sex therapy) and Janet Lieberman (an engineer) designed, crowdfunded, and are producing vibrators with the features they know women want — because they are women.
I’m a medical doctor, not a business wonk. But my hope is that examples like these, the increased awareness of women’s needs through midlife and beyond, a continued rise of women in STEM programs, technology-based funding platforms that make start-ups easier, and more attention to gender equity in venture capital will all add up to more smart products made by smart women to keep us all as sexy as we want to be.
Yes, sometimes I get discouraged. But on balance, there’s plenty of reason to be hopeful. We only need to keep advocating for ourselves, our sisters, and our daughters.