Aging Smart, Aging Well, a nationwide survey of 3,100 midlife women, offers up fairly stark accounting of what’s happening in the exam room:
As a practicing clinician focused on sexual health conditions, such numbers do not surprise me. Instead, they underscore the need for more attention, support and compassion for women’s most personal sexual health conditions, including those that impact women’s sexual pleasure.
While there’s no one simple answer to improving our sexual health, one thing we know for sure in men and women is that by the time you get to your 50s your free circulating testosterone—which has a lot to do with libido and sexual function in women and men—is about half what it was in your 20s. That change has a major impact on all of us.
And yet, testosterone therapies are still not a common treatment for women. Patches, gels and the like are accepted for men but discounted for women. It’s a double standard means that large numbers of female patients who may be helped by testosterone therapy are not being served.
Instead, most attention, research and treatment regarding female sexual dysfunction tends to focus on vaginal lubrication. That’s certainly important to address in certain cases but in the end, still doesn’t drive the libido. Other established and emerging options include mental health counseling, stress reduction, serotonin reuptake inhibitors (SSRI) and a promising new medication category called melanocortin receptor stimulators.
Improving sexual drive is of particular concern for today’s Boomer patients who are unwilling to give up robust living. Indeed, this generation has little interest in going gentle into that good night and hold an entitled notion in regard to their health, whether talking about bad knees, hurting hips or fading libido.
Even so a lot of reluctance remains on both sides of the health care fence between patients and clinicians to explore libido and sexual dysfunction in a meaningful way. This is something I’ve seen in my own OB/Gyn practice for years: When it comes to conditions or symptoms that are not life threatening but still cause anxiety and impact quality of life—take, for example, urinary incontinence or pelvic organ prolapse—women are reluctant to address them, especially when not invited to discuss sexuality with their HCP in the first place. And of those who are brave enough to bring it up? Even today too many are still told, “Well, you’re getting older, what do you expect?”
It doesn’t help that today that patient/clinician face time is a very distracted experience, even behind the closed door of the examining room. Regular checkups are not a conducive environment for bringing up intimate issues. It doesn’t help, too, that many women don’t even see sexual dysfunction as a health issue but rather as an inevitable result of aging. As a result, sexual health remains a don’t ask/don’t tell topic for too many women.
It shouldn’t be.
The health care space still has much work to do when it comes to supporting women’s sexuality beyond its role in either preventing or supporting pregnancy. The question of how to support a woman’s sexual life is something that isn’t being answered broadly except by clinicians who specialize in women’s sexual health.
As a result, I believe there is an untapped market for tested medication, devices, exercises and techniques that support evidence-based options for women’s sexual pleasure. It is time for mainstream medicine to fold women’s sexual issues into quality of life research and service delivery, so that women have options beyond the market-driven vaginal rejuvenation space that relies on patient testimonials over scientifically controlled studies. I also believe there the moment is now to ask women the sexual health questions that they want answered—and in the way they want them answered. We must create the comfort zone for women to talk about the sexual challenges so many face as they transition into menopause.
Together, we can foster greater awareness of the health changes that can occur over a woman’s sexual life, ensure women have the information they need and bring meaningful change to our health care system to improve care to women at all life stages.