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Sex and the Older Woman

An OB/GYN addresses sexual problems in older women

Middle-aged woman

For many older women, talking about sex is still downright awkward. But if you want to enjoy a happy, healthy sex life (which has been shown to reduce stress and improve heart health), candid discussions with your partner and doctor are often essential, says Carrie Smith, MD, an OB/GYN at Rush University Medical Center.

Here, she offers advice to older women on how to have a fulfilling sex life after menopause — and why it's still important to protect yourself during sex.

Q: What are the causes of sexual problems in older women?

Smith: Most of the problems older women have are due to decreased estrogen levels that accompany menopause. When those levels drop, it often leads to vaginal dryness, as well as other changes to the vulva and vagina that lessen a woman's libido and make intercourse uncomfortable.

Q: Is it best to just stop having sex altogether if you experience pain or discomfort?

Smith: No. In fact, avoiding sexual activity actually has the potential to make matters worse; with sex, the adage "use it or lose it" is especially true.

If sex is painful or uncomfortable, it simply means that some changes might be necessary. For instance, over-the-counter lubricants and prescription vaginal estrogen therapy help ease discomfort brought on by vaginal dryness, and testosterone — yes, that's the male hormone — patches can improve sexual response.

If you have heart disease, however, talk to your doctor before using topical or vaginal estrogen to make sure it’s safe for you.

New positions may also be helpful in reducing discomfort brought on by age-related problems, such as osteoarthritis.

It's important to note that more frequent sex promotes vaginal elasticity and lubrication — both of which suffer as women age. So discuss the problems you’re experiencing with your partner sooner rather than later and suggest making some changes. Your ob/gyn can help identify strategies that will work best for you.

Q: What if you feel self-conscious about the aging-related changes to your body?

Smith: Instead of wishing for the body you once had, embrace and care for the body you have now.

Yes, you are no longer 30, but isn't that a good thing? While your body has changed over the years, you have so much more to offer in terms of having a healthy and fulfilling relationship.

So exercise at least three times a week for 30 minutes and eat right to combat health problems that can interfere with a good sex life, such as obesity, high blood pressure and diabetes. You'll not only feel healthier but more confident in the bedroom.

And visit your primary health care provider; he or she can put you on the path to healthier — and sexier — living.

Q: Since pregnancy isn't possible after menopause, can older women skip birth control?

Smith: Unfortunately, pregnancy isn't the only issue sexually active women have to worry about.

If you're not in a long-term monogamous relationship, regardless of your age, you must insist that your partners always use condoms.

Unlike Generations X and Y, older women — and men — didn't come of age worrying about HIV/AIDS and other sexually transmitted diseases, so incorporating safe sex practices into an intimate relationship isn't as automatic. Condom use, for many older women, fell off the radar once they reached menopause and the threat of unwanted pregnancies disappeared.

But thanks to Internet dating and erectile dysfunction medications, more and more older adults are having sex. As a result, instances of STDs in this age group are on the rise according to the American Association of Retired Persons.

I urge all sexually active women, whatever their age, to be proactive about protecting themselves and their partners against STDs. This means talking about your sexual health with your partner, getting screened for STDs — which can lie silent and dormant for years — and using condoms, even if you're the one who has to go to the drug store to purchase them.

If you feel too embarrassed to buy condoms at the store, you can easily — and discreetly — order them online.

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