Let’s Talk About Sex
Midlife sexual health changes and what to do about them
Back when I was an internal medicine resident, the doctors who supervised my outpatient clinic were passionate about caring for patients and had so much knowledge to share. One doctor in particular always struck me as being ahead of her time, especially when it came to women’s health.
She taught me how to prescribe hormone therapy at a time when many doctors still considered prescribing it too risky. And she taught me that, while screening for sexually transmitted infections and prescribing contraception is important, there is so much more to women’s sexual health.
While progress in women’s health feels and sometimes is slow, we have learned more about women’s sexual health since my residency days. Yet, there is still plenty we don’t know. Today we are taking stock of where our knowledge stands now.
How it works.
Women’s sexual function is complex. Nearly a dozen hormones work in concert to drive sexual desire, arousal, and orgasm. Estrogen keeps the delicate lining of the vulva and vagina plump and moist, and keeps the tissues sensitive to touch.
Estrogen also affects dopamine function in the brain and dopamine increases desire, arousal, and interest in sex. When estrogen levels are high before ovulation, women’s sexual desire peaks. On the other hand, progesterone reduces sexual desire and many women note feeling less interested in sex after ovulation when progesterone levels rise.
