How to Talk About Menopause and Sex with Your Doctor

Dr. Alyssa Dweck

Written by Dr. Alyssa Dweck, MS, MD, FACOG, Chief Medical Officer

Surprisingly, women have never been too keen on bringing sexual concerns to their health care provider’s attention.  Some feel embarrassed or ashamed; while others suspect nothing can be done about their issues anyway, so why bother.  Throw in the stigma that surrounds menopause and the sexual changes that may arise during this time and approaching the topic doesn’t necessarily get any easier with age. No matter what reproductive stage a woman is in, one thing is certain: sexual issues can be quite distressing and do negatively impact quality of life.

Believe it or not, health care providers are not so great at asking their patients about sexual health either.  They cite limited time, lack of sufficient training on the subject and scarcity of available treatments to offer.   But there’s good news ladies. The tide is changing and there has never been a better time to talk about sex!

Which Doctor to Consult for Sexual Concerns

Who better to discuss sexual concerns with than your gynecologist?  After all, it’s not out of bounds to discuss contraceptive needs or to screen for sexually transmitted infections (STIs).  These are surely sexual health issues.  Moreover, your gynecologist has likely seen you through various, significant life stages: your first sexual experience, your first pregnancy and even your transition hormonally towards menopause.  This allows for a tight bond and trust.

The most common sexual health concerns among women have remained constant over time, although diagnostic and medical terms have varied.  Low sexual drive, vaginal dryness and pain, dyspareunia (pain during intercourse), and weakened or absent orgasm are typical complaints. These symptoms are even more commonplace during perimenopause and menopause, when a drop in estrogen can noticeably affect a woman’s sexual function.  Each can present itself as an isolated complaint, but more commonly they are interrelated.  In fact, one sexual complaint often begets another.  As an example, pain during sex due to vaginal dryness can eventually lead to avoidance and lower drive.  Once the dryness is treated, the pain resolves and libido returns.

How to Raise Sexual Health Concerns to your Doctor

A direct conversation is usually best when dealing with complaints of this nature.   Women should ideally come to their appointment prepared, with questions or concerns written down in case they feel nervous once in the office.  Without counting on Dr. Google too much, do your homework so you are better able to articulate your needs.  By the same token, your health care provider should ask specific questions during a patient intake.  For example, something simple and straightforward, such as, “Are you sexually active and if so, do you have any concerns about it?” is a good icebreaker and normalizes the issue. Sexual activity refers to sex, partnered or solo.  Sex can also mean intercourse or other activity aka “outercourse.” The sexual health changes women experience during menopause can be dramatic and disconcerting, which is why it’s all the more important to keep an open line of communication with your doctor during this transition.

Keeping a detailed, thorough health history and tracking any physical or emotional changes may provide important information about your pain, dryness, or sex drive. In order to best understand and be able to help, a candid conversation is vital.  Your doctor may have some general advice to assist or be able to recommend specific treatments for your symptoms. 

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Sexual health concerns are often complex with multiple variables to consider.  With that said, don’t be surprised if your doctor suggests several visits to evaluate, treat and follow up. Oftentimes a second opinion or consultation with a sexual medicine specialist is advised.

All in all, sexual concerns are important.  Since sexual health and general health go hand in hand, it benefits everyone to discuss the subject without hesitation. And take comfort in knowing you’re not alone: many women have sexual concerns, particularly during menopause. Your gynecologist has probably heard yours before, so there is no reason not to be open with them about it. 


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