Menopause, Sex, and Modern Solutions

Understanding Your Body's Changes

As a board-certified OBGYN and Menopause Society Certified Menopause Practitioner, I want to start by normalizing something: there will be times in your life when your sex life isn't what you want it to be. Think of low sex drive as the common cold of your pelvis – it happens to everyone at some point. Whether it's now, after having a baby, or during menopause, changes in sexual desire are a normal part of life's journey.

The Truth About Sexual Desire

Let's bust a major myth right now: Hollywood has sold us a false narrative about desire.¹ They'd have us believe we should experience spontaneous desire – that sudden urge to have sex – all the time. When we don't feel this way, we think there’s something wrong with us.² But here's the reality: that's not how our bodies naturally work.

There are actually two types of desire:

1. Spontaneous Desire: That Hollywood version where desire appears out of nowhere

2. Responsive Desire: When you become interested in sex after arousal begins

Think of responsive desire like this: you're not hungry, but then you see a delicious dessert and suddenly develop an appetite. As we age, particularly during perimenopause and beyond, resonsive desire becomes much more common. This isn't a flaw – it's your body's natural response pattern.

When Sex Hurts: Addressing the Root Cause

Here's something I see frequently in my practice: women avoiding sex because it's painful. Your body is smart – it doesn't want to do things that hurt. But here's the good news: pelvic pain is treatable. Let's break down the main causes and solutions:

Hormonal Changes and Dryness

When estrogen levels drop during menopause, the vulvar and vaginal tissues can become dry and painful. The simplest solution? Lubrication. Here's a fact that might surprise you: studies show that the majority of Americans use lube.^3,4 It's not just normal – it's smart!

Pro tip: For menopausal women, I recommend silicone-based lubricants over water-based ones. Why? Dry, thirsty tissue will absorb water-based lubes too quickly, but silicone-based products provide longer-lasting comfort. (My favorites are UberLube, Oh My Glide and Glissant.)

Modern Solutions: Light Therapy and Vibration

Is it just me or is your social media filled with ads for lasers and pick-your-color-light face masks? There is a lot of data showing certain types of light therapy can be good for your skin. Lasers are a type of light therapy that is a useful tool for many symptoms associated with menopause.⁵ But there are now low-level laser therapy options and some with vibration therapy too, and I’m not just talking about using this on your face (which I do regularly with a Fringe face mask or LumeBox). Recent research⁶ has shown promising results for various pelvic health concerns, including sexual dysfunction⁷, pelvic pain⁸, and tissue health⁹.

How Light Therapy Works

Light therapy, particularly red and near-infrared light, can help with^{10,11 :}

• Tissue rejuvenation
• Reduced inflammation and pain
• Increased blood flow
• Muscle tone regulation¹²

The Role of Vibration Therapy

Vibration therapy complements light therapy by^{13,14 :}

• Supporting tissue rejuvenation
• Improving blood flow
• Helping regulate muscle tone
• Reducing various types of pain

The Fringe Light Therapy Wand: A New Option for Home Care

In my practice, I'm always looking for evidence-based solutions that women can use at home to support their pelvic health. Recently, I've been impressed by the Fringe Light Therapy Wand, which combines both light and vibration therapy in one device.

How the Wand Works

The device offers three different light therapy modes:

1. Deep Rejuvenation Mode: Combines red and near-infrared light (630nm & 830nm) for deep tissue support
2. Antimicrobial Mode: Uses blue light (415nm) to help balance vaginal health
3. Gentle Rejuvenation Mode: Uses red light only (630nm) - perfect for those who are more sensitive to heat or light

What makes this device particularly versatile is its four vibration settings, ranging from 10Hz to 120Hz. Each frequency serves a different purpose:

• 10Hz: Gentle mode for muscle relaxation and pain reduction
• 50Hz: Helps with muscle relaxation while increasing awareness of pelvic floor function
• 90Hz: Supports pelvic muscle awareness and function
• 120Hz: Designed to aid in pelvic floor strengthening

Using the Device Safely

If you're interested in trying the Fringe Heals Light Therapy Wand, here are some important guidelines:

• Use water-based lubricant only. Good Clean Fun and Astroglide have some good water-based options. Avoid oil or silicone-based products while using this device. (I know I mentioned silicone lube earlier as being best, BUT it's important to use only water-based lubricant with this device. Oil- and silicone-based products can reduce its longevity.)
• Start with short sessions and gradually work up to 10 minutes per day
• Use 3-7 times per week for best results
• Always clean the device and your pelvic area before use
• If you are or may be pregnant, consult your healthcare provider first

What to Expect

Unlike devices designed specifically for sexual pleasure, the Fringe Wand's vibration is more of a gentle "buzzing" sensation, as its motors are located in the core of the device. This makes it particularly suitable for therapeutic purposes while remaining comfortable to use.

When to Consider Light Therapy

You might want to explore the Fringe Light Therapy Wand if you're experiencing:

• Vaginal dryness or atrophy
• Mild to moderate pelvic pain
• Pelvic floor weakness
• Stress incontinence
• General pelvic floor dysfunction

Remember, while light therapy can be a helpful tool, it works best as part of a comprehensive approach to pelvic health. Some women might need to combine it with other treatments like vaginal estrogen or pelvic floor physical therapy for optimal results. This ONE device will not cure all the things. It is a tool we can use if needed.

The Truth About Female Sexual Response: Let's Talk Facts

As your OBGYN, I'm going to be completely honest about something we don't discuss enough: female orgasms and sexual satisfaction. What I'm about to share might surprise you, but it's crucial information that every woman should know.

The Reality of Orgasms During Penetrative Sex

Let's start with a statistic that often surprises my patients: only about 20% of women consistently reach orgasm through penetrative sex alone.¹⁵ If you're part of the other 80%, you're not broken or abnormal – you're actually in the majority.¹⁶ This leads us to an important discussion we need to have about what's called "the orgasm gap."

Understanding the Orgasm Gap

The orgasm gap refers to the significant difference in orgasm frequency between men and women, particularly in heterosexual relationships.^17,18 This isn't just a minor statistical blip – it's a meaningful disparity that deserves our attention. The reality is that men report experiencing orgasms far more frequently than women during sexual encounters.

Why does this gap exist? The answer involves both biology and society¹⁹:

1. Anatomical Differences: Every woman's body is unique, particularly in the distance between the clitoris and vaginal opening. This variation can significantly affect sexual response during penetrative sex.
2. Societal Factors: Let's be frank – our society has historically prioritized male pleasure over female satisfaction. This has led to:
• Limited understanding of female sexual response
• Insufficient focus on women's pleasure in sexual education
• Unrealistic expectations set by media and popular culture

The good news? Understanding these facts can lead to better sexual experiences. When we acknowledge that most women need more than penetrative sex for satisfaction, we open the door to more fulfilling sexual experiences for everyone involved.

Taking Charge of Your Sexual Health

I hate the number of stories I have heard about women who have gone to see their providers and have been told to “just have a glass of wine” if sex is an issue for them. I think we have had enough of that and you deserve better! If you're struggling with sexual health issues, here are the key specialists to know about:

1. Pelvic Floor Physical Therapists: Experts in treating muscular pain and dysfunction. Not all physical therapists have this special training. Make sure to find a certified pelvic rehab pracitioner.
2. Sex Therapists: Trained professionals who can address psychological and relationship aspects of sexual health.²⁰

A word about that glass of wine: while a glass of wine might lower inhibitions, it actually decreases sexual function and can make it harder to reach orgasm.²¹ Instead of reaching for the wine bottle, focus on addressing the root causes of any sexual concerns.

The Role of Vaginal Estrogen

Here's something I tell most of my patients over 45: vaginal estrogen is often beneficial and extremely safe.²² Think of it as skincare for your vulva! The microscopic difference between pre- and post-menopausal vaginal tissue is dramatic – going from a "tropical rainforest" to a "desert." Vaginal estrogen helps restore that healthy tissue environment. If you’d like to dive deeper into this topic, I recommend you read this article I wrote about the genitourinary syndrome of menopause.

Remember This

You deserve pleasure and satisfaction. If you're experiencing sexual health concerns:

1. You are not broken! Read the book or listen to the podcast of the same name created by my friend and colleague, Dr. Kelly Casperon. Be sure to follow her on Instagram for a plethora of free, helpful educational content. (Also check out this live discussion we recorded together a few years back!)
2. You are not alone!
3. There are solutions available!
4. It's okay to ask for help!

The key is finding the right support and avoiding quick fixes or dismissive advice. Every woman's experience is unique, and you deserve healthcare providers who take your concerns seriously.

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