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E110
December 16, 2025
Where Did My Orgasm Go? Menopause, SSRIs, and the Science of Pleasure with Dr. Lauren Streicher
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What happens to your orgasm after menopause? It's something that nearly half of women experience during midlife, but so few are talking about it. In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Lauren Streicher to discuss exactly what changes to orgasm, libido, and sex, why it happens, and what you need to know if you're struggling.

Dr. Streicher is a professor of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine, the host of Dr. Streicher's Inside Information Podcast, and the creator of Come Again, a 30-episode audio series on sexuality and sexual function. She's a senior researcher at the Kinsey Institute and one of the true pioneers of sexual medicine, helping to define and legitimize a specialty that for decades simply didn't exist.

Dr. Haver and Dr. Streicher start with the basics: what an orgasm actually is, the anatomy of the clitoris, and why most women cannot have an orgasm from penetrative sex alone. Dr. Streicher explains vaginal orgasms, cervical orgasms, the G spot, and the historical research of Princess Marie Bonaparte, who measured the distance between the clitoris and vaginal opening in 240 women in an effort to understand why she couldn't orgasm during intercourse. They discuss what happens to orgasm and sex post menopause, including the role of blood flow, nerve health, clitoral atrophy, cardiovascular disease, diabetes, and medications, especially SSRIs that can affect both libido and orgasm. Dr. Streicher walks through how genitourinary syndrome of menopause affects the clitoris, why the pelvic floor matters for orgasm, and why so many women have never even seen their own anatomy. They also talk about anorgasmia, the inability to have an orgasm, both primary and acquired, and why this is almost never discussed in medical training.

Guest links:

Books:

Subscribe to COME AGAIN: Sexuality and Orgasm DrStreicher.com/comeagain         
Use code UNPAUSED20 for 20% off (This code expires Dec 23)

Gyne Hacks! (Including how to How to Get a Hands-free Free Vulvar View)

Other Resources:

Articles:

Chapters

00:00:00 — Sponsor: K18 Hair Repair (Molecular Mask + Damage Science)
00:01:21 — Hollywood’s “10-Second Orgasm” Myth (And Why It Messes With Women)
00:01:59 — Welcome + Guest Intro: Dr. Lauren Streicher & “Come Again”
00:03:52 — Lauren’s Origin Story: Chicago Roots & Choosing OB-GYN
00:05:18 — From General OB to Surgery to Menopause Care (The Pivot)
00:06:38 — Writing Her Way Into Sexual Medicine (Sex RX + Research Deep Dive)
00:08:19 — What the Kinsey Institute Is (And Why It’s Groundbreaking)
00:09:25 — Why Doctors Don’t Ask About Orgasm (Training Gap + Stigma)
00:10:46 — What Is an Orgasm? Blood Flow, Nerves, Brain, Pelvic Floor
00:12:21 — Penetration vs Clitoral Stimulation: What’s “Normal” for Most Women
00:13:26 — Vaginal Orgasms Explained: Fantasy, Cervical/Vagus, “G-Spot Plexus”
00:18:12 — Princess Maria Bonaparte + The “1-Inch” Anatomy Theory
00:21:23 — Sponsor Break: Quince + Primally Pure + HelloFresh
00:25:41 — When Anatomy Changes: Weight Loss Surgery, GLP-1s, Hysterectomy
00:31:09 — Post-Menopause Orgasm Changes: Blood Flow, Nerves, Pain, SSRIs
00:38:48 — Pelvic Floor, Incontinence & Orgasm (Why PT Matters)
00:42:53 — Sponsor Break: Alma + Alloy + MIDI Health
00:47:10 — GSM & Clitoral Atrophy: Treating the Clitoris (Not Just the Vagina)
00:51:37 — Getting Help: Who to See + Why This Isn’t a DIY Problem
00:54:06 — SSRIs: Timing, Dose, “Holiday,” and What to Try (With Your Prescriber)
00:57:50 — Sildenafil/Viagra for Women: Oral vs Topical + What’s Coming
01:01:20 — Wrap-Up: Where to Find Dr. Streicher + Call to Action

About the guest

Dr. Lauren Streicher

Lauren Streicher, MD, is a professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine and the founding medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause. She is a Certified Menopause Practitioner of The Menopause Society, serves on the Editorial Board of the journal Menopause, and is a Senior Research Fellow for the Kinsey Institute, Indiana University. She is the host of two podcasts: Dr. Streicher’s Inside Information: Menopause, Midlife, and More, and COME AGAIN: Sexuality and Orgasm. Streicher is the best-selling author of multiple books, including  The Essential Guide to Hysterectomy, Sex Rx- Hormones, Health, and Your Best Sex Ever, Slip Sliding Away: Turning Back the Clock on Your Vagina, and Hot Flash Hell: A Gynecologist’s Guide to Turning Down the Heat. Essays, videos, and educational guides can be found on her Substack, Dr. Streicher’s Inside Info. She is routinely interviewed as a reliable, accurate source for national publications such as The New York Times, Newsweek, the Associated Press, and dozens of magazines. She writes columns for Prevention magazine and The Ethel from AARP. She is currently working in collaboration with AARP as their menopause expert and will release a comprehensive book on menopause next year.

Dr. Streicher was the 2019 recipient of the North American Menopause Society Media Award and has been honored with numerous other recognitions. Dr. Streicher is the medical correspondent for Chicago’s top-rated news program, the WGN MorningNews, and has appeared multiple times on outlets such as The Today Show, Good Morning America, The Oprah Winfrey Show, CNN, NPR, Dr. Radio, Nightline, Fox and Friends, The Steve Harvey Show, The Dr. Oz Show, CBS This Morning, ABC News Now, NBC Nightly News, 20/20, and World News Tonight. In addition to her consumer books and articles, Dr. Streicher has authored multiple scientific publications and serves on many advisory boards.