At a recent, well-attended panel talk organized by Stony Brook Southampton Hospital that addressed healthy aging for women, audience question after audience question concerned sexual activity during and after menopause.
To dig a little deeper into the topic, The Star spoke with one of the panelists, Louise Collins, M.D., a board-certified gynecologist with Meeting House Lane Medical Practice in East Hampton. A graduate of the Georgetown University School of Medicine, she has been in practice for more than 25 years, and often advises her patients on sex health for women 60 and older.
East Hampton Star: Sex after 60 is a big topic. Is there anything women in this demographic should or should not do?
Dr. Louise Collins: Not really! They can get up to whatever they'd like and there's not really any restrictions at all. I have some patients in their seventies having the best sex of their lives and I have patients in their eighties still having sex, so it can go on as long as they want it to without restriction. Sometimes my patients will find out about those other spaces on their own — like more oral sex or using sex toys — so I always tell them you don't need a goal, just see where it takes you and communicate with your partner.
E.H.S.: What are some common issues for patients from this demographic?
L.C.: When women go through menopause and lose natural production of hormones, specifically estrogen, they can develop something called genitourinary syndrome of menopause, a constellation of symptoms coming up right around — or just prior — to menopause, though sometimes it doesn't show until 60-plus. Symptoms can include pain with sex, a burning sensation, dryness, [or] irritation, and can also include bladder symptoms like leakage or urinary tract infections. Some people don't really notice the symptoms if they're not having regular intercourse, while others do, but intercourse can become painful. It can become harder to have an orgasm, and it can make women feel like they don't really want to have sex.
E.H.S.: What would you do for someone experiencing this?
L.C.: We generally take a multipronged approach. One, I'm making sure the patient is using a really good lubricant. There are several types on the market that you can use with sexual activity. There are water-based lubricants, which include things like KY and Astroglide. Those are safe to use with condoms and sex toys, so they're a pretty good all-around lubricant, though they may not last as long as some people need. Next up we have silicone-based lubricants like Uberlube, which are also sold over the counter, and a lot of the companies will make both kinds. Note that sometimes you can't use the silicone-based lubes with sex toys if they're also silicone.
E.H.S.: Let's talk about condom use for older adults. Are patients aware these are still important? Are silicone-based lubricants okay to use with condoms?
L.C.: Yes, and obviously if they're in a newer relationship, they need to think about condom use because even if they aren't able to get pregnant, they need to be thinking about preventing sexually transmitted infections. When patients come in, we always ask about sexual partners in the past year and offer S.T.I. testing for gonorrhea, chlamydia, H.I.V., hepatitis, syphilis — the general panel — but I will also offer it to people even if only thinking about adding someone new as a sexual partner. They can offer their results to that person and make sure the other person does the same, or make a plan to both get tested — you don't know where they've been and you could possibly be exposed to anyone they've been with prior — I always offer that to patients, even if they're not sexually active at the time, and to do repeat testing any time it's needed.
E.H.S.: Does more foreplay help women in this arena?
L.C.: It does help to have a lot of foreplay before having intercourse because it takes longer to lubricate the tissues, so they should try to communicate to their partners that it can take more than a couple of minutes to get things going down there. I like to tell my patients, 'You come first,' and that sex and intimacy doesn't have to be about penises and vaginas, which is clearly directed at heterosexual couples. I feel like my female couples have figured that out a long time ago, but for male-female couples, I think for men there tends to be this focus of sex means putting a penis in a vagina when there's a lot of other ways that women experience pleasure. That should be something that, again, you kinda have to be open with your partner about. Most women don't orgasm just with penis and vagina, they need clitoral stimulation and things like that. I always encourage patients that if they want to add in sex toys as part of being intimate, that's totally cool, and places like CVS and Target actually carry a lot more than they used to, so you can actually find a lot of these lubricants and vibrators there, plus, of course, there's a plethora of things available on the internet.
E.H.S.: What other tools are used in this multipronged approach?
L.C.: The other big piece of this is the use of local estrogen. Taking local estrogen is very different from taking systemic things like an estrogen pill or patch. We use estrogen in the vagina to treat symptoms of genitourinary syndrome. It's available in a cream form, tablet, or suppository for the vagina, and there's also a ring, which are all considered very safe to use. There's also DHEA [dehydroepiandrosterone, a hormone] suppositories, which basically break down into testosterone and estrogen, and is for treating the same thing. For patients who don't want to use estrogen at all, or have a contraindication, we do use other vaginal moisturizers. They make hyaluronic acid suppositories, like we use in our anti-aging face cream, and those are used twice a week. And then there are moisturizing gels like Replens that you can get over the counter, which can also be used twice a week. The estrogen will make the vagina more supple and lubricate better, and while the moisturizers won't do quite as good a job as the estrogen, they work pretty well for patients who don't want to -- or can't -- use estrogen. These wouldn't be for using while you're having sex. You would use moisturizers twice a week regardless, then use a lubricant with intercourse.
For older women and couples looking to learn more, Dr. Collins recommends a few resources. Among them are the books "She Comes First: The Thinking Man's Guide to Pleasuring A Woman" by Ian Kerner and "Love Worth Making: How to Have Ridiculously Great Sex in a Long-Lasting Relationship" by Dr. Stephen Snyder. Helpful online resources include the podcast "You Are Not Broken" by Dr. Kelly Casperson and a mobile app called Rosy, which addresses sexual health for all women of all ages, and which even features erotica and sexy stories for women looking to get in the mood.