Wellness Resources
The Top 3 Things I Learned About Sex, as a Gynecologist
After nearly 20 years as a gynecologist, Dr. Jen has learned that some of the most important conversations about sex happen behind closed doors—and often well outside the classroom. From lubrication and clitoral stimulation to understanding responsive desire, these are three lessons she wishes more women knew as they get older.
After almost 20 years as a gynecologist, I can tell you that women will ask their doctor things they may not ask their best friend. Sex is definitely one of them. And, strangely enough, some of the most useful things I learned about sex came not from medical school, but from years of listening to women describe what was actually happening in their bedrooms.
1. Lubrication matters (especially as we get older)
But not all lubricants are created equal. Some over-the-counter lubes can be irritating to vaginal tissue, particularly after menopause, when declining estrogen can make that tissue thinner, drier, and more sensitive.
If you look at the ingredients in most over-the-counter lubes, you may see propylene glycol on the list. While these ingredients are considered safe for many uses, highly concentrated or hyperosmolar formulations can actually pull water out of vaginal cells and irritate already-dry mucosa. In addition, this is the same compound that makes the de-icing fluid that gets sprayed on the wings of an airplane during a snowstorm. Forgive me for stating the obvious, but the vagina is not an airplane wing flap. What this does is akin to putting ice on top of a cracked driveway. The surface gets slippery, but there are still cracks (dryness) beneath the surface. So the dryness just gets worse.
I’m a big fan of keeping things simple. Coconut oil and sunflower oil work really well for most women, even internally, and they tend to last longer than many water-based products. Of course, in menopause, the gold standard is to restore integrity to the vaginal tissue with estrogen, either vaginal or systemic. Just remember that if you use natural oils, they can weaken latex condoms, so if condoms are part of the equation, choose a condom-compatible lubricant instead. They can also stain sheets, so use sparingly. You’re not making a salad, you’re lubricating your vagina.
2. The clitoris shouldn’t be an afterthought
Then there’s orgasm, which may be the area where women have been given the most misleading information.
Most women don’t reliably orgasm from vaginal penetration alone. The clitoris is not an accessory to sex. For most women, it’s central to orgasm. And I say this not only as a gynecologist, but as a woman who learned this embarrassingly late. (But better late than never!)
I had a baby before I had an orgasm.
I always enjoyed sex, so I didn’t really think anything was missing. Then, around age 40, a girlfriend gave me a vibrator for my birthday. I tried it and thought, Wait. THIS is what everyone has been talking about? And then, very quickly, Is this how men feel every time?
That vibrator was a revelation, and I think women should be much less intimidated by them. A vibrator can be something you use alone, but it can also absolutely be part of sex with a partner. It’s not a substitute for a partner, and it certainly isn’t a sign that anything is wrong. Think of it as another “tool” in the toolbox (pun intended!).
And while we’re talking about partners, it’s worth remembering that male sexual function changes with age too. Erectile dysfunction becomes increasingly common as men get older. Current estimates suggest that about one third of men ages 55 to 64 meet criteria for ED, rising to nearly half of men ages 65 to 74. That can change the sexual dynamic of a relationship, and sometimes couples interpret it as loss of attraction when it’s actually biology, vascular health, medications, diabetes, hypertension, or simply aging.
3. You don’t have to wait until you’re in the mood
This brings me to perhaps the biggest thing I learned. For many men, sex operates almost like a physical currency. It’s a way of feeling close through the body. For many women, sex is more often emotional currency. We want to feel close first, and then we want sex.
That is obviously a generalization, but I think there’s something useful in occasionally flipping the script. Especially in midlife, women often wait to feel desire before having sex. But desire doesn’t always arrive first. Sometimes you start with touching, kissing, a vibrator, or physical closeness, and then desire follows. That’s called responsive desire, and it’s very common.
So maybe instead of asking, “Am I in the mood?” try asking, “Would this feel good?”
After all my years practicing gynecology, I think that may be one of the most freeing lessons about sex as we get older. You do not have to recreate the sex you had at 25. You get to figure out what works now.
And sometimes what works involves a little coconut oil and a vibrator.
