When it comes to aging, women are comfortable talking about hot flashes. But what about sex?

Carol Kuhle, an expert on menopause, aging and sexual health at the Mayo Clinic’s Women’s Health Clinic, thinks sexual health should be part of the conversation.

“People have a hard time talking about it,” said Kuhle.

But that could be changing, as women get more information about the changes in their bodies and more comfortable in talking about sex during menopause and beyond.

We asked Kuhle about relationships, sexual function and how older women — and men — can improve their sex lives as they age.

Q: What do women ask about most often?

A: One of the bigger questions we get in the clinic is what happens to their sexual drive. Hormones can certainly be a driver, but it’s oftentimes more complicated than that. You’re trying to reframe your thoughts about sexual function and your relationship.

There was an interesting study done among people whose kids had grown up and gone. Now they’re faced with their relationship, which has been on the back burner. The kids are launched, and it’s like, “OK, who are you?” So that becomes an important part of the piece, teasing out the factors in why people have a decrease in sexual drive.

Q: Anything else?

A: People want to know what happens to women during that transition that affects their sexual functioning. It’s a very complicated topic. There are physiologic changes that make a difference. One of the biggest changes, if women do not get hormone therapy, is that the vulva and vagina will feel dry, and there are ways to treat that.


Q: Do enough people talk about these changes — with their partners or with their doctors?

A: It wasn’t talked about. There was a study looking at sexual activity as people age and, clearly, there was a decline. They also looked at whether people talked to their physicians about this, and the answer was no.

I think it’s generational. Today, women that are menopausing are talking more to their girlfriends. But it depends on how they grew up. One of the things we ask when women are having difficulty with desire or sexual issues is what were the messages they were given. Was there a religious component? People say, “Oh, gosh, we never talked about that at home.”


Q: Do you think that reluctance to talk about menopause and sex is changing?

A: That’s our experience. But we’re in a clinic where they’re coming here with an issue.

Q: What are some things older women can do to improve their sex lives?

A: We discuss the use of vibrators, because we know with the changes at the vagina and the vulva, there is a decrease in sensitivity and an increase of blood flow. Using a vibrator can help enhance the arousal.

There are moisturizers. Vaginal mucosa sloughs off every 72 hours. Putting moisturizer on, outside and inside, has been shown to help with those changes. You can treat the vaginal mucosa with a moisturizer like you do your face. We laugh and say, “This is your new face.”

Q: What if the issue is a lack of desire?

A: That’s a complicated issue. We look at the different domains: physiologic, neurologic problems, cardiovascular disease, medications such as antidepressants, and the psychologic piece — anxiety, depression, self-image. And alcohol — a little bit helps you relax, more will put you to sleep and [cause you to] have difficulty having orgasms. If they have pain, how is that affecting the relationship?


Q: What happens to men’s sexuality as they age?

A: Sometimes what’s going on with the female is really reflective of what’s going on with the male. If a man is having erectile issues and Viagra doesn’t work for them, then they’re rethinking what is sexual activity. There are lots of ways to enjoy intimacy without an erection. It’s redefining what intimacy is.