ASK THE DOCTOR: Intimacy & Aging

If you are a woman of a certain age, you have probably wondered if doctors skipped the lecture on menopause during their schooling. More accurate would be that doctors of a certain age were never given a lecture on menopause.

Who knew that half the population might have menopausal issues in their middle and later years (some even earlier if they had certain surgeries or illnesses affecting ovarian function)? Of course, med students learn anatomy and physiology, the specifics of hormones and how they stay in balance with a nifty feedback system, and how to catch a baby coming quickly and slickly into the light of the world.

But it was radio silence in our textbooks about women after about age 45. To be fair, I don’t remember a nuanced lecture on elder males either, beyond the inevitable growth of prostates gumming up the waterworks. I bet medical schools have improved in this respect since my day, unless old people — especially old women — have wound up on the list of things we can no longer discuss in medical science.

I recently read a New York Times article titled, “What Menopause Does to the Body” (12/10/25). Although I found useful basic knowledge about what it can feel like to age and what might help, I found myself alarmed by the scrolling graphics, first a desperately sad-looking woman hunched over, then a cracked desert floor and a wilted flower. I try to picture a similar article about aging in men, wilted flowers and all, but doubt that would be well received.

We are overdue to start talking frankly about aging, intimacy, sex and the challenges that can be involved for all genders without making aging seem like some kind of failure. It is true that as hormone levels change, our bodies feel different. We call it dysfunction, whether ovarian or erectile, along with the unromantic phrase “atrophic vaginitis” (recently renamed the only slightly less depressing “genitourinary syndrome of menopause”).

Humans experiencing these changes with aging can find sex uncomfortable or find they are sexually aroused less easily. The brain may think the body is ready, but the genitals can be several steps behind or completely uninterested in engaging. Hormones are one aspect of this, but other factors can contribute as well, including medications, vascular disease, obesity, alcohol, smoking and unreasonable expectations.

Grief can be involved with losing this aspect of relating to others, and anxiety about the challenges can interfere with enjoying what intimacy can be shared. But when people wish to be intimate in a consenting relationship, there are ways to adapt to the aging body. Talking frankly about one’s fears and giving oneself and one’s partner grace can open space for creativity. Products, both prescribed and over-the-counter, are available to reduce discomfort and improve ability to maintain erection. Women may benefit from twice-weekly use of a vaginal estrogen cream or tablet inserted vaginally to increase lubrication and help the tissue be more robust. Besides making sexual activity more comfortable, these products can also reduce frequency of urinary tract infections — another not-so-fun side effect of aging.

Men can take phosphodiesterase-5 inhibitors (e.g., Viagra), which allow blood vessels to dilate. If taking nitrogen tablets, or long-term nitrates like isosorbide for heart issues, Viagra-type medications should be avoided due to precipitous blood pressure drops. This could also occur if concurrently taking drugs like Flomax for prostate issues. Testosterone replacement is available for men with low levels, though only after a discussion with a physician and reviewing potential risks. Women may also benefit from testosterone use, but this is not well studied and can have potential harms.

There is a big industry of products to treat symptoms of menopause and erectile dysfunction or decreased libido. Internet snake oil runs rampant, and the costs can be financial as well as physical for unproven therapies. I understand the reason for this industry, given that Western medicine has been slow to address the discomforts of aging, but it makes me sad that people who are seriously distressed have to look to sketchy sources to find relief. If you have difficulty with genitourinary symptoms, erectile dysfunction, hot flashes, urinary tract infections, pain with intercourse or psychological anxiety about all of the above, please talk to your doctor. If they answer, “That’s just aging for you,” you need a second opinion.

Once, a patient in her 90s who was quite frail commented to me on the beauty of a famous young actor. I must’ve given her a look (for which I feel ashamed), because she straightened up and said to me, “I may have frost on the roof, but I still have coal in the furnace!” Sexuality is part of human experience and, although the activity and experience may not be the same in middle age and beyond as it was in our teens and 20s, it does not have to be abandoned. Sex can be embraced, enjoyed and celebrated, no matter how much frost is on your roof.

Dr. Jennifer Heidmann is medical director and primary care provider at Redwood Coast PACE (707-443-9747) at the Humboldt Senior Resource Center. This column should not be taken as medical advice. Ask your medical provider if you have health questions. Send comments to SN@humsenior.org.