“Pearls” For Better Sex After Menopause

By: Red Hot Mamas

Published: July 14, 2015

Contributed by Dr. Michael Goodman- Red Hot Mamas Medical Expert 
This “Menopause Minute” is all about what the title says. YES, Virginia: you can still have a fine time! As Woody Allen said, “Sex is the most fun you can have without laughing.” Use it or lose it..!  In no particular order, here are some useful tidbits:

  1. Testosterone (for women, available as a compounded cream or implanted pellet) improves antidepressant-caused lowered libido and sexual function.
  2. Approximately 50% of women discontinue or aren’t dose-adherent to SSRI anti-depressants (Prozac, Zoloft, Celexa, Lexapro, etc…) secondary to sexual side-effects. Moderate sympathetic nervous system activation, as achieved with vigorous exercise, increases women’s sexual arousal. Boosting this activation prior to sex may mitigate the sexual arousal and orgasmic side-effects of medication. Intense exercise (to ~ 70% of heartrate max, or to heartrate ~ 100-110) gives a huge boost to sympathetic activity and doubles arousal. This exercise is advised ~ 15 minutes prior to sex, lasting ~ 10 minutes; arousal is maximal 5-15 minutes after exercise.
  3. If you have bad sex, you’re not likely to like sex (both men and women). Opiod activity in the brain is the basis of sexual reward. Bad sex leads to sexual frustration, and little opiod activity. Thus it is so important to not give up hope, and teach each other to be better lovers. There are many wonderfully helpful websites , and books  available to help. Check these out!! 
  4. Headaches and sex? First, is there an aversion to sex operating here (see above…) If this may be the case, this is the time to see a sexual therapist, couples counsellor, or sexual medicine practitioner. If not, the following medications taken prior 30- 60 minutes prior to sex may help: 1. Imitrex/Maxalt/Zomig, etc (one of the “triptan” migraine medicines); 2. Indomethacin; 3. Bellergal. Ask your doc!
  5. Do you have lichen sclerosis or a vulvo-vaginal irritative skin condition? Ice packs for ~ 20 minutes afterwards may help.
  6. It must feel good! There are multiple safe estrogenic and non-estrogen therapies for a dry, tight, scratchy, uncomfortable vagina; there is no reason to suffer! (**It usually takes a couple of months of treatment before “…you’re back…”)
  • Estrogen: Microdose bioidentical vaginal estrogenization is available via vaginal cream, non-alcohol-based oil or cream, vaginal suppository tablets, and long-acting, stay-in-place vaginal ring. These products are available via traditional Rx, or may be compounded.
  • Non-estrogen therapy includes DHEA compounded cream or 10 mg suppositories, the new oral medication, Osphena (ospemifene), and intra-vaginal fractional CO2 laser therapy.


(By the way, the average amount of estrogen absorbed per week from vaginal estrogen therapy is so low that most oncologists do not deny micro-dose vaginal estrogen therapy to their breast cancer survivor, or high-risk BrCa patients.)




[Michael P Goodman, MD, NCMP, IF

Davis, CA]

Dr. Michael Goodman specializes in labiaplasty and other vulvovaginal aesthetic surgeries, peri- menopausal and sexual medicine, lifestyle enhancement, bone densiometry, pelvic ultrasounds and both routine and difficult gynecologic issues.Stanford University trained in obstetrics and gynecology, Dr. Goodman is also a critically acclaimed author and pioneer in the development and advancement of Minimally Invasive Gynecologic Surgery. Through his private practice and writings he focuses on patient education and involving patients in the therapeutic decision-making process.