1. Vaginal estrogen is for almost everyone.
In general, everyone needs vaginal estrogen after menopause. It’s like sunscreen, even if you don’t go outside all the time, dermatologists recommend everyone use sunscreen in their skincare routine as a preventative measure. Vaginal estrogen will also help your skin. I encourage women to think about this peri-menopause and post-menopause. It’s not really used as preventative care by most physicians, but I encourage women to think about preventative care both in terms of hormones and vaginal estrogen. You can preserve the health of your skin for years to come with the use of vaginal estrogen. When should you start? Definitely as soon as you notice symptoms, and perhaps by age 60.
2. Systemic versus vaginal estrogen.
The difference between systemic and vaginal estrogen is this: systemic means your whole body, vaginal means in your vagina. Systemic hormone therapy is usually in the form of a gel, cream, or patch (and a vaginal ring which makes it confusing). It helps will all of the post-menopausal stuff like mood swings, hot flashes, quality of sleep, and decreasing the risk of colon cancer, osteoporosis and heart disease. Vaginal estrogen does not go into your body at all, it’s a much lower dose. A year of vaginal cream is the equivalent of one dose of systemic estrogen. Both of these options are very safe. When you use systemic estrogen, if you still have a uterus, you need a progestin to protect your uterine lining from unopposed estrogen. Check out www.menopause.org to find a NAMS certified practitioner near you for a hormone discussion if you are within 10 years of your menopause.
3. Responsive desire is normal.
There are two types of sexual desire, spontaneous and responsive. Both are normal! Responsive desire is when you enjoy sex, but you forget because you’re super busy with work and the kids and life in general and you’re not surrounded by constant sexual cues and you are not just randomly seeking it out day to day. However, with responsive desire, once you get into the sexual experience, you remember that you enjoy it. Spontaneous desire is seeking out sex without external cues or stimulation. If you don’t have spontaneous desire, you are not broken. Responsive desire becomes more common as we age, get busy with the demands of life, and settle into a long term relationship longer than 6-18 months.
4. Expand your view of sex.
Specifically heterosexual people, I encourage you to expand your view of what sex is. Sex is not just inserting the penis into the vagina until the penis has an orgasm. 70 percent of women need clitoral stimulation to orgasm, and 10 to 15 percent of women have never had an orgasm at all!
If you expand the scope of what sex is, it can be the way you speak to each other, how you look at your partner, the way you hold hands, the way you cuddle, the way you approach each other, they way you achieve orgasm together - sex is all of the things.
The thing I say all the time, you are not broken! There is absolutely zero upside to telling ourselves that we are deficient or lesser than. Why would we want to tell our bodies that? They’re wonderful as they are. They are good enough and lovable as they are. You might have a medical condition and you are not broken.