Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

Photo by summerbl4ck via Flickr (Creative Commons License)

This is the fifth in our two-months-long series (40 Things for Every Woman in Her 40s) of Medical Monday articles intended to be useful to all our readers, but pointed especially toward those in their 40s—that in-between decade in which hormonal change has begun but fertility is still possible. Our first article focused on self-care; our second emphasized the need to pay attention to psychological issues; the third provided tips on preventing and repairing skin damage; and last week the fourth topic was ‘exercise as medicine.’

This week, our Dr. Patricia Yarberry Allen focuses on sex in the 40s and stresses the importance of making time for sexual intimacy. Dr. Allen is a gynecologist, Director of the New York Menopause Center, a Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and an Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. In addition to her weekly “Medical Monday” column for Women’s Voices for Change, she along with her colleague Dr. Hilda Hutcherson, have both written many articles for us as the “Sex Talk Team.” —Ed.

25.

Hormonal change in the forties begins long before the last menstrual period occurs and often affects vaginal comfort before other symptoms appear.  Be informed and discuss this issue with your health care provider. Vaginal lubrication often occurs naturally during sexual excitement and arousal. During peri-menopause there are times when estrogen production falls, which can cause a decrease in natural lubrication, which causes vaginal friction and a decrease in sexual pleasure. Often the estrogen levels decrease during the days before a menstrual period begins when estrogen levels are low. Lubricants improve sex by making genital tissues moist, which decreases friction and makes intimate contact more pleasurable.

26.

Find a sexual lubricant that works for you even before you need it and you can use it for the rest of your sexual life. Sexual lubricants can be purchased without a prescription, contain no hormones and generally have no side effects.  Sexual lubricants are not tested as rigorously for safety as substances considered to be drugs because they are considered part of the medical device market and the FDA has considered these to be short term, mucosal contact products.  They are meant to be applied to the clitoris for masturbation, on the penis and into the vaginal opening for intercourse. This is what you need to know before you go shopping online or at the local pharmacy to find the right lubricant for you.  Only water based lubricants can be used if latex condoms are used since the oil based lubricants destroy latex and produce condom failure. Read the labels. Some lubricants contain parabens or propylene glycol, which may cause genital irritation for some women. Lubricants may cause vaginitis in very few women so do discuss with your health care provider if you develop symptoms.  This list contains names and components of some of the many products available in the sexual lubrication market:

Marshall DD, Iglesia C. A guide to lotions and potions for treating vaginal atrophy. OBG Management 2009; 21:29. Copyright © 2009 Dowden Health Media. (Click Image to enlarge)

27.

Make time for sexual intimacy.  The 40s are that in-between decade for women when everyone wants something from them. It is truly hard to find time for adult fun during this decade.  Sex often was fun for many women until their 40s, when the demands of work, home, children, partner and elders took all the time away from that fun. The truth is that we can be better at managing everything else if we recharge our batteries with time for personal care and interests and time for sexual intimacy.  The “use it or lose it” mantra does apply here.  Women who find time for everyone and everything else, forgoing sex because they have no time, do have more painful intercourse than women who have sexual intimacy on a regular basis. The vaginal opening becomes narrow and tight. The muscles of the pelvic floor often develop a spasm response when intercourse is attempted, adding to the pain of penetration. Date night should be about more than the routine of going out to eat and drink too much then coming home tired with the bloat. Make the time outside shorter and the time in the bedroom more meaningful. The benefits of sexual intimacy are well recognized and the barriers to achieving sexual intimacy are real as well.  At 40, put your sex life on the schedule and keep it there.