Libido can change with age, but a satisfying sex life doesn't have an expiration date. In recent years, we're finally talking about this once-taboo topic more candidly. And now that we're addressing the elephant in the bedroom, we can start finding ways around it. 

Changes in desire and comfort can happen as women get older, particularly around menopause. A U.S. study that followed more than 3,000 women through the menopause transition found that over time, sexual desire decreased and vaginal or pelvic pain during intercourse increased. Yet many women may never address these changes with their doctors: The American College of Obstetricians and Gynecologists notes that women are unlikely to discuss sexual dysfunction with their healthcare providers unless they’re asked.

On this episode of Next Question, Katie sits down with Lauren Streicher, MD, clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine. (She's also the founding medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause, a certified menopause practitioner, and senior research fellow at the Kinsey Institute — so she clearly knows her stuff.) She explained what can happen to our sexual health as we age — and what women can actually do about it.

Why does libido change as we get older?

There isn’t one simple answer. Libido can be influenced by hormones, medications, medical conditions, stress, relationships, sleep, pain, and more. And sometimes what feels like a desire problem actually starts somewhere else.

Dr. Streicher gives the example of a woman who says she has no interest in sex, but also says the last time she had sex, it hurt. “We don't need to fix her libido,” Dr. Streicher explains. “We need to get rid of her pain.”

The same can be true of other midlife symptoms. If you’re exhausted from insomnia, dealing with hot flashes, stressed, or experiencing joint pain or sexual pain, sensuality may understandably fall pretty low on your priority list.

And importantly, not everyone even wants a more active sex life. Dr. Streicher says that if someone is perfectly happy without sex, that in itself isn’t a problem. Sexual dysfunction is defined in part by whether the issue is distressing to the person experiencing it, or negatively affecting their relationships.

What if sex becomes painful after menopause?

As estrogen declines, vaginal and vulvar tissue can become thinner and drier, and lubrication can decrease — all changes that fall under genitourinary syndrome of menopause, or GSM.

And while lubricant may seem like the obvious solution, Dr. Streicher says it only goes so far. “A lubricant does not change the tissue. A lubricant just greases the skids,” she explains. “So it’s going to help you if you’ve got a little bit of vaginal dryness.” But there are other options, including vaginal moisturizers and prescription treatments. The important thing, Dr. Streicher says, is knowing that painful sex isn’t simply something you have to accept as you get older.

So, who should you talk to?

Start by bringing it up with your healthcare provider, even if they don’t ask first. Sexual health problems can be complex, and your primary care physician or gynecologist may ultimately refer you to someone with additional expertise, such as a sexual medicine specialist, pelvic floor physical therapist, or certified sex therapist.

And if you don’t get the answers you need the first time, don’t give up. “If you're having difficulty, pain, or any problem when it comes to sexual function, and if you haven't been given a solution, it doesn’t mean there is no solution,” Dr. Streicher says. “You just haven’t been given one.”

Watch Katie’s full conversation with Dr. Streicher on Next Question to hear more about libido, arousal, orgasm, painful sex, vaginal dryness, pelvic floor health, and maintaining intimacy as you age.

This interview has been condensed and edited for length and clarity.