Sex psychologist Dr. Laurie Mintz joins the series host Dr. Mary Jane Minkin to discuss the joys and challenges of maintaining a healthy sex life during menopause.
Sex psychologist Dr. Laurie Mintz joins the series host Dr. Mary Jane Minkin to discuss the joys and challenges of maintaining a healthy sex life during menopause. Dr. Mintz helps address some common questions and misconceptions around sex and menopause, talking about desire, comfort, and communication. This episode explores how women can work to reframe what sex and intimacy mean to them in midlife. Dr. Mintz believes sexual health and wellness are integral components of self-care and overall health and she provides practical information that may help women enjoy sex during midlife.
About Dr. Laurie Mintz:
Dr. Laurie Mintz is an author, therapist, professor, and speaker whose life’s work has been committed to helping people live more authentic, meaningful, joyful—and sexually satisfying—lives through the art and science of psychology. Dr. Mintz has published over 50 research articles in academic journals and six chapters in academic books. She has received numerous professional and teaching awards. She is the author of two popular press books—both written with the aim of empowering women sexually: Becoming Cliterate: Why Orgasm Equality Matters and How to Get It (HarperOne, 2017) and A Tired Woman’s Guide to Passionate Sex: Reclaim Your Desire and Reignite Your Relationship (Adams Media, 2009). For over 30 years, Dr. Mintz has also maintained a small private practice, working with both individuals and couples on general and sexual issues.
menopause: unmuted is designed to raise awareness, encourage communication, and share information. It is not designed to provide medical advice or promote or recommend any treatment option.
Useful Links:
Dr. Mintz’s Instagram: https://www.instagram.com/drlauriemintz/
Dr. Mintz’s Website: https://www.drlauriemintz.com/
Mary Jane Minkin 00:00
It's time to unmute menopause. Hello and welcome back to menopause: unmuted, a podcast series sponsored by Pfizer. Menopause is a major transition in life. Some of those changes can be a challenge, but with a little knowledge and good communication, many of them can be positive. I'm your host, Mary Jane Minkin. I'm an obstetrician gynecologist and clinical professor at Yale University School of Medicine. This is a collection of bonus episodes designed to dive a little deeper into some of the issues raised by the women in this podcast and so many of my own patients. I'm talking with experts to learn how lifestyle changes like nutrition, strength training and taking care of our mental health can assist the menopause journey and set us on a positive path for midlife. And today we're exploring a subject that some women and their partners find difficult to discuss: sex. But talking well about sex and intimacy can positively impact our physical and emotional well-being, whether you're single in a long-term relationship or returning to dating. So, to help us talk well about sex, I'm delighted to welcome my expert guest today. Dr. Laurie Mintz, thank you so much for joining us, Laurie.
Laurie Mintz 01:20
Hi, I'm so glad to be here.
Mary Jane Minkin 01:23
Laurie, please, could you tell listeners a little bit about yourself and your work?
Laurie Mintz 01:28
I would be delighted to. I am a professor at the University of Florida where I have the honor of teaching the psychology of human sexuality to hundreds of students a year. I'm also a licensed psychologist and a certified sex therapist seeing individuals and couples for general and sexual issues. And I'm the author of two books, both aimed at empowering women sexually, A Tired Woman's Guide to Passionate Sex, and Becoming Cliterate: Why Orgasm Equality Matters and How to Get it.
Mary Jane Minkin 02:05
Thank you, Laurie. Now we're gonna get into the details very soon. But Laurie, could you give listeners an overview of some of the most common issues that women have when it comes to sex and menopause?
Laurie Mintz 02:17
Absolutely. First, I want to say that many of those issues they’re due to decreased estrogen, which causes vaginal dryness, mood shifts, lack of sleep, and all those things can interfere with arousal. They can interfere with desire, orgasm, etc. And so, it's really important if you're experiencing those symptoms to see your health care provider. However, what's really important is that it's not all bad. First of all, not all menopausal or perimenopausal women experience sexual issues. Many do. Many don't. Also, we know that for many menopausal women, sex gets better and the people who are having magnificent sex said it often started at around age 50,[1],[2] when they were more comfortable with their own bodies,1,[3] or they were not fearing pregnancy,[4] they were more communicative and comfortable.1 And so it's important to know that menopause doesn't need to be a negative, it can actually enhance one sex life, if you're handling it appropriately, both in terms of seeing your provider and also communicating with your partner.
Mary Jane Minkin 03:46
Laurie, thank you very much for talking about the pregnancy issue, because that's really important to a lot of women. However, we do need to remind people of course, that until you've gone that magic year without the menstrual period, you still have to worry about getting pregnant. So do practice some form of contraception, and of course, sexually transmitted infections are ever present. So, if you're with a new partner, we always want to make sure you're using condoms because we want to protect you against getting an infection. And again, I'd like to emphasize the same point that Laurie is menopause does not have to mean the end of your sexuality. And again, a lot of women will find that sexual dysfunction is at its worst during the perimenopausal period. So even if you're having a hard time right now, during perimenopause, things are likely to settle and improve. And I would like to add one special word for special group of women and those are the women who have experienced a surgical menopause. That is, they've had their ovaries taken out oftentimes at the time of hysterectomy. And what that means is the hormonal changes can be quite sudden, and women of course think about the hot flashes occurring, which is the thing you'll notice almost immediately, but they also need to be aware of the vaginal dryness which can also occur suddenly. So, we want you to speak to your gynecologist about ways to help the hot flashes and also vaginal dryness. Laurie, I've spent many years talking with my patients about sex in midlife. And I'd like to break our conversation today into the three issues that I think are the building blocks to help women enjoy sex during menopause: desire, comfort, and communication.
Laurie Mintz 05:18
Those are three essentials, yes.
Mary Jane Minkin 05:21
Could we start with desire? What is it? And how does it figure?
Laurie Mintz 05:26
Absolutely. And this, I think, is sometimes the most important point for perimenopausal and menopausal women to hear. And that is when we think of desire, we think of the way that it's shown in the movies and talked about in our culture. And that is what we call spontaneous desire. Or in laypersons language, it's feeling horny, which is actually the beginning of physiological arousal, tingling in the genitals etc. And a lot of perimenopausal and menopausal women say, “I've lost my desire.” And by that they mean their spontaneous desire their feeling of being horny. But there is a different type of desire. And it's called responsive or receptive desire, which is I am receptive to the idea of sex for reasons other than feeling horny, and I will be responsive to that sex when it gets going. So for example, there was a study that asked people why do you have sex and they listed 237 reasons.[5] And only one of those was being horny, there's many other reasons to have sex.5 Like I'm wanting to be closer with my partner, I want to feel relaxed, I want to sleep better.5 So responsive desire is having sex because you're open to the idea. And then it's good when it gets going. When I talked to my patients about this, I talked to them about reversing the equation. Don't wait to be horny to have sex, have sex to get horny, and allow the touch itself to bring on desire. And that is so important. A lot of women are doing that. And they if then I say, “good for you, you're using an actual sex therapy technique.” But so many times women say it's du- they call it duty sex. And I tell them, “No, if it’s fun, if it’s good once it gets going, it’s not duty sex.” And there’s some ways to help make it fun when it gets going, including communication with your partner, mindfulness and not being so focused on the goal of orgasm or penetration.
Mary Jane Minkin 07:43
And Laurie, a very interesting point you bring up. Can you comment on the differences between what I know some psychologists refer to as staircase or orgasm-focused sexual activity to circular sexual activity, which is more pleasure focused? Can you comment on those?
Laurie Mintz 07:59
Absolutely. And that’s really important to making using your responsive desire and having it be fun is so many times in our culture, when we talk about heterosexual sex, we have this way it proceeds right. Foreplay just to get her ready for intercourse, intercourse which we consider this main event—even though most women don’t orgasm that way—and then sex over. And it’s a very linear staircase model. You go from this, to this, to this, to get to the top of the staircase, which is often male orgasm during penetration. And what we know as sex therapists is that better sex—and this is especially true in perimenopause and meni- menopause—is that the best sex is not goal focused, you’re not focused on the goal of penetration, you're not focused on the goal of orgasm, you’re working together as a circle, and in terms of mutual pleasure. And you can go from one activity to the other, to the other, and back and forth and all around without being focused on the goal of penetration or orgasm.
Mary Jane Minkin 09:17
And I also think it’s helpful to be aware of some mindfulness techniques. Staying in the moment can be difficult, and that the circular model is more accommodating of that.
Laurie Mintz 09:26
Absolutely. And the mindfulness is essential to sexual pleasure and satisfaction. What is mindfulness, right? For those people who don’t know, I like to define it as putting your mind and body in the same place. So many times in our life, we’re doing one thing with our body and our mind is somewhere else and that includes during a sexual encounter. Now, no one is ever there 100%, even during sex, but it’s really important to notice when your mind wanders and to be able to bring it back to your body. Maybe by using your breath, meditation practice outside, and we know that yoga helps with orgasm function.[6] And I believe that's because of the mindfulness and body focus that it teaches.
Mary Jane Minkin 10:13
And Laurie, can you talk more a little bit about the orgasm gap that you’ve talked about?
Laurie Mintz 10:19
Absolutely. The orgasm gap is the consistent finding in the scientific literature that when women and men have a sexual encounter, the men are having way more orgasms than the women.[7] So for example, in one study, 39% of women versus 91% of men said they usually or always orgasm during a sexual encounter.7 Now that study didn't ask the context of the sex, but subsequent studies tell us that it's biggest during hookup sex or first time encounters.7,[8] It gets smaller over time, but it never closes all together. Even in relationships, sex long term relationships, women are having fewer orgasms than men are.7 And now many people will say, “Oh, that's because women's bodies are difficult to orgasm, we're elusive.” And that the other research tells us that's not true.7 We know that women have substantially more orgasms when having a sexual encounter with another woman than with a man.[9] And there's many reasons for that. But the staircase model is one of them. Because in heterosexual sex, we're often focused on that goal of penetration, which is much less likely to bring most women to orgasm, whereas sex with other women is more turn taking, more circular. And penetration isn't always the main event or often is not the main event.
Mary Jane Minkin 11:51
Thank you much on that, Laurie. And we'll cover some specific ideas for listeners to explore in just a moment. But first, I'd like to tackle an important physical aspect of being able to enjoy sex, and that is comfort. Many women are dealing with vaginal atrophy during menopause. That's when the vaginal skin becomes thin and fragile due to lack of estrogen, and it can make sex extremely uncomfortable.
Laurie Mintz 12:15
Yes, so it’s really that's such an important point, that if sex is uncomfortable and painful, which it often is, with untreated vaginal atrophy, you're not going to want to do something that's painful. And sexual pain can be due to a lot of things. So, you know, if you're having pain at all, definitely important to see your provider because sex is not supposed to be painful. And research shows that 30% of women had pain at their last instance of penetrative sex, and many didn't even say anything.[10] And they just push through it, which I tell my patients never to do. Stop if sex is painful and there's many reasons sex can be painful. One is if you have penetrative sex before you're aroused enough, it can be painful. Or in perimenopause and menopause, you might be feeling aroused, but you're not lubricating, and your vaginal walls are thin, and then it's painful. And it's very, very important to see your provider about that because there's things that can be done in terms of vaginal moisturizers. Most sex therapists and gynecologists will say use lubricant during penetrative sex. But the other thing that's really important and it’s the reason why so many menopausal women and their partners start having better sex is if something is painful, while you're being treated by your doctor to hopefully get it to a place where it isn't stopped doing the painful activity. And that painful activity is often penetration and what we know is when we take penetration off the table, we get back into that circular model, we get more creative. And the fact that the matter is that only 4% of women orgasm reliably from penetration alone, most need external stimulation.[11] So take that painful activity off the table. And many find that they become more and more aroused, more interested in sex because it's more enjoyable, less goal focused. And you know, it's a myth that that's the only sexual activity that's pleasurable. There are so many others that you and your partner can engage in.
Mary Jane Minkin 14:37
Yeah, and just to finish up a couple of comments, you know, to add to what you were saying there, Laurie. The dryness, of course, can be treated, so do talk with your provider if it's an issue. And it's not one of those things you just have to live with, and unfortunately, it's not going to get better on its own. So that's one area isn't going to get better over the course of time it can get worse. And just a couple of quick comments to follow up on lubricants. If you are using a condom, you're gonna want to look for a water or silicone-based product as that's more compatible with condoms, you don't want to use an oil-based product there. And again, one of the things that I do want to mention is that for heterosexual couples, the man may be facing his own issue, and that is erections are perhaps a little less reliable. So, there's a really strong case for exploring what works beyond that standard staircase model. You're listening to an intimate menopause, a bonus episode to accompany season three of menopause: unmuted. You can listen to all our previous episodes and find more information at menopauseunmuted.com. I'm your host, Mary Jane Minkin, and today I'm joined by sex therapist and psychologist, Dr. Laurie Mintz to talk about sex and menopause. Laurie, I'd like now to move on to communication because in many ways, its what sex is all about. Let's imagine a listener who wants to enjoy sex during menopause. Where should she start?
Laurie Mintz 16:03
Well, the first place she should start is with herself. That is, spend time with yourself, pleasure yourself, masturbate. In fact, in sex therapy for women who want more pleasure is we send women home with instructions to pleasure themselves, to masturbate with their hands, with a vibrator, with lubricants. It's also a great time to practice mindfulness, mindful self-pleasure. And then once you know what you need, and like to experience orgasm, what your body needs, then the most essential step is to transfer that to partner sex. It's underutilized, but essential advice for women, that the most reliable route to having an orgasm is getting the same type of stimulation with a partner, as you do alone. And so many times we don't do that. We know how to stimulate ourselves, for example, externally alone. And then when with a partner, we kind of forget that and focus on penetration. So, start with yourself, learn what you like, and then transfer that to partner sex.
Mary Jane Minkin 17:18
Laurie, any suggestions on how women can communicate that to their partners?
Laurie Mintz 17:24
Absolutely. And that's essential, because, as I'm fond of saying, “communication is the bedrock to make your bed rock.” And without good communication, you're not going to be able to make that transfer. So how do you do it? There's many, many ways but I suggest starting with what I call a kitchen table sex talk. It doesn't have to be at the kitchen table, but what's essential is that it's not in the bedroom. And using really good communication skills. What are those good communication skills? Meta communication, which is communicating about communicating, I'll give an example in a minute. Not asking questions that aren't questions like: “do you want to have sex?” or “do you want to do this?” Instead, using “I” statements. So, you might sit your partner down and say something like, “I'd like to talk about our sex life. I'm kind of nervous to do it, I'm fearful you might get defensive. This isn't because I'm complaining, it's because I want us to be the best we can be. And I have discovered that now that I'm menopausal, I need much more specific type of stimulation. And I've been using a vibrator on my own, and it works really well. And my- I listened to this podcast where I learned that that's really common. And I would like to us to incorporate that vibrator into the bedroom.” So again, start with a communication outside of the bedroom, and then start communicating in the bedroom, during sex. It's a myth that everybody should know what to do and do it just right, without speaking. You can actually use your words during sex, like, “please touch me here,” “let's change to this position,” “I'd like to get my vibrator out now.” Really essential. And we do know couples who communicate about sex have much, much better sex.[12]
Mary Jane Minkin 19:27
Excellent points, Laurie. And you know, along those lines, I don't know if you think this is a good idea. But one of the things I've done for many years, is know certain websites that have things like sex toys on them, and that are medically sound, I think, and I suggest to my patients that they go to the website and review the website with their partner, and that they pick out together things that might be interesting to them. And what I find is that by me talking about a particular website for vibrators, or whatever, is that patients know I'm saying these are okay to do. Do you tell that to your patients too?
Laurie Mintz 20:02
Absolutely and I particularly talk to my patients and their partners about the importance of vibrators, we know that women who use them have easier and more frequent orgasms.[13],[14] A man's acceptance of a partner's vibrator use is highly correlated with her sexual satisfaction.[15]And this is essentially important in menopause and perimenopause.14,[16]
Mary Jane Minkin 21:12
Well thanks for that explanation too. And one of the other medical issues actually is the use of vibrators, and there is some literature on this, actually helps increase pelvic blood flow.14,16,[17] And what that's good for is increasing moisture. So, it's another modality to get women more comfortable.
Laurie Mintz 21:29
Wonderful. Yes.
Mary Jane Minkin 21:30
A couple of other questions. I know some people talk about scheduling sex, what's your advice to your patients on that?
Laurie Mintz 21:37
Absolutely do it and I like to use the word tryst, instead. What is a tryst? A tryst is a planned meeting between lovers. And that's what you're talking about. And why does this work so well? First of all, it’s if you remember that idea of responsive desire, of having sex to get horny rather than waiting to be horny to have sex. If you schedule it, you can get your body, your mind in the mood, you can save energy for it. So, it really works well with that model. Additionally, what we have to do is understand that spontaneous sex is a myth. That is, think about it, I'll tell my patients, when you were young and dating, and you would go out on a date, you would take a shower, you'd get dressed up, you’d put on perfume and oh, the night ended in sex. That's not spontaneous, that was well orchestrated. And the bottom line is, we go with this myth of being spontaneous and by menopause, perimenopause, most of us are extremely busy with many multiple demands, and nothing happens without scheduling it. And the same is true of sex. So, schedule your sex, talk to your partner, that communication, what's our ideal frequency, and schedule those trysts, allow yourself to take the time to prepare yourself and to receive pleasurable stimulation in a mindful way.
Mary Jane Minkin 23:11
Excellent advice. And I know one other area that you've spoken about is a message that you give to patients about “am I normal?” You know, women saying, “Am I normal?” Can you talk about that a bit?
Laurie Mintz 23:23
Yes. So many sexual concerns are around “am I normal?” Is it normal to not orgasm during penetration? Yes. Is it normal to have my mind wander during sex? Yes. All of these things is- does my vulva look normal? All of these things that so many of us worry about, we are completely fine. We are normal, beautiful. I don’t even like the word normal. We are normative. We are beautiful the way we are, and everybody needs something a little bit different. So instead of worrying about if you’re normal compared to someone else, tune inward, and ask yourself, “What do I like?”, “What do I need in general?” and especially during perimenopause and menopause. So let's let go of this anxiety about being normal. And let's just embrace ourselves the way that we are.
Mary Jane Minkin 24:22
Excellent advice. And I know the other excellent advice that you've talked about with your patients is that women who enjoy sex have a better quality of life. Can you comment on that too?
Laurie Mintz 24:32
Yes, I mean, sexual health and wellness is a part of general health and wellness. And again, we have research here showing that couples and women who are more satisfied in their sex life are more satisfied in terms of life in general.[18] And we also have some anecdotal evidence I have a lot from my patients that becoming empowered in the bedroom being able to say to your partner, “I need more stimulation,” or “I want more lubrication,” or “I want to use a vibrator.” Becoming empowered in the bedroom can help you feel empowered in other areas of your life. Sex is not something that's just separate from the rest of our lives. It's a really essential, important part of our lives, and that is through our whole lives.
Mary Jane Minkin 25:22
Laurie, fabulously put. Thank you very much. And I'd like to thank Dr. Laurie Mintz for joining me on this bonus episode of menopause: unmuted because it is such an important conversation.
Laurie Mintz 25:35
Thank you for having me. It's been an honor and a pleasure.
Mary Jane Minkin 25:40
And thanks to you all for listening to an intimate menopause, a bonus episode this part of menopause: unmuted. I'll be back for our final bonus episode, which is all about emotional well-being and do check out our previous episodes on nutrition and strength training during menopause. And I hope they help inspire you to learn more during your menopause journey. There's more information in our show notes at menopauseunmuted.com. And if you have any questions about your own menopause, talk to your health care provider. That might be your OB-GYN, primary care provider, nurse practitioner or midwife. There are even designated menopause practitioners that a woman can visit if she needs more information. Special thanks to the women's health team at Pfizer and to Studio Health for producing this series.
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[16] NAMS https://www.menopause.org/for-women/sexual-health-menopause-online/effective-treatments-for-sexual-problems/sexual-devices
[17] MysteryVibe Latest Study Finds that Vibrators Relieve Menopausal Symptoms including Arousal Disorder and Vaginal Atrophy. Press release, October 20, 2021. Available at: https://www.prnewswire.com/news-releases/mysteryvibe-latest-study-finds-that-vibrators-relieve-menopausal-symptoms-including-arousal-disorder-and-vaginal-atrophy-301404368.html#:~:text=Sponsored%20Placement-,MysteryVibe%20Latest%20Study%20Finds%20that%20Vibrators%20Relieve%20Menopausal%20Symptoms%20including,therapy%3B%20it's%20a%20public%20service [Accessed October 18, 2022]
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