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While in the rush of everyday life, many women do not place enough emphasis on their sexual well-being, a significant component of which is libido or the desire to have sex. Further, many women in their 40s and above resign themselves to thinking that their lack of desire is simply a normal and unavoidable part of aging. While we do go through hormonal changes that reduce our sex life in midlife and later, it’s my goal to ensure that women understand the options they have so that they can choose the path that’s best for them. So, with that, let’s dive into a few lifestyle changes that can be made to help with rebalancing hormones and improving our sexual wellness.
Get Some Sleep
Sleep is one of the most crucial components of sexual mood. Sleep is readily available to us, completely free, and has some of the most significant benefits of any activity we can do. If I were to stop there and tell you that you need more sleep, you’d likely respond that circumstances in your life, including perimenopause and menopause, stress, and more, are making you sleep less, and while the idea of sleep sounds excellent, it just doesn’t seem possible. But it is. First, practice good sleep hygiene. This means turning off your phone or shutting off the TV at least an hour, and preferably two hours, before bed. Instead, grab a book and engross yourself in a good story. You also want to sleep in a dark environment with as few ambient lights as possible. Make sure the room is cool when you fall asleep, and if you have the luxury of a programmable thermostat, make it warmer as you wake up rather than falling asleep. Lastly, remember that you spend about eight hours a day in bed – about a third of your life, so invest in an excellent mattress and pillow that suits your needs. Don’t resign yourself to poor ergonomics, pain, and stiffness when you wake up.
While sleep medication is an option to discuss with your primary care physician or sleep specialist, some patients can develop a dependence on these drugs, and others may find that, long-term, it makes their insomnia worse. Instead, there are more “natural” options that you can speak to your doctor about, including melatonin and magnesium. Of course, before taking any supplements, ensure they do not conflict with your medications and that your doctor feels they are safe for your particular circumstance. Always remember to choose high-quality supplements and note that there are many kinds of magnesium, each with distinct uses – magnesium citrate, glycinate, and L-Threonate are often posited as the best forms for sleep and relaxation.
Losing Some Weight
Unfortunately, excess weight and obesity have become an epidemic in the United States, and this has caused several major health issues, not least of which is hormonal imbalance. We’ve known for a long time that the pro-inflammatory compounds secreted by adipose tissue (abdominal fat) can wreak havoc on our hormones and even cause infertility. These same compounds can cause patients to lose their desire for sex. As we hit middle age, controlling fat accumulation becomes even more challenging, and losing natural muscle tone doesn’t help. Of course, there are solutions to excess weight, and the most obvious are diet and exercise. Increasing protein intake and reducing sugar and saturated fat consumption are probably the quickest ways to regain some of that spark. You know what they say about oysters, right? Yes, they are aphrodisiacs, but they’re also fantastic sources of lean protein that can help you maintain muscle and bone mass well into your later years. So, if you like them, go for it!
Exercise is also critical to maintaining overall health, especially sexual wellness. Most of my patients believe they have to be in the gym five times a week working out hard – and they don’t have the time or inclination to do so. But that’s not entirely true. Exercise comes in many forms, from brisk walks during your lunch break at work to performing chores around the house. I certainly want you to perform some muscle-building strength training. It has unbelievably beneficial effects on muscle tone, sexual health, and mental health, but I also know that you might need to work up to it. So, set aside half an hour a day to start and build up from there. Within a few weeks, you’ll be amazed at the difference. Remember that in the early days, as you build muscle, your weight loss will slow, so don’t get discouraged if you don’t see the pounds falling off as fast as you thought they would.
Of course, sometimes we need help when diet and exercise simply haven’t worked. You’ve almost undoubtedly heard about GLP-1 receptor agonist medication (like Wegovy® and ZepboundTM) – weekly injections that have helped some patients lose over 20% of their body weight. These injections can be great, though I consider them a temporary back-on-track solution for patients who need to lose weight. I’m proud that Aayla now offers these options to qualifying patients.
Manage Stress
While this is last on my list, it’s certainly not the least. I would argue that stress may be the single biggest impediment to sexual wellness that I see in my practice. Unfortunately, stress is everywhere, and many of us believe it is simply a fact of life and unavoidable. To some degree, that might be true with expectations from family, work, and society. But how we handle those stresses makes a difference. First, stay healthy by following points one and two above – optimizing your weight and sleep significantly affects stress suppression. From there, it’s also essential to address some psychological and mental health concerns that may add stress to our lives. For example, some of our patients stress about the look and feel of their vulvar and vaginal area. While most urologists and even gynecologists do not address female sexual function, it’s one of my passions as the founder of Aayla.
Bonus – Procedural and Surgical Interventions
Elsewhere on my site, you will learn more about when I do not suggest patients pursue a procedural or surgical solution in their intimate areas. We must address the appropriate cause of a patient’s psychological or physical concerns. However, I like to discuss several key points with each of my female patients.
First, virtually every female patient, 40 and over, should be using vaginal estrogen. This is a localized application that is not absorbed into the blood. As such, any (often misinformed) concerns about hormone replacement therapy are essentially moot. Vaginal estrogen goes a long way to restoring the vaginal lining, making it more plump and reducing the likelihood of painful sex or that terrible feeling of dryness.
In that same vein, peri-menopausal and menopausal women should also speak to me or their trusted doctor about hormone replacement therapy. Understand, however, that there are still many misconceptions both in the public eye and in the medical field about estrogen therapy. Many incorrectly believe that hormone replacement will cause cancer in all patients, but this is based on faulty interpretation of old data. Today, we know that when appropriately applied, hormone replacement therapy can be very effective and even protective against cancer and all-cause mortality.
For patients concerned about the appearance of the labia minora (inner lips) or labia majora (outer lips) of the vulva, we have a range of vaginal rejuvenation, non-surgical labiaplasty, and surgical labiaplasty options that can tighten and generally improve evolver area. Mild to moderate labial concerns are often handled non-surgically. Surgical options are always available for patients who need more significant intervention.
The Bottom Line
Ultimately, what I want patients to know is that there is help out there, even if you have been told by your primary care physician, urologist, or gynecologist that there’s little or nothing that can be done for your sexual wellness. Conversely, we see how much emphasis is placed on male sexual health, with products and techniques being developed every year to maintain a man’s virility. The idea that you have no options is false.
I hope that in addition to paying attention to your sexual wellness, you make this topic less of a taboo by speaking to your friends about it and openly having a conversation with your medical providers to ensure that your needs, which affect both your physical and emotional life, are being addressed.