Talking about sex all day is why I got into this business. It doesn’t embarrass me. I find it interesting. I think I am pretty good at listening, so I hope you would be able to talk with me about this stuff. I actually think sexual topics are the most common/important thing people want to talk with me about (even when I was doing family practice and seeing lots of varied problems in the day). But, you know, I often find myself in the mindset where I want to make sure you are aware of risky behaviors. I want to be sure you do not get an STD and that you do not get pregnant when you don’t want to be pregnant. I check in to see if you are in a safe relationship. I want to understand what is going on and I will usually ask pointed questions to figure out what started when and how to “fix” it if there’s a problem.

But not everyone perceives not wanting to have or not enjoying sex as a problem—especially not one to talk about with your health care provider. Here are some things you can say and questions you can ask when you want to discuss this issue but aren’t sure how to start the conversation.

  1. I am having problems with dryness or pain with sex.
  2. I’m not having sex as often as I’d like.
  3. My periods are really affecting my sex life.
  4. I want to have an orgasm/I’ve never had an orgasm. What can I do?

So what if you want to experience more pleasure in your relationship but you don’t feel like coming in for a visit? Here are some of the most common things I hear in the office and the advice I might give if you were here.

  1. Sex is boring. Let’s say you have been with your partner for 40 years (or 20 or five or one). Of course doing the same thing with the same person can become monotonous! If every time sex is initiated you know that you are going to kiss for three minutes, turn around four times, bend down and touch your toes and then have sex, your brain is going to lose its ability to get excited about that routine activity. If it is always on a Wednesday afternoon it can be something to look forward to for some, but just another “errand” on the to-do list for others. You know how sometimes your routine is so established that after your commute to work you ask yourself, “how did I get here?” The same thing can happen in loving relationships. So change it up! Take a new route. Drive with the windows down instead of the air conditioning on. To some, this might mean doing something small. For others it may mean taking a bigger risk (like talking very frankly with your partner or visiting a sex toy store to take a class).
  2. Sex is uncomfortable or painful. Do you have a history of trauma? Are you getting enough foreplay? Do you need to add some extra lubrication? Is it the position, insertion or the motion that is hurting? Lots of things can cause pain. If you have a history of someone harming you during sex and you think this is causing distress, I would highly recommend getting counseling as a first step.
    Most people have partners who want to be kind and please the one they are with. If you’re having a hard time with vaginal lubrication, talk to your partner. Let them know what turns you on. If you can’t get lubricated well enough on your own, then use lubricant to make it more comfortable. If you have an uncomfortable experience, your body remembers that and may anticipate discomfort the next time. The more comfortable experiences you have, the more your body will look forward to it. Also, don’t forget some infections and medical conditions can cause vaginal irritation and pelvic pain specifically when you are having sex—so come in for a visit. The bottom line is sex should not be unpleasant to you.
  3. You have trouble with orgasms. This is a very common complaint, let me put that out there right away. Did you know only about 30 percent of females can have an orgasm with penetration alone? Most women need some other stimulation (especially to the clitoris) to orgasm. Sometimes it takes patience and time or a vibrator. Some people need a partner to help and others need to do it themselves. Sometimes it’s a sexy thought or phrase. Sometimes it involves fantasy. It’s interesting because we live in a competitive culture and some people use an orgasm as a signal that they have “won”—that puts a lot of pressure on the idea of having an orgasm. No wonder why people occasionally fake them! If you have never had an orgasm the most important thing is to figure out what you like. This might mean you need to experiment on your own first. This might mean you need a partner who will listen to you as you guide them. This can feel very vulnerable to some and may be difficult. I love this book. It is a good place to start. A small warning, it is very direct and uses very graphic language.
  4. You have lost the desire. First, read #1 again. Is sex so boring that you could literally think of five other things to do that would be more fun? That could be a place to start. Are you and your partner in a particularly stressful time in your lives? Are you arguing a lot? Do you have kids or pets interrupting romance? If there are obvious things that are getting in the way, it is best to address those first. If you are co-sleeping with two kids in your bed, it might take a while to get back into a sexual rhythm. I like this podcast: Parent’s guide to doing it. Could you do something as a couple that would rekindle some romance? Maybe go on a date together? Could you put it on your calendar so it is a priority instead of something set on the back burner if you only had the time?

One other final thought for now: sometimes after menopause your biological reason for having sex goes away and your body becomes very aware that sex is no longer “necessary” because it can no longer get pregnant. Is it sexual intercourse that you really want or do you actually desire intimacy? Could you feel good with a nice snuggle and some good conversation? It is totally OK for your sex life to evolve! Sex does not always have to mean a penis in a vagina or an orgasm. Sometimes it’s the little things.

Hopefully these thoughts can help and if you have questions, talk with your provider. Keep in mind that maybe the provider who has delivered all of your children and is your next door neighbor may not be the ideal person to talk with about sexual pleasure, so also realize you can ask to see someone else. We want you to enjoy your sex life as much as you want—even if it is a hard subject to bring up sometimes.