What Is Sexual Health?

Our health is multifaceted. It consists of our physical, mental, emotional, spiritual, and sexual health. Today’s article is going to address sexual health, which means something different than it did when we were in our 20s and 30s.

I’m excited to bring back Dr. Ferzandi to get her perspective on sexual health. “ She and I discussed incontinence and uterine prolapse a few months ago and today we discuss sexual health, a topic she is passionate about!

Dr. Ferzandi is the Service Line Chief of Obstetrics & Gynecology at Keck Hospital, the Director of the Division of Urogynecology and Pelvic Reconstructive Surgery, Associate Professor of Obstetrics and Gynecology, and the Associate Fellowship Director for Urogynecology at USC Keck School of Medicine. 

Karyn: As an OBGYN what does sexual health mean to you? 

Dr. Ferzandi: Having taken care of women for almost two decades, I have come to think of sexual health in terms of what the woman wants. Too often, women are subjected to what society or men impose. I believe if a woman is comfortable with her body and understands her own sexual needs, that is healthy. 

Many women in their 40s and 50s are feeling more empowered to say what they do and do not want. Many still enjoy being sexually active. However, I unfortunately often see patients who feel pressure to be sexually active even if they are comfortable not being sexually active. They might only like touch, rubbing, or cuddling. They don’t necessarily want intercourse but feel pressured to do so.

The pressure on women to feel like they did in their 20s is real. But it is just not possible. The norm is to not want sex the way we did in our 20s. In the same way it is not normal at 40 or 50 to look like you did in your 20s or to expect a woman’s vagina to look the same as it did before having children.

I think the porn industry feeds this pressure for younger women. As women have gotten onboard with shaving more of their pubic hair, they can see more of their anatomy. In turn they become more critical of themselves, thinking something is wrong with their vagina or labia. They might think the lips are too big or too small, or not symmetrical. All of which has led to a cottage industry of vaginal cosmetic rejuvenation.

I love this piece of art, The Great Wall of Vagina, by Jamie McCartney because it shows the variability of vaginal anatomy and proves there is no one “normal” vagina.

Karyn: What are the most common sexual health issues you see women grappling with in midlife?

Dr. Ferzandi: I think declining libido worries most women and I would love to see the stigma and negative connotation around low libido reduced. I think it does both men and women a disservice. 

I put women who are concerned about low libido into 2 categories.

In the first are women who worry about decreased libido as it pertains to their relationship dynamics. Most of women I see fall in this category.   

It can be difficult for women to say, “I’m happy how I am.” “I don’t have to have sex; I don’t want it all the time.” If they are in a partnered relationship where this is not reciprocated, this can create pressure to feel and do things they don’t want to do.

Sometimes women say once they get going it is fine, but I have also had women say, “Well if I don’t do it, I don’t want them to go someplace else to get it.” Unfortunately, this kind of sentiment can affect a woman’s emotional wellbeing and overall sexual health.

What I love hearing is when asked if they are OK with having less sex, they say, “I’m fine.” “We have had a good life together, both of us are very content.” It makes me happy for them they are not encountering pressure to feel something they don’t.”

The second category is women who still want to be sexually active but for one reason or another it has become more difficult. For painful intercourse due to dryness, we can use estrogen cream or pills to make sex more enjoyable. Or, if the problem is due to anatomy, like prolapse, we can take steps to address it.

But if the problem is an inability to be aroused, it is more difficult to address as it often involves more emotional and psychological arenas. For women sex is not just a physical act. Things need to be lined up in order for women to feel wanted, needed, sexual…women are not an on/off switch…women are different than men.

Karyn: What role do changes in hormones play in these issues?

Dr. Ferzandi: Hormones play a huge role as we age, as does aging itself. Our attitudes and beliefs about sexuality and sensuality evolve as we age. We also feel differently about our “space” in relationships and our needs.

Karyn: What can women do to address these common issues? 

Dr. Ferzandi: I think all women need their own “kitchen cabinet” of people with whom they have a close relationship. This can help you feel free to speak about what is happening and not feel judged. In talking to other women, you will see you are not the only one thinking or feeling a certain way. It gives you a place to say, “It’s hard.” “I don’t feel that way anymore.”

Psychological warfare is being waged on women all the time in the form of societal norms which are unrealistic: try to be wrinkle free, have the same body you did when you were 25, have the same libido as when you were 20.

Because of society women don’t feel comfortable being who they are most days. I often ask, “Why can’t I feel good about my wrinkles?” And “Why do we all color our hair?” “Why aren’t we OK with going gray?” “Is it because we are trying to look younger, rather than just being “ourselves?” It is so much about trying to be younger and youthful.

No woman should feel ‘less’ of a woman by comparison to a societal expectation which is unrealistic.

I would like to see all women given the space and independence to decide what they want to feel, how they want to feel, and what they want their sex lives to be. Instead, they often are pressured to feel there is only one acceptable way to answer these questions.

Western cultures do not embrace getting old and do not respect the aging process. Older people in our cultures are not revered for their age, wisdom, and experience. So, I think the aging process is harmful to women as we are not allowed to embrace it. Some women are really working to change this attitude. For example, Andy McDowell is fighting back against agism in Hollywood.

Karyn: What symptoms should a woman be discussing with her doctor? 

Dr. Ferzandi:  Vaginal dryness, lack of orgasm if that is something that was normal for her, any pressure from partners, and changes to libido.

I want to encourage your readers to talk to their OBGYN about their sexual health. We are not just the people you see to have a baby, perform your yearly pap smear/breast exam, or “fix” things which are broken.

Parting Thought

One of my takeaways from this conversation is that sexual health is yet another opportunity for being kind to yourself. Embrace the beautiful body which has gotten you this far and accept the changes you experience with grace.

See you next week…