Midlife brings a lot of change—and not all of it is hormonal.
For many of us, our children are becoming adults. They’re away at college, working, spending weekends with friends, or building lives of their own. After years of prioritizing everyone else, you may look at your significant other and think:
Now what?
Maybe now is the time to prioritize each other again.
Sexual wellness has been an important part of my work throughout my career. Before becoming a nurse practitioner, I worked as a sexual health educator, and later served as the Female Sexual Medicine Nurse Practitioner at a leading academic cancer center in New York City. That experience shaped how I care for women today: sexual health is not an “extra”—it is an important part of our health, relationships, and quality of life.
When Your Body Isn’t Cooperating
Hormonal changes during perimenopause and menopause can affect desire, arousal, orgasm, and vaginal health. You may experience decreased libido, vaginal dryness, painful sex, reduced sensation, or difficulty reaching orgasm.
Sometimes what feels like “low libido” isn’t really about desire. If sex hurts, you’re exhausted, or your body isn’t responding the way it used to, you’re probably less interested in having sex.
That’s why treatment should focus on what has actually changed.
There Are Treatment Options
Depending on your symptoms, health history, and goals, options may include:
- Testosterone for appropriately selected women with hypoactive sexual desire disorder (HSDD)
- Addyi® (flibanserin) or Vyleesi® (bremelanotide) for appropriate candidates
- Vaginal estrogen, vaginal DHEA, moisturizers, and lubricants
- Menopausal hormone therapy when appropriate
- Pelvic floor physical therapy and sexual counseling
- Selected compounded treatments, sometimes called “Scream Cream,” for concerns related to arousal or orgasm
Sexual wellness is highly individualized. The first step is understanding whether the concern is desire, arousal, orgasm, discomfort—or a combination.
Sexual Wellness After Cancer or Risk-Reducing Surgery
This conversation is especially important for cancer survivors, previvors, and women with hereditary cancer risks such as BRCA1, BRCA2, or Lynch syndrome.
Cancer treatment, endocrine therapy, and surgical menopause can significantly affect hormones and sexual function. Having a cancer history or increased cancer risk doesn’t mean your sexual health should be ignored—it means your treatment deserves a thoughtful, individualized approach.
Sexual Wellness Through Telehealth
Many sexual wellness concerns can be evaluated and treated privately through telehealth.
At Milli Women’s Health & Menopause, I bring together my background in sexual medicine, menopause, women’s health, and oncology to help women navigate changes in libido, arousal, orgasm, vaginal health, and intimacy.
Your kids may need you differently now. Your life may finally have a little more room for you—and your relationship.
Maybe this is your time to reconnect, rediscover intimacy, and prioritize your sexual health.
Ready to Start the Conversation?
Schedule a confidential telehealth sexual wellness consultation to discuss what’s changed, what matters to you, and which treatment options may be right for you.