Midlife Intimacy: Myths vs. Reality

That your sex life has to sour after a certain age may be one of the biggest myths of midlife sex.

Challenges exist, to be sure. However, issues with lagging libido or performance anxiety can be largely addressed with modern treatments. Cheryl Iglesia, MD, a urogynecologist at MedStar Washington Hospital Center, explains the many steps you can take to prevent your sex life from becoming ho-hum.

For example, women who are experiencing perimenopause or menopause and going through hormonal changes often encounter dryness in the vaginal area, or what’s been coined genitourinary syndrome of menopause (GSM).

Dr. Iglesia recommends starting with either a lubricant during sex or a daily moisturizer, both of which are non-hormonal. Many moisturizers are designed to reset pH levels and prevent overgrowth of unhealthy bacteria.

If either of those options don’t ease the dryness, you may want to look into a hormonal topical treatment. Topical creams include  Estrace® and Premarin®. Other options are a vaginal tablet (Vagifem®) and a ring (Estring®) that is inserted in the vagina and releases daily estrogen for three months.

Might the extra estrogen present health risks? “Now that these treatments are FDA-approved, the doses are so low that there really isn’t any significant cancer, blood clot or heart disease risk,” explains Dr. Iglesia.

Another issue couples face is waning libido. Men have had solutions for some time now, such as name brand Viagra® or Cialis®. And even though Flibanserin has been touted as the new “female Viagra,” it’s only FDA approved for premenopausal women.

Dr. Iglesia reassures this doesn't have to be a roadblock. In fact, lowered libido may be more mental and emotional than chemical, particularly in women. "There’s a lot of things that go into desire, just in terms of the way women feel about their bodies. Changes can occur in the architecture of the vagina, particular after you’ve had children. It takes longer to orgasm, maybe you don’t feel as much, you’re just feeling very different about your body, less confident. And, of course, there can be relationship issues."

The key is to switch things up.

“Everybody’s got to change their game. I would say change the location, change the time of day, even get some toys in there. Read the Kama Sutra, look at different positions, start doing other fun things together to revitalize your relationship.”

If you and your partner have unresolved issues, a couples therapist or sex therapist can also be beneficial.

Finally, don’t neglect any outside influences. Many drugs can negatively impact libido, including antidepressants and blood pressure medications.

Dr. Iglesia’s last piece of advice is to not give up. “If it’s something that’s really bothering you and really bothering your partner and you really want to make improvements, don’t blame all your problems on age. You can see a specialist, someone who’s going to validate these concerns and offer a very thorough evaluation, give you the appropriate referrals, and provide advice on other things to try.”

By giving yourself permission to explore your options, you can push past the misconceptions and maintain your sex drive well into your elder years.

Listen in on Dr. Iglesia’s full podcast interview here.

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Fighting Fibroids

Abnormal bleeding. Pelvic pain. Backache. Not long ago, a woman either suffered with fibroids or surrendered her uterus. But modern medicine offers many better options.

Abnormal but non-cancerous, uterine fibroids affect more than 50 percent of all American women, a figure that jumps to 80 percent among African Americans.  Fortunately, most women never even know they have the growths until their gynecologists tell them so.

But those who experience fibroid’s most troublesome symptoms crave relief from the abnormally heavy or long periods, intermittent bleeding, backaches, pelvic pain, uncomfortable sex and other problems caused by the benign masses. At their worst, fibroids can even result in infertility, premature labor and miscarriage. 

Not too long ago, a woman had two choices: Suffer through fibroid’s woes to preserve child-bearing and hormone-producing abilities, or undergo a hysterectomy to surgically remove the uterus, host to the unwanted growths.

Modern medicine offers many better, and less dramatic, options.

“Today, we have a range of approaches—medical, surgical and non-surgical— to help women with fibroids,” says James Robinson, MD, Director of Minimally Invasive Gynecologic Surgery at MedStar Washington Hospital Center. “When surgery is the answer, many procedures are minimally invasive, performed on an outpatient basis and using small incisions and precise targeting for less pain and a quicker recovery.

“Some procedures can even get rid of the tumors while preserving the uterus and ovaries. That allows for future pregnancies and hormone production, which is important for healthy aging.”

And if a woman and her doctor decide that removal of the uterus is the best approach? Fear not, Dr. Robinson says.

“This isn’t your mother’s hysterectomy. Whenever possible, we’ll leave the ovaries intact so you won’t automatically go into menopause.”

The exact cause of fibroids is still unknown, although heredity, race and obesity all play a role. While today’s procedures can successfully remove existing lesions, others may grow afterward.  At this time, the only way to rid the body of fibroids completely is a hysterectomy.

But Dr. Robinson cautions that a diagnosis of fibroids doesn’t mean you should be overly concerned.

“We can take care of your problem,” he says. “Our goal is to get you back to your life in the least disruptive, and fastest, way possible.”

We are here to help!

If you have any questions call MedStar Washington Hospital Center at 202-877-3627.

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Aging Gracefully: Women’s Health Issues

Staying Healthy in the Middle Years

Our bodies are changing as we reach our middle years (ages 50-70), and taking good care of ourselves allows us to embrace the new experiences ahead of us at this stage in our lives. We’ve asked one of our MedStar Washington Hospital Center physicians for advice to help you feel your best. Here Dr. Amy Park, a urogynecology expert, discusses women's health issues, and when you may want to seek advice from an expert.

Common and Treatable

The good news about urogynecological issues in women 50 and older is that most are very treatable, says Amy Park, MD.

“So many women feel uncomfortable discussing common women's health issues, such as leaking urine and vaginal bulge, where the vagina can prolapse, which can result from aging and damage from childbirth injury,” she says. “But often, we can help them dramatically improve their quality of life. Treatment of the incontinence and prolapse enables them to regain their confidence, engage in social activities and exercise comfortably again.”

Options for treating common conditions include making dietary changes, such as reducing caffeine intake (excessive caffeine can be a bladder irritant), using low-dose estrogen creams for vaginal dryness and considering minimally invasive surgical procedures to correct stress urinary incontinence and pelvic organ prolapse.

Healthy Body and Mind

Maintaining core strength is another important factor in urogynecological health, so Dr. Park recommends exercises like yoga, pilates or planks, which target the core muscles. But, she says, perhaps the most vital part of being active and healthy in the middle years is accepting where you are.

“You can’t compete against the idea of your younger self,” she explains. “I believe in the importance of optimizing who we are and what we want to do, whatever age we happen to be.”

Have Any Questions?

We're here to help! Contact us for more information about women's health issues or to schedule an appointment with a urogynecologist. Call us at 202-877-3627.

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Why Choose Us

Urogynecology: Why Choose Us


The National Center for Advanced Pelvic Surgery (NCAPS) at MedStar Health provides unrivaled expertise in the diagnosis and treatment of pelvic floor disorders.

Pelvic floor disorders are conditions that affect a woman's pelvic organs, such as urinary incontinence, pelvic organ prolapse, fecal incontinence, defecatory dysfunction, fistulae and other complications from childbirth. These conditions are common in women and cause a significant burden if left untreated.

Our mission is to provide comprehensive, compassionate medical and surgical care to women with pelvic floor disorders; to contribute to the field of female pelvic medicine and reconstructive surgery through clinical research; and to educate peers, physicians-in-training, other allied professionals and patients about pelvic floor disorders.

Our team of fellowship-trained urogynecologists, urologists, colon and rectal surgeons, physical medicine and rehabilitation specialists, physical therapists, pain management specialists, psychologists and nurse practitioners at NCAPS is the most experienced in the Washington/Baltimore region. We focus on the latest medical and minimally invasive vaginal, laparoscopic and robot-assisted surgeries to improve the patient experience, reduce pain and allow for a quicker recovery. Our center offers a caring environment sensitive to the needs of those with pelvic floor disorders. 

Urogynecology also provides Gender Affirming services and culturally competent LGBTQIA+ care. If you are interested in learning more about any of these services, please email [email protected] for more information and/or to schedule an appointment.

Awards and Recognitions



The Washington Women's Wellness Center and the National Center for Advanced Pelvic Surgery are First SCOPE Certified Offices in the District




NCAPS has been recognized as a "Center of Excellence" by the National Association For Continence.





Dr. Andrew Sokol discusses urinary tract health in this Washington Post story.




Dr. Cheryl Iglesia discusses new treatments for sexual dysfunction in postmenopausal women in this Washington Post story.



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