What No One Told You About Sex After 40
I want to have an honest conversation with you. One that most doctors have never initiated, most medical schools never prioritized, and most women have been quietly waiting their entire lives to have.
It's about your sexual health. And it deserves to be talked about with the same seriousness, the same evidence, and the same urgency as your heart health, your bone density, and your hormones.
Because here's the truth: your sexual health is your health.
Your sexual health is your health.
The Silence Has a History
For decades, women have walked into their doctors' offices and described real, disruptive symptoms — pain during sex, loss of desire, inability to reach orgasm, vaginal dryness that makes intimacy feel impossible — and been met with a shrug. Or a referral to therapy. Or worse, the quiet implication that this was simply what getting older looked like for women, and that acceptance was the only prescription available.
That was never acceptable. And it was never the whole story.
Here's what most women don't know: the majority of clinicians — including OB-GYNs — received little to no formal training in sexual medicine. Not because the need wasn't there, but because for a very long time, female sexual health simply wasn't treated as a clinical priority. It wasn't in the curriculum. In many programs, it still isn't.
So when you were dismissed, redirected, or told everything "looked normal," that wasn't a reflection of your body failing you. It was a reflection of a system that failed to prepare your doctor to help you.
That distinction matters enormously. Because the problem was never you.
The System Wasn't Built With You in Mind
Let's talk about something that should make every woman pause.
When medications for male sexual dysfunction came before regulators, they moved quickly. When equivalent medications for women's sexual health were proposed — drugs with evidence behind them, drugs that worked — they faced far greater scrutiny, repeated delays, and rejections rooted not in comparable safety concerns, but in paternalistic assumptions about women's sexuality and how it might be "misused."
The message embedded in that history is one women have been receiving from medicine for generations: male sexual function is urgent. Female pleasure is optional.
Your desire, your comfort, your pleasure, and your sexual wellbeing are not frivolous. They are not vanity. They are quality of life — and quality of life is medicine.
What Actually Happens to Your Body in Midlife
Perimenopause and menopause bring real, physiological changes that directly affect sexual health. Estrogen decline leads to changes in vaginal tissue — reduced lubrication, decreased elasticity, increased sensitivity to friction. This can make sex painful in ways that have nothing to do with desire or attraction or how much you love your partner. It is biology, and it is treatable.
Testosterone, often overlooked in women's care, plays a meaningful role in libido and arousal. As levels shift with age, many women notice a quieting of desire that feels foreign and frustrating. Again — this is not inevitable, and it is not permanent without support.
Pelvic floor changes, nerve sensitivity, and shifts in blood flow all contribute to how pleasure is experienced in midlife. Understanding this is the first step to reclaiming it.
You Are Allowed to Want This
I want to say something clearly, because not enough women hear it from their doctors.
You are allowed to want a satisfying sex life. At 45. At 55. At 65 and beyond. Wanting pleasure is not indulgent. Seeking help for sexual symptoms is not embarrassing. And accepting pain or disconnection as your new normal is never something you are obligated to do.
Sexual health is not separate from your overall wellbeing — it is woven into it. It connects to your self-worth, your relationships, your sense of identity, and your joy. When it suffers in silence, so do you.
The goal of evidence-based sexual medicine isn't to turn back the clock or make you into a different version of yourself. Women who finally receive the right support often describe it the same way: I feel like myself again. Not younger. Not different. Just fully, wholly themselves.
That is what you deserve.
What the Toolbox Actually Looks Like
The good news — and there is genuinely good news here — is that the tools exist. The science exists. And when care is thoughtful, personalized, and informed by current evidence, real change is possible.
Depending on your symptoms, history, and goals, options may include local or systemic hormone therapy to restore tissue health and support libido, non-hormonal medications where indicated, pelvic floor physical therapy (which is far more powerful than most women realize), and education that helps you understand your own body with clarity and without shame.
No single protocol works for every woman. Your care should be as individual as you are. But the starting point is the same for everyone: finding a provider who takes your sexual health seriously, asks the right questions, and offers real options rather than a polite dismissal.
This Is Where It Starts
If you have been quietly enduring symptoms you were told were normal, I want you to know something. You were right to know something was off. You were right to want more. And you deserve a provider who meets you there.
The conversation is changing. Women are demanding better — better research, better training, better access to care that sees them as whole human beings whose pleasure and comfort matter.
I am here for that conversation. I always have been.
You don't have to survive midlife. You are meant to thrive in it.
Defy Menopause - Own the Change
Many women tell me: "One day I feel amazing. The next, I can barely get out of bed. Is this normal?"
Yes, it is. And no, you don’t have to suffer through it alone.
Hormonal fluctuations during perimenopause can make you feel like you’ve lost control of your body. But knowledge is powerful. And there are clear, science-backed ways to support your hormones, ease symptoms, and reclaim your energy.
That’s exactly why I created Defy Menopause: Own the Change — a 30-day program designed to give you the tools, knowledge, and support you need to move through these changes with clarity and confidence.
Inside, you’ll find:
Weekly access to Dr. Tracy Verrico at live, group sessions
Clear action steps for managing symptoms naturally
Because you deserve more than just "putting up with it."
You deserve to thrive.
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Medical Disclaimer: The information provided in this blog is for general educational and informational purposes only and is not intended as, nor should it be considered, medical advice. This content does not establish a physician-patient relationship and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read in this newsletter. If you think you may have a medical emergency, call your doctor or emergency services immediately.
