For too long, conversations surrounding menopause have been shrouded in silence and stigma, often reducing a significant life stage for over half the global population to hushed whispers and medical jargon. However, a cultural shift is underway, bringing women's midlife experiences into the open and normalizing discussions around hormonal changes, sexual wellness, and personal empowerment. This growing openness is crucial as women navigate a phase of life that impacts their bodies, relationships, and overall well-being.
Dr. Carol Queen is a pioneering sexologist, author, and educator who has been at the forefront of sex-positive advocacy and sexual health for decades. With a deep understanding of human sexuality and a commitment to empowering individuals, Dr. Queen's work has consistently challenged conventional norms and promoted open dialogue about pleasure, intimacy, and body literacy. Her insights offer invaluable guidance for women seeking to embrace their changing bodies and redefine their sexual wellness journey during menopause and beyond.
Here, Dr. Carol Queen shares her wisdom and expertise in a candid Q&A.
Breaking the Silence Around Menopause & Sexual Wellness
Q: Menopause is finally having a moment in the cultural spotlight, from Oprah to Michelle Obama. Why do you think it's taken so long for women’s midlife experiences to be openly discussed?
Dr. Carol Queen: In my opinion, there are three significant elements:
Women's principal roles have been as wives (more recently sexy wives!) and mothers, which of course places us in relationship to men and children, but can highlight just how difficult it's been not just for women who don't fit those molds, but also those who do, but who are moving past their reproductive years and entering a new phase of life. There can be a shameful element to this for many, and it's taken decades (at least since the early-'70s advent of Our Bodies Ourselves!) for really high-profile peri/menopausal women to start speaking plainly about it and for the press and public to start listening and amplifying those voices.
As Heather Corinna notes in their great book about perimenopause/menopause, doctors have often been worse than no help with menopausal "symptoms"—this was certainly true in my mother's era. Lack of understanding—and let's face it—prioritizing men as far as health research is concerned has left real gaps. I asked Heather how medical training deals with these issues, and they said that menopause care is a specialty. That is mind-blowing—over half the population, most of whom will live til the age of the menopause transition, all of those people will go through it, and this is not something ALL doctors will learn?
Put those together and you get a lack of open discussion, mentoring, information about what to expect at midlife... just much more silence than this experience warrants, and women (and other people with uteruses, whatever their identities) have paid the price.
Q: You’ve been a pioneer in sex education and sexual health advocacy for decades. What shifts have you noticed in how women in perimenopause and menopause talk about pleasure and intimacy?
Dr. Carol Queen: I have noticed many changes, but they are far from universal. I would say that until recently the public (and among-women) discussions often included more discussion about sexual pleasure and relationship issues than bodily wellbeing. The former is part of a sex-positive feminist discourse, after all, while the latter can be considered in fact more private—the things that seem like health "symptoms." (I am scare-quoting the word to try to indicate that menopause isn't an illness and bodily changes aren't either—though they are certainly wellness-related. Menopause isn't always a rough transition, but it can be, and when we are not getting good care and information it can really make it harder--plus that shame I mentioned above can even extend to not feeling your best, at least for some "do-it-all" women.)
One irony is that all those individual "symptoms" are the basis for some of the sexual problems! Many of us know about increasing vaginal dryness (and eventually pain with penetration for some). Many of us have experienced increased emotional volatility too. But we shouldn't just be talking about lubricant and the importance of therapy and communication in our relationships*---we should also know how the body's wellbeing as a whole, and certainly the way it's linked to our hormonal fluctuations, can set us up for sexual and intimacy issues. Such as:
Vasomotor symptoms like hot flashes can impact our sleep quality, and sleep quality is integral to wellbeing, including libido and pleasure, mood, and much more.
It impacts how we handle stress also! And stress makes any emotional issues worse, as well as itself negatively impacting sexual functioning.
Dehydration can become an increasing problem as we age. That doesn't cause vaginal dryness per se—but being under-hydrated certainly doesn't help!
*Speaking of relationships: At the end of a woman's reproductive years, no matter how else she experiences gender roles and identity in her life [there are many ways to live as a woman]), gender roles are in flux. And that can show up in our relationships and their expectations, sexually and in many other ways also. This isn't a problem! Unless either or both partners experience it as one, and then it can be thorny.
Q: There’s a persistent myth that menopause marks the end of a woman’s sex life. What’s the reality, and why is that mindset so damaging?
Dr. Carol Queen: There are some women for whom that's true, of course, but it is NOT inevitable, or the rule, or "just the way things are." People of all genders can continue to be interested in sex and intimacy all the way through the lifespan. For women in particular, it can be a time of assessing how sex has been and how they want to experience it going forward, and so sometimes menopause becomes a catalyst for growth and ongoing pleasure. (This is especially true if such a woman has a partner who wants to go on that journey of rediscovery with her, or who doesn't have a partner to object to those sorts of changes. This sort of thing brings many couples to therapy at midlife.)
The idea of our sex lives "naturally" ending at menopause is linked to some really damaging ideas—both personally and culturally:
It implies that reproduction is the sole function of sex (some would come dangerously close to saying the function of a woman herself).
It further implies that women aren't sexy and desirable as we age, and maybe we're not even sexual subjects—able to have and pursue our own ideas of pleasure (and everything else).
When we define sex as intercourse and declare that menopausal changes make intercourse problematic so it's just time to stop, we minimize two important things:
A focus on genital health and wellness
The fact that for many women intercourse is never the most pleasurable sexual option, at any point in the lifespan. Many, many women do not orgasm that way—or even get aroused enough to feel optimal pleasure from it. IMO this whole myth really reinforces that intercourse is THE sexual act we should be focusing on and minimizes all the varying ways that women (and everybody else) can receive pleasure.
Pleasure as Self-Care
Q: How can women reframe sexual wellness as a form of self-care, especially during the hormonal shifts of perimenopause?
Dr. Carol Queen: Well, it's always been a form of self-care, not that we get a lot of cultural info or mentoring about it unless we're quite fortunate. And many of the issues I discussed above stand in the way—though they can also open the door to the reframing you're asking about. Let me start here: The "what is sex for?" question wouldn't always be answered "for reproduction" by those who aren't reproducing types! But a lot of women I've spoken to—when I was young, and today as well—often think that sex is primarily for their male partners. Lots of women may say things like "He really needs it," "When he's satisfied our relationship is smoother," "I don't want him to have a reason to cheat"... and a classic workshop request at bachelorette parties is blowjob skills (I just did one a month ago).
So let me be clear: Sex is for everyone, at least for those who desire to have it. And some of the women who might be prone to leaving sex behind come to that point because they aren't getting what they could in terms of pleasure and connection from it. This doesn't inevitably add up to rejecting sex—it can instead mean adopting a self-care and wellbeing approach to it, an enquiry that can help us center our own experience (sometimes for the very first time in our lives).
This can look a lot of ways, depending on the person:
Reading and learning via workshops etc. about sexual wellness and pleasure
Speaking to professionals—a doctor who is knowledgeable about sex and menopause and comfortable about talking with you about it; a therapist who has info about sex and well as communicating about it in a relationship; maybe a pelvic floor therapist, depending on your issues
Enlisting your partner (if you have one who is willing) to go on a journey of exploration with you to see what kinds of things YOU like
Solo sex exploration and self-pleasuring, engaging in fantasy, reading erotic stories or audio erotica The explicit level of exploration isn't just about giving yourself pleasure or sexual ideas, though that can be valuable. It's to learn your body and its responses—including how they may be changing.
It's never too late for this, ever! But I want to say that some of us started the journey in college when we read Our Bodies Ourselves. That health book (and the organization and other books that grew from it) was always groundbreaking, and not the least because it frankly discussed and centered sexual health and pleasure. (I am affiliated with them today and couldn't be more proud to speak up for the work they have been doing for over 50 years. Without them, our landscape re: sex and wellbeing would probably look much different.)
Q: What role does desire play during this life stage, and how can women reignite or reconnect with it?
Dr. Carol Queen: Desire is a really powerful and motivating force. Our desires are our own, so they can also help us center our experience in a way that supports growth and exploration. The simple question "Am I getting what I want?" can lead us on life-changing journeys. So the first thing re: reigniting it is to take this question, and your experience, seriously. You might ease into it more easily (depending on your situation or history with sex) by recognizing your desires outside of an erotic context. Therapy can help, with the right provider.
And in erotic terms: Move that way with curiosity, self-acceptance, and solo at first, unless you have a truly supportive partner (but even then, partnered patterns can arise that might affect this enquiry—I think solo first helps with that). Solo can mean exploring erotica, masturbation, learning... and better understanding how desire and sex have showed up in your life before, if they have played a role.
Sometimes desire can be nudged awake by hormone therapies. Sometimes learning to give yourself an orgasm with a vibrator, or getting curious about erotic exploration, can do it.
It's worth your while.
Q: For women experiencing vaginal dryness, discomfort, or decreased libido, where should they start? What are some essential “tools in the toolbox”?
Dr. Carol Queen: Some of the things I referenced in question #4 are essential tools, but here's a list of attitudes, actions, and items that I'd consider essential for at least some women (and other people too!):
Stay aware of changes, as well as sources of stress (they may be linked to a degree, and if you are able to mitigate that stress, it couldn't hurt!)
Consider your comfort levels and communication ability re: any relationships
Be honest with yourself if any past experiences or attitudes are impeding to make things worse. Take that to a therapist or at least journal!
During sex, stay aware of arousal. Don't engage in penetration play until you're very turned on. (If you don't get very turned on? Do something else! Starting intercourse etc. without arousal makes things worse)
Also—LUBE! (But at midlife and beyond, with vaginal issues manifesting, it is not a substitute for arousal)
Choose at least one toy you can play with together with your partner, bonus if it can be used for clitoral stimulation during penetrative play
Stay curious and engaged about sex and your bodily changes. Share what you can with your partner
Be open to things you might want to explore
If you aren't already able to communicate comfortably with your partner, this is a must as your body changes
And if you haven't communicated with your doctor, do it (and find out if they are comfortable and knowledgeable about menopause-related questions. If they aren't, find a doc who is)
Product Guidance & Body Literacy
Q: Can you walk us through the difference between different types of lubes, and why it matters during perimenopause?
Dr. Carol Queen: Your vaginal tissue begins to get more sensitive during perimenopause and eventually (particularly without hormone supplementation) it begins to thin and will be less robust. This makes lube a must, but the increased sensitivity also means you might react to lubes (or specific ingredients) in a way you didn't in the past. This is why type of lube matters—and vaginal pH can be part of this too. If you can, try a few samples of varying types. You can read up on them if you like—but certainly listen to your body!
Most recommended: water-based lubes, which are also compatible with everything (condoms, silicone toys). Some are particularly well-thought-of for those in menopause or dealing with other vaginal health issues, like Sutil and Good Clean Love.
Many like hybrid lubes, which are creamy in texture—they have a bit of silicone in them, though they are primarily water-based. (In general, these lubes are okay to use with silicone toys.)
Silicone lube and oil-based lubes are both very slippery and many users love them (they're especially great for anal, if this is on your radar). If you are lubricating less on your own, though, you should know that these types of lube are a little more likely to cling to vaginal tissues and not be "rinsed out"* as readily with ordinary dscharge... so if you try these, stay aware of your comfort level. No silicone with silicone toys; no oil with latex; if you use an oil-based lube, make it plant-based oil, since mineral oil/petroleum products can be drying.
*Speaking of "rinsing"—NEVER douche, especially with store-bought chemical products. It is damaging.
You can also find lubes enhanced with CBD, and some users appreciate this extra ingredient, feeling it helps with comfort and relaxation.
Q: Cooling gels, vibrators, and pleasure tools are becoming more openly discussed. How can women explore these options with confidence, especially if they’re new to the space?
Dr. Carol Queen: Let me start by saying I'm not positive what you mean by "cooling gels." This isn't something I recommend, so if you can send over one or more brands of the kind of gel you're thinking of, I'd appreciate it. Any substance which cools (or numbs!) tissue might be actively problematic for some. Numbing agents: never.
Re: products to add to your sex life: these can be great, stimulating, fun, and informative as you explore. They can be great for partner play, enhancing communication and intimacy. (Unless your partner is grouchy about them! In that case, the partner also is way past the need to go on an informational journey.)
Find trusted sources of toys—obviously I will mention [suspicious link removed] and [suspicious link removed] here. Check review sites, comments, info pages, and other sources of informed POV.
Think about what kinds of experiences toys can potentially give you (vibration, insertion, anal exploration if the toy is anal-safe, and so on), think about what you want, and choose with that in mind.
Then explore solo 'til you have a good sense of how you like to use them and which ones might be worth sharing with partners (if you want to and that seems appropriate for you and that person).
Q: Do you recommend any rituals or routines that help reconnect women with their bodies and sensuality during this phase?
Dr. Carol Queen:
Mindfulness meditation; affirmations; solo play; dressing in ways that make you feel comfortable but also aware of your sensuality (silk panties! Or whatever it is for you).
Body oils or lotions that feel and smell great; healhful beverages that taste great and bring pleasure (because you want to stay hydrated, and if yummy mocktails help you do that, make 'em special!) (BTW Chardonnay is not a source of healthy hydration, sorry).
Also, explore erotic media and find what you like. Audio, video, photos, stories, novels—creators are out here making fantasies manifest to spark your own, so explore that if you are at all inclined.
Cultural Commentary & Next-Gen Advocacy
Q: Sexual wellness brands like Babeland and Good Vibes have helped normalize the conversation. What’s next in the evolution of pleasure-positive advocacy for women over 40?
Dr. Carol Queen: These are challenging times for sexuality—even post-menopause, when an individual woman might feel she no longer personally has a dog in the reproductive choice race, there is still a push to make women's lives more traditional, which by definition may limit our roles and rights. So we must stay aware, but also stay connected and communicate about sexuality and sexual health—for ourselves and our partners as we age, for our kids, for others in our communities. More women who care about these issues are running for office! There will be opportunities to advance this conversation very intimately and on a societal level. Soon, the first menopause guide for non-binary people will be released! (By Northern CA author LaSara Firefox Allen.)
The next stage, beyond this sociocultural part, will be more info about the different ways different women and AFAB people (and everybody else!) are a diverse group with varying experiences of sexuality and bodily pleasure. This has started, but it's still considered to be more about varying orientations and such; it's important to question the idea of "normalcy," which is so simplistic and ignores how people might like different kinds of touch and literally everything about sex!
Q: What do you wish every woman in midlife knew about her body, her pleasure, and her power?
Dr. Carol Queen: I wish her to know that she has probably been ill-served by the information she's been given and very possibly the expectations placed on her, but that she deserves pleasure that works for her, and she can learn more and explore... for the rest of her life! Everyone has at least a little bit of experience with fluidity and change over the lifespan; this is her time to tune in and imagine what she wants the rest of her life to be.
Q: Finally, what are three things every woman in perimenopause should have in her pleasure toolkit?
Dr. Carol Queen:
The lubricant she likes best.
A vibrator or other toy that helps her achieve higher arousal and more pleasure.
As much info as possible about her own sources of pleasure. This info and perspective can help guide her onward, whether she is solo or partnered.
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