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sex education

Why am I so happy to be the Radical Sexologist?

What is radical sexuality and why is it essential for lasting sexual freedom and resilience?  Ultimately, I believe that people who have created their most authentic sex lives are living by a set of principles that are universally nourishing for sexual expression, relational presence, and a passionate existence.

I’ve pulled all of these principles and practices together into one place, simplified, streamlined so that you can take radical action and create the sex life you have always wanted.

Now I know that when I say radical sexuality, some of your minds might run wild, imagining all the sex acts that I could possibly be referring to.  Awesome!  I love helping people imagine fantastical sexual experiences.  I hope that your mind went to something really arousing and sexy!

For some of you though the idea of wild sexual acts is not your cup of tea and in fact Big Overt Sexuality shuts you down.  Well, I am glad you are here too.  You are in exactly the right place!

Because radical sexuality is about so much more than particular sex acts, in fact in has very little to do with what you choose to do in bed.

So, what is Radical Sexuality?

Radical Sexuality is a practice based on a few radical notions about sex:

  • Pleasure is a guide to a deep, resilient health for ourself and the planet
  • Sexuality is deeply integrated into every aspect of our being
  • Radical sexual authenticity and pleasure activism can change the world

So Radical Sexuality is on the one hand radical because it is REVOLUTIONARY, it’s on a mission.  I believe it’s part of our fundamental guidance system, it’s a north star of human consciousness.

Radical sexuality wants to change the world, to create the better world our hearts desire.

Radical Sexuality also believes a few radical notions about you:

  • Your sexual self is whole and perfect right now just as you are
  • You can create the authentic sex life you always dreamed of

Radical Sexuality is available in all of us and yet we all know there are things that get in the way.  These are not your personal failings.  The barriers to authentic sexual expression originate in our family and cultural systems, these barriers are done to us, not something inherent to our being.  And you can overcome them with the right support. 

Radical Sexuality can bring us back into ourselves, by healing the many wounds inflicted on us or that deflect us from our true radiance.

But in order to meet this force within us, we have get a little radical ourselves.

We need to get radical in the sense of getting to the ROOT CAUSE, going all the way to the bottom so that you can manifest your sexual birthright.  This is where the science meets the woo, where the mind body connection is explored, developed, enhanced.


Radical Sexual AWARENESS

            Becoming aware of what is driving your sexuality and what is holding you back

            Taking a deep dive – mind and body, past and present

Focused, supported exploration

Radical Sexual ACCEPTANCE

            Building capacity for presence and acceptance of your sexual self

Creating a strong ground from which to offer loving kindness to all parts of yourself

Radical Sexual ACTION

            Taking chances, stepping into the unknown

            Meeting awkwardness and shame with courage and humor

Moving messily forward to learn more about yourself

Radical Sexual ATTUNEMENT

            Integrating knowledge with experience, adjusting course as needed

            Finding your flow


Knowing who you are and how to manifest yourself in flow sexually

Bringing this deep wisdom to every aspect of your life

It’s time for your sex life to evolve, it’s time for Radical Sexuality!


This practice is radical because it believes sexual energy is  FUNDAMENTAL to health, INHERENT to the powerful energy at the center of your being.

This practice is radical because it a HOLISTIC, COMPREHENSIVE approach to restoring sexual wholeness and authenticity.

This practice is radical because it challenges you to take BOLD action towards personal REVOLUTION.

This practice is radical because it is ICONOCLASTIC, open and willing to receive wisdom from any source but not constrained by any belief system

This practice is radical because it is CUTTING EDGE and at the FOREFRONT of what is known about living a deeply integrated sexual life.

This practice is radical because it believes good sex can CHANGE THE WORLD.

Wanna get a little more radical? Book a free consult; let’s chat!

What’s so radical about radical sexuality?

Sex counseling
A woman wondering what sex professionals do

Where should you turn when you have a problem?

Knowing who to turn to when you are looking for support with your sexuality can be complex.  Most likely, if you have had health problems in the past, you simply went to your primary care doctor or maybe you saw a specialist such as a gynecologist or gastroenterologist.  

Maybe you are a little skeptical of western medicine and have sought out chiropractors or naturopathic doctors instead.  

If your health problem has been more emotional, psychological or mood-related, perhaps you have sought out a social worker, therapist or psychiatrist for support.

But can these same resources help you with your sexuality?  Maybe, but likely not.  Providers trained in western medicine get woefully little education about sexuality (see previous blog post).  Even gynecologists and urologists often don’t have much more education or interest in the nuances of sexuality.  Practitioners trained to provide more holistic or integrative care also don’t typically have such training.  Though it may surprise you, neither do therapists!


Standard American medicine and therapy has not tended to address sexuality in any meaningful way other than to pathologize it or to offer ways to avoid the deadly harms of sex, like STIs and pregnancy.  But if you have ever had sex before, you may know that there is more to it than that.

In the past few decades, there has been an explosion in the number of folks available to help you with your sex life.  Some are trained professionally in an academic model, some have worked in an apprenticeship model, others have little training but lots of hutzpah.  Most of these folks offer support through medications or through talk therapy, but others will get naked with you and engage in therapeutic intimate touch.

How are you to make sense of this landscape and find the kind of personalized support you need?


Certified Sex Counselor: Sex counselors have a back ground in a helping profession such as nursing, medicine, clergy, or physical therapy and have thousands of hours of training and supervised experience to specialize in sexuality.  After a rigorous training process, they are certified through the American Association Sex Educators, Counselors and Therapists (AASECT). Counselors practice in a variety of ways consistent with their background and personal philosophy.  Sex counselors often are solution focused and engage in short term counseling.  As a sex counselor, I am grounded in my background as a nurse practitioner and licensed to provide holistic medical care.  With the support of extensive additional training in sex counseling, I can also seamlessly integrate therapeutic counseling strategies to truly provide holistic support for the physical, emotional, psychological, and spiritual aspects of sexuality.  You can learn more about my background and training here. Sex counselors do not engage in intimate touch.

Certified Sex Therapist: A sex therapist has a background in a mental health discipline such as social work, marriage and family therapy, mental health counseling, psychology, psychiatry, etc.  They too have undergone rigorous additional training to become specialists in sexuality and are certified through AASECT.  Sex therapists can do both short and longer-term therapy.  The work of sex counselors and sex therapists can overlap and there is not an absolute defining line between them. However, sex therapists tend to work with clients and couples who have chronic or complicated mental health issues in addition to sexuality concerns.  Sex therapists do not engage in intimate touch. 

Certified Sex Educator: As the name suggests, sex educators are trained to provide education to individuals, couples and groups about sexuality. Given the state of sex education for our young people in America, so much of the support that is needed within sexuality comes down to the need for excellent information about the many domains related to sex including anatomy, physiology, gender identity, sexual development, consent etc.  Sex educators can work in school settings or they may work privately providing public classes.  They may also offer one-on-one sex education as well.  Certified Sex Educators do not engage in intimate touch.

Somatic Sexologist/Sexological Bodyworker: Somatic sexology and sexological bodywork are two of the disciplines that do engage in intimate touch.  These practitioners support clients to  engage deeply with the body through breath, movement, sound and touch.  Often these practitioners are connected to the long traditions of Tantric or Taoist philosophy and sexuality.   Somatic bodyworkers and sexologists are trained to a high ethical standard and code of conduct in order to effectively and compassionately engage in body-to-body contact when it is appropriate.  Certification is available for these practitioners as well through the Institute for Somatic Sexology.

Sex Coach: In truth the title sex coach can mean just about anything.  Some are highly trained professionals who have chosen to offer coaching as a way to expand their ability to engage with clients in less restrictive ways than their licensure requires.  Others have trained specifically in sex coaching with experienced coaches.  Some may have no significant training at all, but simply have a deep passion for the work.  Sex coaches can be certified by a variety of groups.  Sex coaches do not typically engage in intimate touch.  A great example of certification in sex coaching is the Somatica Institute.


It is helpful to have some sense of what these five broad categories of sex specialists are all about.  But as you may have noticed, many of them overlap and most of them are not well defined at all.  Ultimately, there is probably just as much heterogeneity within each category as there is between them.  So, do these categories even mean anything? 

Unfortunately, even if these categories were clearly defined, the fact is that there is no certification required to use any of these titles.  

Maybe it would be helpful if there were stricter criteria for use of these titles.  However, this would likely vary state to state and would likely remain just as confusing, only more regulated (perhaps not helpfully so).


So, what are you to do?  Here are some tips on how to find the right sex specialists for your needs:

1. Check out the big organizations.  Not sure where to start to find a sexuality professional?  One good option is to check out the websites of the national organizations in sexuality.  Most of them have a “Find a Professional” link where you can see practitioner who are associated with the organization.  Here are a few:

American Association of Sex Educators, Counselors and Therapists (AASECT)

International Society for the Study of Women’s Sexual Health (ISSWSH)

Somatica Institute

Institute of Somatic Sexology

Association of Certified Sexological Bodyworkers

International Pelvic Pain Society

2.  Check the Bio.  Found someone you might want to work with? Check out the person’s training and certifications in their biography from their website.  Many people will spend a lot of time in their bio telling you their personal story and why they got into sexuality work.  This can be important when you are evaluating your felt connection to them (see below) but do take a minute to look at what type of training they have done, how long they have been in practice, and what specific certifications in sexuality they may hold.  Sexuality is a complex biopsychosocial phenomenon; training and experience are essential to providing effective support.  If you don’t recognize the training they had, look it up, see what vibe you get.  Does it look legitimate?

3. Check out their services and philosophy. Given that there is so much variability in how people practice within each type of sexuality profession, you can’t rely on their title alone to define what to expect.  Read through the services they offer.  Read about their philosophy and how they describe their work.  Do they work with individuals or couples?  Can they prescribe medications or do a physical exam?  Do they offer intimate touch?  Do they have a special niche in their practice?  Do you see yourself and your issues represented on their website?  Does their way of describing the problem and importantly the ways to work towards resolution of the problem resonate with you?   If you aren’t sure after looking over their website, reach out to them and arrange for time to talk.

4.  Check your Spidey Sense. Do you feel a connection to this person? What is it based on? Take a moment, take a breath, check inside.  Do they feel safe? Do they feel trustworthy? Can you get a felt sense of their compassion and competence?  Intuition is a good indicator that you should trust, but you should also verify.  It may take meeting them for an appointment to better determine if it is a good fit to go forward.  Ultimately, the relationship that you build with your sex specialist is one of the most important factors in determining whether your work with them will be supportive to you and successful.  

5. Check out if you need to.  Don’t be afraid to discontinue work with someone if it is not the right fit.  Life is short! You deserve to work with someone who is right for you, right now, just as you are.  If you do not feel supported, move on.  But don’t give up, your sexuality is important and you deserve to work with someone who respects you, who honors your journey and who you can resonate with. 

Here is my shameless plug for sex counseling!  Since sex counselors have a broad background they are a great place to start.  Sex counselors can offer support in a wide range of sex related concerns, many can offer examination, diagnosis and treatment – in addition to education and counseling.   Sex counselors can connect with you where you are right now and help you navigate the wide world of professional sexual support when needed.   


Sex counseling

Lubrication.  What a wonderful thing.

It reduces friction when body parts rub together. It makes sex comfortable.  Heck, it makes it more than comfortable, it makes sex pleasurable!

Many women* feel very proud of the amount of lubrication they create when aroused.  For some it is a sign of their femininity. For others it expresses something about their sexual vitality.  This external sign of sexual arousal can also be arousing in and of itself.  Feeling wet can tell the mind what the body is feeling, helping the mind find its way to deeper arousal.  

But becoming wet or producing lubrication is not the most reliable indicator of sexual arousal.  

Emily Nagoski makes this point in her book, Come As You Are, when she explains about arousal non concordance.  This just means that sometimes that body gets turned on, but it’s just a physiological reaction to sexual things, not an actual reflection that the person thinks something is sexy.  In terms of lubrication, this can mean that the vulva is wet but the person is not turned on.

It is also the case that women can be turned on and not produce lubrication.

Every woman’s body is unique and the amount of lubrication a woman produces varies.  For many women, vaginal lubrication naturally occurs when aroused, but not always. 

Women often carry some shame if they are not able to become wet with stimulation. 

However, lack of lubrication shouldn’t necessarily be taken to mean there is a problem – in the sexual relationship or with a woman’s body.  All kinds of things effect lubrication.  

The ability to lubricate is a lovely thing but it is not the be all and end all of women’s sexuality.  Just as it is a good idea to not focus on a man’s erection as a sign of his “virility”,  it’s also not a great idea to focus solely on wetness as a sign of woman’s readiness or “feminine power”.  

Just as men have more to contribute to sex than a hard penis, women have more to contribute than a wet vagina.  

So, what is a person to do when they can’t always rely on the body to produce lubrication?  

Rather than fretting about natural lubrication, I recommend that all vulva owners use really good lubricants to take the pressure off of the body to respond in any particular way and to simply increase pleasure.   Viva la lubricant!

Lubricants increase pleasure, right from the very start of sexual play.  Vulvas, clitorises, and vaginas love slipperiness.  By applying lubricant at the start of genital play, you have kick-started pleasure in to high gear right from the beginning.  

This can increase natural lubrication.  Excellent!

And if natural lubrication isn’t available, then a great lubricant can continue to facilitate pleasure throughout sexual play.  Wonderful!

Lubricants aren’t just great for vaginal play.  They are an absolute necessity for anal play.  But for goodness sake, where aren’t they helpful?  Elbow play? Yes, please.  Armpits? Knees? Breasts?  Toes? Bring it on. 

Seems like a simple formula: Lubricants + Sexy Playtime = More Pleasure

There is no shame in the lubricant game!


Many people have used a lubricant at one time or another.  

You may have picked up a name brand lubricant at the drug store or in the grocery aisles.  Brands like KYJelly and Astroglide are some of the most commonly used.

You may have just used whatever your partner had at the bedside and not thought much of it.  

But lubricants matter.  This is because YOU matter.  Taking the time to find a lubricant that meets your specific needs can go a long way to leveling up your sex life and even improving vaginal health.  

But not all lubricants are created equally.  So, what should you look for?

What you need in a lubricant is one that is super slippery and ALSO healthy for vulvovaginal tissue.  Seems pretty straightforward.  

Other considerations can include:  Is this lubricant ok to use with a condom?  Will it stain my sheets?  Maybe taste is a consideration?

How is a busy person to figure this out?

Believe it or not, there are lubricant nerds!  People who have thought long and hard about lubricant composition and quality.  You can benefit from their hardwork and research.

First, let’s consider lubricants in terms of slipperiness and ease of use during sex with condoms and sex toys.

There are many different types of lubricants but they generally fall into three broad categories: water-based, silicone-based, and oil-based.  

Water Based: Water-based lubricants are most commonly used but they aren’t usually the slipperiest choice.   They are, however, safe to use with vibrators, sex toys, and condoms.  They are easy to clean up and are available in a wide variety of consistencies, from thin liquids to thick gels.  The one problem with water-based lubricants is that they tend to dry up quickly and may need reapplication or a few drops of water or saliva to keep them slippery.  A fun fact, aloe vera gel straight from the plant is one example of a safe, natural water-based lubricant and is a component of many good commercial lubricants as well. Good Clean Love is a great option.  

Silicone-based: Silicone-based lubricants remain slippery longer than water-based ones.  They are often the best lubricant for women with dry or irritated skin.  They are regarded as hypoallergenic since they do not soak into skin and do not use preservatives.  They only real down side is that they can be a bit more expensive and cannot be used with silicone sex toys. However, they can be used with latex condoms and sex toys not made of silicone.  A great option is Uberlube.

Oil-based lubricants: Oil based lubricants hydrate tissues and last longer than water-based lubricants.  However, they are not compatible with condoms.  The beauty of a product like coconut oil is that it is cheap and easy to find.  Many women may also prefer it as it is a more “natural” product without potentially irritating chemical ingredients. There is some controversy over the safety of oil-based lubricants but the fact is that there is no good research to confirm oil-based lubricants are problematic and many women highly enjoy them.  Some people argue that they may predispose women to recurrent infections such as bacterial vaginosis or yeast.  You may want to avoid oils if you have a history of these types of infections.  Only plant-based lubricants are recommended for use as a personal lubricant; I recommend coconut oil.  Petroleum-based oils like Vaseline can breed bacteria and should not be used internally.

Tips for using coconut oil: Opt for an unrefined coconut oil product.  Spoon it into quarter size balls and place in a container in the freezer.  This can make it easy to use, avoids contamination and the cool temperature can be very soothing.  

Hybrid: Hybrid lubricants are a combination of water and silicone lubricants.  They last longer than water-based lubricants but not as long as silicone-based lubricants.  They are compatible with safer sex barrier methods and most sex toy materials.  However, some hydrid lubricants are not compatible with silicone sex toys. One good option is Sliquid.

Ok, this is a lot of information.  But never fear, I have created a handy-dandy one page resource that summarizes all of this and suggests some good brands for you.

There are four different types of lubricants.  But importantly, you don’t have to pick just one!  

Maybe you want a water-based lubricant for sex with condoms or your sex toys.  But you end up deciding an oil-based or silicone lubricant is better for skin to skin contact because of its maximal friction reduction and pleasure production.  

How do you know which brands are best?

Some lubricants have ingredients that aren’t great for vaginas such as parabens, glycerin, chlorhexidine, mineral oil, petroleum, and propylene glycol.  Products containing these substances are out in my book.

Some have qualities that actually dry out the tissues of the vagina (due to their osmolality if we wanna get nerdy) or can change the vaginal microbiome (due to their pH).  Ultimately, you want a product that matches the environment of the vagina and is most like your natural lubrication or else there are likely to be problems like irritation etc.   

Another thing to avoid would be “warming” or “arousing” gels.  I mean, what’s in that anyway and do you really want it in your vagina?  These are likely to contribute to irritation and infection.  

So that covers some ideas that come up around the healthiness of a lubricants.  The problem is that manufacturers don’t often include all the information you need to know on their packaging.  

Never fear!  The World Health Organization has got your back!

Yes, the WHO did women everywhere a huge solid by doing extensive research on lubricants and providing a handy dandy guide to their various qualities.  Of note, the WHO was worried that bad lubricants could cause tissue damage and increase the likelihood of contracting sexually transmitted infections, more food for thought.


All women can benefit from use the lubricants at least some of the time ( I advocate all of the time!).  

Though you may see moisturizers mixed in with lubricants in the “personal hygiene” section of your local store, moisturizers are a different product and have a different purpose.

Moisturizers are used to provide long term relief of vaginal dryness, usually for women who are post-menopausal.  These can also be helpful for women any time they have low estrogen for whatever reason.  For more on why low estrogen can be a problem for vulvas, see this article.

Moisturizers work much like the lotions used on other parts of the body.  They hold water in place to prevent the tissues from becoming dehydrated and dry.  

Unlike lubricants, which are used as needed for sexual play, moisturizers are used routinely, usually about 3-5 times a week, to provide continuous hydration.

Like lubricants, not all moisturizers are created equally.

A good moisturizer will have qualities like that of the vaginal tissues (the right pH and osmolality) and will not have any irritating ingredients. 

Though stores are carrying moisturizers more often these days, good moisturizers are often only sold online.   

One ingredient that has been getting a lot of research and attention recently is hyaluronic acid.  You may have heard of it as the go-to ingredient in serums and moisturizers for the face.  Well, it is also being shown to be equally helpful for the vulvovaginal tissues.  

Good moisturizer brands to consider are Hyalo Gyn ,Ah! Yes or Good Clean Love’s Moisturizing Vaginal Gel

For more information on how to keep postmenopausal vulvas happy and healthy, please check out Five Things You Can Do to Have Pain Free Sex After Menopause.

Bringing Lubricants into the Bedroom

Lubricants are the OG sex aide!  

Maybe you are fine with the idea of using lubricants but are here to just find a better one.  Awesome!  Use these recommendations to find a few that are perfect for you! 

But maybe you are feeling a little embarrassed about this whole thing?  Maybe you feel a bit uncomfortable reaching for a lubricant during sex?

No problem.  

First, you don’t have to use lubricants.  But if a part of you is interested–even though other parts are running in the other direction…

Maybe a little exploration with “friction reduction” can make lubricants less intimidating.  

The truth is that lubrication is enormously helpful in making any skin to skin contact more pleasurable.  

Maybe try this with your partner.  Start by caressing each other’s hands.  Just exploring touching each other’s hands in a pleasurable way.  Next, apply lotion or massage oil to your hands.  Resume your exploration.  Notice anything different?   Maybe the touch feels better? More arousing?

Maybe try out how this “friction reduction” feels on other body parts.  How does it feel to your partner? 

Consider that sexual lubricants are just like the lotion or massage oil you may be using on other body parts.  It’s just that sexual lubricants are made to be safe for your vulva.  

Maybe the packaging of the products is too “sexy” for you?  Too embarrassing?  Well, then consider something simple like a little bit of coconut oil.  Try it on other body parts, make it part of a massage perhaps.  Then see if also reaching for it during sex seems less intimidating.  


 Lubricants are really a win-win for everybody during sex.  Find good products that work for you and know that you are fully empowered by me to use them every time.  

Viva la lubricant!  Viva la pleasure!

*In this article, the term “woman” or “women” will refer to people that are born with a vulva and vagina. As we know, there are women who are not born with this genitalia and other genders who do have a vulva and vagina. Language is somewhat inept in its ability to elegantly capture this beautiful complexity. I encourage you to use the information in this article as it applies to you or your loved ones.

Viva La Lubricant!  Superpower your Pleasure

Pain with sex
A woman wondering what sex professionals do

What is the most common complaint of women* in my office?

Sex hurts.

What is the most common reason that women have pain with sex?


What is the most common reason that I get frustrated and enraged on a daily basis?

Untreated pain with menopause!

Up to 87% of women will experience pain with sex after menopause.  Basically, most women are gonna feel this change, whether it affects their sex life or not.  But most women seem to have never heard anything about this.  

Why is menopause such a problem for women’s sex lives? The vulva, clitoris, are vagina are all dependent on estrogen.  Estrogen causes these tissues to develop in puberty and is necessary to maintain vulvovaginal health. 

Menopause means the end of the menstrual cycle and therefore the end of estrogen. 

No estrogen = mo’ vulvovaginal problems. 

If you still have your period, maybe you won’t have any issues at all at menopause, some women don’t.  If you are in menopause already, maybe you feel fine.   

But these changes (called genitourinary syndrome of menopause to be precise) are something you should know about, because it explains a lot about how the vulva and vagina works.  It’s also important because the changes that start at menopause can get worse over time.  

I lay out the whys and wherefores of the effects of estrogen or the lack thereof on the vulva, vagina and clitoris here.

This may all sound a bit dire.  But the real problem with these menopausal changes is only that people don’t know about it.  Because, for the most part, treatment is straightforward.

Let’s review the 5 tips for pain free sex after menopause.

Tip 1: Get an exam

While hormonal changes are the most common cause of pain with sex after menopause, they aren’t the only ones.  

It’s a good idea to have someone examine your vulva and vagina to rule out other causes of pain.  

I don’t recommend an exam lightly.  I am well aware that the medical establishment doesn’t have a record of treating women all that well during genital exams.  It’s a common source of trauma for women.  

If I were in charge, I would decree that all women should have access to qualified and compassionate medical providers.  Every exam would be trauma-informed (link to trauma informed exam info), meaning that the patient’s experience would be the guide, not provider convenience.  And while we are at, no one shall be asked to have an important conversation while in a paper gown with their butt hanging out!  And no more stirrups!  

Until my queendom begins, I hope that you can find an excellent provider to help you with an exam and support you in working with any sexual pain that you may have.  If you live near me, come on in for an appointment (link to booking a consult)!  Finding a provider that is listed on this website or this website would be a great place to start.  

Your local gynecologist or primary care provider may also do a great job.  But if you don’t feel comfortable during your exam in any way, I encourage you to let your provider know.  If that doesn’t feel possible for you, seek out someone else to work with.  There are great folks out there and you deserve to feel supported during this essential exam.

Tip 2: To use hormones or not to use hormones

Since loss of estrogen is often the only cause of pain with sex after menopause, it would stand to reason that replacing this lost estrogen would be the most effective treatment.  And it is. 

Fortunately, there are several hormonal options available.  The most frequently prescribed one is local vaginal estradiol.  Estrogen actually refers to three hormones that the body makes, estradiol, estrone and estriol.  Estradiol is one of the these and is the most abundant and most potent one the body makes. Local vaginal estradiol products come in the form of creams, tablets, ovules and rings.  

If you like working with integrative or alternative practitioners, you will find that they are more likely to prescribe estriol for GSM.  This is also one of the three estrogens that the body makes, but it is much more rare in the body and also a very weak estrogen.  The reasoning for the use of estriol is that it is safer because it is a weaker estrogen.  It is also thought to be safer because it only attaches to receptors in the vulvovaginal tissue and not breast tissue, theoretically leading to decrease risk of activating breast cancer.  Overall, estriol seems safe and effective but there much fewer studies on estriol compared to estradiol.  Estriol is also only available from a compounding pharmacy; depending on how you feel about compounding, this is either a pro or a con.  

Another effective hormonal option is DHEA  suppositories (prasterone).  DHEA is a hormone that the body makes that is a precursor to the three types of estrogen.  The cells of the vulvovaginal tissue can convert DHEA to an estrogen.   They can also convert DHEA to testosterone, which may make it work better for some women (link to article about why sex hurts after menopause).

An older product, Premarin, is still on the market.  It is a conjugated equine estrogen.  Yes, equine – made from the urine of female horses.  This was the way that estrogen was first produced for women.  Though it is effective it does contain lots of other horse hormones that may not be every woman’s cup tea.  That being said, the product has been around for decades and is safe based on the research.

Lots of choices out there!

But maybe you are wondering, “Hey Lori! I heard these hormones aren’t safe!!  Are you trying to kill me or what??”  

I got you!  I hear this all the time from women.  And women have good reason to think these treatments may not be safe because there is a lot of misinformation out there, even coming straight from the FDA.  

Yes, these hormones are safe – maybe even for women with a history of breast cancer.  If you doubt me, check out this post for more information.

But even if you decide that hormones aren’t right for you, you can still get relief with non-hormonal options, namely moisturizers.  Moisturizers are like the lotion that you put on the rest of your body.  And just like on the rest of your body, vaginal moisturizers can plump the tissues and increase moisture. 

There is actually some good new data that moisturizers can work just as well as estradiol for decreasing symptoms related to genitourinary syndrome of menopause (let’s just call it GSM). 

So, if you can’t get on board with hormones for whatever reason, use a good vaginal moisturizer 3-5 times a week. Check out this article for more information. 

Whatever treatment you decide on, choosing the right product for you can be a bit of a process of trial and error.  Each product has its own pros and cons in terms of dosing, effectiveness, packaging etc.  

Cost is a big thing to consider.  Moisturizers cost about $20-$40 a month.  Hormonal treatments are often cheaper if you have Insurance coverage.  But each company covers these medications differently and never in a predictable manner.  Women without insurance may have a hard time affording them at all (that’s a whole other thing worth ranting about! If men had this kind of trouble with their penis, testosterone would be available for free in every bathroom in America!)

The goal with treatment for GSM is to find what works for you and stick with it.  Unfortunately, the changes that happen after menopause are chronic and progressive.  These symptoms don’t go away without treatment.  

Care of the vulvovaginal tissue should become part of your routine self-care after menopause.  Brush your teeth, floss, use sunscreen…do something to take care of your vulva and vagina to keep things happy and healthy.

Tip 3: Use an awesome lubricant every time!

Hormonal treatments or moisturizers used a few times a week are the backbone of treatment for GSM.  

But the next best way to decrease pain with sex and INCREASE PLEASURE is to use a great lubricant every single time for sexual play.  

The number one reason anyone has pain with sexual penetration of any kind is simply related to friction.  Dry fingers or toys or penises dragging against delicate vulovaginal tissue is gonna hurt.  And at no time is this more true than after menopause.

Women often feel some shame around the use of lubricants and I think we just have to blow this whole idea out of the water.  There is nothing wrong with you if you want to use a lubricant, it’s the most basic and probably the most essential aide to sexual pleasure out there. 

I strongly recommend that you take some time to pick out a couple of lubricants that you love. As a quick and easy recommendation, silicone (uberlube) or oil-based lubricants (coconut oil) work well for menopausal women.  Check out this article for more information.  

Tip #4: Keep if flexible

The loss of estrogen at menopause (or any other time) causes the vulvovaginal tissue to become tighter and stiffer.  The opening of the vagina be a particular problem because even subtle loss in flexibility here can make penetrative sex very painful.  

Applying moisturizers or local hormonal treatments can go a long way towards hydrating and loosening up the tissues.  But these tissues also need to be mobilized,  just like every other part of your body.  

What, you may ask, are good ways to mobilize the vulvovaginal tissues?

Well, my friend.  Let your imagination be your guide!  

The goal would be to engage in some sort of regular vaginal penetration, hopefully of the pleasurable variety when possible.  You can do this alone or with a partner.  It can be approached like a type of physical therapy but I think adding in pleasure improves vulvovaginal health even more and is also….well, pleasurable!  

If you do not have bothersome symptoms, there is no need to purchase any special equipment.  However, some women may pain and restriction at the opening of the vagina who cannot tolerate penetration well may benefit from using dilators.  Dilators are cylinder shaped and come in varying sizes.  They are used to slowly help release the opening of the vagina and increase flexibility.   

How often should you do this?  There is no strict consensus on this.  It also depends on whether you currently have pain or are just hoping to maintain vaginal health.  

If you are having trouble with pain with sex, especially if you are unable to tolerate penetration at all, I would strongly recommend that you find a good pelvic floor physical therapist.  Did I say strongly recommend?  I mean really, really strongly recommend!  For more information about why pelvic PT can be essential for overcoming painful sex, check out this article.

Tip # 5: Keep the focus on PLEASURE

When pain becomes a problem, either in actuality or as something you may be anticipating as part of menopause now, it is easy to lose sight of the fact that, no matter what, pleasure is also always possible.  

Your body is built for pleasure.  Even when there are changes to the body and mind which lead to pain.  Pleasure is still always available to you.

In many ways, I view pleasure as an antidote to pain.  

In the most literal sense, sexual pleasure does heal the tissues of the vulva and vagina.  Sexual pleasure leads to arousal.  Arousal increases blood flow, this is how clitorises (and penises) swell and become erect when you get turned on.  

Improved blood flow heals tissue by bringing oxygen to tissues and taking away waste products.  Think of how wounds need good blood flow to heal, for instance.   

So, arousal is great for healing the vulvovaginal tissue.  Another way to augment blood flow is to add vibration into the mix (yes, that kind of vibration!) to increase arousal and even further increase blood flow.    And bonus!  You can get a vibrator that you can also use to mobilize those vaginal tissues with regular penetration.  I love efficiency! ☺

But pleasure doesn’t just heal the body but it also heals the mind.  Pleasure, joy, comfort, intimacy – these are the basic resources of life. Your whole body, all your five senses, have the capacity to bring in this pleasure if only you take the time to tune into it.  Sexual pleasure is one form of this sensual pleasure that connects us to our fundamental selves and to our partners.  Leaning into sexual pleasure even when there may also be sexual pain helps to maintain this connection and provides much needed refuge.

Sex is after all about pleasure – so regardless of the ability to tolerate penetration – that pleasure is still possible.

Lean into pleasure as much as possible as often as possible.  I give you full permission.  Don’t believe me, well…then here is a prescription to make it official.


The sad truth is that all of this should be common knowledge.  But women tell me all the time that they have never heard this story.  Maybe the same is true for you.

The unnecessary suffering causes is unacceptable as far as I am concerned.  

If any of this this is news to you, I’m glad you found it. Pass it on. Tell anyone who needs to know. 

Here’s to women living long, happy sex lives without pain!

* *In this article, the term “woman” or “women” will refer to people that are born with a vulva and vagina. As we know, there are women who are not born with this genitalia and other genders who do have a vulva and vagina. Language is somewhat inept in its ability to elegantly capture this beautiful complexity. I encourage you to use the information in this article as it applies to you or your loved ones.


Pain with sex