Yes, Virginia, There Is Female Viagra
Yes, Virginia, There Is Female Viagra
It’s safe, it’s simple, it works, and it’s been around since the 1970s. So why aren’t we screaming about this?
In January, I came across a study in the journal Menopause that claimed that sexually active older women are more resilient. No, duh, I thought. But I was also thrilled to see that someone had actually gathered raw data to prove what many of us in middle age already sense in our guts (and brains and vulvas), even if no one wants to think about post-reproductive women having sex.
But hello! We are! In fact, approximately 85% of us who are still sexually active in middle age remain so well into our 70s, and the sex we’re having is measurably better, because we’re no longer afraid to ask for what we want or to claim our inalienable right to it.
I turned 56 two weeks ago. I became sexually active at 16. During the four intervening decades, the longest I’ve gone without sex were the eight months after my two-decade marriage broke up in 2013, when I was a) solo parenting; and b) had no idea how to find sex again, let alone how to act on those findings. Enter dating apps, whose meteoric rise magically coincided with my sudden need for them. And I don’t use that word—need—lightly.
Yes, a large bell curve of human behavior exists when it comes to female sexual desire and frequency, but most of us fall somewhere in the middle: our bodies need sex the same way we need food, sleep, air, and water. Sex produces endorphins and regulates our bodies with a release of the soothing “love hormone,” oxytocin. It lowers our blood pressure, improves sleep, eases stress…the list goes on and on. (For more on the benefits—and societal hurdles—of sex, watch Netflix’s new limited docuseries, Pleasure, which I really enjoyed.)
At the same time, we Americans have been marinating in (nay, pickled by) a puritanical bias that has consistently told us that sex is dirty, dangerous, and to be avoided altogether. Sex, we are told, is for making babies after marriage. Everything else outside of that narrow reproductive definition is icky, indulgent, or a sin. (Except if you’re male, of course. Then it’s: here’s your $97 billion dollar mostly misogynist and heteronormative porn industry, enjoy!)
Not surprisingly, conservative states’ insistence upon abstinence-only sex education has lead to dramatically higher teen birth rates. America’s lack of universal healthcare puts the cost of birth control out of reach for many young women and girls, and don’t even get me started on what Texas and Oklahoma are doing to abortion. Meanwhile, Denmark, which has a comprehensive sex ed program promoting consent and pleasure while also stressing the importance of love in relationships—can you imagine? sigh—now has so few unintended births that, instead of teaching kids how not to get pregnant, the Danish government has been encouraging its younger citizens to get cracking in the bedroom already, in order to replace its shrinking population.
Because our society not only allows older men to be sexy (see: George Clooney) but also encourages them to keep having sex—albeit with younger women—well into middle age (see: Bond, James Bond
), the accidental discovery of sildenafil’s secret powers to combat erectile dysfunction means all of us now get to see cheeky Viagra ads everywhere.
The compound was originally developed by Pfizer to treat hypertension and angina. Fun fact: researchers also discovered that Viagra could eliminate period cramps for up to four hours without any side effects whatsoever, but they couldn’t expand that part of their study, because the all-male panel at the NIH did not see dysmenorrhea as a real issue worthy of research dollars. Still, one wonders why Pfizer would not want to tap into a potentially lucrative market. Maybe they couldn’t come up with an idea for the billboard? Or maybe the mixed metaphor was too much for one drug: hardened penises and softened shedding uteri are not exactly a Clio-winning match made in Reese’s Peanut Butter Cup heaven.
If Hollywood’s portrayal of older women is any indication—and I would argue Hollywood’s portrayal often defines societal norms—we women stop having sex around 40. Definitely by 50. Or rather, if we are having sex after 40, no one wants to see it on a screen let alone think about the mechanics and challenges of our aging, thinning vaginal tissue. Not even our primary care physicians are talking to us about our sexual health and wellbeing, or at least not in the same way they talk to their aging male patients and prescribe them Viagra.
As many of my readers here already know, I am a loud proponent and consumer of menopausal hormone therapy (aka MHT, the preferred terminology replacing HRT) to combat the symptoms of menopause, including the chronic UTIs from which I and so many middle-aged women suffer. After starting on Divigel, a systemic estrogen, in 2020, I no longer had any UTIs with my live-in partner, and all of my other menopausal symptoms vanished as well: a huge relief! But then, oops, my partner and I broke up, and wouldn’t you know it? Immediately after publishing this story on the benefits of MHT to prevent UTIs, I had a fun second Tinder date and immediately came down with a new UTI.
Dr. Rachel Rubin, the urologist and sexual medicine specialist who has helped me, other doctors, and half the women on Twitter to understand the benefits of estrogen to combat UTIs and GSM
, explained that the systemic estrogen I place on my thigh every morning is great for combatting the usual symptoms of menopause, including the brain fog from which I was also suffering, but it is not targeted enough for vulvar health. I needed vaginal estrogen as well, which, by the way, carries no risks. It’s even (and often) prescribed for women with estrogen receptor positive breast cancer.Okay, cool, I said, and off I went to visit my gynecologist, Dr. Molly McBride, who prescribed a thrice-weekly dose of vaginal estrogen in addition my daily dab of systemic estrogen.
What I would learn next would blow my mind. And make me angry, on behalf of all middle-aged women, that we have been kept in the dark for so long.
My version of vaginal estrogen comes in a generic pill form attached to an applicator that looks like a narrow tampon, which I place inside the vagina before bed. You can also get Estradiol creams and rings, the latter being the easiest if you’re feeling flush, as Estring costs $536.22 (without insurance) for a three month supply, which—thanks, capitalism!—is usurious and insane. But the pharmaceutical industry does this because they know they can.
Why? Because while diabetics can loudly and rightfully protest the outrageous cost of insulin, and a growing demand for on-demand erections has deflated (heheh) the price of generic Viagra to as low as 44 cents a pill, older women aren’t exactly on the front lines advocating for their right to affordably moist vaginas. Even I, who make my living these days writing and talking about women’s health, put the idea for this article on ice for a few months out of both fear of being shamed as well as my own subconscious internalized sexism before finally finding the will to sit down and tap-tap it out. I’ve had enough public slut-shaming to last a lifetime, and that was before I slid headlong into middle age, and the New York Times called my near death from vaginal cuff dehiscence—and I quote—“gross.” Anyway, be sure to check out the prices at Mark Cuban’s pharmacy before paying too much for Estradiol, in whatever form you prefer. Yuvafem, the generic I use, costs $35 for a three-month supply (36 pills) from Capsule, but that’s with coupons and decent health insurance.
“Have fun out there,” said Dr. McBride, as we were saying goodbye. “Use this time just to be in the moment and enjoy yourself.” (Did I mention I love her?) The vaginal estrogen would help thicken my vaginal tissue, she explained. Picture the difference, she said, between a Kleenex and a steak.
Got it. Yes. Those are two very different things.
But then, a funny thing happened on the way to vulvar and urinary tract health. A few months into following Dr. McBride’s advice, I noticed that my sexual health had greatly improved as well. Things just worked better down there, without any need for lubricant. When I told friends about my discovery of the genital fountain of youth, they were confused. What did I mean? I tried to put it in clinical terms, but I soon realized there was no use beating around the—ahem—bush: “I mean my vagina feels 22 again.”
Each, to a woman, said some version of, “What?!!! I’m calling my doctor right now.”
Wanting to verify my single data point findings, I wrote Dr. Rubin an email:
I've now been on vaginal estrogen for about three months, and I have both thoughts and questions.
Thoughts:
1) Have not had one UTI since starting it, and during that time I entered into a new relationship, which, in the past, nearly ALWAYS resulted in a UTI.
2) Vaginal discharge seems to be at the same level as it was when I was in my twenties, pre-births, pre-hysterectomy, which brings me to my questions:
Questions:
1) Could vaginal estrogen be the holy grail of sexual arousal and sexual functioning to middle-aged women in the same way Viagra is to men?
2) If so, WHY ARE WE NOT TALKING ABOUT THIS PART OF IT, TOO, AND FRAMING IT THUS all the time? That it's not just about comfort and lack of pain during sex, but that (correct me if I'm wrong), it makes you, for lack of a more clinical word, hornier?
Dr. Rubin wrote me back the next day:
Let me just say I told you so….all this “Divigel is good enough for me” always had me smiling and nodding but thinking you needed more.
So it’s been about sex since the 70s, and it’s gone NOwhere. We physically CANNOT fathom sex over 50 as a society. It repulses us. The GYNs have had this in their wheelhouse for sex and have DONE NOTHING.
So yes. it’s as good as viagra. It IS the holy grail. The only essential oil there is...
BUT
My platform has been to make it about bladder and urinary health to see if that can get men to care and to prescribe. It’s working better.
Dr. Rubin is right, of course. To fight the good fight, first you have to fight the patriarchy, then you go after societal disapproval of and hostility toward women’s pleasure, especially older women. Her gospel is spreading not because she’s shouting, “Hey, ladies, you’ll have a better sex life if you take vaginal estrogen!” but because she’s tweeting, day after day, some version of, “Hey, ladies, you don’t need to suffer from recurring UTIs.” Yes, it’s 2022, and we still prefer to picture middle-aged vulvas as dutiful urine machines in need of a tune up instead of warm, happy pleasure palaces of intimacy, orgasms, and sexual health, which even the World Health Organization considers part of our overall quality of life.
As a result of Dr. Rubin’s admirable restraint and advocacy, a growing number of male doctors have now started to tweet out their gratitude, both to her and to her colleagues Ashley Winter and Rena Malik, who, along with Kelly Casperson, Heather Hirsch, Jill Krapf, and many others are also doing their part, every day, to spread the vaginal estrogen gospel. Here are just a few of the male doctors these activist urologists have convinced to prescribe vaginal estrogen to their female patients:
In other words, Dr. Rubin is working within the system to break it. Maybe one day we can promote and accept female sexual health and the miracle of 20-something vaginas on 50-something women in the same way we promote and accept the benefits of male sexual health and Viagra. Until then, it’s up to us to insist upon sexual health at any age.
Talk to your friends. Spread the information far and wide. Talk to your doctors, many of whom received exactly zero lectures on menopausal medicine, and insist on your right to a thick steak vulva instead of a Kleenex. Depending upon their age and medical education, your doctors may not have even heard about the benefits of vaginal estrogen to treat genitourinary syndrome of menopause, never mind the proper term for the syndrome itself. (GSM wasn’t even acknowledged or put into medical terminology until 2014.)
In fact, according to a recent Mayo Clinic study on the knowledge gaps in menopausal medicine of those on the front lines of it right now (young residents in family medicine, internal medicine, and obstetrics and gynecology), 34% of respondents said they would not offer MHT to their menopausal patients without contraindications; 20% had not received any menopause lectures during residency at all; and only 6.8% reported “feeling adequately prepared to manage women experiencing menopause.”
(Excuse me while I scream.)
Meaning, we’re not just fighting against the patriarchy and disgust at both vulvas in general and female pleasure in older women. We are fighting against an entire medical system that has ignored our bodies, gaslit our maladies, and disregarded our basic needs and anatomy since its inception. (I wrote a whole book about this, if you’re interested in reading further.)
Eventually, if Dr. Rubin has her way, every woman, on her fiftieth birthday, will be given a prescription for local vaginal estrogen, which we will continue to take it until death do us part. And a hearty amen to that. My marital vows might only have lasted twenty years, but my Estradiol and I? We are in it for life.
Roger Moore was 53 in Octopussy and 57 in A View to a Kill; Pierce Brosnan was 49 in Die Another Day; Daniel Craig was 50 and 51 while making No Time To Die, etc.
Genitourinary syndrome of menopause, formerly called vaginal atrophy, a name which was deemed both offensive and inadequate.
Yes, Virginia, There Is Female Viagra
Gonna broadcast this to my list of 84 friends and acquaintances, & post on FB. This is terrific! You're terrific! But I already knew that from reading Ladyparts. (Note: I'm a 68 yr old man)
As always, I laughed, then cried. The endless fighting vs the patriarchy is exhausting. Thanks for your constant challenges and humor through it all.