Living Vividly After 70: How Hormones, Communication, and Research Are Reviving Sex and Connection

At 76, Sue Goldstein says she’s more sexually vibrant than she was in her 40s. She proves that age is not a barrier to intimacy, and that understanding the biology, the conversation, and the science behind sexual health can transform relationships. In this in‑depth conversation, we unpack the realities of menopause, hypoactive sexual desire disorder, hormone therapy, pain in sex, and the evolving field of women’s sexual medicine.

Menopause Isn’t the End of Sexual Health

Menopause is often framed as a decline, a time when sex “just stops.” That narrative is misleading. Women can experience hot flashes, vaginal dryness, and a drop in libido, but these symptoms are treatable, and many women find their sex life improves after appropriate care. Goldstein’s own journey illustrates this: “I had hot flashes that stopped after I started on estradiol and progesterone. I went from one great night of sex in ten to nine out of ten.”

Menopause is a hormonal shift, not a death sentence for intimacy. The key is to recognize the symptoms and seek solutions—whether hormone therapy, lubricants, or lifestyle changes. The conversation should begin with a partner, a trusted clinician, and a willingness to experiment.

Key Hormonal Players

• Estrogen: Maintains vaginal lubrication, elasticity, and blood flow.
• Progesterone: Balances estrogen and supports pelvic floor health.
• Testosterone: Drives libido in both men and women; low levels can lead to hypoactive sexual desire disorder.

Goldstein notes that many women were treated with testosterone in the early 2000s, even before FDA approval for women. She still uses a combination of systemic testosterone, estradiol, progesterone, and local DHEA to keep her genitals healthy. “I’m 76 and people laugh at me saying my age,” she says, “but I’m still having good sex.”

Hypoactive Sexual Desire Disorder (HSDD): The Invisible Barrier

HSDD is often misattributed to a partner’s erectile dysfunction or to stress. Goldstein reveals that she herself had HSDD in her 50s: “I was thinking my husband had a little ED, but it was actually me.” HSDD is a biological condition where a woman has a persistent lack of sexual desire, not merely a temporary dip.

Diagnosing HSDD

Clinicians use validated questionnaires like the Female Sexual Function Index (FSFI) to differentiate between desire, arousal, and orgasm. Goldstein shares that her husband would have her fill out the FSFI and was shocked to see a diagnosis of sexual dysfunction.

Once diagnosed, treatment can include hormone therapy, lifestyle changes, or a combination of both. Goldstein stresses that medication alone is rarely enough; therapy, communication, and sometimes couples counseling are essential for lasting change.

Myths vs. Facts About HSDD

• Myth: It’s all in the mind.
• Fact: Hormonal imbalances are a major contributor.
• Myth: Only women with low estrogen have low desire.
• Fact: Testosterone levels also matter.

Painful Sex: The Silent Signal

Painful sex—vaginismus, dyspareunia, or post‑menopausal dryness—can signal underlying health issues. Goldstein explains that many women have chronic pain that they ignore, leading to a cycle of avoidance and reduced desire.

Common Causes

• Vaginal dryness due to low estrogen.
• Pelvic floor muscle tension or spasm.
• Infections or yeast overgrowth.
• Neurological conditions like neuropathic vestibulodynia.

Goldstein’s clinical experience includes treating patients with local DHEA, which she found effective in reducing vestibular pain. “We did a trial in our office—no FDA approval needed, but the results were clear.”

Treatment Pathways

• Topical estrogen or testosterone creams.
• Lubricants and moisturizers.
• Pelvic floor physical therapy.
• Hormone replacement therapy (HRT) when appropriate.
• In some cases, surgical or nerve‑sparing procedures.

Goldstein advises patients to bring a partner to appointments, ask for clear instructions on dilator use, and to be open about pain during the consultation. “A partner’s perspective can help the clinician understand the full picture.”

Communication: The Glue of Long‑Term Intimacy

Goldstein emphasizes that many couples fall into a pattern of “duty sex”—engaging in intercourse because the partner expects it, not because of desire. This can erode intimacy and lead to discord. The key is honest, non‑judgmental dialogue.

Practical Conversation Starters

• “What did you enjoy most about our last intimate moment?”
• “Is there anything that makes you uncomfortable or painful?”
• “What can we try that would make you feel more desired?”

Goldstein suggests setting aside a “date night” specifically for intimacy, even if it’s just a few minutes of foreplay or mutual massage. “Planning sex helps us mentally prepare and reduces performance anxiety.”

When the Partner Is the Issue

Sometimes a partner’s erectile function or lack of stimulation can cause a mismatch in desire. Goldstein warns against assuming the problem lies solely with the woman: “If your partner’s erection is not firm enough, that can reduce stimulation and lead to pain.” She encourages couples to discuss erectile aids, lubricants, and the importance of a firm erection for comfort.

The Science Behind Sexual Medicine: Research, Funding, and Real‑World Impact

Goldstein recounts the challenges of conducting research on female sexual dysfunction. Funding is scarce, especially for women, and many clinical trials take years to complete. Yet the data that emerges is transformative.

Early Clinical Trials

One of the first studies Goldstein helped design involved women with HSDD, leading to the FDA approval of flibanserin (Addyi). “The trial was a landmark,” she says. “It proved that a drug could treat desire.”

Exploring Pain and Hormones

Goldstein’s office has tested local DHEA, an off‑label therapy, and found it safe and effective for vestibular pain. “We published a paper on that,” she says. “It’s a win for patients who had no other options.”

Funding Gaps

Goldstein explains that NIH funding for women’s sexual health has historically been limited. “My husband had decades of funding for erectile dysfunction, but when we shifted focus to women, the money vanished.” This gap makes it harder for new drugs and therapies to reach patients.

Practical Tips for Women of All Ages

Goldstein shares a set of actionable steps that women can take, regardless of age, to maintain sexual health.

1. Know Your Anatomy

Many women are not taught the names of their genitalia. Understanding the clitoris, vagina, vestibule, and labia can empower women to describe symptoms accurately to clinicians.

2. Monitor Hormone Levels

When on hormone therapy, regular blood tests can ensure levels stay within a safe range. Goldstein emphasizes that gynecologists historically did not monitor hormone levels; now, a collaborative approach is essential.

3. Use Lubricants and Moisturizers

Lubricants are not a sign of dysfunction—they’re a tool to enhance pleasure. Goldstein advises choosing water‑based lubricants for most uses.

4. Practice Self‑Care

Physical activity, a balanced diet, and adequate sleep all support hormonal balance and sexual desire.

5. Seek Professional Help Early

Don’t wait until symptoms become severe. A clinician trained in sexual medicine can offer early interventions that prevent long‑term complications.

The Future: A World Where Sexual Health Is Normalized

Goldstein envisions a future where women feel comfortable discussing sexual health with their doctors, where treatments are available, and where the stigma around menopause and sexual desire is lifted.

“I want a world where women understand there were treatments for them and so they can go to their doctor and demand the treatments.” – Sue Goldstein

With the removal of the FDA box warning on hormone therapy and increased awareness of female sexual medicine, the field is poised for growth.

In the meantime, the most powerful tool remains communication. Whether you’re 25 or 76, talking openly about desire, pain, and pleasure can transform a relationship and restore intimacy.