Not Seeing a Gynecologist After 40 & 4 Sexual Health Mistakes Women Make As They Age

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Women who are finished having kids, past a certain age, or who are no longer sexually active often think that they’re exempt from an annual gynecologist appointment. But the truth is, contrary to popular belief, there’s no “stop” date for gynecological health. Not seeing a gynecologist after 40, or at any time during your life, is a mistake that many women make without a second thought.

But according to OB/GYN and Director of Female Sexual Medicine Program at Stanford University School of Medicine, Leah Millheiser, it’s important to see your gynecologist throughout your life. “Mid-life health and beyond, [seeing a] gynecologist, is equally important” as it is when you’re younger, Dr. Millheiser tells “Think about it: Women live half their life post-menopausal and there’s a whole array of health challenges that women face in that part of their life,” she continues.

Things like low sex drive, vaginal dryness, painful sex, urinary incontinence, menopause, and cancer screenings can all be addressed at the gynecologist’s office. Here’s why it’s important to keep up with your annual visits, what to do about condoms as you get older, and how to approach menopause.

What Should I Expect at an Appointment?

Your exam at the gynecologist remains the same throughout most of your life. Guidelines from the U.S. Preventive Services Task Force say you should continue to get pap smears until around age 65, but Dr. Millheiser says, based off of individual needs and medical history, this number could be adjusted. “Women in their 90s still need breast exams and other feminine health checkups, but they might be done less frequently,” she says.

What does change at the gynecologist’s office as you age is the conversations you have. When you’re in your teens to your 40s, your appointments revolve around safe sex practices, sexual health, birth control options, and information on fertility. After 40, the conversation switches to perimenopause, menopause, and postmenopause, as well as sexual health and overall health. “Many women are just not aware that there are solutions for mid-life problems that are very common,” says Dr. Millheiser. “For example, if you are embarrassed to go running with friends because you are afraid you’ll pee in your pants, you should see your gynecologist.”

Dr. Millheiser says she hears from patients all the time who had no idea there was a treatment or solution for their problem. Her response is always the same: “You shouldn’t suffer in silence.” If something is wrong, painful, or impacting your daily life, make an appointment with your gynecologist.

Do I Still Need to Use Condoms?

There’s a belief that if there’s no risk for you to get pregnant (you’ve gone through menopause), there’s no reason to continue to use condoms. But aside from protecting you from pregnancy, condoms also serve another very important function: to protect you against sexually transmitted infections (STIs). “It doesn’t matter how old you are, whether you’re 20 or 90, safe sex is important across a lifespan,” says Dr. Millheiser.

Dr. Millheiser says that not using condoms is the biggest mistake that older women can make and that STIs are in fact on the rise in the senior population. “There is a belief that someone older wouldn’t have an STI or someone who has been married before wouldn’t have a disease, but the truth is, you just don’t know where people have been or who they’ve been with,” explains Dr. Millheiser.

If you are having sex with new partners later in life, regardless of if they were married before, their age, or the fact that they tell you they don’t have an STI, always wear protection. Additionally, you should seek out regular STI testing from your gynecologist.

What If I’m Not Sexually Active?

“If you’re not sexually active, my big question is why,” says Dr. Millheiser. It’s natural for women to be sexually active and if they’re not, there’s probably a reason for it like low-sex drive, vaginal dryness, painful sex, or even depression. Talking to your gynecologist about your lack of a sex life might actually help bring other health problems (that have solutions) to the surface so you can be intimate again.

Additionally, if you stopped being sexually active and want to become active again, you might have a harder time. According to Dr. Millheiser, it’s very common for the vagina to get smaller and tighter: “Not having penetration will cause the vagina to get smaller [over time] and sex can feel like it’s impossible.” In addition to getting smaller, the vaginal lining can get more narrow, which can make sex extremely painful.

But that doesn’t mean there isn’t a solution.Talking to your gynecologist about these problems can provide you with helpful tips and even treatments if necessary. “Women should empower themselves to bring up sex. If the doctor doesn’t ask you about it, make sure you bring it up,” encourages Dr. Millheiser.

Should I Still Be Getting Pap Smears?

According to professional recommendations, after the age of 30, you can decrease your pap smear frequency from every three years to every five years, by combining with HPV testing. This does not mean you should stop getting them entirely. “Some women will just take that as a pass to duck out for 10 years,” says Dr. Millheiser and that’s not good for your health.

According to the Amercan Cancer Society (ACS), “Many older women do not realize that the risk of developing cervical cancer is still present as they age. More than 15 percent of cases of cervical cancer are found in women over 65.” The ACS does state that this doesn’t not occur as frequently in women who have been regularly screened throughout their life.

Do I Really Need to Talk to a Professional When I Go Through Menopause?

The short answer is yes. During menopause, your body goes through a lot of changes, and you should be checking in with your gynecologist on an annual basis to discuss. Dr. Millheiser recommends visits more frequently if there are more serious problems, such as sexual dysfunction, uncontrollable bleeding, or relentless hot flashes.

If you’re worried that your gynecologist doesn’t know a lot about menopause because you feel like their speciality is in reproductive health, find a new one. It’s that simple. While all gynecologists should be knowledgeable about a woman’s body through all stages of life, there are gynecologists that specialize specifically in menopause health. Dr. Millheiser recommends checking out the North American Menopause Society for more information.

“One thing that I tell my patients who are really suffering through menopause is if your doctor doesn’t give a treatment option, get a second or a third opinion. There is a treatment for everyone that has data to prove it’s effective and safe,” says Dr. Millheiser. Always be an advocate for your own health and to remember you never age-out of going to the gynecologist. The gynecologist’s office is not just for young women, it’s for all women.


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