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Home » What Happens to Sex in Midlife? A Look at the “Bedroom Gap” – Maria Sophocles (Transcript)

What Happens to Sex in Midlife? A Look at the “Bedroom Gap” – Maria Sophocles (Transcript)

Here is the full transcript of gynecologist Maria Sophocles’ talk titled “What Happens to Sex in Midlife? A Look at the “Bedroom Gap”” at TEDWomen 2023 conference.

Listen to the audio version here:


So the other day, a woman walked into my office and exclaimed: “My vagina has betrayed me!” Not what most of us hear on a Monday morning before coffee, but welcome to my world as a gynecologist and sexual medicine specialist. You know, everybody thinks of menopause as hot flashes, but for over half of menopausal women, it’s accompanied by sexual issues. Things like loss of libido or painful intercourse, even total destruction of a relationship.

It’s what I call the “bedroom gap,” the difference in sexual expectations and capabilities of men and women in midlife. Now the bedroom gap is a combination of the genital effects of menopause and deeply entrenched cultural and historical gender roles. To understand how to close the bedroom gap and to get the sex we want, we have to examine its root causes.

The Science of Menopause

So let’s start with some science. In menopause, the ovaries make estrogen less consistently and eventually stop making it altogether. And this loss of estrogen has two huge effects in the vagina. The first is on collagen. Less estrogen means less collagen is made, and the quality of that collagen deteriorates from strong and stretchy to brittle. Ouch.

The second effect of the loss of estrogen in the vagina is on blood vessels. We need blood vessels for lubrication. When I’m examining a patient, I can literally see if she’s deficient in estrogen. The deterioration from thick, ridgy, dark pink, elastic, moist tissue to thin, dry, inelastic, pale pink, even yellowish white tissue. We also need blood vessels for arousal. This is where you’re supposed to wake up.

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