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Dr. Alyssa Dweck, an OB/GYN in Mount Kisco, NY, has delivered thousands of babies, but she doesn’t stop caring for and about her patients once their childbearing years are behind them. She consults with them about nutrition (she hold a Masters Degree in Human Nutrition from Columbia University), and has a special interest and expertise in female sexual health and medical sex therapy. A strong proponent of the “use it or lose it” credo when it comes to our vaginas, Dr. Dweck offers outstanding advice to women of all ages.

I sat down with the great doctor to learn what she has to say about the sexual health issues women face in their forties, fifties, sixties and beyond. Here’s the first installment.


“Many women in their forties are going to go through the perimenopausal transition, and they must understand that this is not a one-day-to-the-next type of situation, but more like a 10-year-transition for which they can prepare. Dealing with the transition is like packing for a trip. You know what you need; you know the weather; you know how to get ready for it. Perimenopause typically starts in the forties.

“Most women are going to still be menstruating in their forties, and while they may be having some symptoms. like night sweats, hot flashes, or vaginal dryness, these may not be big, huge complaints until they’re in their later forties. Irregular periods are often the first clues that the transition is happening. The most common symptoms are missed periods, erratic and irregular periods, or something that changes with the flow.

“If you’re using hormonal contraception, perimenopausal symptoms might be difficult to recognize. Women who are on the pill, for example, might have vaginal dryness, but may still have regular periods and may be spared hot flashes or night sweats; if you’re on a hormonal IUD, you may have some random bleeding or no menses at all, but vaginal dryness may not be an issue. Condoms will allow for typical perimenopausal symptoms to occur spontaneously, since hormones aren’t being manipulated. In any case, contraception still is needed until you’ve gone through one year without a period. Until then, you’ll need contraception if you don’t want to become pregnant and you’re having regular sex. Many women don’t realize they have to use something.

“For well-woman visits, I always ask about a patient’s periods, because they may get a little bit erratic and I want to provide reassurance. I ask about birth control, and I will always ask about sexual function. Are you having sex and, if so, are you having a problem with that, such as dryness, pain, or libido troubles? I find that a lot of women will not initiate that conversation, so I make it my business to initiate it myself and try to remove any taboo about it and to normalize it. These should be normal questions at your annual physical exam.

Irregular periods, mood changes, or emotional lability are common symptoms. Lots of women, especially those who aren’t taking birth control pills, actually will have an enhancement of their libido. They literally hide their faces when they ask if it’s normal or whether should they be worried about it? Surges in testosterone might occur during this time.

“Some women find their vaginas becoming more sensitive in general during the perimenopause, so the products they’re using should be discussed, including condoms, hygiene products, and lubricants. Condoms still are essential for protection against STIs, especially for women who might have new partners.”

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