A Midlife Tune-Up for Sexual Health Month: Desire, Pain, and pH
Last Reviewed: September 08, 2025
Midlife is a powerful transition. It can also be a season when intimacy feels different from how it used to. Maybe desire feels low. Maybe sex has started to hurt. Perhaps you are noticing dryness, irritation, or more frequent urinary issues. None of this means you are broken. It means your body is changing, and there are clear, evidence-based ways to help you feel comfortable and connected again right now.
At The GYN & Sexual Medicine Collective in downtown Chicago, your care is provided through a concierge membership, not a one-time consultation. Membership gives you longer visits, direct access, and coordinated care that meets you where you are, including in-house pelvic floor physical therapy when it is part of your plan.
Why midlife changes your sexual health
As estrogen declines through perimenopause and after menopause, the vaginal ecosystem shifts. Protective lactobacilli decrease, vaginal pH rises, and tissues can become thinner and less elastic. This cluster of changes is called genitourinary syndrome of menopause, or GSM, and it is a prevalent driver of dryness, burning, urinary symptoms, and pain with sex. The good news is that while GSM is a chronic progressive condition, it is highly treatable only with the right mix of daily care and targeted therapies.
Let’s talk about desire
Low desire can have many root causes. Hormonal change plays a role, but so do mood, sleep, stress, relationship dynamics, medications, and pain. Step one in our clinic is ruling out and treating the fixable barriers, especially unaddressed pain or GSM. When low desire persists, we use a biopsychosocial approach and discuss additional options.
When sex hurts
Pain with sex, or dyspareunia, is not something you have to push through. Causes include GSM-related dryness, pelvic floor muscle tension, vestibulodynia, dermatologic conditions, endometriosis, and more. Effective treatment starts with an accurate diagnosis and takes time and elaborate evaluations to get to the appropriate treatment. Depending on your exam and history, your plan may include lubricants, regular vaginal moisturizers, local vaginal estrogen or DHEA, oral options like ospemifene, topical therapies, vaginal dilators, pelvic floor physical therapy, and lifestyle changes. Pelvic floor physical therapy, in particular, has strong evidence for improving pain and quality of life when overactive or tender muscles are part of the problem.
pH and products 101
While it is important to note that these do not treat the core problem, two simple tools can make a big difference: the right lubricant when you are sexually active and a regular vaginal moisturizer for day-to-day comfort.
Lubricants. Not all lubes are created equal. Some very thick, high-osmolality products can pull water out of the vaginal surface and irritate tissues. Look for options that are iso-osmolar or near-iso-osmolar, or choose medical-grade silicone lubricants that are less likely to disrupt cells. We will walk you through brand-level choices during your visit.
Moisturizers. These are used several times per week regardless of sexual activity. Many are pH-balanced and designed to support a healthier environment. Moisturizers do not replace local estrogen when that is indicated, but they are a helpful baseline for comfort.
Your Midlife Sexual Health Tune-Up at The GSM Collective
Our 60-minute Sexual Health appointment is built for women who want a thorough, respectful, and solution-focused visit. Here is what to expect:
A complete story. We start with your goals and concerns. We review health history, medications, mood, sleep patterns, relationship context, and any past experiences that may be impacting intimacy.
Focused exam and testing. When appropriate, we assess vulvar and vaginal tissues, look for tender pelvic floor muscles, and check for dermatologic conditions. Vaginal pH testing can help confirm GSM.
Your Lube and pH Quick-Start Guide. You will leave with practical, brand-specific product recommendations that match your tissues and your preferences, plus a simple routine for moisturizers and lubricants.
Hormonal and non-hormonal options. We individualize treatment. This may include local vaginal estrogen, vaginal DHEA, oral ospemifene, systemic hormone therapy when appropriate, and non-hormonal strategies like moisturizers, dilators, and device-based pelvic floor therapies.
In-house pelvic PT. If pelvic floor muscles are part of the problem, we will loop in our own pelvic physical therapist. You get one team, one chart, and a shared plan. That means faster communication, easier scheduling, and care that adapts in real time.
Desire support. We address contributors like sleep, stress, pain, and medications. If low desire persists, we can discuss counseling, sex therapy, or the details of your communication with your partner and their relationship with sex.
Follow-through. Concierge care means easy scheduling, direct communication, and timely adjustments until you feel like your best self.
Simple symptom tracker you can start today
Bring this to your visit, or use it for one to two weeks to see patterns:
Comfort check each morning and evening. Note dryness, burning, itching, or irritation.
Activity log on days you are sexually active. Record whether you used lube, which product, and how comfortable it felt during and after.
Pain map if sex hurts. Where is the pain located, what does it feel like, and how long does it last afterward?
Desire snapshot once per day. Low, medium, or high, plus any triggers that helped or hurt.
Bladder notes. Frequency, urgency, leakage, or urinary burning.
Sleep and stress score from 1 to 5.
Medications and supplements taken that day, especially any new changes.
You do not have to track forever. A short window often reveals where to focus.
Why choose The GYN & Sexual Medicine Collective
Dr. Rahman is a board-certified OB/GYN, certified Menopause Practitioner, and fellowship-trained specialist in sexual medicine, who has created a boutique model of care to provide women with the time and attention they deserve. Our practice combines clinical expertise with practical coaching, enabling you to feel at ease in your body and confident in your choices.
Take your next step
Memberships are limited to ensure access and personalized attention. Explore tiers and become a member through our Memberships and Services page or call 312-574-3434 for help choosing the right fit. We are ready when you are.
Medical information is for education only and does not replace care from your clinician. Treatment plans are personalized based on your history and goals.
