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What you need to know at any age.

By Jill Case

Happy sensual woman lying in bedWhat is sexual health? According to the World Health Organization, it is “a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.” Women of all ages are sexual beings, and Austin Woman talked with Dr. Karen Swenson to find out what some of the important sexual health issues are for women at every age.


One issue for young women when they are becoming sexually active is knowing what to expect.

“Sex should be an enjoyable part of their life. They shouldn’t just be having sex to satisfy their partner,” Swenson says. “They should be learning to be self-satisfied and also to be satisfied in a sexual relationship. It’s not something that happens immediately; it takes practice, knowing your body and learning to experiment a little bit.”

She also wants young women to understand when they need to talk to a doctor about intercourse.

“Intercourse can hurt initially, but it shouldn’t be something that hurts the whole time you’re having intercourse,” Swenson says. “If it’s repetitively painful, it needs to be evaluated.”


When life is dominated by pregnancy, childbirth and life with small children, women may experience many different emotions. Women who are breastfeeding, for example, usually enjoy it, but they may be fatigued by all the touching and not as interested in having sex with their partner. Women should talk to their partners and talk to their physician to look for solutions.

Women who have young children may also be tired and lose interest in sex. Swenson suggests couples put sex on their schedules, but she says if women are still not enjoying sex, they need to talk with a doctor.

“I think it’s really important to look at your relationship and make sure you feel centered because when there are relationship issues,” Swenson says, “it’s not uncommon to have sexual manifestations in the relationship.”



Swenson says a woman’s 40s are an “unpredictable time of women’s lives, hormonally.”

These are the years when ovulation becomes less effective and estrogen levels start to decline. Despite declining hormones, women shouldn’t assume they can stop using birth control.

“You need birth control until you stop menstruating for at least one year,” Swenson says.

A physician can do a blood tes t to check women’s FSH (follicle stimulating hormone) levels to definitively diagnose menopause and determine with certainty when a w oman no longer needs to use birth control.



The majority of women go through menopause during this decade. Oftentimes, about two to three years after menopause, Swenson sees women coming in with complaints about pain during intercourse and decreased sexual responsiveness. Swenson notes women need to seek treatment as soon as they begin to experience these symptoms.

“Some people try to tolerate the pain, and it becomes completely unbearable. Then, not only has the tissue become thinner and thinner, but they also enter into a pain cycle,” she says.

These women benefit from physical therapy. Women who seek treatment early on for thinning vaginal walls due to lack of estrogen may benefit from vaginal estrogen creams and lubricants. Some patients may also benefit from an oral medication called Osphena.


As women age, they may be dealing with medical conditions and medications that can affect their sex lives, and it’s important to talk with a physician about these things, as well as any pain during intercourse. In addition, Swenson notes that men also develop issues with sexual health, and this is the time for couples to talk to each other.

“It’s a matter of coordinating both partners and learning to manage sexual issues. A lot of the guys have a hard time when they start seeing their sexual function becoming less consistent,” she says. “This is a time when it’s OK to talk about it, and it’s OK to help your partner get the right kind of help. … I like to try to encourage my patients to remain sexually active into their older years. There is good data that shows that it keeps you healthier.”

Dr. Karen Swenson co-founded Women Partners in Health in Austin in 1985. She emphasizes open communication and works with her patients to achieve wellness. For more information, visit  



Unless you are involved in a long-term, monogamous relationship, you should always talk with your doctor about protecting yourself against sexually transmitted diseases. At every annual examination, talk with your doctor about whether you need to be screened for diseases like chlamydia, gonorrhea or syphilis, which is on the rise in Texas, according to Dr. Karen Swenson. In addition, women 30 and older are now being screened for HPV as a way to screen for cervical cancer. Your doctor should also talk with you about the importance of using condoms to protect against STDs, no matter what your age.



Austin Woman spoke to Sarah Janosik to learn more about sex therapy and what it really involves.

“We’re often trying to fight people’s misperceptions of what sex therapy is,” Janosik says. “People see it as a sex surrogacy, but it’s not. We’re a science-based practice. People who are trained to do sex therapy have research-based studies to tell them about the specific sexual dysfunctions, along with the best way to try to resolve them.”

Janosik points out that studies show “the best way to treat someone with a sexual dysfunction is to have a multi-disciplinary team that consists of physicians, sex therapists and physical therapists.”

At The Relate Center, there are psychotherapists, physical therapists and Pilates instructors who work together to provide patients with comprehensive treatment. The psychotherapists provide sex therapy, as well as talking about any other problems that may be affecting sexuality.

“We act like detectives,” Janosik says. “We send you home with some information, some exercises and have you come back in a couple weeks and see how that worked. Then we have people really start to talk about what happens in their body, and about what happens when they communicate with their partner. We’re helping them with this whole area that people tend to not be able to talk about.”

Physical therapists have become an important part of treating sexual problems for some patients.

“Our physical therapists are trained to understand what the muscles in the pelvic area do, how well they are functioning,” Janosik says, adding that treatment may include anything from learning exercises for the pelvic-floor muscles, to biofeedback, trigger points or different kinds of myofascial release.

Those at The Relate Center also believe patients benefit from Pilates. “The idea of Pilates is that when people have gotten disconnected from their bodies, they are working with their physical therapist to learn to use and recognize the pelvic muscles. The next step is to start to do the work on their own,” Janosik explains. “It’s taking it to one more practical step as a way to help people learn.”

In addition, Janosik, along with Dr. Karen Swenson and other physicians, therapists, psychotherapists and physical therapists, is part of the Austin Sexual Health Group. According to Janosik, the purpose of this collaboration is to “meet quarterly and talk about new ideas and share referrals so we really start educating ourselves about each other and the community.”

As you can see, sex therapy is not just about sex; it’s about connecting with your feelings, your body and your sexuality so you can improve the quality of your life.

Sarah Janosik is a clinical social worker in private practice and the co-founder of The Relate Center, a professional therapy practice that focuses on mind, body and emotional connection as a foundation for change, resolving issues and living a more satisfying life. For more information, visit


Many women don’t talk about it, but vaginal dryness can be a huge problem for women’s sexual health, causing pain during sex. It can be a problem for women who have just given birth, as well as a problem that begins in the 40s, when estrogen levels begin to drop, and it continues to be an issue after menopause.

There are several ways to treat vaginal dryness, including using lubricants, vaginal estrogen cream or seeking the services of a physical therapist that specializes in treating the pelvicfloor muscles. No woman should suffer from vaginal dryness in silence. Talk to a physician to find relief.

Republished, with permission from Austin Woman Magazine

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