Painful sex, lower desire and changes in orgasm are common during menopause and after cancer treatment—but many women never mention them to their doctors. And too often, their doctors never ask.
In this episode, I talk with Dr. Rachel Pope, a gynecologic surgeon and specialist in female sexual health, about the concerns women often carry quietly: sex that suddenly hurts, a body that no longer responds in the same way, difficulty reaching orgasm and the effect these changes can have on confidence and relationships.
Dr. Pope explains how shifts in estrogen and testosterone can affect desire, vaginal tissue and orgasm. We also talk about the pelvic floor—and why strengthening it is not always the answer. For some women, those muscles are already too tense, creating a cycle in which anticipated pain causes the body to tighten and the tightening creates more pain.
Our conversation also turns to cancer recovery. Surviving cancer does not mean a woman should be expected to quietly accept pain, loss of sexual function or feeling disconnected from her body. There are hormonal and nonhormonal treatments, pelvic-floor therapy, specialized devices and, in some cases, reconstructive surgery that may help.
We also discuss why psychological safety matters for arousal, what women need to understand about the clitoris, and why partners should be included in conversations about menopause and sexual health.
This is a candid, medically grounded conversation about women’s bodies—and why sexual health deserves to be treated as health.
In This Episode
- Why sex may become painful during menopause or after cancer treatment
- How estrogen and testosterone affect desire, vaginal tissue and orgasm
- Why pelvic-floor muscles can be either weak or overly tense
- How pain and anticipatory anxiety can interrupt arousal
- Why orgasms may take longer or feel less intense after menopause
- The role of clitoral stimulation in female orgasm
- Treatment options for vaginal dryness, pain and sexual dysfunction
- Sexual health and quality of life after cancer
- How changes in intimacy can affect relationships
- Why women and their partners need better menopause education
About Dr. Rachel Pope
Rachel Pope, MD, MPH, is a board-certified obstetrician-gynecologist, reconstructive gynecologic surgeon and Director of Female Sexual Health at University Hospitals in Cleveland. She is also an associate professor of obstetrics and gynecology and urology at Case Western Reserve University School of Medicine.
Dr. Pope completed fellowship training in global women’s health, with a particular focus on childbirth injuries and obstetric fistula. She spent four years in sub-Saharan Africa performing complex fistula repairs and reconstructive surgery. After returning to the United States, she pursued additional training in sexual health, menopause, and vulvar and vaginal disorders.
Her clinical work includes painful sex, pelvic pain, low desire, menopause-related sexual changes, vulvar disorders, vaginal reconstruction after cancer, postpartum birth injuries and fistula repair. She created Our Womanity to provide women with trustworthy, science-based information about sexual and reproductive health. Read more about Dr. Pope’s background or view her University Hospitals profile.
Connect With Dr. Pope
- Website: Our Womanity
- Instagram: @drrachelpope
- Women’s health resources: Our Womanity Resources
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