Orgasm After Menopause: Vibrators, Testosterone & Solutions with Dr. Lauren Streicher (Pt. 2)

Dr. Streicher explains that many women lament, 'I can’t orgasm anymore, but I can with my vibrator.' This is not a sign of weakness — it’s a sign that the touch-sensitive nerves are gone but the vibratory nerves remain. She breaks down the research on vibration parameters and stresses that a vibrator is a medical tool, not a toy. She incorporates her daughter's expertise to address the relational aspect: many husbands feel like failures if a vibrator is brought in, so the partner script is essential. She gives the example of a Sonicare toothbrush (with a gym sock) as an ultra-strong makeshift vibrator, but warns of abrasions. She prefers women invest in a purpose-built vibrator with adjustable patterns. The goal is to normalize vibrator use as part of a healthy sex life at any age.

Dr. Streicher notes that many women use an arousal cream right before sex and feel it doesn’t work. She believes the instructions are wrong: the cream should be used consistently to improve the health of the clitoris, much like a moisturizer. The idea is to prime the tissue so that when arousal occurs, the vasculature is already responsive. She mentions that there are multiple compounded mixtures on the market, and she goes through the ingredients in her Come Again series. She also explicitly discourages the term 'scream cream,' calling it offensive, and prefers 'arousal cream' or 'orgasm cream.' While acknowledging a lack of randomized trials, she maintains that for many women it makes a difference.

Dr. Streicher is conducting unpublished research on this topic. She explains that many women have shared positive anecdotes, and she feels comfortable recommending it because, at minimum, it’s not harmful. The key is rubbing it in for a prolonged time, which may improve absorption and act as a sensory stimulus itself. She distinguishes this from systemic cannabis use, which works more on disinhibition in the brain rather than local genital contact. She is cautiously optimistic and believes this will be studied more formally.

Dr. Streicher clarifies that while Addyi is labelled for younger women, her clinic uses it off-label for postmenopausal women and has studies supporting efficacy. She emphasizes that it is not an on-demand drug; it must build up in the system. The main barrier is cost and the idea of taking a daily pill. She notes that most women are unaware these options exist. The 50% response rate is not a failure but reflects the multifactorial nature of desire.

Dr. Streicher frames Vyleesi as the on-demand counterpart to Addyi. She acknowledges the nausea scare, but says many patients find it manageable or transient. The injection pens are like epinephrine injectors. She offers both drugs and testosterone to patients, and most choose testosterone because it feels more 'natural.' She emphasizes that these drugs are not orgasm pills per se, but they enhance the transmitter environment that allows arousal to happen, which is a prerequisite for orgasm. The PR around these drugs has been poor, leaving many women unaware they exist.

Dr. Streicher explains that when she presents the options — flibanserin, bremelanotide, and testosterone — most women choose testosterone because it feels less like taking a drug and more like replacing a missing hormone. She stresses that efficacy is still about 50%, because desire is multi-determined. She is fiercely against pellets, which she calls a dangerous cash business that delivers supraphysiologic testosterone, causing irreversible side effects and higher hysterectomy rates. She herself will prescribe compounded testosterone but insists on initial baseline levels and monitoring to keep doses safe. She warns voice professionals that even physiologic doses can alter voice permanently. The protocol is to start low, check labs, and aim for normal range, not for supraphysiologic 'energy highs' offered by pellet clinics.

Dr. Streicher states that in her sexual medicine clinic, almost every woman needs pain addressed first. She gives the example of a woman who had sex months ago and it hurt 'like hell'; the vagina is 'not stupid' and will tell the brain not to go there. Until the pain is gone, talking about arousal creams or testosterone is pointless. She advocates for a thorough workup including medication review, menopause symptom management, and direct visualization of the vulva and vagina (perhaps using the hands-free vulva-view mirror hack described by Dr. Haver). Only after pain is resolved can treatments for desire and orgasm work. This approach is often missed in general practice.

Dr. Streicher explains that the clitoris contains different types of nerve endings: small, unmyelinated ones that respond to light touch, stroking, and licking tend to atrophy most rapidly with age and hormonal changes. However, the nerve endings that detect vibration are not only larger but are encased in a thick myelin sheath that protects them from deterioration. This means that even when a woman says ‘nothing works,’ a vibrator can often still trigger an orgasm because those nerve fibers remain functional. She calls this a 'tool' to make orgasm possible, akin to using a life raft if you can’t swim — it’s not a sign of failure, but a practical aid. The shift in language also helps patients and partners see the vibrator as a legitimate medical device rather than a sex toy. Her daughter, a sex therapist, provides a script so that women can introduce the vibrator into partnered sex without the man feeling like a failure. Streicher even notes that the strongest vibrator is often a Sonicare toothbrush (with a gym sock over it), but she warns of abrasions if used directly. She has studied the vibration parameters: pulsatile patterns seem better for arousal, while steady vibration is better for triggering the actual orgasm. This is a data-driven refinement that most consumers don’t know.

Dr. Streicher points out that by the time women hit their 50s and beyond, most have discovered where their clitoris is and what to do with it — either manually, orally, or with a vibrator. They are also less willing to sacrifice their own pleasure and will often take charge of their orgasm during partnered sex. Simultaneously, men’s erectile function and ejaculatory control often decline, so they may not orgasm as reliably. The combination closes the gap. She adds that no formal studies have tracked the orgasm gap into older age groups — she wants to do one with the Kinsey Institute — but her clinical experience strongly suggests this narrowing. She also observes that older women are more likely to demand that their pleasure matters, flipping the script from the younger years when many didn’t even expect to orgasm because sex education taught only pregnancy and STI prevention, not pleasure. The result is that by menopause, the playing field is more level, even if both partners face new challenges.

Dr. Streicher lays out a three-part rationale: First, cannabidiol is a vasodilator, increasing local blood flow to the clitoris, which is essential for engorgement and arousal. Second, it has anti-inflammatory properties, which may reduce any micro-inflammation that dulls sensation. Third, and most intriguing, in diabetic patients with peripheral neuropathy, topical CBD cream has been shown to improve nerve sensitivity. While she cautions that clitoral nerves are not foot nerves, the principle that nerves are nerves suggests a possible effect. She discusses her own unpublished research (not yet peer-reviewed) that anecdotally shows enhancement of orgasmic ability when women use CBD oil on the clitoris. Rubbing it in for a long time may help with absorption. She stresses that, unlike systemic cannabis, topical CBD does not cause a high and is considered safe given its widespread use. However, she underscores that this is a data-free zone and recommends using it only if it’s not harmful.

Dr. Streicher argues that postmenopausal women, who may face orgasmic challenges due to atrophy, pain, or medications, need to rewrite the script entirely. She explains that many women fake orgasm just to end sex because they’re exhausted or in pain. The true endpoint should be when you’ve felt intimate, loving touch that made you feel good — whether or not an orgasm occurs. She emphasizes that ‘sex is over when you’re ready for it to be over because you’ve been having pleasure.’ This removes the pressure on the woman and her partner and opens up a wider definition of sexual satisfaction that includes kissing, touching, and emotional connection. She shares a story from a TV appearance where a sex therapist said the number of times you have sex is irrelevant; what matters is how often you are sexual — touching, kissing, speaking lovingly. Streicher believes that for many peri- and postmenopausal women, this redefinition is the key to maintaining a healthy sexual relationship.