unPAUSED with Dr. Mary Claire Haver

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

Date: December 18, 2025
Host: Dr. Mary Claire Haver
Guest: Dr. Lauren Streicher

Overview

In this candid and information-packed episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with Dr. Lauren Streicher, Professor of OB/GYN at Northwestern and author of the audio series Come Again. They delve deep into orgasm after menopause—why orgasms can become elusive, the science behind vibrators (and which ones work best), the role of testosterone and other treatments, closing the orgasm gap, how to find a sexual medicine expert, and what gives Dr. Streicher hope for women’s sexual health moving forward. The tone is frank, empowering, and focused on practical solutions for midlife and beyond.

Key Discussion Points & Insights

1. The Orgasm Gap and Why It Narrows with Age

• Orgasm gap definition: Men are statistically more likely than women to have orgasms during sex, particularly in younger age groups, but the gap narrows as both age ([23:51]).
• Why the gap narrows:
  • Men’s sexual function declines, while women grow more confident in advocating for their own pleasure and learn what works for them.
  • “Most women, hopefully by the time they hit 50, do know where their clitoris is and do know what to do with it.” — Dr. Streicher ([24:18]).
• Changing expectations: The cultural script is shifting—older women are less willing to compromise on their own pleasure ([25:11]).

2. Vibrators: Tools, Not Toys

• Vibration as a solution: Dr. Streicher reframes vibrators as “tools,” not toys, because they make orgasm possible for many women after menopause ([04:44]).
  • “Vibration will often work when nothing else does… the nerve endings that respond to vibration are not only bigger, but they have a thick myelin coat… and are going to last and last and last.” ([05:25])
• Vibrator science:
  • Different types respond to specific nerve endings—vibration-sensitive nerves are more durable with age.
  • Pulsatile modes may help with arousal; steady vibrations can be better for triggering orgasm ([07:25]).
• Including partners: It’s important for women to be able to discuss vibrators openly with partners. Dr. Streicher’s daughter, a sex therapist, provides scripts for these conversations on their podcast ([06:43]).
• Travel “hacks”: Some women use Sonicare toothbrushes as stand-ins for vibrators while traveling, though Dr. Streicher warns against using the brush head directly for safety reasons ([08:29]).

3. Gyne Hacks: Hands-Free Vulvar Viewing & More

• Hands-free mirror setup: Dr. Streicher describes a clever way for women to view their vulva using a magnifying mirror and the toilet seat—practical “Gyne hacks” also shared on her YouTube ([10:03]).
• Removing devices: For those with long nails, using dental floss as a retrieval string for vaginal rings is another tip ([11:05]).

4. Non-Hormonal Arousal Solutions

• Arousal creams: Most are vasodilators aimed at increasing blood flow; evidence is largely anecdotal ([11:37]).
  • “A lot of them are compounded products… do they work? Anecdotally, for a lot of women they do seem to make a difference.” ([12:07])
• CBD creams: Could help by increasing nerve sensitivity and blood flow—anecdotal reports of enhanced orgasm, with no known risks if used topically ([13:09]).
• Placebo effect: Acknowledged, but “at a minimum, it’s not going to be harmful” ([13:09]).

5. Neurotransmitters, Libido Drugs, and Testosterone

• Brain’s role: Orgasm relies on healthy neurotransmitter function, which is influenced by estrogen and testosterone levels ([14:14]).
• FDA-approved drugs:
  • Flibanserin (Addyi): Daily oral medication, originally approved for premenopausal women with hypoactive sexual desire disorder (HSDD), but also used off-label in older women ([16:32]).
    • “It works in about 50% of women, at best.” — Dr. Streicher ([17:20])
  • Bremelanotide (Vyleesi): Injectable, used on-demand, also about 50% effective. Main drawback is possible nausea ([17:21]).
• Testosterone: Often preferred by women because it feels “more natural”; efficacy is similar (about 50% see benefits), but careful monitoring is needed ([18:43]).
  • “There’s a comfort level with testosterone… just like estrogen, this is something that is in their body naturally.” ([18:43])

6. The Problem with Testosterone Pellets

• Pellet risks: Pellets deliver unregulated, super-physiologic doses of testosterone with higher risk of side effects—hair loss/growth, irreversible voice changes, potential for uterine pathology ([19:13]).
  • “Women should not use pellets because… increased risks of uterine pre-cancer and even cancer... and they’re very expensive.” ([21:19])
  • Voices of caution: Especially for professionals who use their voice (e.g., singers/actors), even normal doses can affect vocal cords ([23:18]).
• Ethical concerns: The business model is often cash-based with unnecessary testing and profit-driven practices ([21:33]).

7. Clinical Approach to Orgasm Difficulties

• Step-by-step approach:
  1. Take a detailed history—medical issues, medications, menopause symptoms, relationship factors ([28:08]).
  2. Address pain first: Pain with sex must be resolved before working on arousal/orgasm ([29:21]).
  3. Manage menopause symptoms, medications, sleep, show “the map to their clitoris.”
  4. Realistic outcomes:
     • “Is everyone going to be successful? I’d like to say yes, but that would not be honest. The answer is no. But that’s okay.” — Dr. Streicher ([30:57])
     • Emphasize pleasure, not orgasm as the only “goal” ([31:23]).
  5. Shift the sexual script: Sex can be defined by intimacy, affection, and touching—not just intercourse or orgasm.

8. Finding a Sexual Medicine Expert

• Expertise scarcity: Few formal sexual medicine fellowships exist; resources can be regional or incomplete ([32:27]).
  • Where to start: Menopause experts are often a good first step for midlife sexual concerns ([33:01]).
  • Oncology clinics: Sometimes have sexual health specialists, especially post-cancer ([33:49]).
  • Directory: International Society for the Study of Women’s Sexual Health maintains a directory, albeit incomplete ([32:31]).

9. Hope for the Future: Sex-Ed and Medical Training

• Grassroots change: Medical student interest is high—Dr. Streicher mentors a nationwide student consortium focused on sex education ([34:23]).
• Bringing specialties together: Multiple paths to become a sexual medicine expert (OBGYN, psychiatry, internal medicine, urology, etc.) ([35:51]).
• Cultural shift:
  • “Menopause is not just having a moment. I’ve been talking about menopause for 20, 30 years, but no one wanted to talk about it… now that’s all they want to talk about.” — Dr. Streicher ([37:51])
  • Goal: Normalize these conversations between all generations ([38:56]).

10. Empowering Women with Resources

• Dr. Streicher’s series:
  • Come Again: 30-episode audio series for clinicians and consumers, with actionable insights and historical context ([36:29]).
• Practical advice: Women without access to specialists can use scripts to advocate for themselves in general clinical settings ([41:35]).
  • “Not only do we have solutions, but… I’m going to give you the roadmap. I’m going to give you the script…” ([41:35])

Notable Quotes

“Vibrators are tools, not toys… because a tool is something that makes having an orgasm possible.”
— Dr. Lauren Streicher ([04:44])

“The nerve endings that respond to vibration are not only bigger, but they have a thick myelin coat… and are going to last and last and last.”
— Dr. Lauren Streicher ([05:25])

“Pulsatile is better for arousal, but steady is better to actually trigger the orgasm.”
— Dr. Lauren Streicher ([07:25])

“I think it’s important to rewrite the script. There’s this idea that sex is not successful unless you have an orgasm… Sex is over when you’re ready for it to be over because you’ve been having pleasure.”
— Dr. Lauren Streicher ([31:23])

“If someone is pushing pellets, don’t walk, run.”
— Dr. Lauren Streicher ([21:33])

“We want to make a difference… Some days it gets overwhelming, [but] someone will say something I wrote… made them find a doctor, change their life… that’s why I’m doing this.”
— Dr. Mary Claire Haver ([41:12])

“If you don’t have a doctor, it’s okay. I’m going to give you the roadmap… and you can go to that doctor and you can say, ‘Dr. Haver told me…’ They will not say no.”
— Dr. Lauren Streicher ([41:35])

Important Timestamps

• Orgasm gap and its evolution: [23:51] – [25:11]
• Why vibrators work post-menopause: [04:44] – [06:42]
• Travel hacks for vibrators: [08:29]
• Non-hormonal arousal creams and CBD: [11:37] – [14:08]
• Neurotransmitters, medications, and testosterone: [14:14] – [18:43]
• Dangers of testosterone pellets: [19:13] – [23:18]
• Doctor’s clinical approach to orgasm issues: [28:08] – [31:23]
• How to find a sexual medicine expert: [32:27] – [34:17]
• Medical student sex-ed consortium: [34:23]
• Empowering women with self-advocacy: [41:35]

Resources & How to Connect

• Dr. Lauren Streicher:
  • Instagram: @doctorstriker
  • Website: drstriker.com
  • Podcast: Dr. Streicher’s Inside Information
  • Audio Series: Come Again (available via her website)
• Dr. Mary Claire Haver:
  • Instagram: @doctormaryclair
  • Website: thepauselife.com
  • Book: The New Perimenopause (pre-order on Amazon)

Final Thoughts

Dr. Streicher and Dr. Haver’s open, solution-oriented discussion demolishes taboos around women’s pleasure in midlife, providing science-backed advice, practical hacks, and hope for better, more accessible sexual health care. Women don’t need to settle—they have options, tools, and the right to advocate for their own pleasure at every stage of life.