Where Did My Orgasm Go? Menopause, SSRIs, and the Science of Pleasure with Dr. Lauren Streicher

What happens to your orgasm after menopause? It's something that nearly half of women experience during midlife, but so few are talking about it. In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Lauren Streicher to discuss exactly what changes to orgasm, libido, and sex, why it happens, and what you need to know if you're struggling. Dr. Streicher is a professor of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine, host of Dr. Streicher’s Inside Information Podcast, and creator of Come Again, a 30-episode audio series on sexuality and sexual function. She is a senior researcher at the Kinsey Institute and a pioneer in sexual medicine, helping define and legitimize a specialty that for decades went unrecognized. Dr. Haver and Dr. Streicher start with the basics: what an orgasm actually is, clitoral anatomy, and why most women cannot orgasm from penetrative sex alone. Dr. Streicher explains vaginal and cervical orgasms, the G-spot, and the historical research of Princess Marie Bonaparte, who measured the distance between the clitoris and vaginal opening in 240 women to understand why she couldn’t orgasm during intercourse. They explore how menopause affects orgasm and sex, including changes in blood flow, nerve health, clitoral atrophy, and the impact of cardiovascular disease, diabetes, and medications, especially SSRIs that can affect libido and orgasm. Dr. Streicher explains how genitourinary syndrome of menopause affects the clitoris, why the pelvic floor matters for orgasm, and why many women have never even seen their own anatomy. The conversation includes anorgasmia, both primary and acquired, and why it is rarely addressed in medical training. Guest links: * Dr. Streicher https://www.drstreicher.com/ * Dr. Streicher (Instagram) https://www.instagram.com/drstreich/ * COME AGAIN: Sexuality and Orgasm https://DrStreicher.com/comeagain * Dr. Streicher: Menopause: The Inside Info (Substack) https://drstreicher.substack.com/ * Dr. Streicher’s Inside Information: Menopause, Midlife, and More (Apple Podcasts) https://podcasts.apple.com/us/podcast/dr-streichers-inside-information-menopause-midlife/id1615785832 * Lauren Streicher - Faculty Profile (Northwestern Medicine) https://bit.ly/4iYTqaf * Dr. Streicher (YouTube) https://www.youtube.com/c/drstreichertv Books: * “Slip Sliding Away: Turning Back the Clock on Your Vagina,” by Dr. Lauren Streicher https://www.amazon.com/Slip-Sliding-Away-gynecologists-post-menopause/dp/B092H87LHQ/ For full show notes, please visit: https://bit.ly/unPAUSEDLaurenStreicher 00:00 — Sponsor: K18 Hair Repair (Molecular Mask + Damage Science) 01:21 — Hollywood’s “10-Second Orgasm” Myth (And Why It Messes With Women) 01:59 — Welcome + Guest Intro: Dr. Lauren Streicher & “Come Again” 03:52 — Lauren’s Origin Story: Chicago Roots & Choosing OB-GYN 05:18 — From General OB to Surgery to Menopause Care (The Pivot) 06:38 — Writing Her Way Into Sexual Medicine (Sex RX + Research Deep Dive) 08:19 — What the Kinsey Institute Is (And Why It’s Groundbreaking) 09:25 — Why Doctors Don’t Ask About Orgasm (Training Gap + Stigma) 10:46 — What Is an Orgasm? Blood Flow, Nerves, Brain, Pelvic Floor 12:21 — Penetration vs Clitoral Stimulation: What’s “Normal” for Most Women 13:26 — Vaginal Orgasms Explained: Fantasy, Cervical/Vagus, “G-Spot Plexus” 18:12 — Princess Maria Bonaparte + The “1-Inch” Anatomy Theory 21:23 — Sponsor Break: Quince + Primally Pure + HelloFresh 25:41 — When Anatomy Changes: Weight Loss Surgery, GLP-1s, Hysterectomy 31:09 — Post-Menopause Orgasm Changes: Blood Flow, Nerves, Pain, SSRIs 38:48 — Pelvic Floor, Incontinence & Orgasm (Why PT Matters) 42:53 — Sponsor Break: Alma + Alloy + MIDI Health 47:10 — GSM & Clitoral Atrophy: Treating the Clitoris (Not Just the Vagina) 51:37 — Getting Help: Who to See + Why This Isn’t a DIY Problem 54:06 — SSRIs: Timing, Dose, “Holiday,” and What to Try (With Your Prescriber) 57:50 — Sildenafil/Viagra for Women: Oral vs Topical + What’s Coming 01:01:20 — Wrap-Up: Where to Find Dr. Streicher + Call to Action Subscribe to COME AGAIN: Sexuality and Orgasm https://www.drstreicher.com/comeagain Use code UNPAUSED20 for 20% off (This code expires Dec 23) Gyne Hacks! (Including how to How to Get a Hands-free Free Vulvar View) https://drstreicher.substack.com/p/dr-streichers-gyne-hacks Never miss an episode—sign up for The ’Pause Life Newsletter: https://thepauselife.com/pages/newsletter Medical Disclaimer: The information, including opinions and recommendations, on this platform is meant for informational and educational purposes only. Mary Claire Media, LLC, the unPAUSED podcast, and The ’Pause Life are not medical organizations. Medical advice or medical diagnosis cannot be provided to you through the platform, any associated website, or customer portals. Using this platform does not establish a patient-physician relationship.