I grew up in a family where even saying the word S-E-X was an offense that would get you sent to your room, which turns out is not the best strategy for stamping out sexual behaviors in teenagers.

Anyone remember that early 1970’s book The Joy of Sex? Somehow one of my older sisters had snagged a copy from one of her progressive friend’s parents and my early sexual education happened hidden under the covers in my bedroom poring over the peculiar pencil drawings of what was intended to represent an “ordinary” 1970’s couple. Visions of that chubby long-haired bearded man who I thought looked like Jesus and his heavily armpit-haired partner, with their thick curly pubic bushes, doing things I couldn’t believe still pop up at inopportune times.

Fast forward 35 years, and with all our unlimited access to plenty more pictures (mostly now of unrealistically thin, young and beautifully airbrushed) people having sex, we are still under the covers with our fears, shame and the lack of a place for real conversation about what’s really happening with sex, especially in what I will politely call our “middle years.” After almost 20 years as the leader of a large all-female Obstetrics and Gynecology practice and focusing on menopausal medicine and sexuality, I have heard literally thousands of intimate accounts of intense suffering and confusion surrounding mid-life sex behind my sacred closed doors, where all the things that women can never ever say out loud are given permission to come out.

This was all just super interesting in a detached way, you know, like studying a disease that you don’t have, until I started the menopausal process myself at age 47 and began to feel that I was hearing my own intensely private story being quoted back to me every day by my patients. And I realized I had nothing much to offer then other than empathy and perhaps a hormone prescription, and more importantly, that each of my patients thought there was something wrong with her and that she was alone. I remember at sitting on the couch in my Practice Administrator’s office complaining that I felt like I had the flu but I didn’t have a fever, that I was hot and moody and irritable and wondered what kind of illness was going around. She looked at me with a sympathetic smile and said, “Honey, why don’t you check your hormones? I think you are going through menopause.” As crazy as it sounds, although I had already established myself as a menopause expert, it had not crossed my mind that this would actually happen to me. Sure enough, my ovaries had gone into retirement almost overnight. And just like my patients I felt like I was totally alone.

In this age of information overload, women of all ages (but particularly in the 45-65 age group) generally have no idea about what is happening to our bodies, and feel like we have no resources to share what is going on with our changing sexual beings. I remember a book quietly slipped to me by my parents at around age 12 called “What’s Happening to Me?” without further conversation. Menopause felt like “What’s Happening to Me? Part II,” where information was slipped more often through clandestine whispers and rumors than from reliable sources, and our mothers either forgot or denied that this had ever happened to them. Even friends would hesitate to reveal the truth and instead hide behind the myth that everything was OK, or create humor around the pain and suffering to prevent facing it head-on. No one seemed to be having a real conversation about “what’s happening to me” and most books minimized it to the science of ovulatory cessation and a handful of common side effects. This information gap creates ripe opportunities for our vulnerability and fear that something is wrong with me, and an opening for us to be preyed on by countless snake-oil salespeople offering non-scientific remedies for all of our ailments for exorbitant prices.

I would often feel flattened and defeated at the end of the day, being completely ill-equipped to help the women who I had dedicated my life to help. There was a lot of crying together, a lot of hugging and saying “I get it, I have been there too… .” But I felt powerless to help myself or my patients out of what sometimes felt like a prison. Was this the way the rest of our lives were going to be? Downhill to the grave? I felt like something had to be done to open up this conversation and to find some solutions. This was much more than something that just hormones or waiting it out could correct. The issues were holistic and affected the body, mind and spirit. Traditional medicine was doing either nothing and brushing it off as “normal” or attempting to treat only the body part of the equation.

So you know when you start a conversation about something private, potentially embarrassing, shameful and controversial, the last place you want to look is at yourself. But it was inevitable. I started talking to women my age about sex, which you might think is normal at the gynecologist’s office, but trust me, we have 10 minutes and are generally hoping we can scoot out the door before the subject comes up because we don’t have time and we have no idea what to say. Plus we sure don’t want to have to look in the mirror and face what is dissatisfying in our own lives and relationships. But something told me that this was work that really needed to be done, and I began investigating and learning for the first time what was REALLY going on, just by listening, and by mustering the courage to deeply look at myself.

Most of the time the stories I heard weren’t pretty. In my own life it wasn’t pretty for sure. At 46 I had been with the same guy for 17 years, married for 12, and with three kids all born within 19 months (try doing that math…) and two big careers. And our sex life had been on life support for years and it was something that we did not, and could not, talk about. Like so many of my patients I had intellectualized and rationalized it into one of the deepest corners of my mind where all the best secrets stay hidden and you simply can’t look at them (picture your hands over ears saying “la-la-la”). My story was that this is “normal”–because of the kids, our work schedules, my hormones changing, combined with nature’s “obvious plan” (trust me, I’m a doctor, so I know nature’s plan) accompanying the biological impossibility and/or loss of desire for future fertility. I conveniently rationalized and, I’m now ashamed to say, consoled many women by explaining that when your body knows you can’t get pregnant, biology tells you that you don’t need to have sex. This is all a great “doctor excuse” for just not being turned on anymore. And I had plenty of patients in the same boat who I heard from every day to make me feel safe and silently supported. In sharing my own story I connected with many, many patients who felt the same way and we all breathed a collective sigh of relief about not being alone. But sometimes “normal” isn’t “optimal.” Very few of us were happy about it and many of us were straight up miserable. Not to mention our partners.

Meanwhile my marriage was going downhill fast. We had stopped talking. We had stopped looking at each other. I stopped caring where he was or what he was doing and simply wanted to know when he’d be home so I could make sure childcare was covered. We stopped connecting and my sex drive was below zero. My patients’ marriages were going downhill too. Did you know that divorce rates for women over 50 have doubled since 1990 while the overall divorce rate has declined? What’s going on here?

Then once a week or so someone around my age would bounce into the office with a rosy glow and stories of a sex life that blew the lid off my old hippy book. I listened wide-eyed and felt like I was talking to an angel with an important message for me. I joked with some of these lucky ladies that I wanted to draw their blood and find out what they had then bottle it and sell it, then they could come and visit me on my private island. But it was easier than that–since some surprising patterns began to emerge. Many of these women had a new partner. Now don’t get me wrong, I’m not advocating that a new partner is our only hope, although it does remain one of the most reliable options. Thankfully for those of us who want to keep our current partner, I also met and studied a different group of women around my age with a self-reported vibrant sex life and a deep sense of wellbeing and connection with their long-term mate. Usually they reported that they had a profoundly new relationship with their old partner, often through counseling after a crisis or a very intentional process of reconnection, shedding harmful old habits and creating new ones. It wasn’t an accident and it rarely was easy. As I dug deeper I met other angels: some in partnerships, some single, some gay, and from widely varied backgrounds, races and religions.

All of these women shared an unusual level of self-awareness and were comfortable in their own skins, inevitably through some process of working on self-discovery and healing old wounds. Beyond connection with their partner, they were deeply connected to themselves. They were whole, and were in relationship (or not) out of conscious choice, not fear or compulsion. Channeling one of my favorite books of all time, Shell Silverstein’s The Missing Piece and the Big O, they had mastered rolling along without another piece to fill some bottomless psychic hole. They had filled it themselves. They knew their own bodies, were unashamed and knew how to advocate for themselves and ask for what they needed, even to demand what they needed. They knew how to communicate with kindness and truth, and seemed to have accepted themselves as being enough, loving themselves first with the understanding that you can’t give what you don’t have. Some important spiritual element was also a common factor in all of the angels’ lives, be it through God, yoga, meditation, nature, or conscious generosity practices–but all of these women shared a deep understanding of their connection to something bigger than themselves that was based in love, connection and compassion.

And all of them had struggled mightily. Confirming recent research in the #MeToo era, more than a fourth of them had suffered sexual trauma, and all had struggled in numerous other ways. They were not innately lucky. Life hadn’t been handed to them on a silver platter but they had found a way to make lemonade out of lemons, or perhaps to see lemonade where I saw lemons. They had moved from a position of victimhood where the world happens “to me” to a place of creativity and strength where the world happens “by me.” They were not perfect and all had bad days. They were works in progress who hadn’t “arrived” anywhere magical, but were on a path, arriving every day exactly where they were and being present. Most fascinating to me in my state at that time was that they self-reported amazingly vibrant and fulfilling sex lives, which presented in many different ways, but all of them reported that sex, or their relationship with sex, was better than ever. They saw the second half of life as an opportunity not a curse. They approached their relationships with themselves and their partners with intention, and found ways to keep things fresh, new and fun. These may have been rather earthy angels, but I now that I knew they were out there I set about studying this group of women and what they had in common. If it was possible for them, then perhaps it was possible for me, and perhaps I could teach it to others. Immediately my perspective changed and no longer was menopause a frightening black hole of doom and gloom, but became a source of great optimism and excitement. There was hope for us all, and perhaps together we could find a better way to relate to this second half of life. Since the word “awakening” and “waking up” came up so often in my interviews, I begin to refer to my angels in the same way that one of my patients referred to herself–”sexually-woke.”

So after years of telling myself (and unfortunately also telling my patients) that declining libido and loss of our sexual selves is a “normal” part of the biology of mid-life for women, I had to face the fact that I was dead wrong. This took a couple of years to accomplish since I had built my life around never being wrong. As a scientist, I had been trained to think that we should know the answer to everything, that everything real can be measured, and that traditional medicine was infallible. My mind had to shift from the world of certainty to the world of curiosity and committing to letting go of being right. My own mid-life career crisis slapped me in the face as I realized that traditional medicine was spending billions of dollars annually making people physically “healthy” with “numbers” that were brag-worthy while at the same time being disconnected, depressed and surrounded by dysfunctional relationships, repressed feelings and resentment. Doctors seemed more interested in the patient’s vital signs and lab results than how she was feeling and her whole sense of physical, emotional and spiritual wellness. As a woman I knew the feeling well of being told by a doctor “Congratulations, you are just fine!” when my heart was telling me loud and clear that I was most definitely NOT fine. But no one wanted to talk about what was really not fine. Part of me was suffocated, stuck in a box and not allowed to talk. I was, after all, an “older woman” and therefore largely irrelevant in this culture that glorifies youth. I had been told my whole life that sex was something that men wanted and women either succumbed to or used as currency in exchange for something else, and that being outspoken about sex or what I needed sexually was not feminine and certainly not acceptable. I wanted to be whole, I wanted to connect, I wanted to feel my feelings, I wanted someone to see me and truly listen to me. I wanted to have sex. Lots and lots of sex. But just not the kind that I was having, and not with who I was having it with. The sexually-woke were my saviors and my inspiration. If women aged 45-65 (and older) can have the joyful sexual energy of a 22-year-old, then clearly nothing is gone; it’s just hidden. And that means we can find it. So I set out on a mission to create the map to rediscover it.

My mission quickly led to an intense grief about my own loss, and intense empathy and compassion for the losses of so many of us, the loss of one of the potentially greatest sources of connection in our lives and arguably (literally, really) the source of the life force itself. Which is not to say that those not engaging in sex due to conscious choice or circumstance cannot be truly happy, because of course they can. In fact some of the most deeply content and connected people I have met and interviewed are not sexually active in the traditional sense. But I do believe that there needs to be a deep connection to the ever-present sexual, emotionally fertile and generative part of our being to live as our full, authentic selves. Our sexual being is creative, energetic, connected, generous and free. She is intimately aware of her body, her emotions and where they present in her body. She doesn’t just have sex, she makes love, with her partner and with herself if her lifestyle supports that, but more importantly with the world. Making love with the world is showing up in your integrity (which I define as being integrated, pulled together, complete, whole) as your full, completely unashamed self, and operating from a place where everything belongs. Wrinkles, sagging belly, gray hair and all. Our sexual being is a huge part of our complete, authentic self. Cutting off part of ourselves by definition limits us from reaching our full potential, and at the risk of sounding overly dramatic, reaching our full potential seems to me to be the purpose of life.

In 2014 I finally mustered the courage to leave my first husband after 18 years. What happened next was a true spiritual awakening, during which I had my “ah-ha” moment about the questions that had been silently percolating for years. What was the connection between sex drive, degree of relationship intimacy, spirituality and menopause? Why did my sex drive and that of so many of my patients come back with a passion when I finally decided to get divorced (or for many women when they passionately committed to a new perspective on an old relationship?) What did spiritual connectedness and sex have in common?

Around the time of menopause we are faced with what feels like the perfect storm of ways in which our meticulously arranged lives start to fall apart. Our bodies are changing in ways that can feel devastating to accept. There is a stark realization of our own mortality as fertility disappears and personal illness may set in. We question our relevance, even if we had no desire for more children–if I am not fertile, who am I? Am I officially “old” now? (I didn’t know whether to laugh or cry when I received an introductory mail offer from the AARP right after my 50th birthday). Children are often struggling and/or leaving. Parents may be sick and/or dying. Relationships and careers are changing and often coming to an end. Combining all that with a raging storm of hormonal change, we are faced with a crossroads. Either wake up to accept and embrace the wondrous possibilities of this new reality, or pile on more delusion and denial. While most of my patients and I had been stuck in the latter, I suddenly (almost overnight) became intensely aware of the optimism and hope that been a giant blind spot for me. Rather than an ending to everything that I valued, instead I sensed the second half of life as a vast openness of limitless possibility, free from the endless hamster wheels that occupied most of my previous life.

Waking up to who we really are and reconnecting in the deepest spiritual sense with ourselves, our partners (if we have one) and the world is the beautiful potential wisdom of mid-life and menopause. We can finally become free to find and show up as our unashamed selves after a lifetime of serving others, and often a lifetime of following a path that was not our own. My work became a calling, focused on blowing the lid off this taboo hiding place of shame, secrets and lies, and starting a conversation about what’s REALLY going on, together figuring out how to embody lives mirroring our fully integrated and innately sexy potential. That calling led me to undertake one of the largest studies ever done on this subject, involving over 1000 women aged 40-65 who were extensively surveyed regarding the most intimate parts of their sexual, spiritual and relational lives. (I called it the “Menopause, Relationships and Sex Study” and will refer to it as MRS going forward). Many brave participants agreed to share their stories through recorded interviews and written testimonies. Through this enormous shared body of information I was able to document the truth behind my suspicions from years of personal and professional experience, to not only describe in statistics what is common and normal but to investigate the lives of women who have found the “secret” to living a vibrant, connected and passionate second half of life.

I feel compelled to recognize that it is from a position of great privilege that we can even consider such subjects as how to “find our sexy self.” I have never forgotten hearing for the first time in middle school how Marie Antoinette could not understand why the masses of her people were rebelling because they didn’t have any bread and allegedly said “let them eat cake.” Although this story probably is not even true, it’s a great example of the unconscious ignorance or that bias exists in all of us, and I am exquisitely conscious of the reality of most women in the world who have much more important pressing things to worry about than fulfilling sex. If you are privileged enough to be able to read, to have lived past 40 and have the means to have bought this book and to care about improving your sex life, I invite you to stop right now for a few moments and give gratitude to that reality. It is only in recent recorded history that we have been able to evolve beyond the human brain’s primary biological drive which is to survive, and to consider instead how to thrive. Pursuing happiness is a privilege that we should never forget is a luxury that comes after survival is taken for granted.