Ep. 30 - Sex & The Older Woman: Thank You Emma Thompson

[00:12] Introduction: Sex, Aging and Good Luck to You, Leo Grande

Dr. Bawa: Welcome back to the Dr. Sex Fairy Podcast. I am Dr. Kanwal Bawa, and I am here to transform your life. This podcast exists so that we can have important discussions that cause you to see the world around you a little differently. Today I would like to discuss the concept of sex and sexuality in the older woman. Specifically, I want to discuss the new Emma Thompson movie Good Luck to You, Leo Grande.

Dr. Bawa: Emma Thompson plays a widow in her early sixties who was married for 31 years to her late husband. Interestingly, they had sex, but she has never experienced an orgasm. She hires a male escort because she finally wants to experience things that she has never experienced. And I think the movie makes a very poignant comment not only about the orgasm gap, but also about the sexuality of an older woman, her insecurities and more.

Dr. Bawa: To help me discuss this, I am joined by Eileen Lemelman, a licensed clinical social worker and psychotherapist with over 30 years of experience. She specializes in treating trauma, which she says is at the root of much of the anxiety and depression that she sees in her practice. Eileen is also the host of It All Starts with You, a motivational speaker and published author. Her mission is to help midlife women by supporting, educating, inspiring and encouraging them to create purpose and meaning in their lives and navigate the second act. Welcome, Eileen.

Eileen Lemelman: Thank you. I am so, so excited to be with you.

Dr. Bawa: So let's talk about the movie. We've both seen it, and I think it is very interesting that when Nancy, Emma Thompson's character, starts out, she is not really expecting an orgasm. I found that heartbreaking.

Eileen Lemelman: Yes. I think the expectation that she puts out there is the expectation of, "I can't have pleasure." The expectation is, "I don't think I can release." It is almost like, "My body has betrayed me, and I don't think that can ever change." It is very sad, because it is almost as though she has betrayed her own body with preconceived notions about what that body can and cannot do. As you find out in the end, it is more in her mind than anything else.

Dr. Bawa: Our mind is our most sexual organ.

Eileen Lemelman: Absolutely. And so much of the inability to release can come from suppression, anger and trauma. When you think about an orgasm, an orgasm is a release. You have to trust yourself, trust your partner and trust your body in order to release.

Dr. Bawa: Yes. There are so many factors that keep women from easing into that pleasure and having an orgasm. From a psychosocial standpoint, what do you think those factors are?

[03:20] Trauma, Anger and the Inability to Let Go

Eileen Lemelman: When I work with women who have difficulty having an orgasm, one of my specialties is treating trauma, and I think so much starts with trauma. And when I say trauma, I don't necessarily mean one enormous catastrophic injury. I am talking about the mindset that can be created by childhood experiences, neglect, emotional injury, sexual injury, parental messages and all of the things we absorb as we are developing.

Eileen Lemelman: When we have experienced those things, it can interfere with pleasure. It can interfere with orgasm. In fact, I was with a client recently, a senior woman who is well into her later years, and coincidentally she had no idea I was coming on this podcast. She told me that she has never experienced an orgasm. It was so tragic. As we started to really explore it, she revealed how much anger she had held onto throughout her life—anger about her upbringing, anger at herself and anger that her husband was never able to satisfy her. She had been bottling all of that up. That anger is significant when you are talking about somebody who cannot let go enough to orgasm.

Dr. Bawa: And on top of that, we have to look at the whole person. There is the psychosocial assessment, but there is also the biological side. What is going on in the body? You cannot ignore that. Hormonal fluctuations matter. You have to check in with your body.

Eileen Lemelman: Exactly. And psychologically, when we are talking about midlife women and baby boomers, there can be depression. There can be the empty nest, retirement, financial insecurity, children leaving the house, changes in identity and all of those transitions. Like Emma Thompson's character in the movie, there can be this point where the person is contracting instead of expanding.

Dr. Bawa: And that contracting matters. When we are depressed, when we are anxious or under stress, our body contracts. It is very difficult to have an orgasm when your entire system is tightened up.

Eileen Lemelman: Absolutely.

Dr. Bawa: And then from the biological aspect, a woman at that age is going through so much physically as well. We just talked about the emotional part, but physically it is no picnic either. Hormones are changing. If she is menopausal or postmenopausal, she has had a massive drop in estrogen. Every stage has its own set of complications.

Dr. Bawa: The vagina can become atrophic. Tissue can become thinner and more fragile. She may tear more easily. She may have pain with sex. She may have trouble getting wet. And if she is not using the vagina very much, that does not help the situation. So emotionally she has stress, family problems, financial stress and all of these life changes, and physically her body may not be cooperating. That is a very difficult combination.

Eileen Lemelman: Absolutely. And I think women in that position often suffer from a lot of shame. They may not even know how to help themselves or how to ask for help.

Dr. Bawa: Yes. And that is why seeking help is so important, whether that help is psychological, medical or both. Especially with the postmenopausal vagina, we need to talk about lubrication, blood flow, tissue health and all the things women are often too embarrassed to discuss.

[08:40] Seeking Help Instead of Accepting Sexual Decline

Dr. Bawa: I have a patient in my practice who came to me at about 69. She and her now-husband later came on this podcast together. She was a widow when she met him, and she wanted to have sex with him, but her body was not cooperating. There was a disconnect. She was smart enough to realize there was a problem and to seek the help she needed.

Dr. Bawa: She came to me and we did significant vaginal rejuvenation. She had incredible results. Then she brought him in because now he had to keep up with her. So he came in and had his own treatments. At the end of the day, he literally said in one of my YouTube videos that when people ask him, "When is the best sex of your life?" his answer is basically, "What time is it?" I mean, bravo. Isn't this why I am in this profession?

Eileen Lemelman: Exactly. That is sexual wellness. That is well-being. It makes such a difference when people get the help they need.

Dr. Bawa: And therapy is critical too, because you cannot really separate sexual wellness from mental wellness. They are intertwined.

Eileen Lemelman: They are absolutely the same conversation. You talk about sexual well-being and reawakening desire and wanting to have more sex. There is a direct correlation between your sexual energy and your joy, your creativity, your passion and your vitality. When you are a sexual being, all of those other parts of you get ignited as well.

Eileen Lemelman: Conversely, when you are very vibrant and connected to your life force, your sexuality gets ignited too. Depression and sexual dissatisfaction also feed each other. If you are sexually dissatisfied, you can become depressed. If you are depressed, you can become sexually dissatisfied. You have to look at both.

Dr. Bawa: Absolutely.

Eileen Lemelman: And we cannot ignore one very important factor in the postmenopausal woman's sexuality, which is how she sees herself and how the culture sees her.

[12:20] Ageism, Body Image and Radical Aging

Eileen Lemelman: We know that American culture has not historically been kind to aging people, especially aging women. That is starting to change, but we need what I call radical aging. We have to be willing to challenge the old concept of what an older woman is supposed to look like and how she is supposed to behave.

Eileen Lemelman: Maybe your grandmother's generation had one idea of what a woman in her sixties was supposed to be. That does not mean we have to accept that. We can be sexual. We can be passionate. We can be playful. We can have changing bodies and still want pleasure. If you do not have the perky breasts you had when you were 25 and you start judging yourself, you can shut down your own sexuality before anyone else even has a chance to respond to you.

Dr. Bawa: And if we are sexual, if we are vibrant, if we are alive and creative, we have joy.

Eileen Lemelman: Absolutely.

Dr. Bawa: There is a scene toward the end when Nancy sees herself naked in the mirror. She is really seeing herself, truly seeing herself, maybe for the first time in a long time. She has seen herself naked many times before, but I am not sure she had really looked at herself in that way or accepted herself until that moment.

Eileen Lemelman: That is exactly how I interpreted it. For the first time, she was looking at herself rather than immediately judging herself.

Dr. Bawa: I tell my patients all the time: fall in love with yourself. Fall in love with your body. Know every single part of your body. Because you cannot really have a partner pleasure you unless you know what you want and unless you know your own body.

Eileen Lemelman: That's right.

Dr. Bawa: Another issue this movie brings up is honesty. You cannot expect a new partner—or a long-term partner—to magically know what you want. It is one thing to tell a partner you are dissatisfied. But more often than not, I blame the women themselves in many cases because there has been faking going on. Faking an orgasm helps absolutely nobody. I would like to believe that your partner wants to please you. But if you keep faking it, how is he going to know he needs to change anything?

[16:45] Faking Orgasms, Communication and Personal Responsibility

Eileen Lemelman: And then you become angry at him and passive-aggressive because you are not having an orgasm, even though you have never honestly told him what is happening. One of the things I emphasize in therapy is that even when you bring your partner into the room, being in a relationship requires you to be 100 percent responsible for your part of the relationship.

Eileen Lemelman: It is not fifty-fifty in the sense that you each get to do half the work and blame the other person for the other half. You have to be 100 percent responsible for yourself. I hear people say, "We've been married so long. He should know what I want." No, he shouldn't. First of all, what you want can change from moment to moment. He does not know whether you are feeling a little unhappy, a little bloated, whether you have a stomachache, whether you are angry with him or what is happening in your body right now unless you communicate it.

Dr. Bawa: Exactly. You have to be honest and communicate effectively.

Eileen Lemelman: And a lot of people were never given the tools to communicate effectively. But that does not mean they cannot learn them. It is never too late. You are never too old to change, and you are certainly never too old to have an orgasm for the first time.

Dr. Bawa: Exactly. And there is another issue I want to bring up: the selfish partner. There are people who really are selfish lovers. You can communicate until you are blue in the face, but if the other person does not care about your pleasure, that is a different issue.

Dr. Bawa: There is a scene where Leo says that one thing he loves is watching someone's face when they are feeling pleasure—watching them let go and watching their body go with it. He enjoys giving somebody else pleasure.

Eileen Lemelman: Absolutely. And Nancy talks about her sexual experience with her husband as though she basically lay there and let him do what he needed to do so he could satisfy his sexual urge. There was no real connection. There was no intimacy. She did not demand that either, because she did not believe she was entitled to it.

Dr. Bawa: What happens with Leo Grande is very different. Yes, he is a male escort, but he is completely present with her. He wants to know her story. He wants to understand her. He is interested in more than just the act itself.

Eileen Lemelman: And he sees beauty in her body even while she is judging every wrinkle and every thing she believes is wrong with herself. He is truly present in the moment. There is that little gesture where he brushes a finger along her collarbone and she almost runs away from the feeling.

Dr. Bawa: She is nervous, but she is also getting a little excited and she does not know what to do with it because she has never really allowed herself to connect with her own sexuality.

Eileen Lemelman: Exactly. People think intimacy and pleasure are mysterious, but so much of it is simply making the effort to connect. It is making the effort to give your partner pleasure—and it is just as much a woman's responsibility to give that attention back.

[21:25] Curiosity, Mystery and Keeping Sex From Becoming Robotic

Eileen Lemelman: I do think sex can be mysterious, and for me the best way to think about that mystery is curiosity. Be curious about your partner. That is what I encourage my patients to do. Be curious instead of assuming you already know everything about the person because you have been together for years.

Eileen Lemelman: Sometimes couples come in and sex is no longer fun because it has become robotic. It is not about curiosity. It is not about mystery. It is not about pleasure. Maybe at one point sex was about making a baby, or checking something off the relationship list, and over time it became a routine.

Dr. Bawa: And with Emma Thompson's character, if the entire encounter is only about whether she has an orgasm, she cannot be present with herself. Leo has to calm her down and get her to let go of the expectation and just experience the moment. She is so tightly wound.

Eileen Lemelman: Very tightly wound. And as we age and our bodies change, we sometimes get even more uptight because we cannot have sex exactly the same way we had sex when we were younger. We have to get creative. We may need different positions. We may need different kinds of touch. We may have to broaden what we think counts as sex.

Dr. Bawa: She literally has a list of things she wants to experience, including oral sex. Why not? There is nothing wrong with being creative in the bedroom and maintaining intimacy in different ways.

Eileen Lemelman: Exactly.

Dr. Bawa: As she starts to experience pleasure, she makes a very interesting comment. She says that sexual fulfillment is a very powerful thing. It made her feel invincible. She says she wishes she had known it sooner because she might have made different choices in her life. She felt more alive.

Eileen Lemelman: And that is why I think this movie should almost be a public-service announcement. It is not just about sex. It is not just about the act. It is about intimacy, feeling safe, feeling seen and knowing that your partner has your back.

Dr. Bawa: That old definition of intimacy—"into me see." You see me, you hear me, you understand me. That creates a deeper connection, and then the sex becomes something created from that connection.

Eileen Lemelman: Absolutely.

[25:35] Orgasm, Authenticity and Learning Your Own Body

Dr. Bawa: When she finally does have an orgasm, what you notice is that the relationship with Leo has encouraged her to be free, to let loose and to stop performing the version of herself she thinks she is supposed to be.

Dr. Bawa: And then later, when she runs into her former student, she finally gets real. She does not invent a story. She does not lie. She apologizes. She becomes more honest with herself and more authentic. That authenticity is what allows her to finally experience pleasure in a completely different way.

Eileen Lemelman: Yes. She gives that to herself because she is finally comfortable with herself. She is accepting herself.

Dr. Bawa: And what is very interesting is that she does not need somebody else to give her pleasure. She was capable of giving herself pleasure all along.

Eileen Lemelman: Exactly. There was a revolutionary book written in the 1970s called Our Bodies, Ourselves. It was part of this movement of women learning not to be ashamed of their bodies and learning to actually look at and understand their anatomy.

Eileen Lemelman: Ultimately, you are the only person who can know exactly what gives you pleasure. Yes, sex with a partner can be wonderful, but unless you know how to satisfy yourself, how are you even going to ask for what you want?

Dr. Bawa: You have to be in line with yourself before you can get anywhere with another human being.

Eileen Lemelman: Absolutely. You have to be in alignment with yourself.

Dr. Bawa: Love yourself. Love your body. Look in the mirror. Understand that you are a whole sexual person. We have to promote self-love because it matters.

[28:30] COVID, Isolation and the Need for Human Connection

Eileen Lemelman: And then we also have to talk about what we have all been through with COVID. We have learned so much in this post-COVID period. It has been a very traumatic time for many people, especially those who lost loved ones or developed long COVID. We became hypervigilant. We became fearful of one another.

Dr. Bawa: It made us fearful of each other, but it also gave us time alone with ourselves.

Eileen Lemelman: Exactly. There was an awful side to it, but one of the things it forced people to do was stop. In an age of constant stimulation, phones and smartphones and endless activity, we very rarely stop. And that stillness forced people to look around, sit in silence and try to make sense of their lives.

Dr. Bawa: And sex requires some of that. It requires you to stop, to be with the other person and allow a connection.

Eileen Lemelman: Yes. For some people, long distance forced them to find different ways to stay connected. For others, the isolation was devastating. Loneliness is lethal. We saw depression, anxiety, addiction and suicide. My practice has been bursting at the seams. So many people are not only depressed and anxious, but they are dealing with post-traumatic stress. Any time you go through prolonged uncertainty, unpredictability, fear and the possibility of illness or death, it can trigger trauma.

Dr. Bawa: And it affected relationships too. It would be interesting to look at the divorce rate during and after COVID because suddenly people who had been able to escape each other by going to work, going to the gym or seeing friends were now face-to-face all the time.

Eileen Lemelman: Exactly. It became a come-to-Jesus moment for many marriages. There was nowhere to go. You had to be with your partner and confront what was actually happening.

Dr. Bawa: And there was a positive side for some couples. It forced people to find ways back to each other.

Dr. Bawa: My own practice had to shut down for a few months because we were considered nonessential. It was devastating, and I still think sexual wellness should be looked at differently. We could make a very plausible argument that this kind of care is essential. It is not simply aesthetics. My patients abruptly stopped getting the treatments that were helping them function and feel well.

Eileen Lemelman: Which leads to a question I have for you. When a woman is dealing with sexual dysfunction, especially a postmenopausal woman, what do you offer? What do you recommend for somebody who needs that kind of help in her sex life?

[32:15] Dr. Bawa's Approach to Postmenopausal Sexual Dysfunction

Dr. Bawa: That is an excellent question. Any treatment I do begins with taking a history and doing a physical evaluation because you cannot understand what is happening without understanding the story. I always say we have to understand the story first. Then, based on what her needs are, I prescribe an appropriate treatment regimen.

Dr. Bawa: There are some things that are broadly applicable. Hormonal fluctuations can wreak havoc on a woman's life—and a man's life for that matter—so hormones are something I evaluate very closely. If hormones need to be optimized, that may be part of the plan.

Dr. Bawa: Then we have to look at tissue health. The vagina can change, and men develop genital changes too. Both men and women can benefit from acoustic-wave therapy. It is painless and it is used to improve blood flow.

Eileen Lemelman: And blood flow is obviously important for sexual function.

Dr. Bawa: Extremely important. Erectile dysfunction is often a vascular issue. In fact, when a man comes to me with erectile dysfunction, sometimes I send him to a cardiologist because I want to make sure everything else is okay. Hopefully it is, but if we find coronary artery disease or another vascular problem, that can be lifesaving. So circulation matters.

Dr. Bawa: For women, improving blood flow to the vagina can help arousal and tissue function. For men, improving blood flow can improve erections. Genital tissue changes with age, and circulation is part of that story.

Eileen Lemelman: What else do you use?

Dr. Bawa: Radiofrequency is another treatment I use for women. It helps build collagen and elastin over time. It can help tighten the vagina—not to the point where nothing can get in, which is not the goal—but enough to increase friction and improve sensation.

Dr. Bawa: It can also help increase lubrication, which is so critical in the older woman. It helps normalize vaginal health and pH, which may reduce issues such as recurrent infections. Overall, you can have better tissue health, better lubrication and more friction when you have sex. That can mean more sensation and better sexual health. It is a win-win.

Eileen Lemelman: And you also do the O-Shot and P-Shot?

Dr. Bawa: Yes. For both women and men, we can use platelet-based regenerative treatments. We draw the patient's own blood, process it and inject the concentrated platelets into specific sexual tissues. For women, that can improve sensitivity and orgasmic response. For men, regenerative injections can support erection quality, sensitivity and sexual function. There is so much we can do that people do not even realize exists.

Eileen Lemelman: So people do not have to just cross sex off their list because they are older.

Dr. Bawa: Absolutely not. Remember the couple I mentioned earlier? They are having sex twice a day in their late sixties and around 70.

Eileen Lemelman: Wow. Beautiful. And if somebody is already postmenopausal, can she still get the same kind of results, or is it better to start earlier?

Dr. Bawa: The earlier you address changes, the better. Prevention is always better than repair. Women who start sooner often have better results. But even if you waited and things have progressed, it is never too late to have improvement. You may not have the vagina you had when you were 16, but you do not have to simply accept your current vagina if it is causing pain, dryness, poor sensation or other problems.

Dr. Bawa: There is no reason an older woman cannot have better sexual health, better pleasure and a better quality of life.

[37:20] Sexual Confidence, Asking for Help and Rejecting Shame

Eileen Lemelman: That is the connection I keep hearing between what you do physically and what I do psychologically. They are connected. When people are having better sex, it can make a tremendous difference in confidence.

Dr. Bawa: Absolutely. And that applies to men too. If a man is self-conscious about his penis, why should we automatically dismiss that? Women can get breast implants. Why can't a man want his penis to look a certain way? I am not even saying that in a narcissistic way. When I treat men who are very self-conscious and I improve something that has bothered them for years, they walk in one way and strut out another way. The confidence is real. If they are happy, why the hell not?

Eileen Lemelman: And again, that goes back to mental health as well as physical health. Very often people have shame. Shame is huge. And even asking for help can feel shameful.

Dr. Bawa: Exactly.

Eileen Lemelman: But asking for support is not coming from weakness. You can reframe it as coming from strength. You are saying, "This matters to me, and I am willing to do something about it." That is a beautiful thing.

Dr. Bawa: And you have to be able to tell yourself that pleasure is possible in your life. If you have convinced yourself mentally that you cannot have an orgasm, then you have shut one of the doors before any physical treatment or therapy even has a chance to help.

Eileen Lemelman: Absolutely.

Dr. Bawa: And that brings us back to the movie. Nancy is in her early sixties. She has never had a sexually satisfying relationship and has never had an orgasm. Yet at that age she is standing on the precipice of this joy, excitement and pleasure.

Eileen Lemelman: Yes. And I thought the performances were outstanding. Both of them were outstanding.

Dr. Bawa: Emma Thompson was amazing. And Daryl McCormack, who plays Leo, is very handsome and absolutely fabulous. When you really think about what it takes as an actor to reveal yourself physically and emotionally and be that vulnerable, it is extraordinary.

Eileen Lemelman: It was liberating for me to watch.

Dr. Bawa: Yes. I think this movie is applicable to so many people because the themes are universal. It does not matter whether you are an older woman, a younger woman, raised in the United States or somewhere else. We can all identify with some part of it.

Eileen Lemelman: Absolutely.

Dr. Bawa: So how can our listeners reach you? I am sure many of them will want to come to you for therapy.

Eileen Lemelman: They can go to my website, eileenlemelman.com. They can also find my YouTube channel and It All Starts with You. And they can call my office at 561-265-5738.

Dr. Bawa: Awesome.

Eileen Lemelman: Thank you.

Dr. Bawa: At the very end of the movie, Nancy has finally had an orgasm. She drops her robe and looks at herself. She is not looking at herself to criticize anymore. She is looking at herself with true acceptance. That moment is about so much more than being naked.

Dr. Bawa: You see the evolution of Nancy in that moment. She has embarked on a journey of self-love, self-fulfillment, growth and, of course, pleasure. There is something we can all learn from this. Life is short. Do not waste it making someone else's idea of what your life should be.

Eileen Lemelman: Absolutely.

Dr. Bawa: Until next time.

[42:28] Recorded Outro

Dr. Bawa: I hope you enjoyed the Dr. Sex Fairy Podcast today. I would love to continue this conversation with you. If you would like to get in touch with me, email me at askme@drsexfairy.com. Don't forget to follow this podcast and leave me a five-star review. And make sure you follow my blockbuster-hit TikTok account, Dr. Sex Fairy.