By Kate Silver - This article originally published on Get Old

In recent years, Barb DePree, M.D., noticed that many of her patients had something in common: when it came to sex, they were dissatisfied.

As a gynecologist and women’s health provider who focuses on the time before and during menopause, this was a concern for her. She learned that a number of her patients hadn’t had sex in months, if not years. Some had never had an orgasm. Quite a few didn’t feel comfortable talking with their partners about sex. Because of physical and hormonal changes, she saw that women were experiencing barriers to sex later in life.

Through her practice, DePree’s goal is to help women anticipate changes that may occur in menopause and understand and enjoy sex in their 40s, 50s, 60s and beyond. "I see women gradually drop out of this activity for a variety of reasons. So my mission is to help women think about ways to engage rather than to disengage," she says.

We asked DePree to share with us the information she wants every woman to know about sex after menopause. Here’s what she said.

1. You may experience changes in your body, but you can prepare for it. During perimenopause—the transition that begins before menopause, which can last several years—a woman experiences hormonal changes that result in physiological changes. "It is likely that you will experience somewhat of a decrease in libido, maybe taking longer to arouse and orgasm, and more discomfort regarding vaginal dryness," says DePree.

2. Having sex may be good for your health. If you stop working out, your muscles begin to atrophy. The same goes for the vagina, especially with age says DePree. Following menopause, the vagina and surrounding tissues begin to atrophy and thin, losing elasticity as estrogen decreases, says DePree. Sex and orgasms act as a workout, increasing blood flow to the vulva and vaginal tissues, invigorating the area. "My mantra is let’s maintain it instead of having to regain it," she says.

3. Make sex a priority and your relationship could benefit. DePree says her patients often tell her that after going through menopause they have no interest in initiating sex. She tells them that their body may not be telling them to do so, but their brain can. "I know you don’t have desire," she says to them. "But if it’s not painful then you can enjoy it. I want you to choose it. I want you to be intentional about putting it on your calendar, just like getting your nails done every two weeks or whatever it is." She says she recently spoke with a post-menopausal patient who, with DePree’s encouragement, had sex with her husband for the first time in eight years. "She said, 'I feel whole again, we have reconnected again in a place we haven’t been for years,’" says DePree. "There really is something that happens sexually in a relationship that doesn’t happen over a movie or a nice dinner. It is this hugely valuable piece of health, which I think isn’t always recognized for the value that it does bring."

4. Court your creativity. Many of DePree’s patients have been in long-term monogamous relationships and are feeling bored in bed. "Adding novelty and changing things up is really great sexually," she says. She says one book, in particular, helped spark excitement for her patients: "Fifty Shades of Grey, while it wasn’t great literature, in my practice it was great for women because I think it took them out of their lane, let them think maybe there’s a different sexual script here I could be thinking about," says DePree.

5. If you can’t orgasm through intercourse, you’re not alone. You wouldn’t know it from television or movies, but many women don’t climax through sexual intercourse, alone. In fact, DePree says she hears from women constantly that this is a challenge. She reassures them encourages them to be creative and add toys and/or other methods and techniques into their sexual repertoire.

6. If you’re experiencing pain, talk to your doctor. DePree says that pain during sex has become a barrier for many of her patients. "It’s not always menopause," she says. "There are a number of reasons women have pain related to intercourse." She encourages women to bring the subject up with their doctor so they can be examined and treated.

7. Therapy can help. If you’re feeling unfulfilled and are having trouble talking to your partner about it, DePree encourages a visit to a sex therapist. "I think it can be a difficult area for couples to navigate on their own," she says. "Sometimes we don’t have the language to communicate the desires. If you say, 'I’d like you to do this,’ it insinuates it’s something you hadn’t been doing. A lot of times one or two appointments with a sex therapist can be really helpful, just to help give people the dialogue of how to move through this."

As with any other physical activity, it’s always a good idea to check in with your doctor before resuming sexual activity after a sustained absence.