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The Longest Shortest Time · Hillary Frank | Realm

Painful Sex and Elusive Orgasms in Perimenopause

April 1, 2026·42 min·3 clips
Dr. Stryker argues women are culturally taught not to expect sexual pleasure — and that orgasm difficulty can be an early warning sign of diabetes or MS.
Hilary Frank begins close to home. The show has spent a long time with parenthood and reproductive health, including plenty of baby stories. Here, that history turns toward bodies after birth, during menopause, or simply through having a vagina. The question is sex. More exactly, it is sex that hurts, feels different, or stops responding the way it used to. Books may not get all the way there. The guest says many books about sexual function stay with relationship and communication, while she looks at the physical, medical, and hormonal side. Her lens is clinical without sounding cold. Dr. Lauren Stryker is introduced as a Northwestern University obstetrics and gynecology professor. Then the excerpt moves to orgasms. The complaint she describes is familiar and frustrating: the same paths are there, but the body does not answer the same way. She starts with blood flow. Less blood supply to the clitoris can make nerve endings less sensitive, which can make climax harder to reach. Aging can be part of it. Medical conditions can matter too, with cardiovascular disease and diabetes named as possible contributors to changed sexual response. Estrogen comes in carefully. Stryker calls estrogen a vasodilator and explains that it supports healthy clitoral blood supply, which supports healthy nerve endings. She also keeps the point from getting too neat. Estrogen can help, she says, but people without it can still have orgasms.

As heard by us

A direct, grounded conversation about pain, hormones, and the body changing.

The episode opens with Hilary Frank in a familiar, human register, then narrows into painful or uncomfortable sex, menopause, and the medical factors that can change sexual response. Dr.

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Why you'd press play

When sex hurts and the usual advice stops short.

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