On this episode of Our Better Half, we enjoy an in-depth conversation with Dr. Sarah Girardi, a trailblazing urologist and female sexual health specialist with over 25 years of experience.
Together, we unpack the often-neglected world of older adults' sexual health. Dr. Girardi connects the physical and urological realities of aging to the broader relational and emotional aspects of intimacy, drawing on her extensive clinical background to bust long-standing myths and advocate for the well-being of her patients.
A primary focus of the discussion revolves around the biological realities of aging and the critical importance of proper anatomical education. Dr. Girardi emphasizes that recurrent urinary tract infections (UTIs) in women—regardless of whether they are 20, 60, or 90 years old—are frequently tied to sexual activity, making sexual health history a vital component of standard urological care.
She addresses the widespread misconception that painful sex or a compromised sex life is just an inevitable part of growing older that women must accept. Through her practice, Dr. Girardi uses direct, empathetic tools—like using a mirror during exams—to help women understand their own changing bodies and reclaim their sexual vitality. She notes that while physical intimacy changes over time, a lack of compliance from one's anatomy doesn't mean intimacy has to end; rather, partners can discover new ways to pleasure each other beyond standard penetration.
The episode also highlights major medical milestones and clarifies the science behind female sexual health treatments. Dr. Girardi discusses the historic November 10, 2025, FDA announcement that officially removed the decades-old black box warning on topical vaginal estrogen, a decision rooted in safety data reviewed during an intensive hearing in September of that year.
She explains that topical vaginal estrogen is not absorbed systemically, but instead safely restores a low pH and healthy lactobacillus to the vaginal ecosystem, serving as a powerful defense against life-threatening conditions like urosepsis in older women.
Shifting the conversation to non-hormonal desire medications like flibanserin, Dr. Girardi clarifies the public discourse surrounding the "Female Viagra" misnomer. She notes that while Viagra works on a purely physical level by maintaining blood flow to an erection, female arousal and desire operate through complex neural pathways in the brain.
