Sex, Health & Aging

Dr. Tonia Mezzini is a highly respected physician specialising in sexual and reproductive health, helping women in particular navigate the complexities of hormonal changes, wellness, and overall wellbeing. 

With a down-to-earth approach and a wealth of expertise, she’s passionate about breaking taboos and providing practical advice for a healthier, more confident life.

Louis Carr Real Estate
With offices located in Castle Hill, Cherrybrook, and West Pennant Hills. Call +61 02 9480 1000

Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.

Transcript

00:00

This episode of The Big Six-O brought to you by Louis Carr Real Estate, helping people in the Hills District find their dream home since 1992. Ready to buy, sell or rent? Check out louiscarr.com.au for all your property needs. If you're old enough to remember when phones had cords and the only thing that went viral was a cold, then you're in the right place. Welcome to The Big Six-O with Kayleigh Harris and Guy Rawlison.

00:28

Because who better to discuss life's second act than two people who still think mature is a type of cheese?

00:53

Well, welcome to The Big Six-O. If this is your first episode, thank you for tuning in.

00:57

My co-host on The Big Six is my friend Guy Rowlison. And each week we talk about issues that affect people basically from 50 up. So if that's you, sit back and enjoy the next half an hour or so, g'day Guy. Hi, I'm Kayley, how are you going? Yeah, good, great to see you again. Now, don't forget you can contribute to topics that we talk about by checking out our Facebook page, which is The Big Six dash the letter O and then an H, as in, oh my goodness, I'm 60. If that makes sense, you'll find us.

01:27

members of our Big 60 community have asked for us to talk about sex and aging and I'm delighted to say we're joined this week by Dr. Tonya Mazini who is a sexual health physician. Welcome Tonya. Thank you, thank you for having me along. I don't want to shy away from these issues of sex and 60 and when you talk to your kids they think you only had sex three times at so many kids I've got and

01:57

don't or shouldn't have sex and I just think it's it's it's a fallacy it's wrong and I think we should be talking about it more openly but obviously when you get to this age there are more issues that you need to consider when it comes to your sexuality and and how

02:17

you demonstrate that I guess to your partner or significant other. This is something that you deal with every day. Absolutely. So Kayleigh as a 53 year old old out myself, sexual health physician, I spend a lot of time talking about this in my professional life and of course you know amongst my circle of friends. I can be a liability at a dinner party, I'll let you know that in advance. But it's not it's not a new thing for young people to think that

02:47

they're the ones that have invented sex and no one else has had sex before them and no one will have sex after them because we tend to think about our sexuality in terms of where we are in our stage of life and it can be harder to project forward to imagine what that might be in twenty or thirty years time.

03:07

And the issues are very different across the generations in terms of what people are concerned about. So pregnancy becomes less of an issue at midlife and then it becomes more about ..

03:18

finding time with with partners and so the issues change. But absolutely sex and sexuality and intimacy are really big issues for people across their lifespan and sometimes even more importantly at midlife when you know there's empty nest syndrome for example so the kids finally move out maybe they boomerang back in change the locks turn the spare room into a sewing room do whatever you need to do.

03:45

but it can often be a time where a couple find that they've actually got time together. So the issue of not having time together before when you're raising a family becomes less pressing. It might be that work commitments have also slowed down and you're actually sitting there looking at one another across the dinner table thinking, wow, okay, we've got all this time, we still like one another, what are we going to do? And sex can be...

04:13

and intimacy can be a really important way of affirming that relationship. As we age and evolve, what are some of the... I like that, evolve. Yes, we do evolve, absolutely. What are some of the common misconceptions people might have about intimacy in later life? Well, I think Kayleigh rightly identified as people assume that you're just not having sex anymore, you're just not interested. I think people are sometimes a bit challenged by...

04:41

their own aging processes and it can be a bit confronting to realise that sex is going to need to be different. So there might be some biological reasons why that is, so there might be bad backs and bad knees and bad shoulders and so the gymnastics of sex might need to be a little bit different. There might be issues with erectile dysfunction, there might be issues with...

05:05

postmenopausal concerns and atrophic vaginitis. So the focus needs to move away from penetrative sex as the main expression of intimacy. And I think it's really important to stress that because if you're not trying to get pregnant anymore, why is it so important to just focus on penis vagina intercourse and to actually use the opportunity to expand your sexual repertoire.

05:32

use your imagination a little bit more, be a bit more creative and actually explore an erotic connection in a more meaningful way. So sometimes what I'm doing with my patients is actually challenging some of those conceptions about well you know sex isn't the way that it used to be and there can be a bit of a panic.

05:54

because people worry that if sex doesn't look the same as it has for many years, that somehow it's wrong and it's not good enough. And I think that that's where, you know, I spend a lot of my time challenging that. It can be the case for long-term couples to get into quite a routine, a sort of a set dance that they have. So he does this, you do that, he does that, six moves, eight minutes, you're done.

06:22

everyone's happy, they know the routine, it's predictable, reliable, tried and tested. But we have to consider that that's going to need to change if the bodies are different. And I often say that if the music is different the dance has to be different. And it's not always a loss. It can be harder when that...

06:43

change is precipitated by significant illness. So I work with a lot of women who've got the lived experience of breast cancer, organocological cancer, colorectal cancer, which is one of you know our biggest cancers in Australia. You know that changes body image and function, you know trying to have sex with a colostomy bag is a different scenario from you know pre-surgery. And so

07:11

Often people will come to me when there's a crisis, so there's a health concern, and they're worried that if sex isn't the same as it used to be, it means that love isn't the same as it used to be. And separating those two out is really important. Because

07:27

Though that doesn't mean that just because sex looks different doesn't mean that love is any different or connection is any different. It's just the mechanics. And I think you've hit the nail on the head that, you know, I was born in the 60s in Brisbane or well, probably considered the 30s if it was in Brisbane, but it was very, very traditional and, you know, nice girls didn't and only bad girls did this and you, you know, stayed, you didn't have sex till you got married and all of that stuff. So we... Yes, you didn't give yourself to anyone.

07:57

That's right and and you certainly didn't you know I even remember you know as a I was under 10 I remember my mother saying to me you know when you're playing with your friends oh you need to close your legs you can't show other people that part of your body and I think you grow up with that and there's this whole stigma attached to sexuality and that stuck with me for a very long

08:27

those things that are always held on to about what sexuality is and then when you when you look at it and go you know what it's just sex it's not this whole thing that's going to affect me mentally it's not I don't know what I'm trying to say here is that it's I understand where you're coming from but I think it's important to acknowledge that sex is really important yeah definitely absolutely yeah that to have

08:55

good sex there needs to be a degree of vulnerability. You need to feel safe for it to be good but I I'm not sure I agree with it's just sex because I do think it is important. But I think the shame that comes with it is

09:17

The narrative of shame, I think, is something absolutely that we need to move away from because you can have very good sex without love, but you can't have good sex without safety, I think, and without respect and without good communication. Yeah, they all get sort of messed up in there together, all of those issues. And we were talking, you know, before we were on air about, you know, little kids, you know, running around without their nappies on because they haven't learnt to be ashamed of their bodies yet.

09:47

Whereas we constantly learn shame and comparison and it's getting worse. I mean, you're talking about, you know, Brisbane in the 60s, which might, you know.

09:57

might have been a more conservative environment. I can remember going through my training thinking, oh, well, we might not need someone like me when I graduate and get out there because there'll be so much information on the internet that everyone will know everything. Well, actually everyone's more confused than ever before. And the shame is actually increased because it's this culture of comparison and taking selfies. And I love the work that Celeste Barber does where she challenges those ridiculous YouTube photos and TikTok, whatever they are.

10:27

to actually make it real because if that's what we think bodies are supposed to be like why are we still thinking that in 2025 why do we still hold up a standard of beauty that is you know so narrow when one of the things that I think comes with aging and wisdom and self-acceptance is they go you know what?

10:51

This is what I've got and this has carried me around for a long time and I've had babies and you know I've lived a life and I've accumulated some scars and some wrinkles and this body works pretty well thank you very much. I know with aging actually it brings changes to our bodies but confidence is a big thing as well isn't it? I mean we can say it to ourselves but confidence is still a really big thing. Are there any sense of self or ways to embrace that?

11:20

that change in our bodies that we can sort of relate to that says, yeah, we're not 20 anymore. We are 50, we are 60. Because we can say it to ourselves as much as we want, but there is still that little voice in the back of our head saying, you know, I'm an older person now and whether it's knees, whether it's backs, yeah, there's still that perception, isn't there sometimes? Yeah, and I think that that's something that all of us battle with.

11:51

If we're talking about how it relates to conversations about sexuality and ageing, I think it's important to uncouple pleasure from performance because it's not just about an end goal or orgasm or ejaculation. It's about the pleasure and the intimacy and the connection. And so uncoupling performance and pleasure is really important.

12:18

because then there can be a kind of freedom to explore all the positive things rather than focusing on things that maybe don't work like they used to 30 years ago. But it can be a life's work to really build confidence within yourself. And that's why it can be so difficult to talk about sex when it changes or when it's not going so well because it requires a huge amount of vulnerability.

12:48

and you know more naked than naked is talking about sex when it's not going well. And it can be hard if your self-esteem isn't as robust as you'd like it to be. I think it's a journey that many of us are on. I certainly wouldn't profess to have arrived there myself but that's the whole thing about getting older and continuing to work on stuff and knowing that you know what stuff I thought about myself 30 years ago.

13:18

I can let a lot of that go and look at where we are now, and the patients that I talk to, and women and men at midlife, and say, well, look at all the things you have achieved. And often that's part of the clinical narrative of survivorship and building resilience, is I'll actually go through and sit down with people and talk about what they have achieved and what they're proud of.

13:43

And I think that that can be a really good way to approach bodies as well So instead of focusing on the things that you think are not good enough That you need to buy something for to fix what about the things that are actually good about your body You know focus on the positives and you know be grateful for those those achievements that you know, we're still Got most of our bits working one of the things I feel fairly passionate about is that

14:11

For some reason in Western societies we don't, it's not something we talk to our children about and the idea that you know your kids think that you, the idea of their parents having sex is disgusting and like you said they think they invented it. But that's not the same in a lot of cultures, like I know in some African cultures the mothers will tell the daughters what to expect on their wedding night and what's going to happen and sex is...

14:40

something that's passed down from mother to daughter but it's not something that we tend to embrace in western cultures. So you know if I tried to talk to my daughter about sex when she was 15 or 16 she would have run a mile and cut her ears and mum stop. But I think it's such a big part of life and such a normal part of life that why can't I discuss things with her about how things work and you know what's sort of...

15:10

normal and what's not and just give her the benefit of that knowledge. It's actually a really complicated question because I think sometimes for mothers and daughters it's about the daughters having a relationship with their mum that is just about their relationship as a mum and then it takes a certain amount of time and wisdom to be able to think about your mum as a woman. And in the preparation for this interview I was thinking about you know

15:39

some some of the conversations I've had with older women about sex when I was growing up and I had some fantastic conversations with my nonna and I wish I had the opportunity to have those conversations again now that I'm older. What she was able to do is to model a healthy approach to what I thought was a healthy approach to sex. There was always a degree of humor.

16:07

there was always a degree of discussion of joy within the context of, you know, a Catholic marriage, of course. So after you were married was fine, before then no. But as an expression of, you know, the joy of a relationship and the joy of her marriage and her relationship as a woman that was modeled to me.

16:32

I probably had more conversations with her about sex and relationships than I ever did with my own mother. And maybe that's because of that, you know, at the time that you probably need to hear it, you're thinking about, you're not thinking about your mum as a woman, you're thinking about her as the person who you go, mum, where's my school bag, my whatever, you know, the practical kind of aspects of mothering.

16:56

I do think it, you know, absolutely it's different across all cultures. But I'm often finding myself in clinic and talking to young women and I think where are these girls' mothers? Where are their aunties? Where are their sisters? And I think we sort of then get back to, you know, we've kind of lost our village because what if you don't have a mum that you can talk to? You know, because you just don't have a mum.

17:20

or you don't have that relationship or because of her culture and the way that she was raised and her experiences she doesn't feel confident to have that conversation with you. So yeah, where are the aunts and the sisters? Where's the extended network of older, wise women that young people can talk to? And the same applies for young men. Gary, how much are young men talking to their dads about...

17:46

sexuality and relationships and what to do if things don't go so well and and how do you you know how do you approach you know the first time and you know young guys having those conversations with their dads. Is this something that is changing generationally that that men are becoming more open not necessarily with their sons but their sons are certainly whether it's their feelings

18:12

whether it's intimacy or whatever, it seems to be that cultural shift where young men are more open about things with their mates and their friends. Is that something that you've come across? And along the same lines, questions, whether it's from men or women in their 50s, 60s, about intimacy. What are the most common questions that you get? Well, to answer the first part of that, I don't tend to see a lot of young men in clinics, so I don't know what conversations they're having.

18:42

I know that as a sexual health doctor in my circle of friends, I do sometimes see people's sons and daughters and it's like, go and see Auntie Tonya and she'll sort that out. And then what goes on in the clinic is behind the vault, the closed doors. And I haven't had the experience of raising sons so I don't know what they're talking about. I do hope that there is more of a dialogue. I despair of...

19:10

you know, social media and the fact that that is the go to for information. Because I don't, you know, that we know that there's a lot of content out there, but it's not necessarily good information. The second part of the question is what are the common questions? The most common questions I get asked. Often it's questions about anatomy. So people, you know, not even really sure what the names of all the bits are and how they all work.

19:40

in younger people and then conversations about what is a normal libido and a normal level of desire and then you know with people in their 20s and 30s it's often about negotiating desire discrepancy you know while you're raising a young family then as people get older there's the

20:10

So menopause transition, the metabolic concerns that can impact on sexual performance and libido. So lots of questions about anatomy and then function and I spend a lot of time going no no that's normal. Yep, it's yep that's totally normal. Absolutely a huge range of normal. So I've got a whole range of textbooks that I use that have got photographs.

20:40

of the range of normal genital anatomy. Like there are whole books devoted to that and women will often come in and say look I'm not sure that down there meaning they're external genitals I'm not sure that they're normal and so we get the book out and we go look this is the whole range just like faces all completely different yep there's absolutely nothing wrong with you your anatomy is normal yet that discharge is normal that's a big part of the conversations that I have.

21:07

Aside from the clinical and the textbook sort of aspect of things, how important is that emotional intimacy aspect of things as people mature? It's important the whole way along and I was reading Emily Ngozi's most recent book called Come Together. She's an American sex educator and she wrote a book, her first one was called Come As You Are, which is very much about...

21:35

normal anatomy, normal physiology and helping young women to understand their sexuality and sexual responses in the age of social media. Because back when I grew up, you just read Dolly Doctor. That's where all the information came from. And the first time you saw a naked man was in the Cosmo or was it Cosmo or Cleo? I think it was Cosmo in the Cleo folder. Don't ask me how I knew that. No, no, no, of course, just in journalistic research. Yeah.

22:04

And I actually remember my dad being most upset that I had access to these magazines and telling my mum off for letting me read them. And so this is what happens when you confiscate the Dolly magazines is your daughter grows up to be a sexual health physician. So Emily Negosi's, it's a very long answer to the second question. So Emily Negosi's book Come Together is about maintaining that connection and joy.

22:31

through a long-term relationship and the vicissitudes of life, kids, mortgage, jobs, pandemics, everything. And she talks about the research on how people rate the satisfaction of their sex lives and the thing that will ensure that someone is most satisfied with their sex life is not how often they have sex, the variety or the exoticness of the sex or the sexual positions, but the closeness and the intimacy.

23:01

intimacy that's shared after sex. So once all the gymnastics are finished the intimacy and time spent together skin on skin the quality of that is what sets apart a happy sexual relationship. I think you touched on it when you talked about young people these days and what they're exposed to on the internet and

23:28

I've shared this story with Guy before that when I was, I think 16, my best friend Fiona told me that she said, like, you need to start having sex because everyone at school thinks that you're frigid. And I was like, oh, okay, right, okay. And she goes, but don't worry, you can't get pregnant the first time you have sex and you can't get pregnant if you have sex standing up. Yeah. So I did that and God knows how I didn't get pregnant, but I didn't. But.

23:55

it's I guess it's what the point I'm trying to make is that that we information that we got in the playground in the 70s they're getting maybe just as bad information now. Yeah they're actually getting more of it and they're getting more of it with things like OnlyFans and they're seeing these girls who are absolutely beautiful and this is what I should look like. Well I disagree with absolutely beautiful because sometimes I don't think that all the surgically enhanced wu wu is

24:24

each to their own. Misinformation is rife on social media, absolutely, and that's why I have quite a collection of books that are written by people who have qualifications from a real university, not the University of TikTok or Instagram, so that I can actually refer people to good resources. And in Australia, we've got Kaz Cook, who is amazing, who is

24:54

has written a number of books around raising kids, books for women and for boys about all of the issues that confront us as we grow and develop from a sexual health point of view, but also there's a very healthy and well-researched dose of information about body image and safety and consent and social media and how to manage it. And her most recent book was about

25:23

it's the menopause, debulking, debunking sorry, debulking that's a bit of a Freudian slip just because there is so much rubbish out there so that people can actually read reasonable information and so part of the consult will always be this is a book that I think will be useful for you because I can't cover everything. I mean I do have long consults in fact my standard consult and this is not a plug this is talking about how medicine's changed.

25:53

in social media and these conversations have changed. My first consults used to be 45 minutes. They're now an hour because I have to spend 10-15 minutes debunking stuff that people have read on the internet. And I often feel like I'm trying to pass a viva like I did at the end of my physician training where it's like, okay, I'll sit back in the chair and you give me your questions from the internet and I'll do my best to answer them and actually tell you what we think medically is the truth.

26:22

It's even crept into the consulting space about, you know, menopause consults and sexual health consults that I've got to spend 10 to 15 minutes unpacking that stuff. Yeah, which is why, you know, I try and recommend reasonable literature that people can read as a resource and dip in and out of, you know, when they need to. And, you know, for your daughter at 15, the Kaz Cook book is a fantastic resource because it's there.

26:51

she's not going to sit down and read a cover to cover, but at least it's a resource, a reference book that she can dip in and out of. And so I've got them all over the shelves here at home. So when the tradies come over, when they came over to do the bookshelves, that was pretty funny. But they were quite interested and they wanted to know. And it's like, oh, you know, there's things that you can read and, and you know, I'm sure they wrote down some names and yeah. So it's about directing people to

27:20

really good sources of information that are reliable. So the Emily Nogosi books, the Esther Perel, I mean she's just a goddess of wisdom and kindness. She's got some fantastic TED Talks, I'd like to be like her when I grow up one day. Alan Bataan who's written a fantastic book called The Course of Love, it's a sort of fictionalized account of a relationship

27:50

how attachment issues and our psychology and our families of origin, how they influence how we are in our relationships. So there's not just society and culture, there's the psychological and psychodynamic issues about who we are and what we bring to our relationship and why we sometimes find sex so difficult to talk about because we have to reveal the truth of ourselves, the vulnerability of ourselves, so it's not just about...

28:14

how we look on the outside and maybe we use that as a kind of smoke and mirrors to convince ourselves that we're okay on the inside. If everything is smooth and shiny and bouncy on the outside, maybe we're trying to convince ourselves that we are on the inside. From a clinical point of view, are there any medical advancements or therapies that have made big difference in supporting sexual health, particularly for older adults? Well, past the oral contraceptive pill, that was pretty landmark.

28:44

I think in terms of women's sexual health, people have been searching for, you know, the pink Viagra or some kind of pill or lotion to improve desire in older women and not surprisingly enough they haven't been able to replicate it because it's not just about hormones and it's not just about medication.

29:12

libido is the only thing that should drive the initiation of intimacy.

29:19

we need to think about emotional intimacy. So I spent a lot of time talking about emotional intimacy as well as biological intimacy. I think for men, the medications like Viagra that help with erectile dysfunction, I certainly think that they've been very helpful, but they can also create some problems as well, because again, we get back to a narrative about performance and then we can still have some mismatch. So if you've got...

29:48

you know, a 65 year old man who's taken a medication for erectile dysfunction and he's got a 60 year old female partner with atrophic vaginitis, then that's often a bit of an unhappy combination. And I end up seeing the woman in clinic with abrasions in her vagina because of prolonged penis vagina intercourse that's not really been negotiated or clarified about how this is going to go.

30:17

Just because you can doesn't mean that you should. There's so much we could talk about. Dr. Tonya, thank you. We're out of time, but I wanted to thank you so much because there is an encourage people that if they are having issues to reach out to someone like you, just to talk about it. It can be uncomfortable to talk about, but I think it's really important to have these conversations with your medical professional, but also your partner as well. But your medical professional is a great place to start.

30:46

I would hope so. Yeah. So, you know, gynaecologist, urologist, sexual health physician, you know, good GP and everyone differs medically in their comfort about discussing these things as well. So, you know, sometimes culturally for primary care physicians, this is not something that they feel comfortable to discuss. It can often take time. So it does need a long consultation. So yeah, find someone that you feel that you can talk to who's who's qualified.

31:14

and we've mentioned some good books that will hopefully help. And keep trying to understand yourself and understand your partner. Dr. Tonya, thank you so much for your time. It's been a pleasure. Thank you so much, Kayleigh and Guy. The views and opinions expressed on the Big Six are personal and reflect those of the hosts and guests. They do not represent the views or positions of any affiliated organisations or companies. This podcast is intended for informational and entertainment purposes only and should not be construed as professional advice.

31:43

Please consult with a qualified professional for guidance on any personal matters. Ah, and before we go, let's give credit where credit is due. Kayleigh Harris and I came up with all the genius content for this week's episode. Our producer, Nick Aboud, well, he keeps the lights on and make sure we don't accidentally upload a cat video instead of a podcast. So thanks for keeping us on track, Nick. Nick.