Sex after menopause
Menopause does not signal the end of female sexuality. In fact, many women find that intimacy is enhanced in mid-life.
Several years ago Judy Grant, a 52-year-old lawyer, realized she was no longer getting her period, her vagina was drier than usual, and sexual arousal was taking longer. She began to worry that her sex life would soon disappear. She had heard that at menopause, women lose their interest in and ability to have sex. But since she started using a little K-Y jelly to add lubrication and has adjusted her expectations, she's found she enjoys sex more than ever. She especially likes the extra time she and her husband spend stroking and cuddling before they try to reach orgasm.
Like Judy, many women fear that menopause signals the end of their sexual desirability and pleasure. This fear comes from stereotypes of the mid-life and older woman as unattractive and asexual. In addition, loss of the ability to bear children may become confused with loss of sexual desirability.
The reality is that the need for and capacity to have satisfying sexual relationships does not disappear as a natural or irreversible part of aging in women or men. According to Paula Doress-Worters, co-author of The New Ourselves, Growing Older and The New Our Bodies, Ourselves, "there is no reason to think that women in mid-life should necessarily have problems with sexuality." Although menopause does bring physiologic changes that may slow down response time and affect sexual activity in a variety of ways, 70-80%of women do not experience a reduction in sexual activity or satisfaction. And for those who do, there are safe, effective solutions.
How you perceive and deal with the changes can have a significant impact on your sexual health and pleasure. Some women have a reawakening of sexual interest when they are no longer concerned about getting pregnant and the now older children require less time and attention. However, there is tremendous individual variation in women's experiences.
Changes at menopause that may affect sexuality
Physiologic changes at menopause can sometimes affect sexual activity and
desire in some women. Changes may occur in lubrication, the vaginal walls,
arousal, orgasm, and sex drive that make sex less comfortable and enjoyable.
Vaginal dryness and pain during intercourse
The most common problem is vaginal dryness, although only about 20% of women
experience it. The vaginal walls may also become thinner and less flexible.
Itching, burning, and occasional pain and bleeding may occur during intercourse.
Over-the-counter water-based lubricants, such as Astroglide and KY jelly, can
help with vaginal dryness. Do not use petroleum-based lubricants such as
Vaseline. They weaken the latex in condoms and can cause vaginal infections.
Vitamin E or moisturizers such as Replens can also help if used regularly.
If lubricants and moisturizers are not sufficient, hormone replacement therapy
can be used to help keep the vaginal walls plump and lubricated. However,
estrogen has many potential side effects. Using it in the form of a cream rather
than a pill can reduce the side effects somewhat. One or two percent
testosterone cream is another option, but it also has side effects. These creams
should not be used as lubricants just before intercourse because your partner is
likely to absorb the hormone too.
Stimulation and orgasm
Many women have fewer and less intense orgasms when they reach menopause. It may
take more time and stimulation to become aroused. For some women these changes
are distressing, while others enjoy them. For all women, having intercourse or
masturbating regularly can help increase sexual responsiveness and pleasure.
They keep the muscles supporting the uterus, vagina and bladder in shape and
increase lubrication. Kegel exercises, contractions of the pelvic muscle near
the vagina, can also help strengthen the vaginal muscles.
Sexual desire
Loss of interest in sex, temporary or long-term, occurs in some women during and
after menopause. Possible causes include:
- Fatigue
- Stress
- Illness
- Relationship problems
- Psychological issues
- Medication side effects
- Hormonal changes
- Discomfort from the physical changes of menopause
Relationship problems tend to be the cause of decreased sexual desire only
when there have been ongoing difficulties in the relationship. These
difficulties may be exacerbated by changes at menopause. If this is the case,
consider seeing a therapist who specializes in sexuality.
If the problem is hormonal, estrogen may help. However, its effect is generally
on the physical changes, such as vaginal dryness and pain during intercourse. No
direct relationship has yet been found between estrogen levels and desire to
have sex. One study in particular published in the journal Menopause in
September/October 2000, found no direct relationship between declining estrogen
levels and desire to have sex. Rather, the researches found that hormonal
levels, health and social changes associated with aging, and the mental and
emotional effects of being recently menopausal probably work together to create
changes in a woman's sexual desire. Longer-term studies are needed to determine
whether reduced estrogen production affects a woman's sexual functioning as she
gets farther from menopause.
A natural decrease in testosterone at menopause can reduce sexual desire. This
hormone is available in pills, injections, and creams, but side effects are a
major concern. See our article on testosterone therapy: The "Other" Hormone
Replacement Therapy: Testosterone in Post-menopausal Women.
Increased intimacy
The changes that take place in mid-life can provide an opportunity to explore
new and different sexual experiences. Men also go through changes, such as
needing more time and stimulation to become aroused. The slower, more sensuous
foreplay that often results is a welcome change for some women.
Increased focus on sensuality, intimacy, and communication can help a sexual
relationship become more rewarding than ever. There are many ways of expressing
your love besides intercourse, including:
- Hugging, cuddling, kissing
- Touching, stroking, massage, sensual baths
- Manual stimulation
- Oral sex
Sexual relationships after menopause can indeed be satisfying if you are able to adapt to the changes that occur.