by Rosenblum LB

Sex After Menopause

IMAGE Menopause does not signal the end of female sexuality. In fact, many women find that intimacy is enhanced in midlife.
Several years ago Judy 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 women lose their interest in and ability to have sex after menopause. But since she started using a little artificial lubricant and 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 about older woman as unattractive and asexual. In addition, loss of the ability to bear children may become confused with loss of sexual desire.
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. 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 adult or older children require less time and attention. However, the experience varies from woman to woman.

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 not every women will experience it. The vaginal walls may also become thinner and less flexible. Itching, burning, and occasional pain may occur during intercourse.
Over-the-counter water-based lubricants can help with vaginal dryness. Do not use petroleum-based lubricants, such as Vaseline.
If lubricants are not sufficient, vaginal estrogen cream, rings, or tablets may be helpful. These products are prescribed by your doctor.

Stimulation and Orgasm

Some women have fewer and less intense orgasms when they reach menopause. It may take more time and stimulation to become aroused. For all women, having intercourse or masturbating regularly can help increase sexual responsiveness and pleasure. 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. There are a range of possible causes for this, such as:
  • Stress
  • Difficulty sleeping
  • Illness
  • Bladder control problems
  • Relationship problems
  • Psychological issues
  • Side effects from medicine
  • 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 increase with 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.
A natural decrease in testosterone at menopause might play a role in sexual desire, although this remains unproven. Testosterone is available in pills, injections, and creams, but side effects are a major concern.

Increased Intimacy

The changes that take place in midlife 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:
  • 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.

A Note About Birth Control and Safe Sex

You will need to continue using birth control until you have not had a period for 12 months in a row. However, protection against sexually transmitted diseases , including HIV/AIDS, remains a concern. Unless you are in a monogamous relationship, be sure to use a male latex condom.

RESOURCES

National Institute on Aging http://www.nih.gov/nia

The North American Menopause Society http://www.menopause.org

CANADIAN RESOURCES

The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

Women's Health Matters http://www.womenshealthmatters.ca

References

American Medical Association. AMA Essential Guide to Menopause . Pocket Books; 2000.

Atrophic vaginitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated February 28, 2013. Accessed March 8, 2013.

Avis NE, et al. Is there an association between menopause status and sexual functioning? Menopause . 2000;7(5):297-309.

Barbach L. The Pause: Positive Approaches to Perimenopause and Menopause . Penguin Books; 2000.

Can menopause change your sex life? National Institute on Aging website. Available at: http://www.nia.nih.gov/newsroom/2000/09/can-menopause-change-your-sex-life . Published September 15, 2000. Accessed March 8, 2013.

Doress-Worters P, Siegal DL. The New Ourselves, Growing Older: Women Aging With Knowledge and Power . Touchstone Books; 1994.

Facts about menopause. Illinois Department of Public Health website. Available at: http://www.idph.state.il.us/about/womenshealth/factsheets/meno.htm. Accessed March 8, 2013.

Greenwood S. Menopause Naturally: Preparing for the Second Half of Life . Volcano Press; 1996.

The Menopause Handbook. The Society of Obstetricians and Gynaecologists of Canada website. Available at: http://www.sogc.org/health/pdf/menopause-for-public-e.pdf. Published February 2006. Accessed March 8, 2013.

Landau C, Cyr M, Moulton A. The Complete Book of Menopause: Every Woman's Guide to Good Health . Perigee; 1995.

Norsigian J, Pinn V. Our Bodies, Ourselves: Menopause by Boston Women's Health Book Collective. 2006.

Schlam J. Menopause Matters: Your Guide to a Long and Healthy Life . A Johns Hopkins Press Health Book; 2009.

Seaman B, Eldridge L. The No-Nonsense Guide to Menopause. 2009.

Sex and menopause. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/disorders/menopause/hic%5Fsex%5Fand%5Fmenopause.aspx. Updated May, 13, 2010. Accessed March 8, 2013.

Sexual health & menopause online. The North American Menopause Society website. Available at: http://www.menopause.org/for-women/sexual-health-menopause-online. Accessed March 8, 2013.

Wingert P, Kantrowitz B. The Menopause Book . 2009.

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