Menopause & Sexual Problems

Menopause occurs when a woman stops ovulating and her monthly period (menstruation) ceases. It is a natural event that marks the end of the reproductive years.

The production of sex hormones, in particular oestrogen, falls significantly around menopause. Testosterone levels in women slowly decline from about 30 years of age. A woman in her forties has, on average, half the testosterone circulating in her bloodstream as a woman in her twenties. The reduction of these hormones may directly affect libido or sex drive and sexual function for some women. It may also cause physical and psychological changes that will affect sexual function.

Other important issues that may influence the menopausal woman’s sexual desire and activity include contraception, physical changes (such as a dry, painful vagina), body image, relationship issues, illness and external stresses.

Contraception
Pregnancy is possible, though rare, before and even after your last period. It is generally advised that menopausal women should use contraception until at least one year after their natural periods have ceased. This is because a pregnancy late in a woman’s reproductive life increases the risk of birth defects for the child and health problems for the mother.

Hormone replacement therapy (HRT) is not a form of contraception. HRT is prescribed by a doctor to help manage the symptoms of a woman’s menopause. However, HRT does not contain sufficient hormones to suppress ovulation, so pregnancy can still occur.

There are many different options for contraception, which need to be discussed with your doctor.

Women who are sexually active should also continue to use condoms to protect against sexually transmissible infections (STIs). When using a condom, choose a water-based lubricant to avoid condom breakage.

Physical changes
Both during and after menopause, a woman may notice certain physical changes that affect her sexuality in positive and negative ways. These changes may include:
Vaginal changes –as oestrogen levels fall, the walls of the vagina become thinner and drier. This loss of lubrication can make having sex uncomfortable.
Slowed sexual response – getting aroused and reaching orgasm may take longer and be less intense.
Infections – the post-menopausal vagina and bladder are more susceptible to bacterial infections.

Menopause symptoms – such as hot flushes, night sweats, insomnia and unusual skin sensations like prickling or itching.

Touch avoidance – some women can’t bear to be touched. Their skin feels more sensitive and they may recoil from closeness, particularly sexual intimacy. The physical discomfort of menopause symptoms may reduce a woman’s interest in sex or make her tired. Even the close proximity of her partner may be distressing because of the combined body heat.

Absent periods – a woman who was troubled by heavy or painful periods may feel relieved and positive about her change of life. This can lead to a renewed interest in sex.
No fear of pregnancy – many women who were trying to avoid pregnancy during their reproductive years may find the menopause begins a time of renewed sexual interest. Without the fear of possible pregnancy, sex becomes relaxed, fun and more frequent.
Body image

Some of the issues that may contribute to a menopausal woman’s body image include:
Social attitudes – Western culture tends to value youth, thinness and beauty, while older women are rarely portrayed as sexual or desirable. These ingrained social attitudes may prompt some women who are approaching the menopause to feel less attractive. Other women may erroneously believe that sex is only for the young, and this attitude can cause sexual interest and activity to wane.

Weight gain – an increase in body fat, especially around the abdomen, can occur during menopause because of hormonal changes. The age-related decrease in muscle tissue and the associated slowing of the metabolism also contribute.
Changes to body hair – some women experience abnormal hair growth after menopause, particularly on the face. Others may experience thinning of scalp and pubic hair.
Other issues
Other issues that may impact on a woman’s sexuality during and after menopause include:
Ill-health – since disorders such as cardiovascular disease and osteoporosis are more prevalent in older women.
Some medications – such as some antidepressants or antihypertensives, which may affect sexual function and libido.
Ill-health or sexual difficulties of a partner – such as erectile problems.
Loss of a partner – through death, divorce or separation.
Depression
Children leaving or staying at home – children leaving home allows more sexual freedom for the older couple; children staying at home may restrict independence; the ‘revolving door’, with children coming and going, can also have an impact.
Enhance your sex life
Suggestions to maintain or improve your sex life after the menopause include:
Talk openly with your partner about sex and the impacts – both positive and negative – of menopause.
Physical changes may slow your reaction times. Plan for slow, lingering sessions of lovemaking.
Try widening your sexual horizons and include sexual activities that don’t involve vaginal penetration such as oral sex, sexual aids and mutual masturbation.
Regular masturbation helps to improve blood flow and muscle tone.
Wash your vulva with warm water and sorbolene rather than soap, which can further dry and irritate the tissues.
If vaginal dryness persists, consider using water-based vaginal lubricants, available from pharmacists and supermarkets.
Vaginal preparations of oestrogen creams, tablets and pessaries or hormone replacement therapy can help manage vaginal dryness. Consult with your doctor.
Exercise regularly and eat a healthy diet to maintain an appropriate weight for your height.
Oestrogen plus testosterone therapy may affect sexuality positively.
Seek advice from a professional if you need help with any sexual issues.
Relationship or sexual counselling may help resolve issues with partners.