Sex After Menopause
Menopause does not signal the end of female sexuality. In fact, many women find that intimacy is enhanced in midlife.
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 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 of the midlife 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 midlife 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% to 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 adult or 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, vaginal estrogen cream, rings, or tablets are generally helpful.
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. 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.
Loss of interest in sex, temporary or long-term, occurs in some women during and after menopause. Possible causes include the following:
- 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 researchers 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 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.
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
When you are having intercourse you 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 long-standing monogamous relationship, be sure to use a male latex condom or female condom.
National Institute on Aging
The North American Menopause Society (NAMS)
The Society of Obstetricians and Gynaecologists of Canada
Women's Health Matters
The American Medical Association (AMA). AMA Essential Guide to Menopause . Pocket Books; 2000.
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? United States National Institutes of Health website. Available at: http://eos13.cit.nih.gov/NIA/news/pr/2000/1013b.htm .
Doress-Worters P, Siegal DL. The New Ourselves, Growing Older: Women Aging With Knowledge and Power . Touchstone Books; 1994.
Greenwood S. Menopause Naturally: Preparing for the Second Half of Life . Volcano Press; 1996.
Landau C, Cyr M, Moulton A. The Complete Book of Menopause: Every Woman's Guide to Good Health . Perigee; 1995.
Last reviewed December 2007 by Jeff Andrews, MD, FRCSC, FACOG
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2011 EBSCO Publishing All rights reserved.