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Enjoying Sex During The Menopause

Enjoying Sex During The Menopause | Jo Divine

Hormones play a key role in our well-being and we tend to take their function for granted until changes occur and our bodies start to respond differently. Oestrogen affects how sensitive and responsive our skin and genitals are, progesterone influences libido and testosterone – the ‘libido’ hormone, helps lubricate the vagina as well as boosting sexual desire. Testosterone production declines by 50% between the ages of 20-45, although there is a slight surge in women post-menopause to compensate for the fall in oestrogen. This is why some women report a surge in sex drive after the menopause.

Menopause is often presented in a negative light as the end of a woman’s sex life and a catalyst for health issues such as osteoporosis and heart disease. Our sexual response changes as we age but it’s not all downhill as this survey shows* and sex and relationships can become more fulfilling as we enter the second half of our lives. Reading up on the role of hormones will give you confidence, ideas and knowledge to help you move through the transition with minimum fuss. Sexuality starts in the mind and it’s about communication, self-expression and finding new ways to be intimate that don’t revolve around penetrative sex. Viewed in this way, menopause can broaden sexual expression; it is a catalyst to try new things and find alternative ways to pleasure your body by taking the focus off penetrative sex.

*A survey of 580 menopausal women conducted by Siecus, the Sexuality and Information Council of the US found that 45% of women said they felt less desire after menopause, 37% reported no change and 10% reported an increase.

It is not always a female issue according to a new survey published in Menopause – the Journal of the North American Menopause Society (July 2019) which found that many women experience less or diminshed sexual satifaction because of the health of their partner. Many women cited beign a widow and having no partner as one of the reasons. 27% said it was due to their partner’s health issues, 13.5% said it was due to erectile dysfunction. The impact of low libido in self (16%) or partner (7%), relationship problems (10.5%) or logistics (6%), and perceptions of ageing (9%) were also mentioned. Few (3%) referred to positive sexual experiences or had sought medical help for sexual problems (6%).

Here are the two main physical changes that affect sexuality and ways to deal with them:

Vaginal dryness

Oestrogen keeps the skin and vagina moist and plump and encourages the Bartholin’s glands to lubricate so when levels decrease the vagina can feel dry, tight and itchy. It can also take longer for you to become aroused. Breasts may become less full and the labia thin a little. Orgasms can feel less intense and penetrative sex uncomfortable, as the body isn’t lubricating as much. On an emotional level you may feel withdrawn or less feminine/sexual depending on how sexually active you were before the menopause. Over time vaginal dryness can affect libido and self-confidence.

What you can do:

Take the focus off penetrative sex and incorporate more foreplay to encourage the Bartholin’s glands to produce the maximum amount of natural lubrication. Experiment with sensual massage and explore tantric sex techniques and BDSM if they appeal. They provide new forms of sensory play, which can awaken the body’s response in new ways – spanking, for example, creates an endorphin rush that will stimulate the senses and can intensify orgasm.

Speak to your doctor about localised HRT to ease vaginal dryness. This comes in ring/cream/tablet form to increase blood supply and rejuvenate the tissues. Localised means you use it vaginally so the hormone isn’t passing through the liver, avoiding potential side effects and it will work more quickly.

Natural pH balanced lubricants such as YES water based and YES oil based are great to make you feel more comfortable and longer lasting moisturisers such as YES VM can be used every three days to moisturise the vagina – available over the counter and on prescription.

Become lube savvy and do your research- some products contin ingredients that irritate the delciate tissues of the vagina, especially during the menopause or after cancer treatments. We do not recommend you use store cupboard or bathroom cupboard products as these have not been designed for vaginal use.

Pelvic toning, using pelvic floor exercisers and more exercise generally will help increase sensitivity and blood flow to the genitals, leading to stronger orgasms. They also help prevent stress urinary incontinence – another common symptom of menopause.

Womens health physiotherapists are pelvic health experts and the best healthcare professionals to teach you how to perform pelvic floor exercises correctly. They help with many vaginal/bladder/bowel issues that can occur during the menopause.

Exercise boosts mood, well-being and body confidence, which in turn, boost your sexual function and sex lfie

Explore sex toys, erotica and masturbate more to encourage natural lubrication and keep you tuned into your body.

Anal play requires lubrication regardless of where you are in your menstrual/hormonal cycle so can feel pleasurable at any time of life!

Hot flushes and night sweats

We don’t really know what causes these but it’s thought to be connected to changes in the brain and how we regulate our body temperature. A bit like having the thermostat turned up too high so your body tries to cool itself down by sweating. They can be unpredictable, unpleasant and at night, make you feel like kicking off the duvet and anyone sleeping in the bed with you! The thought of having sex and getting even hotter may be a complete turn off.

Sleep disurbance can impact upon your sex life, so getting a good night sleep can improve your sexual satisfaction.

What you can do:

Keep a glass of water by the bed, avoid hot baths, sleep naked, and buy two duvets in winter/summer togs that you can join together…

Adapting your diet can help – studies have found phytoestrogens (plant-based foods) can help reduce hot flushes as they have an oestrogenic effect on the body (Marilyn Glenville writes comprehensively on this topic). Sage tea can help – herbalists can make this up for you in stronger form and combine with other helpful herbs. Wear natural fabrics and layer as much as possible.

Dealing with the physical issues is within your control and goes some way to helping with the emotional issues that can arise in our 50s and beyond. If you’ve been bringing up children, working and looking after a family for years it’s time to reappraise your role and find new interests that take you beyond that sphere, particularly if you’ve divorced and are dating again or the kids have finally left home and you have more time for yourself.

Physical changes – hysterectomy and breast cancer can also knock your body confidence and sense of identity.

Talk to your Partner

Many women struggle to talk to their partner about their sexual issues and other menopause issues , yet this is so important to help them understand why you may not want to have sex or feel less aroused and for them to offer support.

Focus on finding new things to open up your world – travel, new forms of work, friendships, interests and these will refresh your relationships and feed into your sex life. A shift in mindset and feeling positive about yourself and your life will deepen all of your relationships.

Dorree Lynn, a psychologist and sex educator based in Washington DC, is the author of Sex For Grown Ups: Dr Dorree Reveals the Truths, Lies and Must Tries For Great Sex After 50. She says: “For some women, there’s a burst of adrenaline that can encourage you to try new things, change your mindset and live through your 50s, 60s and beyond with vigour and an adventurous mindset.

Foreplay should start in the morning with wake-up kisses, gentle pats on the butt, hand holding and whispering sweet nothings during the day. It’s all part of heightening the desire, pushing the sex drive, both partners taking more time and care to enjoy their sexual experience to the fullest.”

It doesn’t matter how well your hormones are functioning if you don’t feel connected to yourself and engaged with life and/or a partner. Viewed from this perspective the menopause is a small transition that you will hopefully sail through – with a little bit of help on the physical side. More challenging are the emotional aspects and dealing with ageing and work identity, which can all knock a woman’s self-confidence.

Invest in some well-cut clothing, make-up, lingerie – whatever makes you feel your best. Have fun with your body and learn to move it in new ways – burlesque classes, belly dancing, and fan dancing are a lot of fun and will get you fit.

Try Yoga and Pilates in addition to long walks if you’ve gained a little weight around your middle (normal after menopause as weight is redistributed from the hips to the waist). A few extra pounds may make you feel sexier (they say you choose between your face and your figure…) as fat contains oestrogen so carrying a few extra pounds is no bad thing.

Going through the menopause should not be seen as a medical problem, it is a normal stage in life that all women experience, some at a younger age than others. Every experience is different and one size does not fit all when it comes to medical advice.

Living with HIV and menopausal

Jacqui Stevenson carried out her PhD research at the University of Greenwich on women who are HIV+ and menopausal and has found that their GPs are referring them to their HIV doctor when they complain about night sweats believing it to be a side effect of antiviral therapy when it is a symptom of the menopause.

As a result and in collaboration with Sophia Forum and Dr Louise Newson they have created a guide to Menopause for Women Living with HIV as part of their “We are still here” campaign (2020).

A Menopause and HIV review recently published on Post Reproductive Health (2018) concluded that Menopause Hormone Therapy is likely to be underutilised in women living with HIV in the UK and should be considered for those who might benefit from it.

We now have access to effective antiretroviral therapy which has resulted in a close to normal life expectancy for people living with HIV, including older women who go through the menopause with one in three attending for HIV care estimated to be aged 45–56 years in 2014. As a result , the lack of experience of many HIV physicians in managing menopause, and the perceived complexity of managing menopause in women living with HIV by GPs means that many women are unable to access appropriate care and support, leaving them suffering with debilitating menopausal symptoms.

A new report published by Terrance Higgins Trust and the Sophia Forum called Women and HIV Invisible No Longer is a national study of the experiences of women living with HIV and includes the menopause and difficulties many face when accessing the right treatment for HIV and the menopause.

Getting the right help

It is important you seek the right advice for your sexual symptoms. If your GP is dismissive of your symptoms, telling you it is normal, ask to see another female friendly GP. Despite the NICE guidelines for the treatment of the menopause, some GPs are still not following them. However there are several support groups such as Menopause Support, British Menopause Society and My Menopause Doctor at Newson Health to help you navigate your way through this stage in your life

Dr Louise Newson, a menopause specialist says she is always amazed at what women put up with when they experience menopausal symptoms incuding the distruption or cessation of their sex lives. With the right treatment, using suitable sexual lubricants and incoprporating sex toys into their sex lives, many women find their sex lives are transformed during the menopause and beyond.

Diane Danzebrink is an amazing person who set up Menopause Support after discovering there was no support following her surgery which sent her into menopause. She is a tireless campaigner, in parliament, on TV, radio and in the press to help women get the right diagnosis, advice, support and treatment to enable them live their lives during and beyond the menopause. Menopause does not just affect women but everyone, partners, family, children, frineds, employers and work colleagues.

Please sign her petition #MakeMenopauseMatter in Healthcare, Education and the Workplace.

MakeMenopauseMatter

At Jo Divine we believe that sexual health and sexual pleasure go hand in hand and have created a health brochure with suitable products to help people with sexual issues during and beyond the menopause. Working with medical professionals, we hope to encourage patients and HCPs alike in talking more freely about sexual problems. A health issue doesn’t mean your sex life will have to stop!

Useful Websites

Dr Louise Newson:https://menopausedoctor.co.uk
Diane Danzebrink:https://menopausesupport.co.uk
Sophia Forum:https://sophiaforum.net
Dr Hannah Short:https://drhannahshort.co.uk
Miss Anne Henderson:http://gynae-expert.co.uk/
Dr Mandy Leonhart:https://hormoneequilibrium.co.uk/
The Daisy Network- www.daisynetwork.org.uk – charity for premature ovarian insufficiency
British Menopause Society – thebms.org.uk
Royal College of Obstetrics and Gynaecology – www.rcog.org.uk
Mpowered Women:https://mpoweredwomen.net/
Ovacome:https://www.ovacome.org.uk/
Latte Lounge:https://www.lattelounge.co/
Jane Dowling :www.menoandme.com – exercise
Henpicked : www. henpicked.net
Womb Cancer Support: www.wombcancersupportuk.weebly.com
Eve Appeal: www.eveappeal.org.uk
Shine Cancer: www.shinecancersupport.org
Clic Sargeant: www.clicsargent.org.uk
Trekstock: www.trekstock.com
Macmillan: www.macmillan.org.uk
GRACE (Gynae-Oncology Clinical Research and Excellence): www.grace-charity.org.uk
Pelvic, Obstetric and Gynaecology Physiotherapy: https://pogp.csp.org.uk/

Cancer and Fertility : www.cancerandfertility.co.uk This has been set up by Becki McGuinness who was left infertile by aggressive cancer treatment when she was just 23-years-old. Now 30, she’s launching a national campaign to ensure women facing cancer are given all the fertility options she should have had

Lydia Brain kindly wrote her experience of being diagnosed with womb cancer at 24 and how she has got back into sex

Further reading

The Wisdom of Menopause by Christiane Northrup MD (Bantam Books, 2012) – New York Times bestseller.
The Sexy Years by Suzanne Somers (Three Rivers Press 2005) – practical and engaging read on bio-identical hormones and The Seven Dwarfs of Menopause: Itchy, Bitchy, Sweaty, Sleepy, Bloated, Forgetful, and All-Dried Up.
Hot Flushes Cold Science: A History of Modern Menopause (Granta Books, 2010) – challenges you to rethink the myths around menopause – that sex stops post 50 and ageing should be feared.
Sex, Lies and Menopause: The Shocking Truth About Synthetic Hormones and The Benefits of Natural Alternatives by TS Wiley, Bent Formby and Julie Taquchi (William Morrow Books, 2004).
_ Natural Solutions to Menopause: Marilyn Glenville_( Rodale 1 Oct. 2013) -How to stay healthy before, during and beyond the Menopause.