By: Dr. Amy Jones, Ob/Gyn
Opening the Conversation About Sex After Menopause
Our sexual existence doesn’t end after menopause, but for some reason, the conversation around sex drops off as quickly as estrogen from our ovaries. If discussed at all, it is often only in hushed, almost guilty whispers. Sex is always hard to talk about, whether it be with our partners, our friends, our doctors, or even our therapists. The pervasive undercurrent of societal shame makes discussing our bedroom habits uncomfortable. This is no more true than in women over 50, a group that seems reluctant to ask questions about their bodies and hesitant, if not embarrassed, to discuss their sexual desires and issues. We need to change this! An open dialogue about sex should flow fluidly throughout every phase of life.
Our bodies change after menopause and, inevitably, so does the way we have sex. The sensation, the climax, the desire, the toys.. all of these things change. But rather than accepting our changing bodies as an end of our sexual lives, we should celebrate this important transition as the beginning of a whole new sexual world ripe for exploration. It’s a time to gain a brand new and fuller understanding of our bodies, how they work, what they crave. After menopause women are often free of burdens that may weigh heavy on their minds in earlier years - work, finances, child rearing, relationship drama.. not to mention getting our periods or getting pregnant! Postmenopausal years are often the years we feel most free and unencumbered, when we are finally able to shed some of the stress of “the daily grind”. Less stress then paves the way to more enjoyable, fulfilling, freeing sex with ourselves and with our partners.
Let’s talk about what changes after menopause.
First, our vaginas. With menopause, the ovaries stop making estrogen, which can cause your vagina to become dry and less elastic or “stretchy.” This is called vaginal atrophy and it can cause sex to be painful. Thankfully there are lots of tactics available to combat the effects of vaginal atrophy. First and foremost, lube. There are many different types of lube - water based, silicone based, coconut oil based. Try them all and pick the one that feels best to you. If you have negative feelings about lube, change them. You can never have too much lube. And the more you experiment the better. Regular vaginal sexual activity is important for vaginal health after menopause because it stimulates blood flow, helps keep your vaginal muscles toned, and maintains your vagina's length and stretchiness.
Don’t neglect the clitoris!
If you’re experiencing pain during sex, it’s possible that you’re not properly aroused. In order to have pleasurable intercourse, you need to be ready for it. This means you have to be wet, and the vagina properly prepared for penetration. This is a job for the clitoris. Our clitoris becomes more needy as we age, so give her the love she craves! Here are the names of some ways to stimulate the clitoris. It’s your job to imagine the descriptions. See where your imagination takes you.. it may help get you in the mood!:
- “Tap it.”
- “Get in the grind.”
- “Peace pinch.”
- “Fun zones.”
- “Penetration station.”
- “Good vibes.”
- “Aye, there’s the rub.”
Side note: this doesn’t negate the need for lube! No matter how wet you get, you can always stand to be wetter.
That brings us to masturbation:
Do it. Often. It’s valuable research! Use your fingers, use toys, use anything that won’t give you an infection. Please see above for suggested moves.
Ok onto libido (sex-drive).
Lower circulating estrogen can also lead to less desire and more difficulty becoming aroused. Libido is a complex aspect of sexuality. Many people are uncomfortable discussing it. And many times, it isn’t until menopause happens that we try to find the time to peel back the layers and figure out what libido really means for us individually.
There are many ways to transform arousal and moments of excitement. Therapies and procedures such as pelvic physical therapy or laser vaginal rejuvenation are utilized to aid vaginal sensation. Sex therapists are an incredible resource when you feel you’ve lost your ability to become aroused. For instance they often suggest changing your sexual routine, focusing on foreplay, and incorporating vibrators and sex toys.
Just be aware that what feels good can change.
Women often become discouraged and quit being sexual all together when they find that getting aroused or having an orgasm becomes difficult. What can help is more mental engagement and physical stimulation.
As you age, blood fills your genitals more slowly as you become aroused, which means you don’t have the same sensitivity and reaching orgasm takes longer. Typically, you need more direct and intense stimulation of your clitoris. Doing things like rubbing and touching instead of always engaging in intercourse may be what you like best at this stage of life, and that’s completely okay! At any stage of life, you need to learn to let go of what we think everybody else is doing and just think about what works for you and your partner.
Communication is key to sexual wellness.
Communicating with your partner is key to setting realistic expectations about what you need sexually.
This kind of communication will help you to achieve deeper intimacy. Living an overall healthy life — getting enough sleep, being physically active and eating well — will go a long way toward helping you focus on and feel good about being intimate and sexual.
And finally, as a gynecologist, I implore you, please talk to us! If we can’t do a whole lot to solve your problem, we can direct you to someone who can.
Keep the conversation flowing, shed the shame, and embrace your sexuality .. however that works best for you.