There’s a little-used adage that the brain is the biggest sex organ. For the 1.1 billion post-menopausal women and their partners expected by 2025, that’s a good thing since such cerebral qualities as open-mindedness, great communication skills, trust, vulnerability, and a sense of adventure are the biggest keys to a happy sex life.
The physical and psychological changes of menopause such as vaginal dryness, erectile difficulty for her partner, and diminished sex drive itself may make it difficult to continue engaging in vaginal penetration and often make it necessary to put a little thought and strategy into menopausal and post-menopausal intercourse. It’s helpful to start with a practical analysis of your sexual landscape, according to Dr. JoAnn Pinkerton, M.D., N.C.M.P., executive director of the North American Menopause Society and professor of obstetrics and gynecology and division director of Midlife Health at the University of Virginia Health Center in Charlottesville.
She says problems can develop with a woman’s desire, arousal, ability to orgasm or strength or frequency of orgasm. It’s important to examine your medications as a contributor to this imbalance. Are you taking any medications that might curb desire, such as antidepressants or blood pressure medications? It may be possible to lower your doses or change medications to lessen their impact on sexuality.
If it’s not possible to decrease medications that negatively affect sexuality, you may instead consider the possibility of adding a medication that could improve your situation. Medications such as Wellbutrin, Flibanserin or Addi may improve sexual desire. Hormone therapy, for example, may combat bothersome night sweats as well as help women who have vaginal dryness and discomfort during intercourse.
But lest we forget it takes two to tango, don’t feel that you’re the only performer whose moves may be off.
“Men themselves go through a form of male menopause which is much slower but may be associated with fatigue, weakness, depression or their own sexual problems,” Pinkerton says. “Men sometimes have a hard time understanding that women can be hot one minute, requiring a fan or air-conditioning, and chilly the next. It is also hard on men when their partners are moody, up and down, not sleeping due to night sweats – they often hope that this phase will be over quickly.”
“And if sex is painful, then often this causes them not to want to engage again because they don’t want to hurt the person they love,” Pinkerton adds. This is where a continued willingness to talk about changes in sexuality and sexual responses, as well as a willingness to be open to new definitions of successful intercourse, can be helpful.
Women can feel good about their sexuality without ever having sex intercourse Pinkerton maintains. But if sexual intercourse is desired, but painful, help is available from your health care provider.
When the ovaries stop making estrogen during menopause, the vagina can become dry and less elastic or “stretchy.” Regular vaginal sexual activity is important for vaginal health after menopause, Pinkerton explains, because it stimulates blood flow, helps keep vaginal muscles toned, and maintains the vagina’s length and stretchiness.
She says keeping sex on the calendar at least once a week will accomplish this. If comfort measures are needed beyond over the counter lubricants, low-dose vaginal estrogen is available in cream, tablet or insertable ring with minimal absorption, making it safe for most women. The boxed warning about estrogen needing to be given with progesterone does not apply to these low-dose vaginal products.
Discuss the use of these products with your oncologist if you have had estrogen-sensitive cancer. For women who choose not to use vaginal products, a new oral designer estrogen agonist/antagonist called Osphenia may be an option. And for those who have lost vaginal elasticity, vaginal dilators can be used to stretch the vagina prior to resuming intercourse.
“Each woman has her own standard of what sexual health or satisfaction is, based on her culture, background, personal sexual experiences, and biological makeup,” Pinkerton says. “As women age, the definition of a sexual encounter can change, and it is only a problem if the woman or her partner view it as troublesome.”
Beyond those personal measures, Pinkerton gives three guidelines that should apply to any sexually healthy woman: some degree of desire for sex, an ability to enjoy sex, and comfort with her level of sexual desire, response, and function between herself and her partner.
To maintain a vibrant sex life or get back on track with one that’s been derailed, Pinkerton encourages the relationship skills that are important in maintaining desire throughout our lives as sexual beings.
- Work on the relationship as a whole.
- Focus on trust.
- Don’t take each other for granted.
- Don’t put sex on the back burner.
- And don’t forget that relationships take time – even if you and your partner have already put in a few decades!
From a practical standpoint, Pinkerton points out that both men and women have higher testosterone levels in the morning, which may make morning sex when both are rested a better option than late evening sex when both are tired.
“As long as couples are willing to redefine sexuality as they age, there is no reason that couples can’t continue having an active ‘sex’ life, even if that becomes cuddling, kissing, or just intimate times together. Sex no longer has to be vaginal, orgasmic for one or both, to be enjoyable.”
Reviewed February 29, 2016
By Michele Blacksberg RN
Dr. JoAnn Pinkerton, M.D., N.C.M.P., via email interview February 22, 2016. http://uvahealth.com/findadoctor/profile/JoAnn-V-Pinkerton
Menopause by the Numbers: Facts, Statistics, and You. Healthline. Retrieved February 23, 2016. http://www.healthline.com/health/menopause/facts-statistics-infographic