By Kelsey Hopkinson, PT, DPT
Menopause, or the ceasing of menstruation, occurs naturally for women between the ages of 40 and 58. Menopause can also be caused by medical interventions such as removal of ovaries with surgery, medications, or cancer treatments and is considered surgical or medical menopause.
Menopause and aging lead to changes in hormone levels, physical changes to the tissues of the vagina and vulva, and changes in sexual function leading to some common myths about sex and menopause. (The North American Menopause Society)
According to A Study of Sexuality and Health among Older Adults in the United States by Lindau et al, only 22% of women have discussed sex with their physican since the age of 50.
However approximately 50% of sexual active women above the age of 57 in the study had at least one sexual problem including low sexual desire, challenges with natural lubrication, and difficulties reaching climax.
Your physician can help you navigate physical and emotional aspects of menopause and sex to allow improved sexual function. There are many medications and creams that are FDA approved to reduce changes due to decreases in hormone levels and or changes in mood such as depression.
These medical interventions require active involvement with your physician to ensure safety and to reduce risk of negative side effects.
A decrease in sexual desire is common for women in starting in their midlife. Unfortunately sexual desire is extremely complex and can be affected by many more causes than a decrease in hormones with menopause including mood changes like anxiety and depression, aging, development of other health issues, and conflicts with one’s sexual partner. Menopause alone should not be blamed for a lower libido and instead all factors should be considered.
Alternatively, some women experience an increase in sexual desire with menopause as the fear of pregnancy is eliminated and often life responsibilities change as women prepare for retirement and adult children leave the home.
Painful intercourse is a common complaint after menopause due to decreases in estrogen. This loss of estrogen leads to vaginal dryness, loss of elasticity in the vaginal wall and tissue, and increased risk of bleeding, tearing or trauma during penetration.
However pain free intercourse is possible after menopause and should always be the goal to maximize pleasure for all involved parties.
Sex without pain or discomfort can be achieved by using water-based lubrication, using a vibrator to increase blood flow to the vagina and clitoris, altering sexual positions to control the depth and direction of penetration, and potentially the use of medications and creams with estrogen and/or progesterone under the supervision of your physician to counteract the side effects of the the decline of sexual hormones with menopause.
Due to the prevalence of painful intercourse previously discussed, many women are afraid of sexual intercourse and causing vaginal damage after menopause.
Without clear communication between a woman and her partner, pain and trauma can occur during sex and cause anxiety surrounding sex. This will greatly affect the sexual health of the relationship.
However pain free intercourse has several benefits to your vulva and vaginal tissue by stimulating healthy blood flow to the area, increasing the tone in your pelvic floor muscles which can reduce or prevent incontinence, and regular intercourse maintains the size and elasticity of your vaginal canal.
Changes in the body’s hormone levels and physical changes in the vagina and ciltoris can make becoming aroused and achieving orgasm more difficult after menopause. Additionally your body may not respond to the same stimulus that caused arousal in previous decades.
This can lead to new sexual exploration including the use of vibrators or toys, masterbation to determine what new stimulus will excite your mind and body, and a shift to focusing on non-penetrative ways to achieve climax both with and without your partner.
Overall each woman will experience menopause and changes in sexual function differently.
Understanding that while menopause is a normal process in aging, it does not have to lead to negative consequences for your sexual health should allow for regular discussions with your health care providers and partner to maximize sexual function well past menopause.
Menopause can instead provide new opportunities to foster and explore intimacy and communication with your partner and your own body.
Menopause.org. Sexual Problems At Midlife, Sexual Side Effects Of Menopause | The North American Menopause Society, NAMS. [online] Available at: <http://www.menopause.org/for-women/sexual-health-menopause-online/> [Accessed 15 July 2020].
Lindau, S., Schumm, L., Laumann, E., Levinson, W., O'Muircheartaigh, C. and Waite, L., 2007. A Study of Sexuality and Health among Older Adults in the United States. New England Journal of Medicine, 357(8), pp.762-774.