Menopause and Sex: Before, During, After

Before
Adult women who experience regular menstrual cycles and have not yet reached menopause have bodies that generally prepare them for sex and for childbearing. The vaginal walls are thick enough to allow for sex and childbirth, and a steady hormonal cycle ensures that the vagina gets enough moisture to keep vaginal walls moist, making sex more comfortable and pleasurable.

Sex during much of adulthood depends on both physical and emotional health. Healthy women with a positive attitude about sex and life in general often have no physical difficulties with sex before the onset of menopause.

Shortly before menopause, however, women may find that mood swings, vaginal dryness, insomnia and hot flashes interrupt their sex lives. These symptoms may continue to affect sex during perimenopause and after it.

During
Menopause is often called a “change of life” and, unfortunately, some of the changes it brings can be uncomfortable for many women. While women experience menopausal symptoms differently, in much the ways that they experience their menstrual cycles differently, most suffer from some symptoms of menopause. These symptoms may interfere with their sexual lives:

• Hot flashes and night sweats can reduce sex drive by their very uncomfortable nature. Hot flashes can feel extremely uncomfortable and can even make a woman feel claustrophobic. Not only do these feelings cause women to feel tense and unromantic, but feeling too warm virtually ensures that they may not want to curl up next to the warm bodies of a partner. Night sweats can be uncomfortable and awkward, leaving women to push their partners away.

• Insomnia is common during menopause, and can leave a woman irritable and uninterested in sex.

• Urinary difficulties may develop during menopause, resulting in some loss of control of the bladder. Obviously, this can be very embarrassing in intimate situations and may affect a woman’s feelings of attractiveness and sexiness. Some women find that they suffer from stress incontinence during menopause, meaning that activities such as sneezing, laughing, or even sex result in slight loss of bladder control. A woman experiencing this symptom may choose to avoid sex rather than risk embarrassment.

• Vaginal walls become thinner and less well-lubricated because of decreasing levels of estrogen during menopause. During this time, blood signals to the vagina may decrease, further causing dryness. For some women, these changes may create pain during intercourse, and, eventually, a lessened interest in sex.

• Physical changes which may occur during menopause include changes in skin tone, changes in breast shape and firmness, and changes in weight. Each of these symptoms can make a woman feel shy about sharing her body with a partner.

• Loss of sexual desire is reported by many women during menopause. This may result from decreasing levels of estrogen in the body or from changes in a woman’s emotional state. Decreased sexual desire not only makes women less interested in sex, but may also result in relationship tensions if a partner feels rebuffed by his partner’s lack of interest.

• Emotional changes vary widely during menopause because of lowered estrogen levels. Some women experience minor moodiness, while others experience irritability or even severe depression. The experience of undergoing menopause itself may make some women feel less sure. The symptoms they experience as well as the new experience of menopause may make them feel uncomfortable with their bodies. Since much of North American society praises youth as a hallmark of sexiness, some women may feel lack of confidence about their sexiness or their womanliness once menopause begins.

• Some of the medications and treatments women are given to help them cope with menopausal symptoms may decrease sexual desire. Women should consult their physicians about all medications and ask about possible side effects. Consulting with a doctor about changing medications may be embarrassing at first, but it may dramatically alter a woman’s sex life.

After
Menopause is considered to end when a woman has had no menstrual periods for a year following the onset of menopause. This means that she is no longer ovulating and thus is no longer able to bear children. This often occurs in the 50s, although the exact age of menopause varies widely among women. Although menstrual cycles have ended, women’s desire for sex and women’s sexuality continue throughout life.

In fact, some women may find that the lack of menstrual periods and the lack of worry about pregnancy to be liberating. For many women, the end of menopause occurs when other areas of life may be more secure or less demanding. Women may find themselves ending menopause at the same time as their children leave home and at the same time that their careers are well-established or reaching endings. Thus, they may find they have fewer duties than younger women and are thus freer to pursue romantic relationships if they are so inclined. Studies have confirmed that many women between the ages of 50 and 65 claim that they are as satisfied or more satisfied both with their lives in general and with their sex lives in particular after menopause.

For some women, however, post-menopause is a difficult time sexually. This may occur for several reasons. Society’s images of sexy women often focus on young women. Some women may believe - wrongfully - that women after a certain age are less sexy or less sexual. For some women, vaginal dryness and thin vaginal walls continue to mean painful intercourse. Some women may experience decreased sexual interest in their post-menopause years. As women age, they may find that they experience changes in their relationships. Women are far more likely to be widowed than men, since women tend to live longer in our society. Some women therefore find themselves with the possibly daunting task of seeking a new partner.

Changes in men’s bodies during aging can also result in altered sex lives for elderly couples, as men experience decreasing levels of testosterone with age, resulting in decreased lack of sexual desire and even impotence.

What Can be Done?

It is mostly the brain, and not our bodies, that determines sexual performance and enjoyment. Even with the changes that occur with menopause, sexual curiosity and relaxation go a long way in decreasing sexual problems. Even just knowing that other women suffer similar problems and overcome them can help in reviving sexual interest. Being ready to experience sexual pleasure, communicating openly with a partner and trusting a partner all ensure that sexuality remains a pleasant and satisfying experience. Something as simple as a bit of reassurance from a partner or a more gentle approach to sex can dramatically improve a sexual relationship.

Some women find that their sex lives change in pleasant ways during and after menopause. Many couples may find that increased touching and sexual activities other than intercourse are pleasurable and intimate. Decreased sexual performance in men in their 50s and 60s also may result in slower and longer love-making, something that may be more gentle and acceptable for a woman experiencing some of the symptoms associated with menopause.

Some remedies are available for the more physical problems which may arise during menopause. A lubricant can help with vaginal dryness. Treatments exist to control incontinence. Even depression is treatable with the help of a sympathetic doctor.

Remaining generally healthy and happy also help keep sex enjoyable. A balanced diet and regular exercise ensure that the body is performing well. Reducing alcohol and eliminating smoking can also be helpful, as both have been linked to decreased sexual performance. Regular visits to a doctor during and after menopause can help women overcome some of the difficulties they may be having as their bodies and lives adjust. These visits are also a good opportunity for women to ask any questions they may have about menopause. A doctor may recommend estrogen-testosterone or hormone replacement therapy to help offset some of the symptoms of menopause. Both these treatments have been shown to increase sexual drive, but both have some risks. It is important to learn about them from a qualified practitioner. Although it may be difficult initially, talking to a health care professional about changes in sex drive and performance can help to eliminate those problems and restore a gratifying sex life. Treatments are available for almost all sexual problems related to menopause. It just takes a bit of courage and a willingness to try.

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