Sex After Menopause

On sex in the last third of life, our old friend Freud is up to his mischief. Again. He told us that sexuality runs out after 65. Well it doesn’t. Or rather, it should. The Janus Report on Sexual Behaviour, which was published in 1993, found that people of 65 and over were having as much sex, sometimes even more, that the 18-26 year olds.

Sure, our bodies alter, libido changes and some hitches occur that make some people want to call it a day, but a lot of the de-sexualization is just due to a lack of information.

Menopause changes sex for women. Being free of pregnancy worries makes sex into an act of pleasure and nothing else. This is liberating, and takes the burden of contraception off. But as the estrogen runs dry, so does the vagina.

From about age 40, women’s estrogen and progesterone levels begin to drop. This takes 5-10 years until the ovaries retire completely, and produce no more hormones. From moods, to sleep, to appetite, to sexual desire, the body takes on a whole new persona, and every woman’s version is quite individual, so no-one can know what to expect. In about one out of five women, vaginal dryness might make you miss the menace of PMS (pre-menstrual syndrome). The walls of the vagina become thinner, and this can make the area itchy, stingy and open to recurrent infection. Sex becomes awkward or painful and soon enough your desire will be down.

Then things start getting out of hand. Perhaps the woman gets hypersensitive and disillusioned with sex. The man can start having sexual function problems because he notices he is hurting her, or he has problems penetrating a dry vagina, and loses his erection. If he is around the same age, men begin to have weaker erections and need more time before they can reach orgasm, manifestations sometimes called “male menopause”. All this when she may want less sex because it is hurting her tender vagina. It’s a nasty cycle.

Actually this is all pretty simple to deal with; you probably just need to speak to your doctor. But that is not the way it happens. Speaking to a physician about sex is something that many women are uncomfortable about, and it seems that they have good reason. A lot of the doctors themselves are not comfortable with the subject. They with just as well not bring up the subject if their patient doesn’t, which doesn’t say much for their preventive medicine practice. They need to learn to routinely ask patients about how sex is after menopause. Who knows, maybe they`ll be as surprised as the Janus Report researchers

Once the subject has been breeched, you will find that solutions are on hand. Certainly, it isn’t worth putting off. A basic lubricant is the simplest trick, but in a way it is like putting on a band-aid. It provides wetness, but it doesn’t give back the luster and flexibility to the vagina that the lowered estrogen has taken away.

Some women decide to take hormone replacement therapy. This means replacing the estrogen and progesterone that the ovaries have stopped producing, so its effect will be very widespread. It may be comforting (in a way) to turn the clock back, but it brings its own risks, and needs to be discussed thoroughly with a physician who knows your personal history and risk factors.

Creams are available that give your body the hormones that can affect your vaginal tissue, lubrication and even you sexual desire. They are used locally, in other words you rub them into your arms, thighs, abdomen or vagina. They may also come in the form of pills, patches or suppositories and some are even available as one-time doses. They are medications and always need to be provided by health care professionals.

Complementary medicine alternatives don’t demand prescriptions, but remember that these may just be weaker, more subtle ways of affecting the same hormonal system that the medications would be affecting. Any chemical substance that you ingest can have side effects.

On a final, perhaps optimistic note, do remember that even if you no longer need contraception, you still need to be having safe sex. Your age is no guarantee against sexually transmitted infections or sexual abuse. And if you think speaking to your doctor about vaginal tenderness is tough, I’m sure that sex bugs should be a blast.


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