Interview with a sexologist, part two.
The hormonal fluctuations that come with menopausal transition can cause physical and emotional changes that can put a real dampener on our sex lives. But menopause doesn’t have to signal the end of your sex life.
In this article we get right into the nitty gritty of sex during menopause, perimenopause and postmenopause with sexologist Jodie Dunn from Kintsugi Sexual Education. And we talk about things we can do to turn the menopausal transition from sexually frustrating to totally liberating.
*This is part two of our interview with Jodie, if you want to know what sexology is all about, check out part one of our interview over here.
What’s the deal with menopause wreaking havoc on our sex lives?
Sexual problems for people with vulvas and vaginas are far more common than most people realise. And there are times in life where problems are more likely to occur; perimenopause being one of them.
Perimenopause is characterized by irregular periods and fluctuating estrogen levels, often with a random mixture of high estrogen and low estrogen symptoms. One week you may be experiencing painful breasts and heavy bleeding and the next, experiencing hot flashes, night sweats, sleep disturbances and anxiety as a consequence of low estrogen.
No wonder it’s hard for so many of us to have any interest in sex!
Hormonal changes can contribute to sexual issues, but it’s important that we don’t just blame the hormones. Sex and intimacy is far more complicated than that.
We need to take the whole person into account when we look to treat sexual issues. We need to consider their relationships, how they feel about themselves, their mental, emotional and physical health, any medications they take, their perceptions and beliefs about sex, and what menopause means to them personally. Whew! If you didn’t think about how complex sexual enjoyment was before, you’re probably overwhelmed by it now!
It’s important to mention too, that if a person has both ovaries removed, or they have undergone chemotherapy, they may experience menopause very abruptly because of the immediate drop in both oestrogen and testosterone.
Sometimes this can lead to an even greater reduction in sexual desire than in those who experience natural menopause.
What are some common sexual symptoms and challenges that come up during the menopausal transition?
The most common sexual difficulties experienced in menopausal stages are:
- loss of interest in sex
- trouble relaxing, switching off or being mindful in moments of intimacy
- vaginal dryness and atrophy
- painful sex (dyspareunia)
- arousal difficulties
- inability to orgasm (anorgasmia).
Some other changes that can impact levels of desire and interest in sex during menopausal transition are:
- insomnia
- mood changes
- hot flushes
- changes in mental health
- changes in self-image and confidence..
That’s a lot to take in, but from what we’ve seen, vaginal dryness is a big one.
It sure is!
Vaginal dryness is very common and affects 70% of post-menopausal women.
A recent study of 8,000 women found that over half experienced vaginal dryness post-menopause and 41% said it made sex painful (Closer study, 2017). The study also found that 25% of women lost sexual confidence after menopause and that both women and their partners found this hard to discuss.
What causes vaginal dryness?
Lubrication is governed by estrogen levels; which on average women produce 2- 3g moisture per day. This protects the vagina and labia, keeping it healthy. The fluid is also slightly acidic so protects the vagina against bacterial and urinary infections. Bartholin’s glands just inside the vagina produce extra fluid during foreplay and sexual arousal. This extra fluid is slippery and enables comfortable intercourse.
Low estrogen levels (like those experienced during menopausal transition) can cause vaginal changes including thinner, shorter, drier less elastic walls, and itching or burning sensations because the vaginal pH is less acidic, and therefore less capable of fighting infections.
Fluctuating estrogen levels can also impact our bodies ability to lubricate naturally. If you are not aroused or have not taken enough time to be aroused, intercourse may feel like there is sandpaper in your vagina. Sexual enjoyment—of intercourse, specifically—is unlikely without either natural or supplemental sources of lubrication, so it’s good to have a plan in mind for those moments where your estrogen levels are working against your natural resources.
What do you recommend for vaginal dryness?
Regular masturbation can increase natural lubrication no matter your age. It’s almost always a good idea to take time to get to know your body, slow sex down, and allow time for plenty of foreplay. You want longer foreplay and more intimacy, not necessarily longer intercourse.
What about lubricants, are they only for people who have sexual problems or disorders?
Absolutely not! The myth that lubricants are only used when there is a problem must be squashed. Quality lubricants benefit women of all ages to increase sexual pleasure for both them and their partner.
You may think lubricants are messy but sex is meant to be messy, noisy, fun, pleasurable and yes, at times, even a little embarrassing. So, don't be afraid to have a laugh and a cuddle if it is!
Using a quality lubricant can make sex more pleasurable and even make you want to have more sex.
One of our favorite water-based lubricants is Velvet Rose, by Intimate Rose. This lubricant is smooth, non-sticky, and a great solution for those moments when you can use a little extra help, making it more fun for everyone.
What other kinds of challenges are you seeing in perimenopausal and postmenopausal clients?
Sexual difficulties going into menopause are also more common if a person is experiencing poor personal health, urinary incontinence, poor mental health, stress, changes in self esteem, poor body image, or pelvic floor issues. And sexual difficulties can also be exacerbated by medications such as SSRI antidepressants.
Research tells us that the majority of us believe sexual activity is important and that higher levels of physical pleasure in sex are significantly associated with higher levels of emotional satisfaction.
So, it’s not uncommon for loss of sexual desire to cause high levels of distress, which often plays out through actions such as withdrawing from sex or even the simplest of intimate interactions or continuing to engage intimacy and sex even though there is no interest or desire.
Experiencing sexual issues at any time during life can adversely impact self-esteem, quality of life, mood and relationships with sexual partners. Did you know that sexual desire or satisfaction within a relationship is a key determinant of the quality of the non-sexual aspects of the relationship?
Despite all of this many vagina owners continue to have sex, but often with a decrease in sexual satisfaction.
Unfortunately, this means that many people are simply enduring sex or intercourse, when, at best it’s undesireable and at worse, it’s painful. This is not something that needs to happen. There are options to help you and your partner to continue to enjoy mutual pleasure or for you to continue to experience pleasure solo.
What about people who say experiencing menopause was one of the best things to happen to them?
Yep, it happens!
Some people actually find menopause a sexually liberating experience.
For many, it is the first time in their sexual life that they are free from periods and concern for family planning, and pregnancy. It’s a new experience to be able to explore their sexuality without those things in the mix. It’s important however, to remember that even though you can’t become pregnant, you can still contract a sexually transmitted infection. Therefore, it’s still important to use protection, even after menopause.
What do you recommend for people wanting to have happy, healthy and fulfilling sex lives going into menopause and beyond?
Use personal lubrication to help make intercourse more pleasurable and comfortable. Choose a water or silicone based lubricant suitable for the activity and that has no added perfumes, coloring and no parabens or glycerin. If suitable for your circumstance, use a non-hormonal vaginal moisturizing cream several times a week to help keep your vagina lubricated.
Ask your doctor or pelvic physiotherapist about using dilators to widen your vagina.
Avoid soap, bubble bath, and creams that can cause irritation.
If suitable for your situation try a vibrator or regular, gentle sexual intercourse.
Enjoy the pleasure of lots of foreplay! Experiment with different positions until you find what works for you. Slow sex down. Explore other forms of sexual play, foreplay and intimacy. Aim to extend pleasure and foreplay.
Shift the focus away from penetrative intercourse towards pleasure and intimacy. When you are ready, take more time before and during intercourse to help you relax, to help the vagina relax and become well-lubricated. Communicate with your partner openly with honesty and humor. Get in touch with yourself and the things you love again. If you can connect with pleasure in your everyday life, and communicate that to those you care about, it can improve your ability to explore and communicate your pleasure in more intimate and sexual situations.
If anyone is experiencing sexual difficulties who do you suggest they get in touch with?
Sexual problems are common in people who going through menopausal changes. Sexual intimacy is a fundamental part of being human, and the inability to engage in sexual activity in a fulfilling, meaningful way can have a negative impact on an individual, relationships.
This is why a multidisciplinary team is so important in your care and in the management of symptoms and your overall physical and mental health moving forward. These include your specialist medical professionals, your GP, a pelvic floor therapist, acupuncturist, osteopath, nutritional advice, exercise physiologist, sexuality counseling and other allied health care that suits your individual needs and values.
If you experience pain or discomfort when having intercourse, you can still enjoy sex and intimacy with your partner through mutual masturbation, oral sex and sex play with a clitoral vibrator and more. It may require a redefinition of what sex and intimacy mean to you and your partner, it could mean working on ways to reconnect with yourself and with your partner and how to communicate through this process, at Kintsugi Sex Counselling & Education we can help with all this and more.
We also love Dr. Amanda Olsen’s Guide to Maintaining Sexuality After Menopause.
*Psst- we have you covered and stock the. best. lubricants. Check them out here. If you want to know more about what to look for in a lube check out our blog. Or, if you want to go shopping on your own make sure you download our handy dandy checklist so you can get the best lube for your needs.
