Sexual problems are far more common across the life span for those of us with vulva’s and vagina’s then most people realise.
There are times throughout our life that this is more likely to occur and perimenopause is one of those times. Hormone changes may contribute to the likelihood that you will experience sexual issues, but it is important that we are not only blaming hormones, but sex and intimacy is also far more complicated than that. It is important that the whole person is taken into account including relationship issues, how you feel about yourself, mental and emotional health, physical health, medications, the messages you hold about sex as well as what menopause means as a woman.
Sex drive in both men and women decreases gradually with age. However, women are more likely to be affected by a decline in sex drive as they age. During menopause, the physical effects of falling oestrogen levels can reduce sexual motivation and drive.
If a woman as both ovaries removed or undergoes chemotherapy bringing on menopause abruptly it causes an immediate drop in both oestrogen and testosterone. These women may suffer a greater reduction in desire than women who experience natural menopause.
The most common sexual difficulties experienced by women 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 in turn impact levels of desire and interest in sex
· mood changes
· hot flushes
· changes in mental health
· changes in self-image
Lubrication is governed by oestrogen levels, on average we produce 2- 3g moisture per day. This protects the vagina and labia, keeping it healthy. The fluid is also slightly acidic so it 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 oestrogen can cause vaginal changes;
· Thinner, shorter, drier less elastic walls.
· Itching or burning sensations because the vaginal pH is less acidic so less capable of fighting infections.
· Regular masturbation may increase natural lubrication no matter your age.
· Take time to get to know your body and slow sex down.
· Allow time for plenty of foreplay. Think longer foreplay and more intimacy, over making intercourse last longer.
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 partners.
The perimenopause is characterized by irregular periods and fluctuating oestrogen levels, often with a random mixture of high oestrogen and low oestrogen symptoms. One week you might be experiencing painful breasts and heavy bleeding and the next, experiencing hot flushes night sweats, sleep disturbances and anxiety as a consequence of low oestrogen. It is no wonder it is hard for so many of us to have any interest in sex. This fluctuation of oestrogen levels can also impact on your body's ability to lubricate naturally. If you are not aroused, have not taken enough time to be aroused, if your definition of real sex is focused on intercourse it may feel like there is sandpaper in your vagina when you try to have sex especially when you have not taken the time to become aroused so your body can naturally lubricate or you are not using lubricants.
It is not uncommon for loss of sexual desire to cause high levels of distress, which often plays out through actions such as withdrawing from sexual or even the simplest of intimate interactions or continuing to engage intimacy and sex even though there is no interest or desire. 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. Did you know that sexual desire or satisfaction within a relationship is a key determinant of the quality of the nonsexual aspects of the relationship? Despite all of this many women continue to have sex this tells us that women are taking on the suck it up princess mindset and just continuing to have sex or intercourse when it hurts. 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.
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. Sexologists such as our resident sexologist Jodie can help with all this and more.
Sexual problems are common in people who going through menopausal changes. Sexual intimacy is a fundamental part of being human, a human right, 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.
and confidence due to changes in our body
Vaginal dryness is a very common condition affecting 70% of women post-menopause.
A recent study of 8,000 women found that over half experienced it post-menopause and 41% said it made sex painful. (Closer study, 2017). The study also found that 25% of women in the study lost sexual confidence after menopause. It also found that both women and their partners found this hard to discuss.