NOT FEELING IT? IT DOESN’T NECESSARILY MEAN YOU’VE LOST INTEREST IN SEX OR YOUR PARTNER. CAN’T GET ENOUGH? THAT COULD BE FREEDOM CALLING KNOWING YOU CAN’T GET PREGNANT. HOWEVER YOU ARE FEELING TOWARDS SEX, KNOW IT’S ALL NORMAL. LIBIDO AND MENOPAUSE — LET’S GET INTO IT.

As our hormone levels change during the menopause transition, so does our appetite for sex. You may be experiencing symptoms contributing to a decreased interest — being tired, it might not feel pleasurable right now (it hurts, or burns to penetrate), you’re too stressed to even think about it, or all of the above?

We don’t want to feel that way, but when you’re tired and have competing priorities, or sex doesn’t feel good, it is hard to prioritize.

What if it doesn’t have to be that way? What if you could take action to bring back desire, make sex feel good again, and be something you look forward to? I mean, who doesn’t love a good orgasm? Sexual well-being is an important aspect of our overall health. Let’s discuss the physical and emotional factors relating to sex and libido, and some recommendations on how you can improve your sex life during menopause.

First, let’s go over what menopause is. Menopause is the time when a cisgender woman, transgender man, or non-binary person with ovaries goes 12 consecutive months without a period. The ovaries stop producing eggs, and the levels of estrogen and progesterone decrease. The average age of reaching menopause in Canada is 52.

A study to determine whether surgical menopause impacted the sex life of women differently than natural menopause showed there was no impact to sexual performance (for example, achieving orgasm). It did state that sexual desire frequency was higher for those who had natural menopause.

Now we get into it.

LET’S TALK SEXUAL DESIRE FOR A MINUTE

There is a sexual response cycle that we follow. It starts with motivation, which is complex. We want emotional intimacy, to feel attractive, loved, and appreciated. And we want to remove any guilt about how often we do or do not have sex.

From motivation we move to stimulation which brings on arousal. If the stimulation is what we’re looking for, we become aroused and our sexual desire kicks in. At times there is “spontaneous desire” which decreases with age, and increases in a new relationship.

Understanding the psychological, emotional and physical elements that go into “being in the mood” will help us understand why our libido changes during perimenopause to post-menopause.

HOW OUR BODY AND SEXUAL DESIRE CHANGE IN MENOPAUSE

Estrogen is a hormone that plays a key role in female sexual health. It helps maintain vaginal lubrication, elasticity and thickness, all of which are important for comfortable and enjoyable sex. As estrogen levels decrease during menopause, women may experience a number of symptoms that can impact their sexual health.

We know sex is an emotional and physical act. It is important to recognize that one’s desire to have sex may not align with how their mind and body are feeling. And that feeling of pain, anxiety or stress towards intimacy are likely linked. Sometimes there is something physical going on that you can address. And there are ways to address the emotional side of the equation that need to be addressed.

VAGINAL ISSUES CAN LEAD TO PAIN DURING SEX

As estrogen levels decrease, the tissues in the vaginal area may become thinner and less elastic, leading to dryness (less lubrication) and discomfort during sex. Tissue of the vulva and vaginal openings may shrink, and vaginal length may shorten. Vaginal dryness (typically in perimenopause) and vaginal atrophy (typical in post-menopause) are hallmark signs of genitourinary syndrome of menopause (GSM). Any of these can make penetration painful, leading to discomfort and a resulting decrease in sexual desire.

According to The Society of Obstetricians and Gynaecologists of Canada (SOGC), only one third of those who are experiencing moderate to severe vaginal discomfort pursue treatment. This isn’t something we need to suffer through. There are options.

For example, if you’re experiencing vaginal dryness mostly during intercourse, using a water-based lubricant can help make sex more comfortable and enjoyable. It can help reduce friction and increase sexual pleasure.

For symptoms more troubling than dryness during sex, there are over-the-counter vaginal moisturizers and products that can help. If your doctor thinks it’s right, they can prescribe estrogen creams that can help restore tissue elasticity and thickness. Local hormone therapies can address vaginal dryness.

DECREASED SEX DRIVE

Some women may experience a lower libido during menopause. This can be due to hormonal changes, as well as stress, fatigue, and relationship issues. According to The North American Menopause Society (NAMS),

“Sex drive decreases gradually with age in both men and women, but women are two to three times more likely to be affected by a decline in sex drive as they age.”

There are a variety of ways to increase desire, both mentally and physically. Dr. Lori Brotto is a registered psychologist and Professor in the Department of Obstetrics and Gynaecology at UBC who researches sex and mindfulness. In an article from Best Health, she breaks down the science behind how being present and aware are skills we can learn as it relates to having better sexual experiences in perimenopause through to post-menopause.

She advocates that planning vs. spontaneous can still be “pro-sexy”. She likens it to the best vacation you’ve ever had, or a successful dinner party. Those took planning. And so does good sex during a time when our physical and emotional changes are a moving target.

Toronto-based sex expert Carlyle Jansen is a registered psychotherapist and author who talks about preventing loss of libido and what to do to get it back. She says it’s all about starting simple — there can be an in between 0 and 100 — and this “in between” helps keep libido on the radar.

Focus on touch and intimacy instead of intercourse. Make out, have a shower, lay naked together – with no expectation of sex. This will drum up the responsive desire. Once you feel close and connected, talk to your partner about what you want to do. If penetration doesn’t feel good for you at the moment, do what does.

Jansen reminds us that if you have multiple partners, dry vagina, less elastic makes us more susceptible to STIs, so remember to take precautions and use protection.

CHANGES IN ORGASM

Some women may experience changes in the intensity or frequency of their orgasms during menopause. This is due to a slower blood flow to the clitoris and lower vagina which can decrease sensitivity, and it can take longer to reach an orgasm. According to NAMS,

“The clitoris is likely to be less sensitive than in earlier years, possibly due to reduced estrogen levels and changes in the vascular and nervous system.”

The decline in sensitivity may require more direct and intense stimulation as opposed to penetration. So maybe the southern region needs a little more love, and you are the perfect guide to tell your partner what you need in the moment.

URINARY TRACT INFECTIONS (UTIs)

Thinning vaginal tissues caused by decreased estrogen can lead to increased risk of UTIs. There are other physical changes that impact the recurrence of UTIs such as pelvic organ prolapse, incontinence and trouble completely emptying the bladder.

In an article written by Harvard Health, they talk about how good urination habits are the first line of defense. Be sure to empty your bladder, even if you’re late for a meeting or to pick up the kids. Always urinate after sexual intercourse to help flush any bacteria that may be in the area from sex. If your UTIs are chronic, it is always best to check with your doctor in the event of a pelvic organ prolapse (which can impact fully emptying your bladder), or if you would benefit from a prescription to bring back the natural bacterial balance of your vagina.

WHAT ELSE YOU CAN DO

It may be hard to wrap our heads around how our desire today isn’t what it was when we were twenty, but hey, neither are our relationships, our careers, our bodies, our lives. We need to adapt. According to the SOGC,

“Research shows that sex increases the blood flow to the genital area, something that is good for the long-term health of the sexual organs, especially the vagina”.

But it needs to feel good. If we can increase desire, we will likely achieve arousal. Here are a few more tips to get you there.

TALK TO YOUR DOCTOR

It’s essential to talk with your healthcare practitioner so they can help you determine if there are any underlying medical conditions that may be causing the decrease in libido. If needed, they can recommend treatments or therapies to help manage your symptoms.

PELVIC FLOOR PHYSIOTHERAPY

Pelvic floor physiotherapy is an underrated resource that can help with pelvic pain and empower women. In this article in Canadian Medical Association Journal, it describes how pain from sexual activity can last up to 3 days and can lead to a multitude of emotions such as fear or anxiety to have sex. There are qualitative studies that support how pelvic physiotherapy can reduce or elevate pain, and also lead to increased blood flow and more intense orgasm.

TESTOSTERONE AND ADAPTOGENS

There is research that shows testosterone therapy is safe and effective for use by postmenopausal women for sexual arousal disorder. NAMS points out there are studies in postmenopausal women that show testosterone treatment can improve libido, but is not significant. They stress there is a lack of research around the long-term safety, especially with regards to breast cancer or heart disease.

There are also natural ways to improve libido without the use of testosterone. There are formulas of adaptogenic herbs used by Naturopathic Doctors that focus on increasing vitality, energy and circulation, all of which can increase libido.

TALK TO YOUR PARTNER

Open up to your partner about what you’re experiencing both physically and emotionally. Your partner loves you, and they don’t want you to suffer. They likely miss the emotional connection that comes from intimacy just as much as you do (not just the sex). Being vulnerable about what you’re experiencing can remove the mask of frustration or blaming. Things are changing, and establishing a way to communicate “in the act” can give you both the freedom to feel good.

PRACTICE SELF-CARE

Taking care of your physical and mental health can help improve your sexual health. Make sure to get plenty of rest, eat a healthy diet, exercise regularly, and manage stress.

Regular physical activity helps to improve blood flow and boosts energy levels, both of which can help improve sexual function. Plus, it reduces stress and anxiety which also can impact libido. Maintaining a healthy diet during menopause can improve overall health, and with foods such as soy products, it can help regulate estrogen levels. All of these habits together can contribute to improved sleep.

TRY NEW THINGS

Why not explore your sexuality? Consider trying new positions, experimenting with sex toys or differ fantasies with your partner. Certainly, give more love to your clitoris.

SEEK EMOTIONAL SUPPORT

Talk to friends, family or a therapist to help you navigate this transition. Talking to others who are open about having gone through or are going through this experience themselves can help you feel less alone and may provide helpful tips and advice. (Isn’t that what girls nights are for?)

Remember, everyone is different. Whether you’re stoked to have more sex or struggling to make it happen: It. Is. All. Normal. Find what feels right, feels good, and go from there.

If you are looking for a healthcare provider with advanced training in menopause, book a Free Mini Consult with us to start the discussion.

WRITTEN BY: AlterEgo Health
EDITED BY: Dr. Christine Kadykalo ND, MSCP

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