What we believe about sexuality at menopause has a lot to do with our sexual expectations and experience. While it is a common misconception that sexual desire and activity inevitably decrease at menopause, this does not have to be true for you. In fact, that “first-love” feeling of sexual desire can be experienced at any life-stage.
At midlife, the challenge for most women is to be able to access that in-love feeling in ways other than looking to another person for fulfillment and gratification. In other words, if you think of sexual energy in the largest possible context — as life force, or Source energy — then it is easy to see that the health and vitality of our sexuality is inexorably linked to the health and vitality of our lives.
Listen to Your Body
Many women at midlife are in the process of negotiating how to tap into their source energy, which is why they often notice a decrease in sexual desire. In addition, many other factors can affect sexual desire, including vaginal dryness, dyspareunia (pain during intercourse), vaginismus (painful spasms in the vaginal muscles), loss of clitoral sensation, and touch sensation impairment.
Determining the cause of sexual problems can be difficult. Sometimes, menopause-related hormone deficiency is to blame. But sexual function is a complex, integrated phenomenon that reflects the physical health of not only the ovaries and hormone balance but also the cardiovascular system, the brain, the spinal cord and the peripheral nerves. In addition, there are almost always underlying psychological, sociocultural, interpersonal and biological influences that affect individual sexual function. Interestingly, in one study where 14 percent of women reported having no sexual problems, one-third admitted they had previously had sexual problems, but that the problems had been resolved when they found new sex partners.
It is also important to note that health conditions and medications may also interfere with sexual functioning. Women suffering from gynecological problems, hypertension (high blood pressure), diabetes, chronic pain, alcoholism, drug use (including cigarette smoking), thyroid deficiency, or depression, as well as those who use anti-hypertensive medications, tranquilizers or sedatives, ulcer medications, glucocorticosteroids, antihistamines, or antidepressants may suffer some sexual dysfunction.
10 Common Midlife Sexual Function Changes
Many of the following midlife changes in sexual function have been associated with normal perimenopause:
- Increased sexual desire
- Change in sexual orientation
- Decreased sexual activity
- Vaginal dryness and loss of vaginal elasticity
- Pain or burning with intercourse
- Decreased clitoral sensitivity
- Increased clitoral sensitivity
- Decreased responsiveness
- Increased responsiveness
- Fewer orgasms, decreased depth of orgasm, increase in orgasms, sexual awakening
As you can see from this list, change itself, and not the nature of the change, is the common theme. It’s important to remember that during the perimenopausal transition, with all of its changes, a woman’s libido may go underground for a while as she reprioritizes her life and the manner in which she uses her energy. This is perfectly normal and can yield great dividends. But, it is only temporary. There is no reason for diminished sex drive to become permanent after menopause. And, while some women truly do notice a decline in libido at menopause, others actually experience heightened sexual desire and activity after menopause.
8 Ways to Keep Your Libido High During Menopause
1. Overcome cultural barriers. Give yourself permission to explore your sexual energy on your own terms.
2. Update your relationship. Question what is no longer viable in your relationship and work with your partner on rekindling your passion together.
3. Make time for yourself and your partner. It can be hard to make the transition from caring for everyone else to taking care of yourself. When you make time for yourself and allow some time to connect with your partner, your passion for each other will return.
4. Get your hormone levels checked. Androgens are the hormones associated with libido; however, declining levels of estradiol (E2) can also affect a woman’s potential for sexual arousal. Having a baseline panel is ideal; it may help you to know what your hormone levels are when your sex drive is normal for you so that if and when you notice a change, you can test your hormones again to see if anything has changed. I recommend the DUTCH test (dried urine test for comprehensive hormones.)
5. Try progesterone cream. A little progesterone cream is often all you need to restore your libido. As a precursor to estrogen and testosterone, progesterone is important in maintaining sufficiently high levels of the other hormones for optimal sexual pleasure. A normal balance of progesterone also acts as a mood stabilizer and supports normal thyroid function.
6. Try phytoestrogens. Many women find that their libido gets restored when they increase their intake of the many known phytoestrogens that nature has given us. These include Pueraria Mirifica, maca, black cohosh, and vitex.
7. Exercise. There is hardly a menopausal symptom that exercise cannot help, including low libido.
8. Tell the truth about your sexuality. All humans are sexual by nature. How you choose to express your sexuality depends on many factors including your upbringing, your hormones levels, your general overall health, and your level of satisfaction with your current partner, if you have one.
9. Read Hot Monogamy, by Dr. Patricia Love. Dr. Love has identified nine factors that can help sustain libido and cultivate a sensual relationship with your partner and yourself.
Related Audio: Low Libido At Midlife? What You Can Do To Increase It
Do You Have Vaginal Atrophy?
It is estimated that up to 60% of post-menopausal women suffer from vaginal atrophy. And due to embarrassment, cultural taboos and the fact that many women just don’t feel comfortable speaking to their health care providers about the intimate details of their sex lives, many women suffer in silence.
What is Vaginal Atrophy
Vaginal atrophy (also known as atrophic vaginitis) is caused when there is thinning, drying and inflammation of the vaginal walls. This is often attributed to a decline in estrogen and occurs most often after menopause, but it can start as early as a woman’s late 30s.
Vaginal atrophy is considered to be a chronic and progressive condition that can affect quality of life. The symptoms can include:
- Vaginal dryness
- Thinning of the vaginal walls
- Pain or burning sensation, especially during intercourse
- Decreased lubrication during intercourse
- Spotting after intercourse
- Shortening and tightening of the vaginal canal
- Frequent urinary tract infections
- Urinary incontinence
Treatment for Vaginal Atrophy
The good news is that vaginal atrophy is a common condition that is easily treated. The two best ways to treat this condition is to use a vaginal moisturizer and have more sex! In fact, sexual activity increases blood flow to your vagina and helps to keep vaginal tissues healthy.
When it comes to choosing a vaginal moisturizer, there are many options today.
1. Try over-the-counter vaginal moisturizers and lubricants. These are non-hormonal products that can be a wonderful first-line defense against vaginal dryness. They are great for women who are concerned about the use of treatments that contain estrogen.
2. Use a natural moisturizer. Some women can be sensitive to – or even allergic to – ingredients in OTC vaginal moisturizers and lubricants, especially those containing warming agents, dyes, parabens, mineral oil, and perfumes. Try Vitamin E gel caps. You need to puncture the gel cap and then squeeze the gel into your vagina. (You also need to wear a panty liner because the gel can stain your clothing.) Aloe Vera is another natural option. You can use it as both a moisturizer and lubricant. And, it does not upset the PH balance of your vagina. You can also try coconut oil or olive oil, but don’t use these with condoms. Be sure to test any product on the inside of your arm before using internally to be sure that you don’t have a reaction.
3. Try herbal remedies. Other solutions to vaginal dryness include herbal remedies that can be taken systemically, including Pueraria Mirifica (this can also be used vaginally), black cohosh, wild yam, Dong Quai or chasteberry.
4. See your doctor. If you experience painful intercourse that is not resolved by using a vaginal moisturizer, you may need a low-dose estrogen preparation, such as estriol vaginal cream.