Sexual Difficulties Experienced During The Menopausal Transition

What is menopause?

Menopause is diagnosed 12 months after a woman’s last menstrual period. The transition to menopause, also known as peri-menopause, can last for a number of years and is characterised by hot flushes, insomnia, anxiety, fatigue, low sexual libido and vaginal dryness.

The truth is that no one prepares us for menopause. We have to figure it all out by ourselves and it can be extremely frustrating to feel that we are being aged out of society. On the other hand, knowing how our bodies work and understanding the physical, psychological, emotional and sexual changes that can happen during this transition can be very empowering.

There is a considerable amount of research that focuses on the symptoms experienced during menopause, however in this blog I will be focusing on sexual and relationship changes.

Low sexual desire:

A decrease in sexual desire is common during menopause and perimenopause, however this does not make it a dysfunction or a disease. First of all we need to ask ourselves ‘If I have a low sexual desire, is this distressing to me? Is this distressing to my partner? Is it causing a problem in my sexual relationships?’ A number of women seek help when they are experiencing low sexual libido because this is causing problems in their sexual relationships.

Interestingly, research suggests that a decrease in sexual desire is unrelated to a difference in hormone levels. So why do several women report a decreased in sexual desire during menopause and perimenopause?

There might be a number of factors that contribute to this:

• Painful sex
• Fatigue and insomnia
• Experiencing feelings of depression
• Being on medication that effects sexual desire including SSRI’s (anti-depression treatment) and beta-blockers (used to treat heart conditions and high blood pressure)
• An increase in age might cause the woman to need more clitoral stimulation

Vaginal dryness/discomfort and pain

During menopause the elasticity of the vagina changes. The vagina might shorten or tighten due to decrease in collagen. It is important to note that vaginal douches and fragrances do not help as these might increase itching and dryness.

Use a vaginal lubricant during sex. It can be water or silicone based and can help if there is reduction in vaginal lubrication. However, if you are using condoms during sex make sure that the lubricant is compatible with the condom being used.

It is extremely important to talk to your gynaecologist if you are experiencing intermittent or heavy vaginal bleeding during the menopausal transition as it might be a sign of cancer.

Difficulties in achieving orgasm:

Achieving orgasm can become a problem during the menopause transition. Speak to your gynaecologist to see if you can benefit from using local vaginal oestrogen that helps increases blood flow to the tissues and increases vaginal lubrication. Focus on:

• Working on pelvic floor muscles through kegel exercises and the help of a physiotherapist who is specialised in women’s health. The strength of pelvic floor muscles which is affected during child birth, for example, is very important in achieving orgasms.

• Increase arousal and stimulation by using a stronger vibrator or asking your partner to touch you differently.

• Concentrate on having better sex through mindfullness and being present in your body rather than in your head during sexual intimacy.

Queer menopause

When we look at menopause and perimenopause the research carried out and conversations, we have focus mainly on cisgender heterosexual women. Unfortunately, societal discourse fails to recognise queer identities and queer sex especially where the menopause transition is concerned, and this makes it extremely difficult for queer folks to find their way around this as there is no representation of queer menopause in media.

So, what can help?

• Talk about your sexual needs with health care professionals and with your partner
• Challenge the ageist idea that older women do not have sex and should not enjoy sex
• Cultivate sexual fantasies maybe through reading erotica and ethically female produced porn that usually focus more on the sexual needs of women.
• Set time for intimacy and teach your partner how to pleasure you.
• Look at the importance of foreplay and introduce new practices in your sexual play
• Spice it up

And remember:

‘For every woman: Your awesomeness is unrelated to your oestrogen’

Gunter, 2021

References:

Brotto, L.A. (2018). Better sex through mindfullness: How women can cultivate desire. Greystone Books.

Gunter, J. (2021). The menopause manifesto. Citadel Press Books.

Nagoski, E. (2015). Come as you are: The surprising new science that will tranform your life. Scribe Publications

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