By Dr Angela Sharma and Dr Angela Wright, sexology and menopause specialists and co-founders of Spiced Pear Health (www.spicedpearhealth.co.uk) a clinic providing a holistic approach to menopause management and treatment of menopause associated sexual problems.
Many women transitioning through the menopause experience changes that affect sexual wellbeing:
● Low desire: 40-55% 1
● Dryness: 25-30% 2
● Painful sex: 12-45% 3
Women often feel awkward about talking about sex with their doctors, and don’t comfortable raising it in consultations. In addition, finding someone with relevant knowledge and skills can be a lottery. At Spiced Health Clinic, we know the importance of being able to talk to someone who is both relatable and knowledgeable about intimate health and are delighted to share with you some tips on what you can do to get support in this area.
The Science
During the menopause transition there are fluctuations, and finally permanently reduced levels of oestrogen and testosterone. The blood supply to the vulvovaginal area for many, reduces and the tissues thin, becoming drier and less stretchy. This may lead to some pain during sex.
Other changes in friendly bacteria may lead to a rise in pH which can encourage recurrent vaginal and urine infections. The pelvic floor weakens, and pelvic organ prolapses can arise. As well as thinning of vulvovaginal tissues, the bladder tissues begin to thin and weaken, leading to urinary incontinence which can make some worry about leakage during intercourse. Clitoral tissues may diminish with reduced blood flow, and this can lead to loss of sensitivity.
This all may sound alarming, but don’t fear! With a bit of effort and time carved out in the day or evening, there are plenty of simple and proactive approaches to help improve our menopause pelvic and intimate health and wellbeing.
The Big Picture
It’s not so simple as to blame hormones or menopause for low libido. At Spiced Pear Health, we use a biopsychosocial model: this means exploring how relationships/homelife/history/body all impact people sexually. It’s not enough to just look at the body and say that if “the bits work, sex works”. It’s rarely as easy as that. Low libido is almost always multifactorial, and not all of us experience desire for sex in the same way.
Some of us have an innate drive, others will need the idea suggested for that spark to flare. To improve libido, we first need to want to want sex. It’s important to remember your mind is your biggest sexual organ.
Sexual identity and how we feel about our bodies is important too: menopause, and other events like cancer or surgery, can change women’s bodies in so many ways. Other medical conditions and medications can all impact too. Relationships and lives don’t stay the same either: divorces, new relationships, coming to terms with the loss of fertility and ageing. Looking after elderly relatives, kids and juggling busy jobs and a social life. All of these can have a huge impact on the space we have for sex.
Simple approaches to improve intimate health
Here are a few of our favourite pro-active tips that we see clinically make a huge difference, not just for current issues but in improving long-term health outcomes:
Vaginal oestrogens
These work to increase blood flow, thicken the walls of the vagina and get the PH back to normal. They come in various forms. Decide with your doctor what works best for you. Women with a history of breast cancer can often also use these safely if their oncologist agrees.
Vaginal moisturisers
These can be used twice a week to help moisturise and rehydrate the area. Some women prefer natural products like coconut oil.
Vaginal lubricants
During sex, lubricants are really useful. There are silicone, oil or water-based versions. Be careful to use a good brand, as some have additives or fragrances that can make the problem worse.
Pelvic floor exercises
These exercises help improve blood flow, pelvic prolapse and the strength of your orgasm.
Hormone Replacement Therapy
Abbreviated as HRT, hormone replacement therapy is a great way to restore your hormone levels. Adding in testosterone can be worth trying. There is testosterone gel that is available on the NHS: although licensed for men, the ingredients work safely in women’s bodies, just using a tenth of the male dose.
See a Specialist
You should review any medical conditions and medications with your doctor to see if they may be impacting your libido or sexual function. You may need to find a doctor with a special interest in sexual function for this kind of knowledge, as many GPs don’t have this training.
If you’re in a relationship, communicate!
Talk to your partner about the issues you are experiencing. It might be simple as changing sexual positions that give you the control over depth of penetration, or thinking about other ways to be intimate, such as sex toys or increasing time before penetration to give you more time to get aroused. Foreplay should be coreplay!
Having regular sex will increase the blood flow to the vaginal tissue and clitoris and help keep the area healthy – but solo sex works too. Don’t push it if it feels uncomfortable. There is an element of “use it or lose it”: but continuing to have sex when it’s sore can lead to cycles of pain and pelvic floor spasm (vaginismus) that can be hard to break. Be creative. Beware not to let avoiding sex become the easiest option: couples can end up losing all forms of intimacy, for fear it might lead to sex!
See a Clinical Sexologist
Too often, conversations about sex at menopause get reduced to just oestrogen or lube. This is not a broad enough focus. Seeing someone with wider training in sexuality and relationships can help you understand and explore what might really be going on for you.
Examining your relationship, your history, and your desire towards your partner, or for sex generally, can be really important. Sexologists use many techniques to help you reconnect with your sexual self.
Delving into your sexual scripts– what we say, think and feel about sex and how our upbringing, culture, religion, society and experiences have shaped our understanding around sex – can be revealing. Expanding your erotic palette or exploring your sexual thoughts and fantasies can help revive what turns you on. They can also help you change the way you feel about your body and reawaken your sensual side.
Touch exercises such as sensate focus get your body used to intimate touch again without the pressure of penetrative sex. A few sessions with the experts can open up a whole new side to you!
Final Thoughts
Sex is about pleasure, play, and connection - whether it’s with yourself, in solo sex, or in partnered sex! Sexuality doesn’t have to diminish during the menopause. The way we used to enjoy sex can shift - but there are plenty of creative ways to rediscover intimacy and find pleasure.
If you’re feeling concerned by low libido, consider seeing an expert and one who looks beyond simple fixes. People need to stop telling menopausal women that “if the bits work, sex works”. There is so much more to a healthy post-menopausal sexuality than lube and hormones.
1, 2, 3 - European Society of Sexual Medicine Red Manual – 2021, online edition
If you liked this blog, you’ll love Over The Bloody Moon’s Menopause Masterclass 3 - Pelvic & Intimate Health, sponsored by Always Discreet! Head over to www.overthebloodymoon.com/always-discreet-menopause-masterclasses to book your FREE ticket whilst they are available!
“Pelvic and Intimate Health in Menopause”, will be held live on September 15th at 20:00-21:00 BST with Dr Angela Sharma and Dr Angela Wright, Nicola Travlos (pelvic health physiotherapist) and host and founder of Over The Bloody Moon, Lesley Salem.
