The hormonal changes that occur at menopause result in a range of symptoms, including hot flushes, mood changes and sexual symptoms. While most of the symptoms of menopause are temporary, sexual symptoms such as low libido, pain during intercourse (dyspareunia) and vaginal dryness often persist if they are left untreated. Sexual symptoms are natural and normal, but they may cause distress for some women. They would benefit from speaking with their doctor about treatments to help them maintain or improve sexual functionduring and after menopause.
For more information about menopause, see Menopause.
Sexual functioning in the menopausal period, as at other times of life, is influenced by a broad range of factors, including:
- Biological factors: For example, characteristics of the woman’s physical body, hormone levels, and illness or medication use;
- Psychosocial factors: Including the quality of a woman’s intimate and social relationships, her psychological health, and social upheavals such as children leaving home; and
- Sexual factors: Such as the quality of the woman’s previous sexual experiences, and her partner’s sexual function.
There is convincing evidence that the hormonal changes that occur at menopause alter the physiology of the female sexual organs (such as the shape and texture of the vagina) and alter sexual response (the amount of vaginal lubrication produced when sexually aroused). But other factors also have an important influence on sexual function, such as the quality of an intimate relationship, previous sexual experience, mental wellbeing and satisfaction with her partner. Some studies have found that these factors are more important as predictors of whether or not a woman will experience menopausal sexual dysfunction than hormone levels.
For more information, see Sexual Changes in Menopause.
There are several strategies that can help women overcome negative factors influencing their sexual function. Maintaining good physical health, addressing any emotional issues which may inhibit sexual function, and engaging in regular, varied sexual activity are some important aspects of maintaining sexual function after menopause.
A healthy body is a good foundation for a healthy sex life. It is therefore important that menopausal women take measures to improve their overall health. Health professionals will be able to offer comprehensive advice about maintaining good physical health after menopause. Women should begin by ensuring that they:
- Eat a healthy balanced diet;
- Exercise regularly;
- Get enough sleep; and
- Avoid harmful substances, including nicotine and alcohol.
In addition to sexual dysfunction, many women experience a range of other symptoms during menopause. These co-occurring symptoms may contribute to sexual dysfunction. Hot flushes, the most common menopausal symptom experienced by 70% of women who undergo natural menopause, may cause insomnia, irritability and reduced skin sensitivity, which may affect women’s sexual desire and responsiveness.
There are treatments that may help to relieve menopausal hot flushes, and in doing so, can have a positive effect on sexual function.
For more information, see Hot Flushes in Menopause.
Psychosocial factors are factors relating to the individual’s psyche and social situation. They include things like a person’s emotional health, the support available to them, and the dominant values and beliefs of the society where they live. Psychosocial factors influence many aspects of an individual’s health.
Psychosocial factors also influence a woman’s sexual function. Menopause is a time when women experience significant social upheaval and are more likely to experience psychological issues. It is therefore important for women to consider how psychosocial factors may be affecting their sex life, and implement strategies to alleviate any negative influences on sexual function.
Menopause is a time of significant social upheaval as well as bodily changes. It is also a time when women may be busy with work or family commitments, and some women may not take enough time out to relax and recuperate. Time for relaxation is important for emotional health. If you are having difficulty finding time to rest and relax, you may wish to try:
- Setting aside some time, just for yourself;
- Taking time out to do something special, either alone or with friends or family;
- Identify roles in life (such as being a mother, worker or friend) and whether these are important or fulfilling. It’s also important to think about any new roles you would like to take on in the menopausal period, for example becoming a volunteer or joining an interest group, if you have extra time on your hands;
- Surround yourself with family members and friends who you trust and whom you can talk to; and
- Consider talking to a health professional, especially if you feel depressed or anxious.
Women who are satisfied with their intimate relationship and partner are less likely to experience sexual dysfunction during and after menopause. Relationship issues such as a lack of trust may contribute to sexual dysfunction. Women in long-term relationships are more likely to experience low sexual desire. It is therefore important that women with issues in their relationship address these, for example by seeing a relationship counsellor.
Menopause is a time when women may face significant changes in family relationships. For example, it is often a time when children leave home, or when more time is dedicated to caring for ageing parents. These may affect a woman’s libido or sexual desire. For instance, women caring for aged parents might experience reduced sexual desire because they are tired. Women whose children leave home may experience psychological issues such as reduced self-esteem because of their changing maternal role, which may in turn influence the woman’s sex life.
Having a negative attitude towards menopause has been shown to increase the likelihood of menopausal symptoms. Women who see menopause as a crisis rather than the start of a new phase of life are more likely to experience symptoms.
Try to focus on the positive aspects of menopause. For instance, some women report a feeling of freedom after menopause, because they do not have to worry about menstrual bleeding.
Low self-esteem can affect libido and sexual function. It is important to address any issues of self-esteem. Try to:
- Focus on the good, not the bad;
- Identify achievements you have made throughout your life and focus on these if you feel low;
- Challenge unrealistic expectations, for example about your body shape or the ageing process;
- Set realistic goals;
- Join an interest group or do volunteer work.
Menopause is a time of significant physical changes, and women may feel uncomfortable or unconfident about the changes occurring in their bodies, particularly if they gain weight. Changes to body shape and weight gain are normal experiences for ageing women. Women should not compare themselves to unrealistic ideals (e.g. younger women’s bodies) and should be aware that the changes they are going through are normal.
Menopausal women can also take positive actions to ensure optimal physical health, for example engaging in regular, moderate-intensity exercise and eating healthy nutritious food.
The values and roles expected of menopausal women vary between cultures, and a woman’s experience of menopause and its symptoms depends on how her culture perceives menopause. Other cultural factors such as diet, lifestyle, economic status and life expectancy can also influence her menopause experience and her sexuality in the menopausal period. During menopause, women who experience sexual dysfunction should:
- Think about their culture and how it might influence their experience of menopause;
- Identify aspects of their culture which may negatively influence their experience of menopause; and
- Brainstorm ways in which cultural factors influencing the experience of menopause may be addressed.
Do not compare your own sex life to other women’s sex lives. Some women experience increased libido after menopause. Others experience a decrease in libido. In some cases decreased libido may not be a concern for the woman or her partner, whereas in others it may cause distress. Each woman has different feelings and opinions, and what is right for one woman is not necessarily right for another. Focus on what you and your partner want, and evaluate whether or not your sex life is satisfying in these terms.
The sexual relationship, the types of sex a woman engages in and the sexual function of her partner all influence her sexual function. Menopausal women should therefore consider how a range of sexual factors might be influencing their sexual function in the menopausal period.
There are a range of treatments for relieving the sexual symptoms of menopause. The safest and most effective treatment option depends on the range of menopausal symptoms the woman is experiencing. Discuss treatment options with yourdoctor.
Although women no longer have to worry about contraception after menopause, sexually transmitted infections (STIs) still present a risk. The vagina is more susceptible to small abrasions and grazes after menopause compared to before menopause, so the risk of sexually transmitted infections may also increase.
Women may experience reduced sexual function with menopause. As men age, their sexual function may also deteriorate. Conditions such as testosterone deficiency (hypogonadism) and erectile dysfunction are more common amongst older men. Having a great sex life takes two, and the sexual function of a woman’s partner influences her own sexual function.
Don’t blame yourself
Good sex takes two, and sexual problems may stem from one or both partners. Changes such as low libido are only issues if they are perceived to be such, so don’t feel bad simply because your sexual feelings have changed.
Assess your partner’s sexual function
Think about how it might influence your sexual function. Identify any factors such as health issues which may be affecting your partner’s sexual performance.
Involve your partner in treatment
Even if a partner has no obvious sexual dysfunction, they can be part of the solution. Involving your partner in the process of treating your sexual dysfunction can help them understand the changes you are going through.
Talk to your sexual partner
Partners are not mindreaders and will not experience things in the same way as you. Some partners may even avoid sex for fear of hurting you. It’s important to let your partner know how you’re feeling, the changes you’re going through and how these affect your sex drive.
Talking to a health professional, either alone or with your partner, can be an important part of resolving menopausal sexual difficulties for some women. Counselling can help women increase their awareness of menopause and provide reassurance that what’s happening to them is normal. Your GP can ensure that there are no systemic health issues which may be causing the sexual symptoms. A sex therapist may also provide emotional support for couples wishing to improve their sex life.
For more information, see Sex Therapy.
Regular sexual activity increases vaginal elasticity (which typically reduces in the menopausal period) and may reduce the sexual symptoms of menopause. If you don’t have a partner, don’t worry! Self-stimulation (masturbation) is equally effective for increasing vaginal elasticity and lubrication.
The brain plays an important role in regulating sexual desire, and thinking about sex can make you feel like having sex.
Don’t wait for intimacy to occur spontaneously. Take a weekend away, or dedicate some time to being intimate with your partner.
Engage in a range of sexual activities, including non-penetrative sex. Women who don’t feel like vaginal penetration or who experience pain on intercourse should think about a range of other ways they can obtain sexual pleasure. These might include:
- An intimate massage;
- Oral sex;
- Using sexual lubricants;
- Using sexual enhancement products, including erotic films and sex toys.
For more information, see Improving Sexual Function During and After Menopause.
For more information on menopause, including symptoms and management of menopause, as well as some useful animations and videos, see Menopause.
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