Introduction to menopause
Menopause is a time when women experience considerable hormonal changes which result in symptoms such as hot flushes, mood swings and sexual problems. While these symptoms are natural, they can cause significant distress for menopausal women and their partners, and can disrupt the couple’s sex life.
Having a supportive, understanding partner and being in a trusting relationship makes it easier for women to cope with menopause and its symptoms. On the other hand, being dissatisfied with a partner can exacerbate the sexual and psychological symptoms of menopause. Many men may have little knowledge of menopause and may be unsure how to react to the changes their partner is experiencing or unaware that treatments to relieve menopausal symptoms are available. In addition, they may not have considered their role and how they might be contributing to (or may be able to help relieve) their partner’s symptoms.
There is considerable evidence that couples can continue having a great sex life after menopause. However, it is also important to highlight that there are many factors that influence the possibility of a woman experiencing menopausal symptoms, including sexual problems. A woman’s relationship with her partner exerts a significant influence on her menopausal symptoms, in particular the sexual symptoms which she experiences.
Men may be unaware that they play an important role in keeping up a great sex life during and after their partner’s menopause, or unsure of specific steps they can take to improve their sex life. While general practitioners and other health professionals are a good source of advice, men are often embarrassed to discuss their sex life with a doctor. However, doctors will treat sexual problems just like any other health problems, so it’s important for men to try and speak openly and honestly with their doctor.
|For more information about menopause, see Menopause.
Sexual symptoms are typically a problem for women because they cause a mismatch between her partner’s sexual needs and her own. For example, a woman who takes longer to orgasm after menopause may only be bothered if her partner experiences quicker orgasms as he ages. Menopausal sexual problems are a joint problem, most effectively treated by involving both partners. It helps when the male partners of menopausal women are educated about why the sexual symptoms of menopause arise and what might exacerbate them. Educated partners are in a better position to help menopausal women treat the symptoms and have a great sex life after menopause.
There are many ways in which you can contribute to ensuring that you both continue having great sex after menopause. As biological and psychosocial factors indirectly affect a couple’s sexual relationship, you should not only think about sexual factors when you consider how to improve sex with your menopausal partner, but must also consider how biological and psychosocial factors influence sexual functioning.
Physical health influences sexual function, and staying healthy is an important part of having a great post-menopause sex life. Try to:
- Eat a healthy, balanced diet;
- Exercise regularly;
- Avoid nicotine, alcohol and other harmful substances; and
- Get enough rest.
Maintaining a healthy lifestyle can provide encouragement for your partner, because you can exercise or plan healthy meals together.
Your partner may have special health needs in the menopausal period, and it is important that you are aware of these needs and support her. In particular, she may need to take hormone replacement therapy or another type of treatment, especially to relieve hot flushes which disrupt sleep and mood changes which affect libido. You can help by being knowledgeable about the various treatments available and helping her assess the pros and cons of various treatments.
You can also provide support by accompanying her to the doctor. A health professional is your best source of advice about menopause and can also offer advice about a range of treatments which may be effective in relieving the symptoms of menopause, including sexual dysfunction. However, some women may not visit a doctor because they are afraid to discuss the symptoms or even because they are afraid to admit they are experiencing the symptoms and menopause.
It is best for menopausal women to visit the doctor with their partner, as it helps the doctor to assess how the relationship is affecting her symptoms, and enables the man to play an active role in the treatment process.
Offering to accompany a menopausal partner to the doctor is an important way of supporting her. She may be more willing to make the visit simply because she has a support person. You can also help by investigating where appropriate health professionals can be found, for example by finding out if there is a menopause nurse at the local family planning clinic, or investigating the resources available in the obstetrics and gynaecology department of the local hospital.
Women experience significant changes at menopause, and it’s difficult for those who are close to them not to notice. As her partner, you likely know her well and spend significant time with her, and are thus likely to notice mood changes more than others (and perhaps find yourself in the middle of a menopausal mood swing once in a while). Unlike her friends and family, your will also notice any changes in her libido or sexual response. All these changes can cause concern and anxiety, and you may wonder what you are doing wrong.
Education about the physical changes that occur at menopause and the symptoms they create can help reassure you that it’s all natural. It can also help you to be a more understanding partner and better express your support. The sexual symptoms of menopause typically include:
- Vaginal dryness;
- Reduced libido;
- Dyspareunia (pain during intercourse); and
- Reduce skin sensitivity and arousal.
Be aware that these symptoms occur in many menopausal women, and don’t be shocked if you observe these symptoms in your partner. It’s also important to bear in mind that non-sexual symptoms such as hot flushes and mood changes can indirectly affect a woman’s sexuality. For example, a woman who has poor quality sleep because of hot flushes may experience reduced libido because she is tired.
Try to view menopause as a gradual transition – it’s important to realise that it will not happen overnight. Women may experience symptoms before their menstrual cycle changes and symptoms typically persist for several years. Don’t expect menopause to be over quickly; be prepared to support your partner for the long haul.
Men do not experience menopausal symptoms and it may be easy to point fingers at a menopausal partner, believing, for example, that she should deal with her quick temper or find some way to get herself in the mood for sex. Instead of blaming your partner, try to think of menopause and its symptoms as a stage of life that a couple experiences and faces together. Think about what you can do to help your partner cope, rather than focusing on changes she could make.
Talking is an important strategy for relieving psychological symptoms, which in turn impact on a woman’s libido and sexuality. You will never know exactly what a woman is feeling, but talking to her can help you better understand how she feels. Take the lead in communicating with her about her menopause experience. Don’t pretend to know what she is going through; instead, focus on listening and being empathetic.
You might start a discussion on menopausal symptoms by asking if there’s anything you can do to help. If you notice any changes such as bad moods or anxiety, bring them up with your partner in a caring way, for example by saying, “I’ve noticed you seem a bit stressed. Is everything okay?” Such a question opens the door for her to talk about her symptoms. It is also a way for you to show your support and that you care and pay attention to the way she acts.
Having trusting, understanding friends to talk to and who listen can be an important part of coping with menopause. Don’t be offended if your menopausal partner wants to talk to other friends – the more friends supporting her, the better.
To improve sex, it’s especially important to find ways of talking with your partner about how sex feels and how both your sexual feelings are changing as you age. Women whose desire declines may be concerned that their partners feel unloved or are looking for other women. Women who experience increased sexual desire (which is perfectly normal, although less common than reduced libido) may feel confused because ageing bodies are not typically viewed as sexual.
Don’t try to read your partner’s mind – you have not experienced menopause and should not be expected to understand how it feels. You can, however, increase your understanding by talking to her about the changes she is experiencing. It is an opportunity for you both to reassure each other that the sexual changes are not because of reduced feelings of intimacy and love. You can also use the opportunity to let your partner know that you still love her and aren’t interested in having sex with other women (and be reassured that she still loves you, even if she doesn’t want sex as much).
If you are worried that you might hurt your partner during sex, ask her if she ever experiences sexual pain and what causes her pain during sex. Also ask about her preferences for sexual activities now she is in the menopausal period. You may find that some aspects of sex from earlier years may have improved for her. Discuss possible strategies for improving your sex life with your partner, and be ready to make some practical suggestions. For example, suggest going shopping for sex toys or talk about articles you’ve read on menopause.
Bear in mind that your own sexual feelings have also changed with age, and it’s important for you to explain these changes to your partner. You may also start a discussion about treatments that can relieve the sexual symptoms of menopause. Hormone replacement therapy is effective in relieving sexual symptoms in most women, and there are also treatments available for male sexual dysfunctions, including erectile dysfunction.
Problems with the intimate relationship or a lack of social support may worsen psychological symptoms (e.g. mood changes) during menopause, and these may in turn worsen sexual symptoms. Try to talk with your partner about any issues in your intimate relationship, and think about how you can deal with these. For example, consider practical steps you can take to improve your relationship, like spending more time together. Some couples may benefit from relationship counselling to address issues such as lack of trust.
Menopause is a time of significant emotional upheavals for women, and these changes may also influence her sexual function. For example, a menopausal woman may be coping with changes to her maternal role because of children leaving home. Talk to your partner about these changes and how she is holding up emotionally. Just talking may help, although other strategies may be needed if she is experiencing severe emotional changes which are negatively affecting her daily life or relationships. For example, she may need some special attention, and you can encourage and help her to:
- Put aside special time for herself;
- Do something special;
- Surround herself with supportive friends;
- Take on new roles in life, such as joining an interest group or doing charity work; and
- Talk to her doctor if she experiences severe emotional symptoms.
The shape, size and texture of a woman’s body typically changes in the menopausal period. These changes may cause women to feel less confident about their body image. Society tends to value young bodies more than older bodies, and often equate the normal changes that occur as a woman ages (e.g. weight gain, wrinkling and sagging skin) with loss of beauty, even though they are completely normal.
You can help by reassuring her that the changes she is experiencing are normal, and encouraging her to be positive about her body. You can also reassure her by telling her that you still love her body, regardless of the outward changes.
A woman’s self-esteem influences her sexuality, and low self-esteem is associated with sexual dysfunction. You may therefore be able to boost your sex life by promoting good self-esteem in the menopausal period. You can encourage and help your partner to:
- Focus on the good, not the bad;
- Identify achievements she has made throughout her life, and focus on these if she feels low;
- Challenge unrealistic expectations, for example about her body shape or the ageing process;
- Set realistic goals;
- Join an interest group or do volunteer work.
The values and roles expected of menopausal women vary between cultures, and a woman’s experience of menopause and its symptoms depends on how she is perceived culturally. Cultural factors such as diet, lifestyle, economic status and life expectancy can also influence her menopausal experience and her sexuality in the menopausal period.
During menopause, you can help keep your sex life great by thinking about how cultural beliefs influence your partner’s experience of menopause. Encourage her to do the same. For example, consider:
- How your culture/s might influence her experience of menopause, for example, whether or not the culture promotes valuable roles for menopausal women, how the culture views ageing bodies, and cultural attitudes towards older people having sex;
- Identify aspects of your culture/s which may negatively influence her experience of menopause; and
- Brainstorm ways in which cultural factors influencing the experience of menopause may be addressed.
Be positive about menopause and focus on how the changes it is catalysing may teach you and your partner new ways of enjoying and supporting each other. Women who have a positive attitude about menopause, and view it as a time of positive change rather than a crisis, are less likely to experience menopausal symptoms, so it’s also important to encourage her to focus on the positive aspects of menopause, such as the cessation of menstrual bleeding and the associated freedom.
Sexual feelings change as men and women age, so it follows that the types of sex that feel best will also have to change. Typically, men and women take longer to become aroused and have more difficulty becoming aroused. This may mean that you need to spend more time on foreplay before penetrative sex. If there’s a problem like erectile dysfunction, exploring non-penetrative sexual techniques will be important.
It is important to take the view that changes to sex life and sexual functioning are normal and can be positive. What happens in the menopausal period does not matter as long as both partners are satisfied. Try to find new ways to display affection and intimacy that make both of you feel desirable. For some couples, that may mean putting penetrative sex on hold and just kissing and cuddling for a while, or spicing up your sex life with sexual enhancement products like dildos, lubricants and erotic film or literature.
Sexual problems including hypogonadism (testosterone deficiency) and erectile dysfunction are more common amongst ageing men. A man’s sexual function exerts a significant influence over his partner’s sexual function; in about one third of couples, problems with the man’s sexual functioning are responsible for the female’s menopausal sexual dysfunction.
Consider your own sexual function and how problems such as erectile dysfunction or premature ejaculation might be contributing to your partner’s sexual difficulties in the menopausal period. As men typically instigate sex, changes to his libido may have a significant impact on the frequency of sex. If he feels like sex less and initiates it less, frequency will decline unless his partner begins to initiate sex. If you are experiencing sexual problems or changes, discuss them with a doctor and find out about the range of treatments for male sexual dysfunction which can help improve your sex life.
Feelings of rejection or fear of causing your partner pain may also stop you from initiating sex, even if you feel like it. In these instances, it’s important for you to talk to your partner.
Men with menopausal partners report feeling rejected and undesirable because their partners take longer to become aroused, feel less like having sex and produce less vaginal lubrication. Be aware that these changes are influenced by hormonal changes, which are beyond her control. Don’t feel personally threatened if she doesn’t want sex as often or doesn’t experience orgasm as intensely as she used to. While her satisfaction with her intimate relationship may also influence her sexual feelings, don’t assume that you are the source of her changing desires – if she is experiencing menopause, hormonal changes are likely to be contributing.
Sexual stimulation promotes vaginal elasticity and may promote improved sexual function in menopausal women, who typically experience declining vaginal elasticity. Encourage your partner to keep having sex. If she doesn’t want to have sex with you, she may still want to masturbate, but don’t be offended. Self–stimulation also helps improves vaginal elasticity, so her masturbating may ultimately improve your sex life!
The brain is an important sexual organ, and thinking about sex increases sexual desire. It’s therefore important for you and your partner to think about sex.
Don’t assume sex will happen. Menopausal women and their partners are usually busy with work, continuing parenting commitments, and new responsibilities such as caring for ageing parents. You may find that you are both simply too tired for sex when everything else is finished.
To overcome this problem, try to dedicate some special time for being together and being intimate. This may involve sex if you are in the mood. However, a special dinner, a moonlit walk in the park, a secluded picnic or a romantic massage might be more appropriate, particularly if her sexual symptoms are severe and she simply doesn’t feel like sex. Even when it doesn’t involve sex, spending time being intimate is a way in which you can show you partner that you want to be close, with or without intercourse.
Every couple’s sex life is different, and in the menopausal period, a couple’s sex life is also likely to differ from that of other couples. Sex is also likely to be different compared to the pre-menopausal period. Don’t compare your sex life to the sex life of other couples, or to how you remember your early sex life. Each couple has different feelings, and what is right for one couple is not necessarily right for the next. Focus on what you and your partner want, and evaluate whether or not your sex life is satisfying in these terms.
In the peri-menopausal period – that is, the period in which women’s menstrual cycles are irregular but still occur – there’s still a risk of pregnancy. Most couples do not want to become pregnant at this time of life, and pregnancies in menopausal women carry a high risk of complications such as birth defects. It’s therefore important to avoid pregnancy.
You can play a role in helping your partner with contraception, for example by reminding her that she can still get pregnant, willingly using condoms, or exploring a range of contraceptive options which might be appropriate in the peri-menopausal period.
For more information on contraception, including types of contraception, protecting against sexuallly transmitted infections, and contraception after childbirth, see Contraception (Birth Control).
Although women no longer have to worry about conception once they have passed menopause, sexually transmitted infections still present a risk. As the post-menopausal vagina is more susceptible to trauma compared to pre-menopause, the risk of sexually transmitted infections may also increase.
You should play an active role in preventing sexually transmitted infections – this may be particularly important if you are in a casual relationship with a menopausal woman.
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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