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Sex and the Menopause


Introduction to Menopause

As our hormones change, our response to sex does, too. Understanding why these changes occur and how we can navigate them is important to ensure that sexual satisfaction and pleasure remain integral components of our daily existence.

Sex plays a substantial role in the identity and self-care of certain individuals, influencing their relationships with themselves and others. The anxiety, apprehension, and shame associated with its transformations during menopause can be overwhelming. Nevertheless, it’s crucial to acknowledge that if sex isn’t your priority, that’s also completely normal.

Menopause is a natural phase in a person’s life, marking the end of their reproductive years. While it brings about significant physical and hormonal changes, it can also profoundly impact a person’s sexual desire and arousal. The relationship between menopause and sexuality is complex and varies from person to person. The most important thing to remember is that there is no universally defined “normal” amount of sex you should be having. Instead, it’s crucial to focus on understanding your body and the changes it undergoes during various life stages, such as menopause. This understanding forms the foundation for effective communication with your partner and exploring ways to derive pleasure in whichever form that may manifest. Embracing your unique journey and desires can lead to a more fulfilling and satisfying sexual life.

Understanding the complex interplay of hormonal shifts, physical symptoms, psychological factors, and relationship dynamics is essential for navigating this transitional period. With the right strategies and support, those going through menopause can maintain a fulfilling and satisfying sexual life during and after menopause.

In this article, we will delve into how menopause can affect sexual desire and arousal and some strategies for managing these changes.

Why do desire and arousal change during menopause? (the science bit.)

During menopause, your testosterone and estrogen levels decrease, which may make it more difficult for you to get aroused and experience the desire for intimacy and touch. Estrogen is probably the most well-known sex hormone, and a decrease in estrogen can lead to vaginal dryness and a drop in blood flow to the vagina. A reduction in testosterone can lead to a decrease in sexual desire and the want to have sex. Although testosterone is the main sex hormone in those with a penis, it is also present in lower amounts in those with a vagina.

Genitourinary Syndrome of Menopause (GSM), formerly known as vulvovaginal atrophy (VVA) or atrophic vaginitis, is a medical condition that affects many menopausal people. GSM is a progressive and chronic condition that affects the vulvovaginal area, sexual health, and lower urinary tract. It encompasses many signs and symptoms, most of which can be attributed to decreased estrogen levels associated with menopause. While GSM predominantly affects postmenopausal people, it can also be observed in many premenopausal people.

Common symptoms of Genitourinary Syndrome of Menopause include:

  1. Vaginal dryness: A decrease in estrogen can decrease vaginal lubrication, leading to dryness, itching, and discomfort.
  2. Vaginal atrophy: The vaginal tissues may become thinner, less elastic, and more fragile, which can cause pain or discomfort during sexual intercourse.
  3. Urinary symptoms: Those with GSM may experience urinary symptoms such as frequent urination, urgency, and urinary incontinence (leakage).
  4. Recurrent urinary tract infections: Changes in the urinary tract and vaginal environment can increase the risk of urinary tract infections.

Around 70% of menopausal people are affected by some of these symptoms, making this extremely common. However, many people who are menopausal are needlessly suffering as at least a third of those do not seek medical advice, and around 50% of those who have symptoms go more than three years before seeking help.

Indirectly, various other menopausal symptoms can significantly impact one’s sexual experiences. Conditions like night sweats and sleep disturbances can leave you feeling fatigued and drained of energy, making the thought of engaging in sexual activity less appealing. Moreover, menopause can take a toll on your mood and self-esteem, potentially diminishing your desire for intimacy with your partner.

Physical Symptoms

Menopausal people often experience various physical symptoms that can also negatively impact their sexual desire and arousal. This can include things like hot flashes, night sweats, body image and self-esteem, which might make it challenging to feel in the mood for intimacy. The physical changes associated with ageing, such as weight gain and skin changes, can lead to feelings of self-consciousness and reduced sexual confidence. Also, Sleep disturbances are another common symptom of menopause, which can leave you feeling fatigued, tired and less interested in sexual activity.

Regular exercise can bring about significant mental and physical benefits during the menopause. It contributes to an enhanced sense of well-being and can also be a powerful tool for improving self-esteem, particularly if you’ve experienced changes in your appearance. By becoming more active, you can foster a positive relationship with your body and boost your self-confidence. Additionally, exercise is pivotal in promoting better sleep, increased energy levels, and a more positive mood throughout the day – essential for maintaining a healthy and satisfying sex life.

Mood and Emotions

Menopause can bring mood swings and emotional changes, affecting sexual desire. Anxiety, depression, and stress are common during this phase of life, and these emotions can interfere with the ability to relax and feel desire and want and need to engage in sexual activity. Coping with these changes requires understanding the underlying factors and adopting strategies to manage symptoms effectively. This would include prioritising self-care activities that help you relax and reduce stress. These may include regular exercise, deep breathing exercises, mindfulness meditation, or yoga. These practices can enhance your overall mood.

Another great way to help manage emotional changes is by joining support groups. Joining a menopause support group or connecting with others going through similar experiences can be incredibly beneficial. Sharing stories and strategies can help you feel less alone and more empowered in managing your emotions.

Vaginal Dryness and Discomfort

As mentioned earlier, declining estrogen levels can lead to vaginal dryness and discomfort during intercourse. This can result in pain and irritation, making sexual activity less enjoyable and desirable. Those with a vagina may also fear pain during sex, which can further decrease their interest in intimacy. This may also lead to performance anxiety, further hindering arousal. These apprehensions can create a self-fulfilling cycle, where the anxiety itself becomes a barrier to arousal, making it even more challenging to engage in sexual activity.

Strategies for managing changes

While menopause can bring challenges to a person’s sexual life, there are several strategies to manage these changes effectively:

  • Hormone Therapy: Some people opt for hormone replacement therapy (HRT) to alleviate the symptoms of menopause, including vaginal dryness and hot flashes. Consult with a healthcare provider to discuss the risks and benefits of HRT.
  • Lubricants: These are formulated to enhance sexual experiences by minimising friction. Among these, water-based lubricants are generally recommended for sexual activities due to their low likelihood of causing irritation and their compatibility with condoms.
  • Vaginal moisturisers: These are formulated as creams or gels meant for regular application inside and around the vagina, typically a few times per week. Consistent use of these vaginal creams helps maintain softness and lubrication in the vaginal and vulvar areas, alleviating itching, dryness, and discomfort, thus facilitating more comfortable sexual experiences.
  • Vaginal estrogen: This, on the other hand, is a specific type of hormone replacement therapy (HRT) available in various forms, such as creams, pessaries, or vaginal rings. It is intended for direct insertion into the vaginal canal, gradually releasing estrogen into the surrounding tissues.
  • Communication and alternative ways of exploring pleasure: Open and honest communication with a partner is crucial. Discussing concerns, desires, and expectations can help both partners navigate the changes and maintain a fulfilling sex life. Finding alternative ways to enjoy pleasure that doesn’t involve penetration may also be beneficial.
  • Emotional Well-being: Managing stress and prioritising self-care can improve well-being and enhance sexual desire. Engaging in relaxation techniques like meditation or yoga can be beneficial. Exploring solo play can boost confidence and help you better understand what your body likes and feels comfortable with.
  • Professional Help: If emotional or psychological issues contribute to changes in sexual desire and arousal, seeking therapy or counselling can be highly effective.

In summary, navigating the changes in sexual desire and arousal during menopause requires a holistic approach. Understanding the science behind these changes, managing physical symptoms, prioritising emotional well-being, and seeking professional help when needed are all crucial components of maintaining a fulfilling and satisfying sexual life during and after menopause. Embracing your unique journey and desires is the key to a more pleasurable and satisfying sexual experience; ensuring that sexual satisfaction remains your journey and finding your own ‘normal’ is critical.

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