Menopause may mark the end of your productive years, but it’s not the end of having good sex. For some women, the freedom from concerns about pregnancy, contraception, raising young children and establishing careers, can make for the best lovemaking yet – they know what they want and are less reticent in asking for it.
For other women, however, the drop in levels of the sex hormones oestrogen and testosterone can affect their sex drive and ability to achieve orgasm, causing vaginal dryness, hot flashes, night sweats, moodiness and urinary incontinence. Vaginal and vulvar tissues can become thinner and less elastic, more susceptible to irritation, burning, itching, discomfort and tearing from penetration. And there can be changes in body shape, as you lose muscle mass faster and bone density, and tend to burn fewer calories, bringing weight gain, especially around the midriff. This can affect confidence and libido.
Happily, today there’s much you can do to combat these issues and still have great sex.
Hot flashes and night sweats
“Hormone replacement therapy has been proven to be the most effective treatment for alleviating these,” says Johannesburg obstetrician and gynaecologist Dr Mpume Zenda. Recent studies confirm that HRT is safe when properly prescribed. And keep your bedroom cool when you have sex – turn on a fan, open a window.
Dryness
Vaginal moisturiser can be applied every few days, or ask your doctor about prescribing oestrogen supplements, such as a vaginal ring that releases a low-dose oestrogen, or an oestrogen tablet you insert. These may have side effects, so it’s important to discuss them first. Over-the-counter lube can be used during sex to reduce friction and irritation.
Sensitivity
Menopause can reduce blood flow to your vagina and clitoris, decreasing sensitivity and making it more difficult to achieve orgasm. Pelvic floor exercises can help increase blood flow and strengthen the muscles you use in orgasm. Longer foreplay can make a difference, as can massages, reading or watching erotic material with your partner, having oral sex, and playing with sex toys.
Vibrators can be great for external stimulation, which can be more comfortable than actual penetration, says Port Elizabeth relationship therapist and clinical sexologist Leandie Buys. “But a woman still needs to be in the arousal phase (meaning the clitoris needs to be engorged) before using a vibrator on the clitoris. So, it’s important to be sensual before being sexual, using a water-based lubricant.”
Discomfort, urinary incontinence
These can result from the extra pressure on your belly during sex. Experimenting with different positions – lying on your side, or on top – can help, as can emptying your bladder before or after you have sex. “I always suggest the three sisters – the vagina, the bladder and the anus – all need to be empty before penetration,” Buys says. “Daily Kegel exercises will also strengthen the pubococcygeus pelvic floor muscle, helping prevent urinary incontinence and give better and more intense orgasms.”
Body image and mood
Manage your weight gain and improve energy and mood by eating healthily and getting regular exercise. Choose whole foods instead of refined ones, replace saturated (animal-sourced) fats and trans (processed) fats with healthy fats such as fish, vegetable oils and avocadoes. Enjoy plenty of fruit and vegetables along with some lean protein and low-fat dairy, drink lots of water, and cut back on alcohol. Aim to get 30 minutes of aerobic activity five times a week, and two or more sessions of resistance training, to help retain bone and muscle strength.
A study in the journal Menopause Review, where women did a 12-week programme of walking, stretching and strengthening exercises with an elastic band, concluded: “There is evidence that regular physical activity may decrease menopausal symptoms and improve physical self-worth and quality of life in middle-life women.”
Communication
Above all, remember that open, honest communication with your partner is key to good sex at any age, along with a willingness to try new things and to compromise. “It can be helpful to seek the help of a sex therapist around the time of menopause, as it’s not just a woman’s body that changes with age, but the man’s too,” says Buys. “Consult with a professional so both of you can be aware of the changes.”
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