Sexual health

• How does menopause affect sexual function?
• My sex drive seems to have disappeared. Is this normal?
• Sometimes sex is more painful for me now. What can I do about it?
• How can I get my partner involved in talking about changes I am experiencing in terms of my body and my sexual feelings?
• If I have had a surgical menopause, will my sex life change in any way?
• What can I do about vaginal dryness?
• What is local hormone therapy and how can it help me?
• Can I expect to have a healthy sex life after menopause?
• Since I am having trouble with vaginal dryness and have some pain with intercourse, is having sex a good idea for me as I age?

How does menopause affect sexual function?

Certain “urogenital” symptoms may develop progressively in the years or decades following menopause:

• Vaginal dryness, discomfort, irritation, itching, burning
• Pain during intercourse
• Vaginal discharge
• Vaginal bleeding
• Urinary infections that keep returning
• Loss of bladder control (urge and stress incontinence)
• A decrease or loss of sex drive (libido)

Studies suggest that only about one-third of those suffering from moderate to severe vaginal discomfort seek treatment. There are many treatment options available, so if you are struggling with these symptoms, be sure to see your doctor. Any vaginal bleeding that occurs 12 months after menopause should be investigated and not accepted as a menopausal symptom.

My sex drive seems to have disappeared. Is this normal?

Many women experience ups and downs in terms of sexual interest over the years as pregnancies, child care responsibilities, and fatigue take their toll. In addition the hormonal and physical changes of menopause can definitely have an impact on sexual interest. It is not unusual for women to report a decreased sex drive after menopause. Other women do not notice such a decline. While some women may feel sadness and a sense of loss, others experience a greater sense of sexual freedom once concerns about pregnancy are gone. And for some, changes in sex drive are not a concern. The good news is that all of these feelings are normal and even though sex drive may be less strong, for the most part, women report that they are able to respond to their partner and have pleasurable sexual experiences. Sexual desire is multifactorial and can be affected by lack of good health (both physical and mental), your partner’s health, previous sexual experience, stress, current relationship, and sexual pain. Sex drive may come and go—many couples report increased sexual interest and activity with a change in routine, for example while on holidays. New evidence suggests that menopause may be an independent factor in the deterioration of sexual drive within 20 months of menopause.

Sometimes sex is more painful for me now. What can I do about it?

Sex doesn’t go away with menopause, and can remain an important part of a relationship. There are many conditions that can contribute to pain during sex. It may be related to reduced vaginal lubrication, or other normal physical changes in the vagina. There may be some shrinkage of the tissues of the vulva, and vaginal opening as well as shortening of vaginal length. If you experience pain during sexual relations, a simple first step is to try a vaginal lubricant. There are many available over the counter at your local drug store. If the problem persists, talk to your doctor, to rule out treatable conditions, and to get help. Both systemic and local estrogen therapy can decrease the pain during sex. Sometimes dilators and pelvic physiotherapy can also help.

How can I get my partner involved in talking about changes I am experiencing in terms of my body and my sexual feelings?

Both women and men experience changes and anxieties associated with their sexual relations as they age. It is useful to discuss these physical changes that are occurring with your partner. As sensitive as these issues may be, couples need to find a way to keep the lines of communication open in order to keep their sexual relations healthy. It is helpful for couples to be able to have open discussions about the sexual dimension of their relationship, to understand the changes that both may be experiencing, to share their feelings about the changes, and to find solutions that work for both.

In some cases you may feel the need to talk to health professionals qualified to provide advice in this area; to make a difference, they will want to understand what each partner is experiencing physically and emotionally.

If I have had a surgical menopause, will my sex life change in any way?

Surgical menopause is often more difficult because of its abrupt onset. The ovaries are a major source of testosterone in the body. There may also be some changes depending on the type and extent of surgery. Women who have had their ovaries removed at a young age may benefit from testosterone supplements, however there are currently no testosterone supplements available in Canada that have been approved for women. It is not known how long a woman can safely take testosterone.

What can I do about vaginal dryness?

As hormone levels decline at this time of life, there can often be a direct impact on the tissues, muscles, glands and functions of the vagina and urinary tract. The loss of estrogen can result in thinning of the tissues, loss of vaginal elasticity, dryness and irritation. Vaginal dryness can be a menopause symptom, even for women receiving low dose hormone therapy (HT). If it is only a problem with intercourse many couples find a lubricant helpful. For more troubling symptoms there are a variety of over-the-counter products available to help reduce symptoms, including vaginal lubricants, moisturizers, and products that modify the acidity of the vagina.

To restore the tissues elasticity and thickness, there are estrogen creams that can be safely used that a physician can prescribe. If dryness worsens and leads to pain or discomfort, you should consult a physician or health professional.

What is local hormone therapy and how can it help me?

Local hormone therapies (HTs) use creams or devices that address a specific menopause problem such as vaginal dryness. These therapies are called “local” because they do not involve a medication that is taken by mouth. Vaginal estrogens come in three forms: creams, vaginal rings, and vaginal tablets.

Can I expect to have a healthy sex life after menopause?

There are many factors that can affect your sex life after menopause, but many women and their partners find that their sexual relations continue to be very satisfying after menopause.

If you have concerns, talk first with you partner, and then make a decision about seeking professional counsel.

Since I am having trouble with vaginal dryness and have some pain with intercourse, is having sex a good idea for me as I age?

In fact, research shows that sex increases the blood flow to the genital area, something that is good for the long term health of the sexual organs, especially the vagina. Issues such as reduced vaginal lubrication can be addressed with over-the-counter lubricants and/or a vaginal estrogen cream.