Let's talk about sex... after the menopause
If you loved sex before menopause, you'll love it after, sexologist Emily Power Smith tells our reporter. It's just a matter of having the right tools at your disposal
Conventional wisdom tells us that a woman's libido begins to wane after the menopause. We are told that night sweats and hot flushes aren't compatible with a healthy sex life, just as we are led to believe that most menopausal women would happily turn their attention from sexual partners to bridge partners.
Irish sexologist Emily Power Smith (right) passionately disagrees. In fact, she says it's a myth that is overdue a good debunking.
Decreased desire is not a menopausal symptom per se, she says. On the contrary, it is due to a number of factors, both physiological and psychological.
"What we know from studies is that there is no single physiological reason for a woman to lose her libido when she hits the menopause," she explains. "It's actually turning out to be more of a myth."
According to Smith, this long-held misconception is a throwback to an era when "a woman's role was related to childbearing and women weren't supposed to enjoy sex".
"We still have these old-fashioned expectations and beliefs around a woman's vitality and her enjoyment of sex," she continues. "But they're not based on scientific evidence."
This isn't to say that declining hormone levels don't play a role.
"During perimenopause, hormones fluctuate wildly, but there isn't necessarily a dip in testosterone which, hormonally, is responsible for our sex drive," she explains.
"Testosterone doesn't really fluctuate much until after menopause, and then it quite often drops and that can be the reason a woman would feel less desirous from a hormonal perspective.
"There is research coming out of the States about the efficacy of small doses of testosterone for menopausal women," she adds.
"The evidence suggests that it can give some women back their libido and their joie de vivre generally."
It's a controversial treatment option that comes with side-effects, though. Actress Jane Fonda revealed that she began taking testosterone at the age of 70. It revived her libido alright, but it also gave her teenage acne.
Smith recommends that menopausal women get their testosterone checked, as well as their levels of sex hormone-binding globulin (SHBG).
However, she is quick to add that hormones are only one aspect of a complex, integrated phenomenon.
A recent study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism bears this out.
"Women's relationships and day-to-day reality are intricately linked to sexual function," concluded the lead researcher. "Our findings suggest menopausal women who are dissatisfied with their sexual function should consider whether these non-hormonal factors are playing a role when discussing treatment with a qualified health care provider."
Smith concurs. "What we've learnt from a lot of research is that [the menopause] can be a really great excuse to give up sex if the sex you were having wasn't doing it for you in the first place."
She's also noticed that many women try to circumvent the issue rather than address the problem, or indeed use it as an opportunity to reinvent their sexual repertoire.
This is one aspect of the workshops she runs for menopausal women during which she shares her three golden rules: communicate, lubricate and masturbate.
"The problem is that, for a number of reasons, women are not empowered to be able to say 'please stop doing that'; 'that hurts' or 'do more of that until I orgasm'," she explains.
Elsewhere, many of her female clients want to protect their partners' egos.
"A lot of women would prefer lousy sex, or stop having sex altogether, than to say to a partner 'you know what, I never had an orgasm with you and I'd rather be doing the ironing'.
"They are afraid that their partner will disintegrate," she continues, "but studies show that men would much prefer to know. It's all about how you deliver it."
In other cases, women allow easily treatable menopausal symptoms to spell the end of their sex life.
Vaginal dryness is one such symptom. "Generally, the problem with dryness tends to set in after menopause," explains Smith. "However that can be corrected with all sorts of things that increase oestrogen.
"The best thing you can do is to ensure you are moist in your vaginal canal as much as possible - not just while you're having penetrative sex - because with menopause you can get really quite dry and it causes discomfort and pain.
"It can cause tiny little lesions on the inside of your vagina and also, if your partner is a man, on his penis, which puts people off sex. In other cases it can increase your risk of thrush and those sorts of infections because you're just not creating enough of the natural defence."
Alongside vaginal moisturiser, Smith advises women to use lubricant during sex, "so long as they are not over-the-counter lubricants which are often highly perfumed and full of chemicals".
She recommends the organic lubricants Yes (yesyesyes.org) and Good Clean Love (goodcleanlove.com).
"All women of all ages should have lubricant by their bed anyway," she adds. Diet can also help. "Healthy fats like avocado, nuts, seeds, coconut oil and wild salmon are really good for increasing lubrication." And again, communication is key.
"Talking to your partner, lover or doctor about vaginal dryness needn't be embarrassing."
Certain physiological symptoms of the menopause are inevitable. However, a declining sex drive is often more of a self-fulfilling prophecy than a singular symptom.
"Creativity overrides sexual difficulty," continues Emily. "If they love sex, no matter how ill they are or old they are, they will usually find a way to be sexual.
"It may not necessarily be the same sex they were having in their 20s. It may not even be penetrative sex. But they will connect sexually because they love it and they understand the value and the benefit of it.
"It is proven that those who love it will find a way to maintain it."
Emily Power Smith is a contributor to My Second Spring, an online resource for menopausal women: mysecondspring.ie; empowersme.com
Health & Living