'Losing your libido feels like castration when you are still in your prime' - Sex & the surgical menopause
What can be done when your head is keen but your body feels cut off during menopause? Give up sex? Suzanne Harrington shares her top tips for survival
In 2015, a month before surgery to remove my ovaries, I write a cheery piece about the menopause, citing it as a time of empowerment and physical freedom.
Goodbye tampons and condoms, and welcome to the liberating mindset of - as my teenage children would say - ZFG, or Zero F**ks Given. After a couple of years of what I have assumed are hot flushes and menopausal symptoms, I am feeling pretty good about my menopause. I am handling it. It is fine. Not a bother.
And then, as a cancer precaution, I am told I must have a bilateral oophorectomy - this is following on from an hysterectomy for cervical cancer a decade ago - and overnight, I fall off the menopause cliff. Or rather, I am pushed. And realise, to my alarm, that what I have been experiencing previously have been the gentlest of peri-menopausal symptoms, giving me only a faint hint of what is to come. Surgical menopause - oh boy. It's not for sissies.
Wham! Flushes so hot they are like nuclear surges, coming with a one second warning approximately every twenty minutes. You become a human volcano, erupting day and night, gasping, red-faced, yanking at your collar. Kicking off the duvet, your hair wet with sweat. All the clichés.
Shazam! The other dreaded symptoms all come at once, mimicking a dystopian unfairy tale - weepy, sweaty, dopey, ragey, sleepy, achey, and anxious. A foggy brain, with memory so bad that parking becomes an ongoing joke (have you lost the car again, Mum?). Forgetting the names of people, places, films, books, bands, until you wonder if you might actually have early onset dementia. No. Just - 'just' - surgical menopause. Anxiety that transforms a reasonably unflappable mindset into Chicken Licken during Armageddon. Anxiety so bad it causes actual physical panic attacks. Shortness of breath, catastrophic thinking, exhaustion that results in 12-hour sleep marathons. Concentration shot to pieces. Oh, and hair falling out and dry as straw.
* Bam! Libido gone
This is the worst. Not because the other symptoms aren't awful - they are - but because losing your libido feels like castration when you are still in your prime. You are now a female eunuch. To make it even grimmer, the double dose of SSRIs prescribed by the doctor to ease the free fall mood swings can leave you anorgasmic. You can't come. This is a common side effect of some anti-depressants, and will eventually wear off, but meanwhile, where is your sex drive? Down the back of the sofa? Dead as a dodo?
At 49, I feel as though the connection between my head and body has been severed. Which is far from ideal - bad enough in a long term committed relationship, but I have recently met someone new. What do I say to them? Sorry, I seem to be suddenly medically asexual? I really fancy you but appear to be numb from the neck down? No, wait, come back!
What to do? While the doctor may reassure you that it is menopause, not menostop, the common consensus seems to be use it or lose it. I consider HRT, but the risks - yet more cancer, plus deep vein thrombosis, heart disease, osteoporosis, dementia - put me off. So how to reclaim your sexual self, and keep the show on the road? What can be done when your head is keen but your body feels cut off? Do you give up and take a vow of celibacy? Wave goodbye to relationships, sex, and desire?
Nooooo! Here are some alternatives to joining a nunnery
This is obvious, but let's say it anyway. Your partner needs to know exactly what is going on. Clue them up, tell them all, so that they know what is happening with you physically and psychologically - if you have always had a hot bedroom connection, they may be feeling as bewildered as you are. If you are with a new partner, they won't have any former points of reference with you, but telling them what's going on is vital. For you, as well as for them.
* FAKE IT TO MAKE IT
You might not be feeling massively in the mood. Or even slightly. But even if your body is switched off, your head may be a bit more responsive - so engage your brain and hopefully the rest will follow, albeit slowly, and not with the automatic responses of yore. Forget about major performative sex - restart your surgically murdered libido with sensuous touch, verbal intimacy, and low expectations. Now is not the time for Tinder. If you are single, continue to - as sex therapists put it - self-pleasure. If you don't already have one, get a vibrator, whether partnered or otherwise.
* LUBRICATION, LUBRICATION, LUBRICATION
There is no delicate way to put this. With surgical menopause, you may think you are never going to (a) feel a frisson of sexual desire again and (b) if you do, your vagina will be unable to co-operate, because it seems to have dried up, like an old crone in possession of an old prune. Thinking of yourself as an old crone with an old prune is enough to dry out the desires of even the juiciest woman, which is why nature invented coconut oil. Cheaper than commercial lube, naturally anti-microbial and containing no nasties like parabens, coconut oil is the menopausal woman's best friend. You can also put it in your thinning hair, massage it into your drying skin, and bake yourself a cake with it. But even with the best - ahem - extra virgin coconut oil in situ, penetrative sex can be uncomfortable after surgical menopause - this may only be temporary, but painful sex is not sexy. Happily, humans enjoy other sexual options beside penetration. Avail of them now.
Looking after your sexual self goes beyond what happens in the bedroom. You may find yourself more prone to UTIs - because menopause is the gift that keeps on giving - but I found these can be countered by including fresh lemon juice in your diet, as it alkalises urine, removing the sting from a urinary tract infection. Supporting the menopausal body via fresh food and dietary supplements is helpful - try tissue salts for hair and nails, sage and black cohosh for hot flushes, kelp for thyroid function, plus soya isoflavones for tiredness, low mood, irritability - although you may prefer Prozac if you have surgical menopause, as all of these symptoms can be simultaneous, sudden and intense. There's only so much tofu can do. Although as Prozac interferes with sexual response, it can be a Catch 22 situation - in order to stay sane, must you temporarily lose the ability to orgasm? The short answer, unfortunately, might be yes. Patience, tolerance and self compassion are all. No point in freaking out.
* SELF CARE
Again, this is obvious, but the more alcohol your drink, the more processed foods you eat, the less you exercise, the worse your symptoms can be. Having said that, even as a teetotal vegan who does hot yoga 3-4 times a week, surgical menopause has left me a desexualised, overheated basket case. With really bad hair. Talking to other women helps enormously, and if someone suggests trying something - anything - that might help, then try it. You have nothing to lose. (Not anything dangerous, obviously. Herbs, not heroin).
* GOING FORWARD
I've been living with surgical menopause for over a year now, and while it is not yet going away, I have adapted myself to it as best I can. You may not have sex like you did when you were 25, you should probably never attempt it without a bucket of lube, and your libido may feel like an arthritic donkey limping up a steep hill - but sex takes on a new depth, as it enters a new stage of being. Rather than worrying too much, once the initial shock of surgical menopause has worn off, it's probably better to keep calm and carry on. Keep your hand in, as it were. And as the brain fog and crippling anxiety give way to a steely sense of who you are and what you want, you may find yourself finally arriving in that most satisfying of headspaces - the one where zero fucks are given. Metaphorically speaking, of course.
Health & Living