Sex After Menopause: Q&A

You’ve retired the birth control. Here’s how to keep your sex life blooming.

By Ginny L. Graves

Menopause vs. Sex

For a generation that has come to own and celebrate its sexuality, menopause, with its twin specters of dryness and diminished desire, seems like the ultimate bummer. Do declining hormone levels spell certain doom for our love lives? Are we really about to kiss good sex good-bye? Do we honestly want to take this lying down? No way. Which is why we asked experts the tough questions and found solid reason for hope — and good sex.

Q: How dry will I get? What does it mean for my sex life?

A: Estrogen dilates blood vessels and thus is key to arousal and lubrication. As levels of the hormone decline, the vagina becomes less moist, and its walls may become thinner and more fragile. This can make sex painful.

THE BRIGHT SIDE "Almost every woman will notice some dryness, but the severity and how much it affects your sex life varies widely," says ob-gyn Hilda Hutcherson, MD, the author of Pleasure: A Woman’s Guide to Getting the Sex You Want, Need and Deserve. In an analysis of data on more than 3,100 women ages 42 to 52 from the Study of Women’s Health Across the Nation (SWAN), researchers found that those who hadn’t reached menopause yet were slightly more likely to report painful intercourse than those who had. But the two groups did not differ in frequency of intercourse, desire, arousal, or physical or emotional satisfaction. And when researchers at the University of Amsterdam analyzed data on vaginal dryness, they found that even when estrogen is depleted, women can become satisfactorily lubricated, provided there’s enough stimulation first—and they’re in the mood.

Q: Intercourse hurts! What can I do about it?

A: Get to your doctor pronto and point out the problem—literally.

THE BRIGHT SIDE Being specific about where it hurts can help your physician zero in on the cause. Deep pain, such as that of your partner’s penis bumping against something inside, can be caused by a prolapsed uterus or bladder, which surgery can correct. "The loss of estrogen can weaken the pelvic-floor muscles, making prolapse more likely," says Laura Berman, PhD, an ob-gyn and psychiatry professor at Feinberg School of Medicine at Northwestern University.

Tenderness at the vaginal opening may result from irritation by soaps, body washes, vaginal sprays or douches. Avoiding them may solve the problem. Pain just inside the vagina can signal an infection or lack of lubrication. If you’re having difficulty becoming adequately lubricated, even when you and your partner spend extra time on foreplay, try an over-the-counter lubricant or vaginal moisturizer. Look for one that’s water-based and fairly thin (such as Replens Long- Lasting Vaginal Moisturizer), so it more closely mimics vaginal secretions. For more persistent lubrication problems, ask about prescription vaginal estrogen. "These products restore estrogen directly to the part of the body that’s having the problem," says clinical psychologist Leonard R. DeRogatis, PhD, director of the Johns Hopkins Center for Sexual Health and Medicine.

Q: My potbelly makes me feel self-conscious. I want to feel sexy again.

A: Amen to that. Most women gain an average of five pounds during their 40s and 50s, and it all seems to go to the area between the belly button and pubic bone.

THE BRIGHT SIDE Although you might not want to hear this, regular exercise helps—a lot. The SWAN study found that women 42 to 52 who maintained or increased their physical activity were able to minimize weight gain.

Exercise also has a direct effect on your sexuality. A University of Vermont study of perimenopausal women found that those who were easily aroused as they aged also exercised regularly. "Arousal is basically blood flow to the genitals, and exercise facilitates that by keeping vessels clear of plaque," says study author Judith Gerber, PhD, clinical assistant professor of obstetrics, gynecology and psychiatry.

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