Midlife and Menopause

Sexuality and Menopause: Physical Changes and Emotional Reactions

Declining sex hormones signal the end of our reproductive capacities, but not the end of our capacities for sexual enjoyment.  Despite old stereotypes that women dry up and become nonsexual after menopause, the reality is often quite different.

The women in my family were strong sexual beings. When one of my aunts was 75, I gave her a vibrator.  She reacted with shock, but when she died over a decade later it was in her night stand, much used.

 

My first signs of perimenopause were extreme fatigue and vaginal dryness. My husband and I fondly described this sexual time as “the Sahara Desert.” We had many hysterically laughing moments trying to bring moisture to this dry land! … I found I needed to alter my lifestyle, and I stopped working so insanely.

 
The physical changes that come with menopause may affect our sexuality. Changes in menstrual bleeding patterns are early signals of the menopause transition. Some women’s periods just shorten and fade without any fanfare.  Other women experience longer and heavier bleeding periods that sometimes may require medical intervention. Anxieties and shame can accompany such heavy bleeding, especially when a woman worries that she will bleed through her clothes. While some women welcome the freedom from menstruation and the possibility of pregnancy and are more interested in sex, others mourn the loss of fertility and feel less feminine. Sometimes sex can relieve some of the tension; sometimes it is the last thing we want to do. Hot flashes and night sweats can also dim sexual feelings.

For many women, dryness and thinning of the vagina may be the first noticeable and disturbing experience of the menopause transition. These changes can make sexual activities, especially vaginal penetration, uncomfortable or even painful and can test the resilience of our communication with our partners. A woman in her early 60s describes her experience:
   

Vaginal dryness and the resulting pain at intercourse not only hurt, they made me mad.   I felt resentment that I was always the one responsible for birth control, with the diaphragm, spermicides, the pill, and then the IUD.  Now I was back to stuffing the creams into my vagina for lubrication to have sex I’m hardly in the mood for anymore.  I decided the only way to deal with my anger was to share it with my husband.  I showed him all the creams and made him read the warnings on the packages.  It turned out my anger was more about the grief I felt at losing my natural lubrication that I had taken for granted all my sexual life.  Sharing this with him was transforming.  It was like he had joined the planet I was living on, sharing the grief, loss, and understanding the risks.  I was able to cry and feel much closer to him. I’m using the vaginal ring, which only needs changing every three months, but I still need additional lubrication.   Now using lubrication is as automatic as using toothpaste when I want to brush my teeth!

Some of us experience changes in our sexual response: lack of or greatly reduced sexual interest and desire, problems with mental or physical arousal, less lubrication, and/or less intense orgasms. This may happen gradually or suddenly. We may be confused over whether or not to attribute this to aging, menopause, or the weathering of a long-term relationship. A 55-year-old woman says,

I’m in a twenty-year marriage and we’ve had a wonderful, satisfying sex life.  But the sensations suddenly stopped for me.  It seemed like it was overnight. My husband has been very accepting and supportive, but not me.  I have cried about this many nights.  I feel like I’ve lost a whole part of myself.

Another woman, who has large fibroids and did not take hormones, describes a difficult eight-year menopause transition that started at the age of 46:

During the worst of perimenopause I felt old and unattractive, and I was very bad-tempered and insecure, even anxious.  However, now that I am almost completely out the other side of what was basically a whole-organism ordeal, I finally feel very good about myself.   I was very dismayed that I developed pretty severe vaginal atrophy right around when my period stopped.  This was so bad without estrogen that fairly rapidly it made intercourse completely impossible.  Even after the worst of perimenopause was over I had lost almost all sensitivity in my genitals and so it was hard to become aroused.  I persevere, and am able to have orgasms using masturbation, thank goodness, but I was very surprised that my sexuality could change so very much at menopause! No one ever told me to expect all this!

Excerpted from Our Bodies, Ourselves: Menopause, © 2006, Boston Women's Health Book Collective.