We all know that menopause comes with a laundry list of symptoms that can affect just about every part of your life, but one area that can be particularly hard to talk about is sex.
As your hormones fluctuate and eventually decline, the experience can start to look and feel different for women. There may be less interest in sex, discomfort that wasn’t there before, or a sense that your body isn’t responding the way it used to.
And if you’re not sure what’s behind those changes, it can be hard to know where to start.
Dr. Sarah Shaw, co-founder and Chief Medical Officer with Lume Women + Health, wants women to know there are options, starting with understanding what’s happening physically.
Hormonal changes during menopause can affect the tissues of the vulva and vagina, leading to dryness, irritation and pain during sex. These symptoms fall under genitourinary syndrome of menopause, which Dr. Shaw says affects approximately 85 per cent of women – so in other words, you’re not alone. The condition can also cause urinary symptoms, including an increased risk of urinary tract infections.
There are practical ways to address these changes, and one of the easiest places to start is lubricant.
“The idea that lubricant means you’re not aroused enough, that there’s something wrong with your body, that you’re not into it, is just completely false,” she says.
Lubricants can make sex more comfortable, while vaginal moisturizers can help with dryness and changes in vaginal tissue. Dr. Shaw says vaginal estrogen is a particularly useful option, with several formulations available.
She also encourages women to involve their partners and let them help figure out what works.
“Your partner is in on this with you. Women bear a large brunt of the health changes in midlife, so share some of this with your partner,” she says. “Have your partner get a bunch of lubricants; find something that can be his or her job.”
Getting comfortable with yourself
Of course, physical discomfort is only part of the story. Hot flashes, poor sleep and exhaustion can all affect how a woman feels about sex or her desire to engage in it.
Changes in sensation can play a role, too. And when intimacy starts to feel uncomfortable or comes with worries about pain or other symptoms, it’s understandable that desire might take a hit.
“Does my partner know what I like? Can I communicate what I like to my partner? Are they interested in knowing what I might like and what brings me pleasure, or what hurts me, or what makes me uncomfortable?” she asks, adding that libido is really addressing all of these key parts.
It’s also a good reminder that sex doesn’t have to stay the same throughout our lives.
Dr. Shaw recommends taking time to figure out what feels good now, exploring options such as vibrators and talking with a partner about what has changed. Couples therapy may also help when those conversations get difficult.
“If you don’t know what brings you pleasure, it’s going to be really hard to communicate that to your partner,” she adds, encouraging women to get to know themselves in this new era.
Breaking the awkward barrier
Then there’s the question of bringing it up with a doctor.
Talking about painful sex, changes in desire or bleeding after intercourse can feel awkward, especially if you’re unsure whether what you’re experiencing is normal. Dr. Shaw recommends finding a provider who is comfortable discussing menopause and being specific about what’s happening and how it’s affecting your life.
Rather than trying to cover every concern in one appointment, she also suggests choosing one main issue and explaining it clearly, giving your healthcare provider a much clearer picture of what needs attention.
“It’s quite different to say, ‘I don’t really want to have sex anymore,’ than going in and saying, ‘You know what? It’s been painful to have sex for about two years now. I feel I bleed after we have sex. It’s made me really scared to have sex. I’m worried there’s something wrong, and it’s impacting my marriage,’” she said.
Her biggest takeaway for women, though? If sex has become painful, your desire has changed, or something simply doesn’t feel right, you don’t have to brush it off as another part of getting older. There are ways to address what’s happening, and you deserve to feel comfortable asking about them, whether it’s with your partner or with your doctor.
To hear more of this conversation with Dr. Shaw, check out our past podcast episodes all about menopause!
Lisa Thibodeau
