Sex and Menopause

Does menopause mean that your sex life has to change? The short answer: no. The long answer: No, but it probably has or will, and we’re here to arm you with information to help prevent it from happening, or tools you can use to change it back.

Change is hard. Like really hard. Today we’re talking about the change, menopause. A lot is happening during perimenopause and menopause. This period of time can be super uncomfortable and disruptive, but, with the right information and strategies to facilitate a smooth transition into postmenopause, it can be freeing. It’s something that should be celebrated, it’s a milestone and it’s a wonderful milestone at that! No more PMS, tampons, no need for contraception, it’s great. There’s no perfect way to get ready for change, but when we’re talking about the change we can prepare by being informed and armed with some strategies + ways we can advocate for ourselves to our healthcare providers.

While this post is about menopause, it’s also about sex. Something I hear from a lot of women I treat who are over the age of 55 is, “I’m not interested in sex.” A *very* common story is “My husband and I used to have sex, but I don’t really enjoy it so I’m glad we don’t do it anymore.” Maybe you can relate. Listen, you have every right to not be interested in sex. If that makes you happy, then that’s great! However, empirically that is unlikely. Sex has some amazing health benefits including improved immunity (hello post-pandemic world!), lowered blood pressure, decreased stress, improved sleep quality, sense of closeness with our partners, and increased pelvic floor strength. Even more, this study found that menopausal women who were sexually active were more resilient and had a higher reported quality of life compared to women who weren’t.

Just because your body is changing doesn’t mean you don’t deserve great sex + all of the other positive health effects that come with it!

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I get it. Menopause is a milestone that is often lamented, mostly because it is known to significantly (and negatively) impact quality of life with disruptive and frustrating symptoms like insomnia, mood swings, brain fog, low libido, and potentially pelvic organ prolapse, pain with sex, vaginal dryness, urinary or even fecal incontinence. Sometimes biology can be rude.

           But I’m not writing this to tell you all the bad news. Often, menopausal symptoms can be treated (very effectively!!) through hormone therapy, getting adequate exercise, sunlight, eating nutritious foods, and pelvic floor physical therapy.

           Before we get into how to help with these symptoms, let’s talk about why they happen. The body goes through a lot of change during this time:

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Decreased estrogen levels lead to:

• vaginal dryness
• more tissue fragility + loss of elasticity
• weak pelvic floor muscles
• can cause: pain, bleeding, and inflammation, especially with penetration

Decreased testosterone levels lead to:

• low libido and less sexual satisfaction
• brain fog
• fatigue
• muscle weakness

Fluctuating progesterone, estrogen, and testosterone lead to:

• mood swings
• hot flashes
• anxiety + depression

Reduced serotonin:

• serotonin is the neurotransmitter that supports happiness and our sense of wellbeing. When it’s reduced it leads to poor mood stabilization and increased risk of depression

Weak pelvic floor muscles and vaginal tissue can lead to:

• pelvic organ prolapse
• bowel or bladder incontinence

Tight pelvic floor muscles (due to vaginal and vulvar composition changes) lead to:

• difficulty to relaxing the muscles and therefore the vulva/vagina can be painful to touch, pressure, and penetration

Weak and fragile vulvar and vaginal tissue leads to:

• frequent or chronic bacterial vaginosis and yeast infections (no thanks)
• pain
• bleeding
• inflammation

It helps to know what these symptoms are a sign of, but it doesn't mean you have to live with it. If you are dealing with any of the above, try these 9 things to bring back your sex life and recapture your pelvic health

1. Hormone therapy

• If you haven’t already, ask your doctor if local estrogen suppositories are right for you if you are experiencing vaginal dryness or pelvic pain.
• Most who are perimenopausal or menopausal need to use vaginal estrogen to support the tissue, and usually bi-weekly for life.
• If you are concerned about using a hormonal treatment, you can try a hyaluronic acid based suppository like this one, which is shown to also be effective in treating dryness and tissue fragility.

2. LOL (Lots of Lube)

• When you have sex, be sure to use water-based lubricant (and plenty of it!). Apply inside, on the vulva, and on your partner. Reapply as needed if you feel pulling or discomfort.

3. Moisturize

• Use a vulvar moisturizers specifically for the vulvar tissues daily, we’re fans of vmagic.

4. See a Pelvic Health Physical Therapist

• We specialize in helping women with all of the things we've talked about here. If you are experiencing any of the symptoms listed above, you will benefit from having a physical therapist assessed the pelvic floor muscles, body mechanics, and other impairments of the musculoskeletal system that are contributing to your symptoms.

5. Move for fun!

• Find a movement activity you enjoy, whether it is pickle ball, going for long walks, yoga, or weightlifting, it doesn’t matter. What matters is getting outside, movement, and doing things you enjoy to help with mood regulation, sleep quality, and stress levels.

6. Take a deep breath

• Find relaxation methods to reduce depression, anxiety, mood swings, and to improve sleep and down training (relaxation) of the pelvic floor. This can be meditation, deep breathing exercises, yoga, or stretching.

7. Strength training for 30 minutes, 3 times a week

• This is important for every person’s longevity, but strength training is also important for mood regulation, posture, cardiovascular health, pain tolerance, bone density, joint health, and for improving pelvic floor and core strength, which makes for better overall function, confidence, and most of all, sex.

8. Use a vibrator.

• This is a game changer. If you didn’t particularly look forward to sex before, you will now. You just need to find the right one for you. We recommend one that is medical-grade silicone with easy handling.

9. Communicate with your partner.

• Get comfortable communicating with your partner about your feelings related to sex. This is what we find most of our patients have the hardest time doing. If you don’t feel comfortable talking to them about how sex is for you, you may need the help of a sex or relationship therapist to facilitate that communication.Your partner can’t understand all the difficult obstacles you’re experiencing if you don’t tell them. Usually, partners want their partner to have good sex, and usually want to help make that happen! The hardest part is starting the conversation, but once you do, you open up the door for positive change.

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Menopause isn't a life-sentence of pelvic pain, discomfort, or bad sex. Your body just needs some extra support right now to adjust to this new phase! If you need some extra help or guidance, we're here for you <3

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