Rebirth of Venus – Sex After Menopause
This can be a touchy subject for any post-menopausal woman. Claudia Mann gets frank about sex after menopause and ways you can feel good in bed again.
By Claudia Mann
Here’s how I found out. I was preoccupied with work and family, not paying attention to my own health. Finally, I went for a checkup and mentioned I hadn’t had a period in six months. I’d just turned 51, so it was no big mystery. Back came my blood work: so much for peri-, I was post-menopausal. Wow, game over. My next reaction was relief. No weight gain or mood swings, not one hot flash. I was Ms. Scot-Free, I thought, considering between five to 10 pounds of weight gain can be expected, more than a quarter of post-menopausal women reported depression over a previous two-week period and up to 80 per cent of menopausal women experience hot flashes. Experts say symptoms as minimal as mine aren’t abnormal, but they definitely rank as lucky. If it makes anyone feel any better, I did start getting up to pee twice a night – not a urine control problem (26 per cent) in my case, more so trouble sleeping (43 per cent).
With menopause to wrap my head around, romance was nowhere near my to-do list. My lacklustre attitude probably had something to do with my ex, a gentlemanly type. “It’s better for you if I don’t thrust,” he told me the first time we did It. I never summoned the gumption to tell him I needed some bang to go with the whispering. His prior partner was exactly my age; I guess she knew what I didn’t.
Tailored Shirts and I broke up. I went 16 months without so much as a wink. Then, last summer, I fell deep in crush and lust with a wonderful, vigorous man. By Date No. 4, he was dying to get me naked and vice versa. We were ready for a whole night of … ow, ow, OUCH. Who in God’s name had filled my lady parts with sand? Why did sex suddenly feel like death by a hundred paper cuts?
The answer is that I, like as many as 50 per cent of post-menopausal women, suffer from vulvovaginal atrophy (VVA), recently renamed as genitourinary syndrome of menopause (GSM). Without estrogen to keep your vaginal tissues robust and moist, sex, by which I mean good old friction-based intercourse, can cause itching, burning and pain. “The vaginal tissues dry up,” explains Dr. Susan Goldstein, a Toronto-based menopause practitioner certified by the North American Menopause Society (NAMS). “They get less elastic, thinner and more friable, which means they bleed more easily.” My year-and-a-half of abstinence did more than keep me in the dark – a woman my age needs to use it or lose it. “The more you have intercourse, the more you stimulate local blood circulation, which helps heal the tissues,” advises Goldstein when it comes to mitigating atrophy if not preventing it. Any stimulation is good, human or sex toy. (Take it from me: shower heads set to tepid may be great for multiples but, in retrospect, I should have gone ahead and lost my vibrator virginity.)
Vaginal estrogen also comes as a cream or a ring. “I tried the ring and hated it,” says my surrogate big sister, Fay, 54. “I could always feel it, and it caused cramping. Sometimes, it slipped out during exercise. And the place I actually needed estrogen the most was my vulva. So I said the hell with it.” Fay switched to vaginal estrogen cream with fewer complaints: “Much of the elasticity and so on returns. The downside is that it makes oral sex for him a bit unpleasant though it only seems to hang around maybe a day and a half.”
“When you have a dry vagina, it can be uncomfortable to sit or straddle a bicycle,” Goldstein reveals. “I always ask women about it. Preventative health, just good surveillance and awareness, is important. My argument is you may not be using it now but you don’t know that you may want to in 10 years when you’ve got severe vaginal atrophy, your opening is the size of a dime instead of a quarter. You’re going to say, ‘I met this great guy, I’m 65 and I want to have sex.’ Why not, but now you’re going to have a problem.”
Full disclosure: anyone with GSM is more vulnerable to urinary tract infections (UTIs) – in my case, four in two months. Thankfully, vaginal estrogen medication restores the pH, or acidity, of the vagina, which helps prevent UTIs. Luckily, my guy is a communicator. Cue a bladder-protective talk about bacteria migrating out and in orifices, me needing to pee before and after and showers à deux as foreplay. Add to that the stopping halfway through when things get too much for me, and planning rolls in the hay around pill days. I’ll say this for GSM, it makes inhibition a luxury.
I spoke to Toronto registered sex therapist Adrienne Bairstow about the emotional fallout that can result from painful intercourse. “Women tend to have multiple feelings – disappointment for themselves, disappointment for their partner. They might feel guilty at denying their partner the sex life they used to enjoy. And then they might feel resentment because their partner is disappointed. Sometimes, women end up avoiding all sexual contact. Maybe intercourse was the main event, so they’re not used to finding other ways to experience pleasure.” By the time a couple sees Bairstow, frustration has often leaked out everywhere. “Sometimes, women and their partners even start to avoid non-sexual contact. If I give you a kiss or hug, you might think that means, ‘Hey, hey, tonight we’re going to the bedroom.’ The man can start having problems with erections or ejaculation because sex is no longer just about fun or love.”
But let’s not allow apprehension to rob us of our mojo. The older we all stay sexually active and speak up about the challenges, the more research and expertise there will be.
“People that come here have seen every specialist out there. Pain with intercourse becomes a huge quality-of-life issue,” says Angelique Montano-Bresolin, a pelvic health physiotherapist at Toronto’s Proactive Pelvic Health Centre. “I see people in their 60s and 70s. We can’t reverse the changes that come with the decrease in the estrogen but we can optimize the tissue length and blood flow so it’s more comfortable. I can feel the tissues that are tight, muscles that are weak, and I work with my hands as well as the client to get them on stretches they can do at home.” I’m starting to get it – why not do at least as much for your pelvis as your shoulders? For significant closure of the vagina, Montano-Bresolin prescribes therapy with a dilator like a small vibrator.