Sex file: Where have my orgasms gone?

Sex advice with Suzi Godson.

Should I give up on having orgasms?Having gone through the menopause, I now find orgasm extremely elusive. I do enjoy sex, but is it time to accept that I’ve had all the orgasms I will have?

When it comes to sex, if you don’t use it, you lose it, so don’t even think about giving up. Menopause affects women in different ways, but the most common symptoms — night sweats, sleeplessness, irritated skin, incontinence, low mood and a reduced interest in sex — are caused by declining levels of sex hormones, most notably oestrogen. Hormone-replacement therapy (HRT) has had a lot of bad press (a report in The Lancet suggested that one in 50 on combined HRT for five years would develop breast cancer), but many insist that it is worth the risk. A year or two of HRT can dramatically improve life-limiting symptoms, and help to preserve bone strength and density.

It is also worth talking to your GP about the benefits of topical oestrogen creams. Depending on your family history, you could also try Estring, a small doughnut-shaped device inserted vaginally that delivers a small but steady stream of oestrogen. Also you may want to consider Viagra. Yes, it is for men, however some women have also found that it can boost arousal. You can buy Viagra Connect, which contains 50mg of sildenafil, the active ingredient, over the counter.

Sex toys will definitely help you to have an orgasm — try the Satisfyer, the Womanizer or the Lelo Sona, which use new technologies.

After the age of 50, lubricant is essential, and there are lots of excellent all-natural luxury brands to try.

Finally, you need to strengthen your pelvic floor with specific exercises, which are easy to do. The sensation feels a bit like lifting a platform inside your pelvis and squeezing your muscles around it. You hold the lift-and-squeeze for as long as you can, then rest for four seconds while breathing normally. Repeat the process 10 times, three or four times a day, gradually increasing the time that you hold each contraction.

There are devices that can help with this. At one end of the price spectrum is the Elvie Pelvic Floor Trainer (€201), which is inserted into the vagina while connected to an app that measures the strength of the contractions and states whether the exercises are being performed correctly. At the other is the Squeezy app (€3.49), a simple programme that guides you through the exercises and, more importantly, reminds you to do them every day.

Pelvic-floor exercises are certainly worth doing because they prevent urinary incontinence, which affects one in five post-menopausal women.

However, they are also great for sex. Last year Soheila Nazarpour, a post-menopause specialist at the Tehran University of Medical Sciences in Iran, and her colleagues published the results of a randomised control trial that explored the effects of pelvic-floor exercises on sexual function in post-menopausal women.

After 12 weeks a group who had received instructions on pelvic floor exercises and were consulted weekly reported significant improvements in levels of sexual arousal, frequency and intensity of orgasm, as well as sexual satisfaction.

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