Sex advice with Suzi Godson: Be aware of changes in your sex hormones

Suzi Godson answers your questions and offers some sex advice. 

I’m 44, have three children, and have always had a good and regular sex life. But about 18 months ago, I stopped being able to have an orgasm. Nothing has changed psychologically or physically — my gynaecologist says there is nothing wrong and that I’m definitely not having an early menopause. I’m at a loss.

You say that nothing has changed psychologically or physically, but I find this hard to believe. You don’t go from having regular orgasms to having no orgasms without something changing. The most likely explanation is a change in your hormone levels, and you are not too young to be perimenopausal. The average age for the onset of menopause is 51, but the transition can take up to eight years and in that period, unstable levels of the three main sex hormones — oestrogen, progesterone and testosterone — can play havoc with everything from your menstrual cycle to your waistline and your libido.

The sex hormones serve different functions, but collectively they are the key to sexual health, desire and satisfaction. Oestrogen is fundamental to normal sexual response and insufficient levels can make the walls of the vagina less elastic, while diminished blood flow to the genital area can mean that it takes longer to become fully aroused, and that makes it more difficult for a woman to achieve orgasm. Testosterone also plays an important role in female sexual desire and sensitivity. The clitoris, in particular, is composed of soft tissue that fills with blood during sexual arousal. Any fall in oestrogen and testosterone can lead to a decrease in the size, function and sensitivity of the clitoris, a condition known as clitoral atrophy.

You don’t say how sexually active you are now, but the “use it or lose it” principle definitely applies. Even if it doesn’t lead to orgasm, continuing to have (well-lubricated) sex will encourage blood flow to your genitals and help to keep the tissue healthy.

Kegel exercises are also a good idea because they strengthen and protect the pelvic floor.

If you don’t have a vibrator, a good one to start with is the Womanizer clitoral stimulator (€199.95 from which, while quite expensive, is subtle yet effective.

You should also consider that there is a wealth of research to support the fact that overall physical health is an important indicator of good sexual function in midlife. Drinking too much, working too hard, or having an underlying illness can all cause problems with arousal and orgasm. Studies also show that weight gain, in particular, can trigger hormonal changes that negatively affect sexual response. Increasing your calcium and vitamin D intake is also advisable, to protect your bones and your heart and make sure that overall you are in good health.

Finally, although we think about the transition to menopause as a time when hormone levels drop, the changes are not linear, and before menopause, levels of oestrogen actually increase and become erratic, before they eventually settle into the low, stable levels of menopause.

Blood tests to establish whether a woman is approaching menopause will check the level of oestrogen and FSH, the hormone that helps to control the menstrual cycle and the production of eggs by the ovaries. However, because oestrogen production doesn’t fall at a steady rate and FSH levels can jump around, a single test provides only a snapshot of what is happening on that day, at that time. Given the variability of female hormone levels, blood results are often misleading, so don’t be fobbed off; it is your gynaecologist’s duty to help you to find out for sure why you have lost the capacity to achieve orgasm.

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