No need to pause your sex life during menopause

From workplace policies to social media algorithms, menopause has become a trending topic, but finding accurate information about how to maintain a satisfying sex life remains difficult

"‘How often should we..?’ is a question that plagues couples of all ages. Other common hang-ups include how long sex lasts, who reached a climax first, and whether everyone else is doing it ‘better’."

Hormonal shifts during perimenopause can impact your energy levels and emotional processing, as well as cause physical changes in the body, which in turn influence your experience of sexual connection and touch. Weight may start to distribute differently, and muscle mass and bone density may reduce. Some women in perimenopause also notice changes in the colour, shape, or sensation of the vulva. As oestrogen levels drop, the lining of the vagina can become a little thinner and less lubricated.

“The decline in oestrogen results in many genitourinary symptoms, such as bladder, vaginal and pelvic issues,” says Loretta Dignam, CEO of the Menopause Hub. “Oestrogen lubricates and keeps the vulva and vagina plump and moist, and so vaginal dryness can cause painful sex, urinary tract infection, and bladder issues.”

If painful sex is an issue, it’s “no wonder” women want to avoid it, she says. “Women need to look after their genitourinary health as vaginal dryness gets worse as they age.”

She advises women to talk to their GPs about local oestrogen in the form of pessaries, creams, or gels that can be used to alleviate symptoms. Vaginal moisturisers are also available over the counter. “Lubricants when having sex can help hugely, too.”

Dignam believes there’s no point in putting up with the pain and discomfort: “Women can, and should, seek help. They can take vaginal oestrogen, and many women say it is a game changer in restoring intimacy to a relationship.”

Get the right support

Our cavewoman’s brain often equates familiarity with safety, so embracing sexual changes may initially require mental graft. That pivot can be isolating without the support of a friend, partner, peer, or healthcare professional. It can be helpful to receive tailored guidance and accurate information on your body’s needs. The Nume Collective was recently launched in Cork to offer a directory of wellness professionals and services focused on menopausal health and an online community for support.

Filtered pictures of influencers leading idyllic lives on our social media feed can make it seem like sexual pleasure is reserved only for the young and fit. In reality, sexual satisfaction remains crucial to wellbeing and intimate relationships for many midlife women, of all body types. Reflecting on your ideas about female bodies and sex can help change limiting beliefs.

Each person’s experience of perimenopause is different. Finding community, expert support and flexing those self-advocacy skills can help you find what’s right for you. If you want to explore options to support your sex life and your GP is not open to discussing it, try to get a second opinion. You deserve it. The government’s delays in rolling out lower-cost hormone replacement therapy (such as oestrogen treatment) are as good a reminder as any that you need to advocate for yourself.

Pleasure principle

‘How often should we..?’ is a question that plagues couples of all ages. Other common hang-ups include how long sex lasts, who reached a climax first, and whether everyone else is doing it ‘better’.

All of this can add up to a mental checklist to torment yourself. There is no right answer to these concerns: All individuals and couples have fluctuations in their desire levels throughout their life, menopausal or not. There are people having sex every couple of days who do not enjoy it and do not feel turned on or connected by it. And there are people who have sex very infrequently and are deeply fulfilled by it.

I agree with sex researcher and author Emily Nagoski, who writes that “pleasure is the measure of sexual wellbeing — not how much you crave it, not how often you do it or with whom or where, or how many orgasms you have.

“It’s whether or not you like the sex you’re having.”

In her book Come Together: The Science (and Art!) of Creating Lasting Sexual Connections, Nagoski explores the best strategies and science for partnered pleasure.

Other myths that can raise our stress hormone cortisol revolve around ‘spark’ and spontaneity. Sexual research shows that the spontaneity of sex on screen is not true to life.

Many people experience responsive sexual desire rather than a spontaneous response. They may decide to engage in sexual activity before they feel turned on, and their desire emerges as a result. For those who do not generally experience spontaneous desire, it can be useful to try scheduling intimate time.

Curiosity and self-compassion are key to embracing any such changes in your sex life, especially if you or a partner have ever viewed your responses as ‘wrong’ (spoiler: they’re not!).

Exploring options

Most women need some other form of stimulation and won’t reach peak arousal from penetration alone. Dr Laurie Mintz contemplates this issue in detail in her book Becoming Cliterate. She believes if we really prioritised women’s pleasure we would likely re-brand foreplay as ‘sex’ and call penetration ‘post-play’.

I would also recommend taking the focus away from the genitals entirely to help the body relax: Pleasure and pressure can not co-exist.

Many women need more than 25 minutes for their bodies to reach a state of complete arousal, so taking it slow can be crucial. It’s also helpful to develop a self-pleasure practice that focuses on appreciating your body in its entirety and on pleasurable touch rather than orgasm or penetration.

Those experiencing penetration issues can experiment with dilators from brands such as Vagiwell. These tube-shaped devices come in packs ranging in size. You can use them at or in the vaginal opening, in your own time, without the pressure of having another person with you.

For many, middle age is an opportunity to develop deeper self-confidence and healthier boundaries. Postmenopause can become a period of sexual liberation if you have clear communication with sexual partners. If you are not confident about putting what you want in to words, you can physically show someone (if they want you to) with their hands or your own.

For those who are rediscovering themselves and want to share with a partner, it can be helpful to make any suggestions in a neutral, unsexualised setting. Telling a partner you want to try a new toy or full body oil massage is best done when you’re having a cup of tea, not when you’re already in the nip.

Change can be daunting, so discussing new preferences should be ongoing, honest, and respectful of what you both want.

Top tips

• Chemical-free lubricants can protect skin during sex, so go for skin-sensitive brands such as Sutil and Yes;
• Coconut oil can be great for full-body massage — the extra virgin coconut oil from the cooking aisle in the shop does the job;
• If you’re using condoms, make sure to use a water-based lubricant, as oil can break the latex;
• Suction toys can be helpful for women with increased sensitivity or pain in the vulva. The Satisfyer suction products focus on the vulva externally and emulate the sensation of oral sex.