Has your sex life taken a dive? If you’re over 40, perimenopause could be playing into that. We spoke to sexologist Chantelle Otten about the perimenopause symptoms that affect your sex life, changes in libido and how to keep your relationship strong throughout these challenges.
Why might our libido take a dive during perimenopause – is it primarily due to hormonal reasons?
"In menopause, we have a drop in oestrogen and progesterone, and they play a crucial role in maintaining sexual health.
“Oestrogen is the hormone that is really in charge of vaginal lubrication, blood flow to the genitals, maintaining the health of vaginal tissue as well. And with that decrease, there might be some vaginal dryness and discomfort during intercourse and decreased blood flow, which can lead to a decreased orgasmic potential. But also, if we're having all of these concerns, it's not like vaginal dryness is something that makes us want to have sex, right? It's something that makes us go, ‘oh, I feel very uncomfortable, it might be painful.’
“We also have that dive in testosterone as well. And it is very important for libido, but it does decrease during menopause. Also [there are] so many other changes. There are physical changes, there's weight gain, there's hair loss, there's facial hair, there's self-image issues, self confidence, there's emotional and psychological factors, anxiety, depression, self-esteem, sleep disturbances, those hot flashes, and it might also coincide with other health issues at the same time. So that in itself can be a very big buzzkill from a sex-drive perspective.”
If someone is faced with multiple issues in menopause, what would be a great starting point, if they were trying to get their sex lives back on track?
Find a good doctor: “I think that it's important to first and foremost, make sure that you're seeing a health professional, who really is there to work with you from an individualised perspective and has a very good understanding of your personal life.
“There is some really great guidance out there on how to manage symptoms and treatments that can help. Menopause has all of these grievances, many of which can be also mediated with hormone replacement therapy [also known as menopausal hormone therapy] – talk to your health care professional about that.”
Communicate your experience and feelings. “Discuss them openly with your friends that have also gone through the same thing or might go through the same thing.”
Talk to your partner about sex: “Explain your feelings, your preferences and your discomforts, to try and find an understanding in each other's needs and find a way to maintain intimacy.”
Adjust your lifestyle, if needed: “There have to be some lifestyle adjustments as well. So, a healthy lifestyle that includes regular exercise, a balanced diet and adequate sleep. I would lean towards a Mediterranean diet. Then [focus on] things that make you happy, bring pleasure into your life."
Tackle vaginal dryness: “Using moisturisers and lubricants or silicone lubricant, or even some olive oil, is fine to just pop down there every morning to get some lubrication, so you're not uncomfortable.”
Explore sexuality: “Broaden your definition of what sex actually is. Moving away from this penetrative sex ideal is helpful, especially because penetrative sex is not available to everyone.”
See a pelvic floor physiotherapist: This “might be a great idea so that there's a tailored approach to your pelvic floor, especially if there's any bladder leakage or incontinence during this time.”
Look into at alternative treatments: “like acupuncture, because these things are not ‘woo woo’, they're there to help you along with your journey.”
From a practical perspective, what do we need to consider when it comes to contraceptives during perimenopause?
“I don't think that there's enough education out there around this. And I think that we probably forget about it, especially with the changes that do happen with perimenopause. But contraception during perimenopause is a really important consideration because pregnancy can still occur until that individual has reached menopause, which is defined as 12 consecutive months without a menstrual period. So, speak with your healthcare provider, especially if you want to avoid pregnancy.
“There are there are a lot of options out there. There are condoms, hormonal contraceptives, pills, patches, vaginal rings, IUDs. And some of these hormonal contraceptives can also regulate menstrual cycles and reduce perimenopausal symptoms like hot flashes, alongside providing contraception. Again, speak to your doctor about the best option for you.”
How do we go about having these conversations with partners, especially new partners, about sex and symptoms?
“I think you have to really think about, am I first and foremost comfortable discussing these topics? Do I have enough education on them? Then think about your partner and the best time and place to talk to them.
“Then, if it's a new partner, actually, I think that can be a little bit easier sometimes, because you can be a bit more open, they want to please you. They're really excited about a relationship too.
“So just say ‘I'm going through a few things at the moment. And, I have to be honest that I feel very vulnerable talking about this. But this is how menopause and perimenopause is affecting me physically, emotionally, sexually. And I'd love to work through this with you, because I want to have fun, but also honour my own feelings and what is happening in my body.’
“Educating your partner about menopause is really important. Explain the changes that you're experiencing, talk about hot flashes, mood swings, vaginal dryness, and how they might be affecting your relationship. Encourage them to discuss this openly and positively as well. I think that we still have to remember that a lot of people haven't had positive education around this.
“You also have to address contraception and STIs. If you don't have the answers, you can talk to a healthcare professional or someone like myself about it.
“I would suggest mainly just reinforcing continued dialogue and also emotional connection.”
What can we do if we think, ‘I have no libido, no desire. It's all too hard.' Does it matter? Can we be happy and fulfilled without sex?
“It really depends on your personal needs and values. Think about how important sexual intimacy is to you and your partner. Intimacy is one thing, sex is another thing. Sex might be a really crucial part of a relationship for some people. But you might place high value on emotional or intellectual compatibility, or fun or excitement or adventure. Think about why you're in that relationship and what your values are, and whether there are options for you as a couple as well.
“There are many things out there that can help us. It can be sex toys. We can look at them as like companions in the bedroom, they're not there to replace anyone. They're just there to bring on the good vibes and to help the experience.
“Think about other forms of intimacy. It can be nurtured through affection, touch, through deep conversation, shared interests, quality time together. And I think exploring those avenues can really strengthen the relationship, especially when there is a lack of sexual interest or when you're going through major life changes.
“See a sexologist if you're a bit unsure, and if you feel like it's causing a little bit of friction. We can provide insights and strategies for managing those changes in sexual desire.
“Adjust your expectations. Maybe sex isn't important to you anymore, but maybe it's still going to be important to your partner. How are you going to navigate that together? And really think about personal exploration of what sexuality actually means to you and the relationship as well.”
Let’s talk about some of the positive aspects to our sexuality that menopause can bring.
“I think it brings the ability to think outside the box. I think that a lot of the time, we have a very prescriptive way of viewing sex before menopause. But I think that we can look at menopause and the freedom that it brings from pregnancy concerns, which can bring a sense of freedom and spontaneity to sexual desire and activity. There is an increase in the self-knowledge that you can learn.
“A lot of people learn more about their bodies, their desires, and what brings them pleasure, that allows them more fulfilling experiences after menopause. I think that when you are reaching menopause, you're also more emotionally mature and confident as well. Confidence in yourself and what you can do, rather than what you can't do, can really enhance intimacy and connection. And it can make you more able to communicate needs and preferences.
“You can look at the fact that hopefully your kids might be grown up and out of the house by that stage as well. So, you know, you might have more privacy, more opportunities for intimacy, you can focus on quality over quantity, having more meaningful and satisfying experiences rather than more and more and more.
“Think about different types of touch, massage, non-penetrative play, or other forms of emotional or physical intimacy as well. Think ‘maybe I can learn something new. Maybe I can learn about tantric massage or maybe we can get a vibrator. Let's go full out and try different things on each other.’ Have a bit of a laugh. We might as well embrace it and enjoy it as well.
“While there are hormonal challenges, they can lead to a really new understanding of your sexual self. And for some, that changing libido can open up a lot of avenues for self-knowledge, exploration and just lots more pleasure as well. I think that menopause can be a really good time of personal growth and re-evaluation of your life.”
We spoke to Chantelle Otten about sex and menopause for the Thriving in Menopause podcast. Listen to the full episode below.
Newsletter
