Along with the hormonal changes that affect the urinary tract and pelvic muscles come changes in the structure and thickness of the walls of the vagina. The mucous membrane and the skin around the vagina become thinner and drier, and the glands that react to sexual stimulation and produce lubrication can become less responsive. This can lead to irritation and painful intercourse. However, sex need not be a problem. In fact, many women say that they enjoy sex more after menopause, but you may need to take a little extra care in its practice.
Take Your Time
With age may come some slowing of sexual responses. Talk with your partner about physiologic changes. Learn to understand each other's changing bodies and changing needs for more prolonged stimulation. Not only does aging affect women, but in men, aging can affect blood flow through the penis and diminish the strength and duration of erections. Many couples find that intimacy in general is more important than traditional intercourse. Take your time and vary your lovemaking. Try to enjoy each sexual experience thoroughly. There's nothing more important to do during the time for sex.
Consider a Lubricant
One change you may notice is that you find yourself feeling a bit dry during intercourse or that you are, overall, bothered by vaginal dryness, which can cause itching or burning. As estrogen levels fall, two changes in the vaginal lining may decrease lubrication. The cells themselves become thinner, making the skin thinner and more easily irritated. In addition, the glands and cells produce less moisture when stimulated.
For many women, this process is subtle and may not cause any problems. For other women, uncomfortable or painful intercourse can be a hidden reason for avoiding sexual contact, which can lead to marital problems. This cycle need not continue. Simply taking time for more foreplay may be enough. If not, a number of simple lubricants are available, all of which have their pros and cons:
Bacteriostatic gels, surgical lubricants: Some prominent brand names include KY Jelly, Koromex, Ortho II, and Astroglide. Incidentally, Astroglide was developed for the space program to help lubricate astronauts' skin inside space suits! Some gels are used as lubricants for vaginal exams and rectal exams in doctors' offices and are also widely available at drugstores.
Surgical gels are an excellent choice for several reasons. First, they have the advantage of being sterile and "bacteriostatic," which means that they discourage bacterial growth. For women who experience recurrent infections, this first line of defense can be helpful. Second, they are not harmful to condoms. Petroleum-based oils can cause diaphragms and condoms to break down in a matter of minutes, leading to the possibility of pregnancy or infection, which can be a concern for women who have not completed menopause. One drawback is that some people are chemically sensitive (that is, allergic) to some of the chemicals in surgical lubricants.
Natural oils: Baby oil, olive oil, petroleum jelly, or any other simple, nonallergenic oil may be used as a sexual lubricant. These substances have been used as lubricants for centuries and have the advantage of being easily obtainable (and for the squeamish, less embarrassing to purchase). Some women like the skin protection of the oils better than that of water-soluble substances; oils can trap moisture and keep the skin more elastic. However, these oily substances have two major drawbacks: As discussed above, they can cause diaphragms and condoms to deteriorate, and the unsterile environment that they create may trigger vaginal infections.
"Plumping" substances: Replens, Gyne-Lubrin, Gyne-Moistrin, and several similar vaginal preparations can be very effective for relieving vaginal dryness. These creams and gels cause the cells of the vaginal wall and the skin around the vaginal opening to retain more moisture. These products actually counteract the thinning out of the cells. The plumped-up cells retain their moisture longer, and therefore, they can secrete more fluid when stimulated. The moisturizers can be applied directly to the dry, irritated external area with the fingertip, or they can be used internally with a special applicator. One advantage of these products is that their effect can be a lasting one; for some women, only a few applications a week is enough.
Topical (vaginal) hormone products: Estrogen products in the form of vaginal creams, vaginal tablets, or a "ring" both thicken the skin in the vaginal area and make the cells in the glands retain more fluid, much like the previously discussed plumping preparations. These substances are available only by prescription and are not sexual lubricants; their effects last long enough, though, that they can usually alleviate any dryness problems. Androgen (testosterone) creams have also historically been used to treat certain vulvar skin diseases and to improve libido (sexual interest and sex drive) and orgasm. In addition, topical cortisone products are helpful for some women who experience a type of vaginal thinning known as lichen sclerosis, a chronic inflammatory skin condition.
Unlike other lubricants, hormone creams are absorbed by the cells and enter into the body; hence, they can occasionally cause side effects such as breast tenderness. However, the prescribed doses are usually smaller than those of oral, patch, or injectable hormones.
Be Less Conventional with Your Sex Life
Because of the physical changes that can affect your sex life, you may have to adjust your behavior to compensate. Make your sex life less conventional. Be creative! Let your imagination go! As a start, suggest sexual activities in different places in your house. Wear different lingerie. Initiate sexual activities at a different time of day than your lifelong routine. Say things you've never said before to your partner. Talk about sex.
After menopause, your sex life can take on new dimensions. You no longer have to worry about unwanted pregnancy and use of contraceptives. You probably don't have small children around to interrupt an amorous hour. Sexual activity can be more spontaneous. It can also be more exciting if you change some of your habitual behaviors.
Do you always have sex only at bedtime? Why wait until you are both tired? Make a "date" with your partner for an earlier time. Start talking about it after breakfast. Just talking about it may arouse your and your partner's interest.
Have you always had sex only in the bedroom? Sex in other places in the house may be even more exciting. Try a seduction in the living room after a candlelight dinner. If eating breakfast first thing each morning is your habit, get up a little earlier on a weekend. Serve breakfast in bed; follow that by some gentle caresses that lead to further sexual play. Who says you have to get up before noon?
Is a long flannel nightgown your style of sleepwear? Excite your partner with something that may be out of character for you. Lingerie departments feature all varieties of smooth, slinky bedroom garments that will make you feel very special and draw renewed attention from your partner.
Talk to each other about your sexual fantasies. Discuss acting them out. If acting out your own or your partner's fantasy doesn't offend you, try it. You will enjoy giving additional pleasure and receiving the additional stimulation that the heightened experience may provide. You may find it possible and enjoyable to incorporate the fantasy behavior into your repeated sexual routines.
To help you overcome your inhibitions, consider doing some things you may never have done before. This might involve renting an erotic video for both of you to watch together. Wear one of your new lingerie items while watching it!
If your usual homecoming routine is to rush into the kitchen and begin making dinner, vary your procedure. Give some attention to your appearance, making yourself as attractive as possible, and greeting your partner with an unusually long embrace and stimulating caresses.
With age, sexual needs may change. For example, if one partner has become heavier or has just recovered from an illness, changing positions during sexual activity may improve the experience. If one partner has always taken the top position, switching places may make intercourse more comfortable and enjoyable. Experiment with side-by-side positions if you have never done so.
Having sex once or twice a week may help preserve the shape, size, and muscle tone of your vagina. It may also help improve lubrication. If you have any concerns about discomforts during sexual intercourse, such as vaginal dryness, talk with your physician. Help is available. The physical changes at midlife involving hormones need not get in the way of enjoying a healthy sex life.
