It’s not just dry vaginas that interrupt our sex lives; so do all the other menopause symptoms, including low libido, anxiety, fatigue, brain fog, low mood, insomnia, joint pain, weight gain, short-term memory disruption, a narrowed bandwidth of temperature tolerance (this includes hot flushes but also cold intolerance), recurrent urinary tract infections, and the list goes on. We’re getting better at talking about menopause, and more women are actively seeking and even demanding support, but we’re less inclined to speak about the way it impacts sex. We’re letting that conversation give us reasons why sex should be a thing of the past.
For many of us going through this phase of our life right now, there is also shame, guilt, and body dysmorphia, adding weight to the key that is locking the door on our birthright. I will be talking about hormone treatment, but with the disclaimer that hormones aren’t the be-all and not necessarily what everyone needs. It is also completely okay not to want sex, but I will continue to shout from the rooftops that you are STILL allowed to want it!
For many women, getting a urinary tract infection (UTI) each time they have sex is enough to put them off wanting to. Not to mention imagining their partners watching the jiggling of our changing bodies during lovemaking. It all seems ‘too much’ to hurdle when the kids need to be dropped off somewhere, and the boss wants that report in yesterday. And then there’s that domestically hellish pile of clean laundry waiting to be folded, growing like a fungus in the darkened spare room. “Haven’t we shut up shop down there?” a gorgeous woman I know asked me rhetorically in a car park recently. All the while, her husband listened intently to the conversation with some hope in his eyes that I might be talking his wife into reopening the said shop.
So, let’s tackle some of these coitus interrupters, starting with UTIs.
Urinary Tract Infections
There is a dreadful name for what happens to our genitourinary system in the absence of sufficient estrogen: genitourinary atrophy. Atrophy?!
atrophy
verb
- (of body tissue or an organ) waste away, especially as a result of the degeneration of cells, or become vestigial during evolution.similar: waste away, waste, become emaciated, wither, shrivel, shrivel up
- gradually decline in effectiveness or vigour due to underuse or neglect.similar: peter out, taper off, tail off, dwindle, deteriorate, decline, wane
So all of the cells dependent on estrogen for their integrity lining our vaginas and urinary systems shrivel up and waste away. They lose resilience, become more prone to injury, and provide less of a barrier to infection. The mechanics of sex, often, unfortunately causes a breach in these weakened barriers ending up with bugs from your ‘poo tube’ travelling to your ‘wee tube’ where they don’t belong, and hence cause infection. This has nothing to do with anal sex or poor hygiene; it is simply mechanical…but easily fixed!
For women who get recurrent UTIs that are putting them off having sex, one tablet of a specific antibiotic taken within hours of sexual activity can mop up any of those pesky bugs heading into the bladder. This isn’t ideal long-term but can bridge the gap while tissue integrity is restored with estrogen cream. Ovestin is the brand name for an estrogen cream that is used vaginally every night for the first couple of weeks and then a few times per week for maintenance. Once the cells have returned to their plump glory, very little, if any, estrogen is absorbed systemically for those who don’t want that or for whom it is contraindicated. There are simple measures that can be taken to help prevent UTIs following sex, like flushing and emptying the bladder soon after. However, for those with a weakened defence (atrophy),these practices will probably need to be ‘as well as’ the pills and cream.
This treatment is enough for women who still want to have sex. For those who don’t, a UTI adds insult to injury, and they will need to explore reasons beyond their atrophied vagina. A fabulous perimenopausal woman said to me in a cafe the other day, “Do you think some women are just no longer interested in their husbands sexually?” Of course! But my job isn’t to point women away from their marital bed; it is to enable women to find the sexual goddess that has been lying in waiting. And if possible, reunite them with the lover they couldn’t get enough of seemingly short years ago as they got swamped by the detritus of modern marriage. I’m not talking about an illicit affair. I mean the person they lie beside each night.
Low Libido
When I discussed some of these concepts and my intention to focus on post-fertility sexuality with some male friends a while back, they both went quiet. I looked at their faces and registered some melancholy in their expressions. I asked what they were thinking, and in a very soft, almost sad voice, one of them whispered, “Don’t forget the men.” The other then went on to share his intense longing for his wife to want him sexually again, knowing that many of the things on my list at the beginning had befallen her. He didn’t want anyone else and damned if he was going to live the cliche of chasing younger women to get his sexual needs met. The conversation reverberated in my feminist soul as I thought about who I believed I was meant to be serving, and first and foremost, it is still women. But many women hurt by our patriarchal narratives, socialised withering, and menopausal landslide are partnered with men who are also hurting. I acknowledge them.
But it’s not just heterosexual relationships that are affected by the changing landscape of menopausal sexuality; so are lesbian couples, and often doubly so. A woman I know called out to me across the crowd at a recent writer’s festival, “Do you have anything that will kick-start hot, horny sex again for these two old lesbians?” Her partner was standing next to her, but she didn’t seem bothered by this public declaration of the state of their sex life. “Yes!” I called back, giggling and euphoric with the idea that we can (and should) be this open about it all.
Another friend of mine is convinced that the lack of a testosterone-driven partner in female-female relationships is the reason for the widely known phenomenon of ‘lesbian bed death’ and wants to make a documentary about it. We know that testosterone levels during perimenopause and beyond are often low, unreadable even, so times that by two and libido takes a double hit. Testosterone is licensed in New Zealand for hypoactive sexual desire dysfunction (HSDD) in women, but it isn’t subsidised. Testosterone deficiency during and beyond menopause is arguably more common than testosterone deficiency in men and yet there are multiple funded testosterone replacements for men. I’ll leave that fact there for you to contemplate and go back to all the other potential benefits of testosterone replacement for women that prescribing for isn’t licensed (yet). Mood, energy, muscle mass and strength are a few of the things that might be improved with testosterone replacement. Its at least worth a conversation and maybe a trial!
There are many factors influencing how sexuality plays out in our lives, especially during menopause, but I believe the more we talk about it, the less of a negative impact it will have. It will require us to open our hearts and minds and be radically honest with ourselves and our lovers while also maybe putting cream up our vaginas.
Keep thriving,
Melissa