It can be very painful psychologically to explore the fears and traumas that may be contributing to sexual problems around the Menopause but communication is key. Talking to a healthcare professional can make chatting about sex feel more normal and can help to initiate conversations about sex as a couple.
It can be difficult to discuss sex with a partner. How do you bring that into a conversation? We tend to second guess what a partner is thinking but the outcome of being honest about feelings around sex is often that a partner is thinking a similar thing and is open to exploring ways to improve sexual intimacy and experience.
Knowledge of sexual anatomy can be really helpful and will encourage self-exploration- knowing what works for you and being able to show your partner will improve the experience! It may be that you have to re-wire the sexual script in your relationship and explore and experiment – change in vaginal sensation or structure may mean that what led to arousal and orgasm before, now doesn’t.
Pelvic floor exercises may improve symptoms of a prolapse and heighten sexual awareness and pleasure. Many women do not feel confident in doing pelvic floor exercises- seeing a pelvic floor physio to assess your pelvic floor and give a structured programme of exercises to improve it can be helpful.
Vaginal pessaries can improve symptoms caused by a prolapse and are completely safe to keep in during sex.
Look at medications that can effect libido unfortunately many medications that we commonly give for other medical conditions can affect sex drive and arousal.
Vaginal oestrogen see section on genitourinary syndrome of the menopause which will explore treatments to improve changes that may have occurred due to low oestrogen.
Lube lube lube!!! It is common to feel aroused but still not have adequate lubrication for comfortable sex. Using a good lubricant can vastly improve sexual experience and reduce discomfort during sex. Many off the shelf lubricants contain products that irritate the vagina so beware and choose carefully!
Some lubricants will have a high concentration of chemicals/ preservatives and/or a high ph. Both can cause irritation and predispose to recurrent infections such as bacterial vaginosis and thrush.
Choose a lubricant which has a low osmolality and a ph similar to the natural ph of the vagina (3.5-4.5) by checking the ingredients and if you’re not sure then a google search will be able to give you more information about what the product contains and which of those may be irritant.
Avoid lubricants which contain parabens, glycerine and gycols, all of which can lead to a sore vagina. Be cautious with coloured or flavoured, warming or cooling lubricants also. Flavoured lubricants can be fun for oral sex but washing this off before penetrative sex is advisable. Itching and burning sensations from a lubricant are frankly a bit of a passion killer!
Sylk, YES and SUTIL Luxe are all good sexual lubricants, some of which are available on prescription. Combining oil and water based lubricants can improve glide during penetration and make sex more comfortable.
Sex toys silicone dilators inserted into the vagina can improve vaginismus and can help to gently stretch the vagina over time. Introducing vibration- either with the above for penetration into the vagina- or for external stimulation to the clitoris and vulva can improve blood flow and lubrication as well as increasing elasticity and thus reducing pain. Try making this part of a sexual experience with your partner or during self-exploration as part of masturbation?
Sexual connection and intimacy a common misconception is that sex has to mean penis in vagina which can be anxiety provoking if penetration is the cause of pain. Sexual connection and intimacy is so important and can be achieved by other sexual experiences. Trying a period of time where there is an agreement not to have penetrative sex can help remove the fear of pain that may come with the assumption that all sexual contact will end in penetration. This in turn may encourage a couple to relax, explore each other’s bodies and rekindle that sexual intimacy that may have been lost.
HRT and testosterone The right HRT can help to improve libido and testosterone can be added in for hypoactive sexual desire disorder (HSDD) if libido is still not improved by taking oestrogen. Please see the section on HRT and testosterone for more information.
Psychosexual counselling some women may benefit from a course of psychosexual counselling, particularly if past trauma is a large contributing factor to sexual difficulties.
The take home message is never be afraid to ask- it might just change your sex life! It’s never too late to sexually reconnect with your partner, whatever your age and everyone is entitled to good sex. Focus on pleasure rather than performance and remember sex is meant to be fun!