Sex and Menopause
Should the words Sex and Menopause still go together? The good news is that women before, during and after menopause remain sexual beings. However, the experience of menopause may cause women to doubt this, due to the influence of Western social and cultural values over the perception of the aging process. During menopause, women’s bodies undergo a series of biological changes which have social implications within our North American context. Furthermore, normal physiological changes occurring in the body, such as vaginal atrophy and hot flashes (link to article 1) as well as the myth that menopause is responsible for depression (link to article 3), may influence a woman’s self-perception. Therefore, it is important to disentangle how the social implications of aging and menopause may negatively impact the experience, in order to challenge that women cannot be sexual during and after this transition.
Social perceptions and the truth about sexuality in menopause.
The societal definition of menopause suggests a ‘failure’ of the ovaries, lending itself to the perception that women’s bodies during and after menopause are in a state of ‘decay’. This may account for the uncertainty many people have regarding the loss of feminine sexuality following menopause. Given this assumption, women may fear that they will become less sexual, and, in fact, research supports that few women disclose their worries about this to healthcare providers, who, along with therapists, can be the front line of treatment for female sexual dysfunction (Thornton, Chevernak, & Neal-Perry, 2017). Furthermore, research has documented a correlation between age-consistent medical conditions, such as heart disease, diabetes, and muskuloskeletal disorders, and decreased sexual function in post-menopausal women (Nazarpour, Simbar, Rameza, & Majd, 2016): similar to the developmental changes affecting women in midlife (link to article 3), physical illnesses may be more responsible for a decline in women’s sexuality, again suggesting the importance of medical monitoring.
Contrary to social implications, rest assured, women do not lose their sexuality after menopause. Women, like their male counterparts, are sexual beings throughout their lives, with both genders experiencing a decrease in estrogen levels, which has been directly linked with sexual functioning. Like puberty, menopause is a period of transition, and is best understood as a part of normal developmental evolution. Within this framework, the expression of sexuality may change, as all humans, themselves, do with age, but it is not a matter of decay or growth, it simply is another life experience.
Furthermore, post-menopausal women report that they want to remain sexual and consider sex an important part of their lives (Thornton et al., 2017). Furthermore, as an added benefit, they disclose they are able to engage in all forms of sexual pleasuring without harboring a fear of pregnancy, nor do they need to concern themselves with birth control methods or their side effects. For example, the side effects of oral contraceptives, one of the most popular forms of birth control, are weight gain; mood swings; remembering to take the pill at a certain time; and the financial burden. Thus, without the fear of pregnancy, many post-menopausal women find themselves more able to enjoy their sexuality and feel are freer to act impulsively.
For women who are experiencing sexual dysfunction associated with menopause, increases in medication, therapeutic interventions, and medical technology have beneficial outcomes on treating symptoms. For example, a 12-week, double-blind, randomized clinical trial of 919 women examining the effects of an oral medication administered to improve either symptoms of painful sex or vaginal dryness, revealed signficant improvements on these symptoms, as well as higher levels of arousal (Constantine, Graham, Portman, Rosen, & Kinsberg, 2014). The traditional lack of societal attention toward women’s sexuality is only recently being addressed in research, but results are promising.
What’s the bottom line?
Women navigating sexuality during and after menopause, must educate themselves about their bodies. This means reading books and literature, speaking with friends and family, joining support groups either face-to-face or through the web, and conferring in an informed manner with primary care health providers. Make sure that your health care does not have a bias towards one particular drug, and is not afraid to exhaust all the least invasive methods first. Above all, share women should share concerns with their partners. Women, like men, are sexual beings throughout their lives. The most important aspect is self-education and communication with one another.
Written by Dr. Erica Goldblatt & Alex Robboy, CAS, MSW, LCSW