A GUIDE TO PRE & POST-MENOPAUSAL SEX

Kim Vopni is a certified fitness professional, an author, a passionate speaker, and a women’s health educator. Her most recent book Your Pelvic Floor launched in March 2020 and was on the bestseller list since pre-orders launched in January. Kim is the founder of Pelvienne Wellness Inc and certifies other fitness and movement professionals to work with women with core and pelvic floor challenges through her Core Confidence Specialist Certification and Pre/Postnatal Fitness Specialist Certification. You can find her on-line at www.vaginacoach.com and on social media @vaginacoach

The menopausal transition is a time of life that is welcomed by some but is often dreaded by many because there are so many symptoms that are associated with suffering. We are told a story that menopause is going to suck and then given a long list of all the possible symptoms.

Sex is something that often comes up as a topic of interest and also because many are often in despair by how their sex life has changed. The good news is that sex doesn’t have to end or be lackluster …in fact it can be better!  Many people report having a new found freedom knowing that pregnancy is now off the table. That being said, it is recommended to use protection for at least 2 years after your last menstrual period to prevent any surprises (yes they are possible) and also to protect from STI’s. Sex, with or without a partner, evolves as we do.

Menopause is simply another time of the evolution of our pleasure.

QUICK LINKS:

1. Can Sex Help with Menopause?
2. Why Has My Sex Drive Declined Since Menopause?
3. Is Postmenopausal Sex Enjoyable?
4. Why is Postmenopausal Sex Painful?

Can Sex Help With Menopause?

Many people believe that sex is going to stop or be painful or no longer be pleasurable once they reach menopause. Menopause is the day that marks 12 consecutive months without a period. The 6-10 years leading up to menopause is called perimenopause and the years after the menopause anniversary are considered postmenopause. People may start experiencing changes in perimenopause- and thankfully, there is a lot more information about options for support, which means people are getting help earlier and not waiting until they have full blown symptoms and are postmenopause.

Penetrative sex is beneficial for the vagina and can help prevent the narrowing of the walls which is called vaginal atrophy. Penetrative sex also helps stimulate blood flow and circulation. Orgasms, whether achieved solo or not, are like a pleasurable form of involuntary Kegels, and help with blood flow, circulation, and stress reduction. Given that the menopause transition is often a stressful time due to menopause itself, and also life, sex, and orgasms can be a great option for preventive maintenance so to speak.

Why Have I Lost My Libido Since Menopause?

Sex improving menopause may sound great but what if your libido is not where it used to be and the desire just simply isn’t there? This is often a result of the hormone shifts that start happening in perimenopause. The ratio between estrogen and progesterone starts to become off balance and can lead to changes to the walls of the vagina which can make sex uncomfortable. This will, of course, decrease desire. 

Testosterone is also often very low in women during the peri and postmenopause years and can be a major contributor to low desire.  Testosterone is accepted as the hormone that will make you want to have sex and estrogen is the hormone that will ensure that you actually do it because of its role in lubrication and maintaining the suppleness of the walls of the vagina.

Working with a hormone specialist or NAMS (North American Menopause Society) practitioner to monitor your hormones and offer support is a great option.

Can I Still Enjoy Sex After Menopause?

Yes!  If you are approaching menopause, you have an amazing opportunity to be proactive and support your muscles and tissues prior to their being any major symptoms or decline in libido. If you are already postmenopause, don’t worry, it is never too late to make a change. Supporting the tissues in the vagina with vaginal moisturizers that contain hyaluronic acid is hugely beneficial. These can be used daily (typically at night before going to sleep) and can help repair already dry irritated tissue while also helping the tissue retain more moisture.

Local vaginal estrogen is also a very effective treatment and can help restore blood flow and tissue integrity, while eliminating discomfort. Pelvic muscle exercise is also important for our entire lives but many people only recognize the important around menopause because of the associated bladder symptoms, like incontinence. Kegels are one form of pelvic floor exercise and are effective but remember to focus on the entire cycle of the Kegel – the contract, the lift and the release. Most people just focus on squeezing and are often using their inner thighs or glutes instead of the pelvic floor muscles. 

People often use their inner thighs or glutes instead of their pelvic floor muscles. 

It is important to build and maintain strength with a proper contraction but it is equally, if not more important, to release that contraction as well. Kegels can help improve blood flow and circulation and can strengthen the pelvic floor muscles which means improved sensation and stronger orgasms. You can also incorporate Kegels into your intimate activities to enhance sensation for you and your partner if you have one.

Why Is Sex Painful After Menopause?

The most common contributors to painful sex after menopause are the loss of estrogen and overactive pelvic floor muscles. When we reach menopause we no longer produce estrogen. We have a ton of estrogen receptors in our pelvis and vagina so when there is no longer estrogen circulating, these receptors have nothing to grab and as a result the tissues become thinner and drier and the walls of the vagina can narrow. This is called vaginal atrophy and evidence shows that over 50% of women between the ages of 52-55 suffer with symptoms. Vaginal atrophy is now one of the symptoms under the new umbrella term of genitourinary syndrome of menopause (GSM) and research shows that the dryness associated with GSM affects up to 67% of people in the year following their menopause. Local vaginal estrogen is a safe and effective treatment and can started around the time of menopause and used for the rest of ones life.

The loss of estrogen can bring on incontinence symptoms such as leaking, frequency and urgency. These symptoms may have already been happening and are often exacerbated with the loss of estrogen or they show up for the first time when our ovaries stop producing it. When people are experiencing incontinence and are afraid of leaking, especially during sex with a partner, they will often start to grip and squeeze their pelvic floor muscles thinking it will help.  This is often a common strategy in people with organ prolapse as well. They often have sensations of feeling like something is going to fall out of their vagina so will develop that same gripping strategy.

Gripping or overactivity in the pelvic floor will reduce blood flow and circulation.  It will also make insertion of fingers, toys or penis’ difficult. If insertion is possible, it may not feel as good because the muscles are not relaxing which can be painful and also interfere with the capacity for orgasm. Using release and relaxation exercises specifically for the pelvic floor is a great practice to adopt and it can also reduce the incontinence and prolapse symptoms.

Working with a pelvic floor physical therapist is beneficial for all vagina owners, especially during the menopause transition. Having a hormone specialist on your health care team is also recommended so you can discuss the benefits of hormone therapy for your vagina but also your bones, your heart, your brain and your skin. Menopause is having a moment and people are no longer accepting it as a time of life they need to suffer through but rather a new chapter where they can thrive!

Further Readings:

Strategies for Staying Sexual After Menopause: National Women's Health Network
A Senior's Guide to Sex without Intercourse: Senior Planet
Keeping the Heat After the Hot Flash- Sex After Menopause: Everly Well

WITH PLEASURE,

LOVERS