How to navigate peri and post menopausal sex

Perimenopause and the post-menopausal phase can wreak havoc on a woman’s delicate bits.  Genitourinary Syndrome of Menopause (GSM) can include vaginal dryness (very common) as well as recurrent UTIs, loss of arousal and, for some, vaginal atrophy (a horrendous phrase but I guess, accurate).  This is where the skin thins to a point where tiny tears occur during any stretching causing burning and itching.  Not surprisingly, this “ouch” factor can have a real impact on libido!

For many heterosexual couples, this phase of life can be tricky to navigate due to the fact that penetrative sex can be very uncomfortable. All is not lost, however!  Here’s our advice on how to navigate this time of life if you are part of a hetero twosome:

• Communicate! The long shadow of our puritanical forebears has made sex an awkward topic for many people.  While it can feel embarrassing to lay out what is working or not working for you, it is the only way to create a positive shift forward.  Choose a good time (typically not immediately before sex) to explain what is happening in your body to your partner and how that is impacting your feelings about sex.  Make sure, however, you do have some kind of idea of what you need for it to feel better.  Read more below on what some of those steps might be.

• Be open to change. Perhaps penetrative sex has always been the staple in your relationship but for a period of time, this may need to change. It may mean that you need to switch things up so that you stimulate each other with your hands or mouths.  Or consider introducing new toys which can help each of you achieve orgasm without the requirement for penetration.  Your play session can still include all the cuddling and kissing that went on in the past during penetrative sex but now it might involve a clitoral stimulation toy for her and a vibrating penis massager for him. Like anything new, however, you need to allow yourselves time to get used to how a new toy feels.

• Invest in a good lubricant. Whether you are suffering from dryness or full-blown atrophy, a lubricant which is long-lasting and thick can be a game-changer. Older women often find an oil-base lubricant is a better option than water-based to counteract dryness and last a bit longer during sex.  And, to be honest, it can be used at any time of the day – irrespective of whether sex is on the menu. Note that if you are perimenopausal and using condoms while you are still (technically) fertile, you cannot use an oil-based lubricant without risking damage to the condom. 

• Speak to your doctor. If vaginal atrophy is the issue, even a good lubricant will struggle to be the silver bullet you need.  You may need to talk to your doctor about options for body identical estrogen creams to help the vaginal tissue to regain some of its former stretch and thickness.  Estrogen cream is used locally and doesn’t have the same health risks that can be associated with estrogen used systemically.  Furthermore, vaginal estrogen can also help with the recurrent bladder infections that can also be part of the Genitourinary Syndrome of Menopause.

• Try supplements for GSM – according to The Hormone Repair Manual by Lara Briden, Zinc can help repair the vaginal epithelium at a therapeutic dose of 30mg taken after food. Another supplement which did well in clinical trials for relieving vaginal dryness and itching was Sea Buckthorn Oil, used at 3g orally per day.  (As an aside, this book is an excellent resource for any woman in her late 30s and older.  It offers a combination of practical advice alongside scientific information that explains what the heck is actually going on in the body at this time of life!)

While it may take some trial and error to work out a pathway to good sex through this phase of your life, it’s certainly not impossible to reach a point where sex becomes enjoyable again.