The nitty gritty of mid­dle age sex

Turn­ing the tri­als and tribu­la­tions of mid­dle-age sex in to the joy of sex is not dif­fi­cult

The Irish Times - Tuesday - Health - - Health - Alana Kirk

If you are drink­ing your morn­ing cof­fee while read­ing this, then per­haps this ar­ti­cle should come with a warn­ing. There are go­ing to be phrases that we tend not to dis­cuss much in pub­lic such as vag­i­nal dry­ness, loss of li­bido and erec­tile dys­func­tion. How­ever, they are a nat­u­ral part of life, and if we want to con­tinue to be ac­tive sex­ual peo­ple well into mid­dle age and be­yond, then we have to ac­knowl­edge and then ad­dress them, be­cause turn­ing the tri­als and tribu­la­tions of mid­dle-age sex into the joy of sex is not dif­fi­cult.

Sex is im­por­tant to all of us, re­gard­less of age. Not only is it ex­cel­lent for get­ting the blood pump­ing and putting a youth­ful spring in your step, it has a num­ber of other ben­e­fits too, such as re­duc­ing stress, strength­en­ing your im­mune sys­tem, boost­ing self-es­teem, and re­liev­ing de­pres­sion.

The fa­mous man­ual, The Joy of Sex, still has some salient ad­vice for mid­dle-aged and older peo­ple even though it was writ­ten nearly 50 years ago.

It’s au­thor Alex Com­fort wrote: “The things that stop you en­joy­ing sex in an old age are the same things that stop you from rid­ing a bi­cy­cle – bad health, think­ing it’s silly and no bi­cy­cle”.

Well, we can pump up a flat tyre, add some lu­bri­cat­ing oil, and still be hav­ing sex­ual en­joy­ment with no part­ner. As re­cent re­search has shown, and de­spite an ageist so­ci­etal view on the topic, our sex­u­al­ity doesn’t die with mid­dle and grow­ing age. Our sex­ual needs and lev­els evolve and change over the years, and the par­tic­u­lar is­sues that might arise from menopause, for ex­am­ple, do not mean we should give up on it. We just need to learn to adapt.

Emily Power Smith may be Ire­land’s only clin­i­cal sex­ol­o­gist, and talks to large numbers of mid­dle-aged women in her clin­ics and at talks around the coun­try. “I’ve spo­ken and writ­ten more on this topic than any other re­lated to sex, and the main driver for women com­ing to me with an is­sue is poor ed­u­ca­tion. Gen­er­ally women are very mis­in­formed about what they should be ex­pect­ing and are very quick to blame them­selves.”

If we look at sex­ual ac­tiv­ity as a life-long is­sue, there can be plenty of in­ter­rup­tions to the nor­mal flow, in­clud­ing ill­ness, child­birth and child rear­ing, loss of con­fi­dence, menopause, and hor­monal fluc­tu­a­tions. Low li­bido, erec­tile dys­func­tion, and vag­i­nal dry­ness are all just nor­mal chal­lenges that can af­fect our sex­ual lives, but im­por­tantly, ones that can be eas­ily ad­dressed.

“We do spe­cific menopause con­sul­ta­tions and coun­selling for women who start ex­pe­ri­enc­ing changes and want to know that they are a nor­mal part of the age­ing process,” says Dr Shirley McQuade, med­i­cal di­rec­tor of the Dublin Well Woman Cen­tre.

“Many women come in with a spe­cific symp­tom think­ing it’s all over, but in fact nearly all is­sues can be ad­dressed. You just need to re­alise that your, and your part­ner’s body changes.”

So what are the main is­sues and what can be done about them?

Peri-menopausal symp­toms Menopause can ef­fect ev­ery as­pect of your be­ing, and symp­toms in­clud­ing hot flushes, not sleep­ing, and poor con­cen­tra­tion lev­els, can af­fect how you feel about your­self.

“Hor­monal changes can mean your li­bido and sex drive go, as well and the emo­tional havoc they can play,” ex­plains Dr McQuaid. Mood swings, empty nest syn­drome, try­ing teenagers, or work/life balance can weigh in to make us feel less than en­er­getic about sex.

“It is re­ally im­por­tant to take the time for your­self when you are peri-menopausal, to take stock and ad­just to the changes that are hap­pen­ing. I see lots of women who have reached se­nior ca­reer level or have lots of peo­ple de­pend on them and it can be dif­fi­cult be­cause they feel over­whelmed and aren’t giv­ing enough time to them­selves to deal with how they feel.”

The ad­vice is to take pres­sure off your­self, and try and cull some of the re­spon­si­bil­i­ties. Ex­er­cise, eat and sleep well and ac­knowl­edge that you can seek help if you need it.

“I’ve seen women go to car­di­ol­o­gists be­cause they think they have heart prob­lems when they wake up sweat­ing in the night, or go to rheuma­tol­o­gists with joint pain, when in fact they are just the symp­toms of hor­monal change.”

Hor­mone Re­place­ment Ther­apy HRT is a com­mon treat­ment for women who are suf­fer­ing from con­tin­ued and dif­fi­cult symp­toms, and it only takes two or three weeks to find out if it will work for you. Ac­cord­ing to the Na­tional In­sti­tute for Health and Care Ex­cel­lence (NicE) in their 2015 rec­om­men­da­tions, the ben­e­fits of HRT, avail­able in tablet form, gels, and patches far out­weigh any risks.

Ac­cord­ing to Dr McQuaid, it is a pos­i­tive op­tion to take. “About 15 years ago there were scares about risks re­lat­ing to heat dis­ease and can­cer, but the stud­ies were se­ri­ously flawed. For women who take it through their 50s, the ben­e­fits are sig­nif­i­cant.”

HRT is avail­able for as long as your symp­toms last, with the av­er­age du­ra­tion be­ing eight years. De­spite scare­mon­ger­ing to the con­trary, there are no with­drawal symp­toms or prob­lems when you stop tak­ing the drug, as long as you leave it long enough for your nat­u­ral menopause to con­clude. HRT masks the symp­toms, so if you stop be­fore they have fully re­ceded, they will re­turn.

Not all women ex­pe­ri­ence menopausal symp­toms, and for women who do, they do even­tu­ally pass.

Vag­i­nal dry­ness It is com­pletely nor­mal for most women in menopause to ex­pe­ri­ence dry­ness. The drop in your body’s oe­stro­gen lev­els means the vag­i­nal mem­branes be­come thin­ner and drier which can makes for un­com­fort­able dry­ness. As a re­sult, thrush and Uri­nary Tract In­fec­tions (UTI) are also more com­mon. Lu­bri­ca­tion is widely avail­able and will trans­form your sex­ual ex­pe­ri­ence if dry­ness is a prob­lem.

Dr McQuaid also rec­om­mends treat­ing the un­der­ly­ing is­sue rather than just the symp­tom. A pre­scrip­tion prod­uct, li­censed in Ire­land as Vag­ifem, pro­vides low lev­els of oe­stro­gen to the lo­cal area, and if taken over the longer term can al­le­vi­ate all symp­toms of dry­ness. Reg­u­lar sex­ual ac­tiv­ity or stim­u­la­tion from mas­tur­ba­tion also pro­motes vag­i­nal health and blood flow.

Erec­tile Dys­func­tion For men who may iden­tify their very male­ness with work and sex­ual abil­ity, a low­er­ing of li­bido or erec­tile dys­func­tion can be

cat­a­strophic. How­ever, ac­cept­ing that this will hap­pen oc­ca­sion­ally, and see­ing it a nor­mal part of the age­ing process and hor­monal changes may en­cour­age them to seek help. The ad­vice is to go to your GP to get checked out to make sure erec­tile dys­func­tion is not re­lated to vas­cu­lar changes and bold pres­sure / di­a­betes, and then again there is a sim­ple med­i­ca­tion so­lu­tion.

Painful in­ter­course

Again this can be a com­mon change in sex­ual ex­pe­ri­ence, usu­ally due to vag­i­nal dry­ness. How­ever, other rea­sons could be a pro­lapse of the uterus or front wall of vagina which can cause dis­com­fort, so the first port of call for any pain is to get ex­am­ined by your GP or at the Well Women clin­ics. All is­sues can be ad­dressed with med­i­ca­tion or pro­ce­dures.

Heavy pe­ri­ods

A com­mon com­plaint for women en­ter­ing peri-menopause is very heavy pe­ri­ods, which are caused by the womb be­ing un­com­fort­able and bulky. Some women from the age of 40 de­velop fi­broids which make the womb heav­ier and along with hor­monal fluc­tu­a­tions, com­bine to make struc­tural and hor­monal changes that af­fect the flow of pe­ri­ods. Some women have low iron lev­els, be­cause heavy pe­ri­ods are the main rea­son for low iron which makes you tired, so it’s im­por­tant to keep a med­i­cal check on your body while go­ing through the menopause.

Tra­di­tion­ally this was of­ten treated by a hys­terec­tomy, whereas to­day women can ac­cess the pill or coil. All coun­tries where the coil has been in­tro­duced have seen a sig­nif­i­cant re­duc­tion in hys­terec­tomy oper­a­tions.

Change of mind

Ad­dress­ing spe­cific symp­toms is only one way of evolv­ing our sex­ual lives. Chang­ing the way we have sex is an­other. “I meet women who have only ever used one po­si­tion, and now that that proves painful they are at a loss,” ex­plains Dr McQuaid. “It’s use­ful to ex­per­i­ment and change. It’s more in­ter­est­ing too!”

What we need to re­mem­ber is that sex is not just about in­ter­course. There is a va­ri­ety of sen­sual, lov­ing, ex­cit­ing ac­tiv­i­ties that can bring joy and sat­is­fac­tion.

For women ex­pe­ri­enc­ing menopause es­pe­cially, they might need and want more touch­ing and fore­play than be­fore, but af­ter years of mar­riage, it can be more dif­fi­cult to change.

Ask­ing for what you need is im­por­tant. Tantric sex – slightly ridiculed in the press af­ter Sting and Trudi Styler ad­mit­ted to it – is en­cour­aged by many coun­sel­lors as it fo­cuses on the sen­sual in­ti­macy rather than an or­gas­mic goal.

What­ever the is­sue with sex may be, Dr McQuaid ad­vises you start with a med­i­cal to check to make sure ev­ery­thing is okay. Once that is done, it’s just about deal­ing with spe­cific is­sues.

“I’ve had a 78-year-old woman come to me re­cently hav­ing a lit­tle bit of trou­ble be­cause her part­ner has been given Viagra. So she went on Vag­ifem and has no more prob­lems,” says McQuaid.

“I have lots of women come to us for help and they’re happy and healthy and they cer­tainly don’t stop hav­ing a sex life. Nor should they.”

Psy­cho­log­i­cally how­ever, it is also im­por­tant to rise above the so­cial con­di­tion­ing that we lose our sex­i­ness as we get older. “There is just no sci­en­tific ev­i­dence to back this up,” ex­plains Power Smith.

“Ir­ish women are very quick to blame them­selves and feel guilty for not be­ing bet­ter, not feel­ing enough or good enough. In part we are brought up to feel this way with mag­a­zines and me­dia, and then when mid­dle age hits, phys­i­cal things hap­pen to com­pound that.”

She has three golden rules for women in their mid­dle age with re­gards to keep­ing their sex lives healthy and func­tion­ing: mas­tur­ba­tion, lu­bri­ca­tion and com­mu­ni­ca­tion.

So while the num­ber of po­ten­tial causes of sex­ual changes and chal­lenges dur­ing menopause and mid­dle age­ing can seem over­whelm­ing, there are just as many strate­gies and treat­ments for over­com­ing them.

You can go back to drink­ing your cof­fee now.

Psy­cho­log­i­cally how­ever, it is also im­por­tant to rise above the so­cial con­di­tion­ing that we loose our sex­i­ness as we get older. ‘There is just no sci­en­tific ev­i­dence to back this up,’ ex­plains Emily Power Smith, Ire­land’s only clin­i­cal sex­ol­o­gist

Sex is im­por­tant to all of us, re­gard­less of age. There are all just nor­mal chal­lenges that can af­fect our sex­ual lives, but im­por­tantly, ones that can be eas­ily ad­dressed.

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