What I wish my patients would dare ask me about sex and the menopause
The answers, says GP Philippa Kaye, might bring a blush – but they’ll do wonders for their relationships...
THE mother-of-two went beetroot-red in the face as I spoke to her in my GP clinic last month. It’s an effect I seem to have on many of my menopausal patients these days. She’d come in for help with hot flushes – and there I was showing her pictures of NHS-approved sex toys and suggesting she try them, alone.
As part of my standard line of questioning about menopausal symptoms, we’d got on to sex.
‘It’s important to get to know your body. And part of that is understanding what you like, and what you don’t like… in the bedroom,’ I said, calmly.
She winced. ‘The truth is I’ve never… masturbated. I was told it was dirty,’ she whispered.
‘And I’ve definitely never used a sex toy. I wouldn’t even know where to start.’
After a further discussion and
some gentle cajoling, she eventually plucked up the courage to say: ‘Maybe I ought to try one?’
Gemma, 59, is typical of many of my female patients who suffer debilitating menopausal symptoms. Although it takes a while for them to admit it, the thing they hate the most is the effect the dwindling hormones have on their sex life.
Once they get over the embarrassment, the flood gates open. ‘I’m never in the mood – I’m always tired and it hurts,’ said another patient, Karen, aged 54. ‘My husband and I used to have such fun, but I guess those days are over.’
I told Karen the same thing I say to all my patients in a similar dilemma: ‘Who says it has to be?’ The menopause, which normally begins between the ages of 45 and 55, is not a one-way ticket to celibacy. It can be quite the opposite.
Last week former weather girl Ulrika Jonsson, 52, revealed that her sex life is healthier than ever, thanks to a passionate new relationship that ended her five-year sex ‘hiatus’.
Then there’s radio presenter Zoe Ball, 49, whose secret to surviving the menopause is, she says, plenty of sex. And, at 58, Carol Vorderman enjoys a healthy libido and regularly gets up to ‘mischief’ with her so-called ‘special friends’.
Up to 30 per cent of couples over 75 are still getting intimate, at least every other week, according to studies. And although British women do have less sex after menopause, research suggests this is mostly due to their partner’s erectile problems.
In short, you can have a fulfilling, adventurous sex life, despite the barrage of bodily changes. Yes, the lack of oestrogen, which keeps tissue supple and moist, causes dryness, itching and pain during penetration. And hormone swings also cause the dreaded hot flushes, sweating and aching joints, while testosterone deficiency may have you feeling miserable and exhausted. But there are plenty of things we can do to help.
Firstly, address the physical problems: vaginal tightness and/or pain during sex can be fixed pretty easily and your GP can advise on whether medication you may be on – such as blood-pressure and heartburn tablets – can affect libido.
Anxiety and depression are also common mood-killers, so consider treating these. And work on the psychological barriers, too. A psychosexual counsellor, available on the NHS, can help couples regain their physical relationship often, ironically, by taking sex off the table.
The pressure to go the whole way is removed, leaving time spent only for touching and kissing, allowing you to focus on other pleasurable sensations.
Eventually you can build up to sex – if you want to. It’s just a case of knowing a few tips and tricks to keep you feeling your best. After a few weeks of experimenting with her new ‘toy’, Gemma returned to my clinic beaming from ear to ear. Getting to know her body had revolutionised her sex life with her husband. The tragedy is, she needed to be granted permission by a doctor to do so because, like so many women, she was too afraid to ask how.
So here, I’ve tried to answer everything women want to know about sex after the menopause – without you having to ask a single, uncomfortable question. Hopefully my answers will mean there’s nothing left to do but lie back and enjoy the results. Orgasms are, after all, great for your health.
‘MALE’ HORMONE GEL TRANSFORMS SEX LIFE
MANY women ask me about replacing their oestrogen, but few ask for a top-up of the ‘male’ sex hormone, testosterone. But this can prove transformative, particularly for your sex life.
Produced in the adrenal glands and ovaries, testosterone is vital for sexual arousal, bone health, muscle strength and producing the feelgood chemical dopamine. By the menopause, levels are half what they were in your 20s. A blood test can identify how much top-up you might need. Currently, testosterone, in cream or gel form, is only given to women already on HRT to ensure a correct balance between the sex hormones progesterone, testosterone and oestrogen.
Rubbed into the tummy daily, it can take three months to have an effect. If there’s no improvement after six months, you will be advised to stop – too much can cause acne, hair loss and excess facial hair.
ITCHY OR PAINFUL DOWN THERE?
I SPEND many hours speaking to patients about dry, sore and burning genitals, so women needn’t be embarrassed when talking about it. One patient, Annie, 59, said she felt an agonising, burning sensation during sex which was causing serious problems for her relationship.
Doctors have coined this genitourinary syndrome of the menopause, or GSM. These symptoms don’t just occur as soon as your periods stop. They are a gradual response to the lack of oestrogen in the tissues and can come years down the line.
Over time, the reduction in hormones in the vagina, vulva and pelvic floor muscles causes a loss of elasticity and the capacity for these delicate areas to stretch during sex. There are also fewer secretions for lubrication and fewer bacteria to protect against urinary tract infections. But there are plenty of simple, effective treatments...
DITCH LUBRICANTS WITH IRRITATING CHEMICALS
ONE effective way of introducing moisture back into the vagina during sex is to use a lubricant. But the products sold in supermarkets – like the infamous KY Jelly – are full of chemicals which can further irritate the sensitive skin and do little to reduce pain. Instead, I recommend Yes or Sylk lubricants, which can be ordered online.
They are made with inert chemicals, so are less likely to cause irritation, and come in oil-based, silicone and water-based versions.
Using a combination of water and silicone-based lubricant can be extra slippery, which may be needed. But be aware that oil-based lubricants can affect the integrity of condoms – and yes, you may still need them (more on this later).
THE MAGIC POWER OF HORMONAL CREAMS...
MANY patients are nervous about applying hormonal creams – which replace oestrogen in the vaginal tissues – due to cancer fears. But they needn’t worry.
The risks of hormone-replacement treatments like this, which are applied internally, are virtually non-existent in cream form.
So little is absorbed into the bloodstream there’s no effect on the rest of the body. Oestrogen
creams are inserted into the vagina – using applicators or by using a pessary.
There are also flexible rings which release the oestrogen gradually and are replaced every three months.
DOCTORS SAY SEX TOYS ARE GOOD FOR YOU
MOST of my patients can’t look me in the eye when I mention the term ‘sex toy’. But when I describe them as a medical treatment, they are more open to using one.
Studies show that women who use devices such as vibrators have improved sexual function, sleep better and suffer less pain or stress. Stimulating the external genitals (vulva and clitoris) increases blood flow to the vaginal area, improving symptoms of GSM-like dryness.
However, involuntary tightening of the vaginal muscles is another problem, often making penetration almost impossible. Medical devices called dilators can help.
They are small, tube-shaped objects inserted into the vagina to help open it – starting with the smallest size and working up to one a little bigger than your partner.
Lie with your legs in a diamond shape and gently insert the dilator (coated in lubricant), leaving it in for a minute, then repeating.
Your GP should be able to recommend a dilator – they typically come in a box of varying sizes.
Some have in-built clitoral stimulators to increase blood supply simultaneously, enabling you to get some positive feedback from the exercise – it should feel good!
BEWARE… YOU CAN STILL GET PREGNANT
I HAVEN’T seen a patient as flabbergasted by a diagnosis as one woman was, when I delivered some news to her last month.
She complained of sore breasts, hot flushes and joint pains. Much to her horror, tests revealed she was pregnant at 49.
‘But I haven’t had a period for nine months!’ she said.
As long as you still have a womb and ovaries, you can still conceive up to the age of about 55.
Even a year after your last period, your hormones may be fluctuating wildly and your ovaries may well pop out an egg. But this doesn’t mean you need to be on contraception for ever.
Over-50s need to use it for a year after the last period. If you’re under 50, it’s two years.
If your contraception stops you having periods, or they’re irregular, keep using it until the age of 55.
Sometimes doctors can perform blood tests to see how long you need to use it for, depending on your form of contraception.
The combined pill can also act as a form of HRT but you’ll need to stop taking it aged 50 as the risks begin to outweigh the benefit.
Other contraceptives, such as the progesterone-only pill or longerterm implants and coils, can be used up to the age of 55.
HOW NOT TO GET AN UNWANTED INFECTION
RECENTLY I had to give one of the most dreaded diagnoses, telling a 71-year-old widow that she had gonorrhoea, a sexually transmitted infection (STI). The patient had recently begun a new relationship and had not thought much about contraception.
STIs in older adults are increasingly common.
Between 2012 and 2017, STI rates in the over-65s shot up by a quarter in women and by 15 per cent in men.
A combination of rising divorce rates, sex-enhancing medication such as Viagra and pitiful sex education have been blamed for the surge.
The only form of contraception that protects against sexually transmitted infection is a condom, so, just as in your younger days, keep some handy!
The M-word: Everything You Need To Know About The Menopause, by Dr Philippa Kaye, is out now (Summersdale, £9.99).