Painful Sex & Menopause: Improve your Sex Life During Menopause
Defining Menopause
Strictly speaking, menopause is the cessation of menstruation, and is usually confirmed when this has occurred for at least an entire year. And when you have gone more than one year without a period, this also means that you are not ovulating. Menstruation is a result of the shedding of the uterine lining when an egg released during ovulation isn’t fertilized or doesn’t implant. Your hormones will then decrease towards the end of the cycle causing the built up uterine lining to sloth off and the cycle starts over again. Most women experience menopause in their mid-to-late 40s to early 50s, though there are definitely outliers. In fact, women who go through menopause earlier than those ages would have what we call premature ovarian failure, and unfortunately this can occur sometimes as a result of aggressive treatments like chemotherapy.
We go through menopause because we only have a finite reserve of eggs, and there comes a point when those reserves are totally depleted. This means we don’t ovulate (release an egg monthly), and therefore don’t menstruate. When we think about menopause, we might think of it as a bad thing, but in fact many women are relieved to no longer have a period especially those suffering from endometriosis. Rather, the worry may be coming from possible symptoms or side effects that may coincide with menopause.
Painful Sex During Menopause
So what does menopause have to do with your sex life?
Unfortunately, it’s true that women who have gone through menopause experience more instances of painful sex than their pre-menopausal counterparts. And one of the main culprits lies in the loss of hormones. For example, estrogen dramatically drops during menopause, and when that happens, it can cause vaginal dryness, poor distension, a decrease in glycogen, a narrowing of the vaginal canal, and a change in vaginal flora. And all of these factors can affect your experience during sex.
In addition to an estrogen decrease, testosterone also decreases during menopause. Though we typically think of testosterone as a man’s hormone, it is very important even for women as it affects vaginal dryness. Dryness can negatively alter an otherwise well-lubricated vagina, which is important for maintaining healthy epithelium (aka a healthy vaginal lining). Additionally, testosterone helps to stimulate nerves and is the main contributor to libido (sex drive/desire) and sexual arousal.
Finally, the hormone DHEA (dehydroepiandrosterone) also declines during menopause. DHEA comes in 2 forms; one produced in the adrenal glands (aka DHEA-S) and the other in the ovaries (aka just DHEA). In the body, DHEA acts more like a parent hormone under the right conditions. It gets converted over to testosterone, which then gets converted over to estrogen. But DHEA since it is an androgen (male hormone) itself does have an impact on sexual function—primarily with desire, arousal, orgasm, and preventing vaginal dryness.
Wait! You might be thinking I neglected to mention progesterone. And while progesterone does drop dramatically during menopause, its decrease actually doesn’t have much of a positive impact on sexual function. Progesterone which is low at the first half of the menstrual cycle (follicular phase) is increased in the second half (luteal phase) as a result of ovulation. The increase in progesterone during the luteal phase can actually lower a woman’s libido. So the decline in progesterone is not as much of a contributing factor as are the decreases in estrogen, testosterone, and DHEA.
Painful Sex Symptoms
As mentioned previously, painful sex during menopause is associated with some specific symtoms generally caused by hormonal changes. Some of those symptoms include:
Vaginal dryness
Vaginal tightness (caused by a narrowing of the vaginal canal)
Loss of vaginal elasticity
Thinning of vaginal tissues
UTIs or yeast infections due to a change in vaginal flora
Urinary problems
Sharp or burning sensations during penetration
Anxiety or depression
Preventing Painful Sex
Luckily, there are measures you can take before menopause sets in, in order to avoid some of these symptoms. But first, we need to understand how sexual arousal works. Women have what has been described as a circular sexual response, rather than linear (which is generally more typical in men). Visually speaking, this is what the linear sexual response looks like:
Linear Sexual Response
Sexual Thought > Arousal/Increased Desire > Engage in Sexual Desire > Relax
The circular response, however, is not quite as simple. For example, some of the key drivers that are important when it comes to sexual desire in women are:
Emotional closeness
Bonding
Physical pleasure
Validation of attractiveness
Comforting partner
Responding to a partner's sexual desire
And unlike in the linear model, you may not spontaneously have a sexual thought come to your mind. This doesn’t mean something is wrong with you, but rather it means that things need to be cultivated via these drivers of sexual desire in women.
Another key factor when it comes to women and sexuality is the idea of novelty. Some women who are of menopausal age may have been with their partner for several years, so the novelty might have also decreased, and this can have an impact on sexual function. So what’s the solution? No, I am not advocating having an affair, but rather looking for new and exciting ways to spice things up in the bedroom, especially if sex has become a routine rather than fun.
It’s also known that after menopause, arousal can take longer than it used to. This just means that you maybe need to put a little bit more work, time, and patience into the arousal process. This can come via solutions like touch, for example. Essentially, hone in on what gets your proverbial juices flowing, so to speak.
A few other recommendations to make the most of your sexual experience is to make sure to schedule or make time for sex. Otherwise, you may not do it at all. Additionally, vibrators or other toys can be really helpful in maximizing your sexual experience, especially after menopause.
Other helpful tips to prevent painful sex:
Get Adequate Sleep: Without sufficient sleep, you can experience more oxidative stress and more stress in general.
Practice Mindfulness
Reduce Stress: This is really important for enjoying sex and feeling sexual desire.
Exercise: This is important for pelvic floor stimulating oxytocin, which is a bonding hormone. Exercise also promotes pelvic circulation.
Take a Probiotic: Specifically probiotics containing lactobacillus rhamnosus lactobacillus reuteri are essential in the postmenopausal stage. Because many postmenopausal women are no longer afraid of getting pregnant, a man’s ejaculate (aka one of the major disrupts of vaginal flora!) may be allowed to enter during intercouse. Because a man’s semen is more alkaline, it can definitely disrupt vaginal flora which thrives in an acidic environment. And these particular probiotics can help build up your defenses against conditions like UTIs or bacterial vaginosis.
Take Vitamin E: Either orally or suppository form (my preferred method).
Take L-Arginine: This can be very effective in increasing libido.
Natural Treatments for Painful Sex Caused by Menopause
Aphrodisiac herbs can provide fantastic natural support to help in the bedroom. But what does that mean? Aphrodisiacs have a three-fold function. They can cause vasodilation (the dilation of blood vessels) through nitric oxide, which basically can cause an erection in males but also increased blood flow to the clitoris in females. They also enhance sexual pleasure. And lastly, they can enhance libido or sexual drive.
I have a set of aphrodisiacs that I generally like to recommend. They include:
Maca (known as Peruvian ginseng), specifically in the gelatinized form, is very effective as a natural adaptogenic aphrodisiac, and has even been named the natural female viagra.
Ginseng, American or Korean form, has stimulating effects by increasing nitric oxide and nerve stimulation.
Damiana increases blood flow to the pelvic region, among other things.
Tribulus can make testosterone more active and has been shown to improve lubrication, arousal and orgasm.
If you are interested in taking a natural herbal approach to your sexual experience, I would love to help. All of my recommended supplements for menopause can be accessed through my online dispensary FullScript by clicking here.
To purchase physician-grade supplements, click here to create an account or login to access my online supplements shop and purchase them directly.
How a Naturopathic Doctor Can Help
Menopause brings many changes, and the sexual ones can come as an unwelcome surprise. As a naturopath, I can guide you through those changes, so that the transition is as smooth as possible. Changes such as diet and lifestyle can also make a difference both in and out of the bedroom.
Book an Appointment
If you are dealing with painful sex during menopause and would like some help, I would love to help you. At Simplicity Health Associates in New York City, I help many patients understand their bodies during menopause, and what to do if something seems abnormal.
Click here to book an appointment online or call (646) 470-8458. You can also email us here.
FAQs
Does menopause affect libido?
Unfortunately, some of the known symptoms of menopause like hot flashes, night sweats, and vaginal dryness can make even the desire to engage in sexual activities dissipate. And this decrease in libido can be even more intense during those first few months and years of menopause. But rest assured that this is common and normal, and can be treated naturally with preventative measures as well as aphrodisiac herbs, as mentioned.
Can lubricants help with painful sex during and after menopause?
Because vaginal dryness is a common symptom of menopause due to a drastic decrease in hormones, many women turn to lubricants to help. But, if you aren’t careful, lubricants can be your vagina’s worst enemy—and this includes saliva as a lubricant. Many lubricants can disrupt vaginal flora, which can lead to infection, odors, itching, and irritation.
If you must use a lubricant, a couple of my favorites are Lola and Good Clean Love. Both water-based and all-natural without fragrance or additives, these lubricants tend to more closely mimic the natural vaginal moisture produced by the body.
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