Archive for September, 2018

I’ve said it before and I’ll say it again: Sex after menopause can be challenging. That’s behind many of the conversations I have in my medical practice, and a major motivation for the conversations on this website. You may have thought your sex life would actually improve as you aged. After all, the kids are moved out (or more independent), you’re likely in a better financial position, and no more periods means no worries about pregnancy.

And you may be encountering the reality that now you’re in the throes of perimenopause or menopause, your sex life isn’t quite what you imagined. You’re not alone.

I spend a lot of time discussing obstacles to sex during menopause faced by women like you. As you read through the list below, see if you identify with some or all of them. You may find that you have a lot of company on the road you thought you were traveling alone.

  • Loss of interest in sex. It’s important to know there’s nothing unusual if you have little (or no) interest in sex. Your body is going through significant changes during menopause, and one of those changes is a loss of estrogen. As a result, sexual function often decreases drastically, affecting libido and making arousal difficult.
  • Stress and fatigue. I lump these together because they often go hand in hand. All the physical and emotional changes of menopause can make you feel especially tired, and night sweats can make it impossible to get a good night’s sleep. What happens next? Your stress level rises because you’re tired. It’s a vicious cycle—one that can leave you less interested in sex.
  • Body image issues. Weight gain during menopause is common. If this is something you’re experiencing, you may not be feeling as sexy as you once did. Your partner may be telling you that you’re beautiful, but that’s not what you see when you look in the mirror. Feeling less sexy can also make you feel depressed or anxious and unable to enjoy sex.
  • Boredom in the bedroom. It’s hard enough to get aroused with all the menopause changes stacked against you. Throw in the same old routine in the bedroom, and your chances of having a night of passion are probably not great.

If you can relate to any or all of these, be assured there are others who have shared your experience, and have sought out ways to surmount each obstacle. Don’t be afraid to talk to your partner and be honest about how you’re feeling. Use this website or print pages from it to prompt discussion. If you feel like your symptoms are more than you can address on your own, make an appointment with your health care provider to investigate solutions.

The best time to work on the challenges of sex during menopause is now. You have years of great sex ahead of you; don’t waste time trying to figure it out alone.

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Before it became okay to call menopause by its name, women called it “the change”—with good reason. The waist thickens, the hair thins, and sleep goes haywire. You may be wondering if there is anything that doesn’t change after menopause. There might be (your favorite food?)—but add your vagina to the long list of things that do.

Declining estrogen changes the vaginal lining, making it thinner and less elastic. The official term used to be vulvovaginal atrophy (VVA), and you may see articles using that term (or hear it from your health care provider). Now, more accurately, it’s called the vulvovaginal syndrome of menopause (GSM). Symptoms include

  • Vaginal dryness, irritation, or burning
  • Burning and/or urgency with urination
  • Urinary tract infections
  • Urinary incontinence
  • Discomfort and/or light bleeding after intercourse

Yes You Can: Dr. Barb's Recipe for Lifelong Intimacy

A new study by European Vulvovaginal Epidemiological Survey (EVES) points to just how prevalent this condition is. In the study of over 2,000 women between the ages of 45 and 75, a gynecological exam was done on each woman who reported one or more symptoms. In 90 percent of those women, GSM was confirmed.

Women often overlook GSM, either because they aren’t aware that the condition even exists, or because they think of each of their symptoms as individual problems, rather than collective evidence of something else.

But as the EVES study also showed, women with GSM also experienced a lower quality of life than those who didn’t have GSM. That’s unfortunate, because, although GSM is chronic, it’s also treatable with, for example, localized (vaginal) estrogen or non-estrogens that restore health to genital tissues.

Your doctor can help, but only if you let your doctor know about your symptoms. So take a deep breath and explain what’s been going on. Once you begin treatment and see that there are ways you can manage the change, rather than just letting it happen to you, you’ll feel a whole lot better.

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You say that you have that sensation even though you’ve had Mona Lisa treatments [a procedure for restoring vaginal tissue] and use Uberlube, and that sensation continues for a couple of days after intercourse.

It’s possible you could have one of three conditions: atrophic vaginitis, vulvodynia, or a urinary tract infection (UTI) caused by intercourse.

The Mona Lisa Touch therapy doesn’t completely take care of atrophy for some women, and you might be one of them. If so, there are safe and effective prescription therapies available, and it may be helpful to add one of those.

Vulvodynia happens when the entrance of the vagina becomes inflamed, causing burning pain during and after intercourse.

Finally, in some women intercourse itself actually causes a UTI, a bladder infection that causes the symptoms you describe.

Those are the most likely possibilities, but please talk to your provider about what’s going on. She or he can determine the cause and recommend the best course of treatment for you–and there is treatment for each option.

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We talk a lot about how to stay connected to your partner and build intimacy (and last week’s post was about taking advantage of your new empty nest). But what if, in spite of your best efforts and intentions, the relationship is still unsatisfying? Here are a few places you can look for help.

Books. How do you find the good ones? Ask people you trust for recommendations. Books that my patients have found helpful include: The All or Nothing Marriage: How the Best Marriages Work (Eli Finkel), The Five Love Languages (Gary Chapman), Ten Lessons to Transform your Marriage, and The Seven Principles for Making Marriage Work (John Gottman).

Podcasts. Esther Perel has a great podcast called “Where Should we Begin.” Each episode features a couple in an actual counseling session with Perel, who helps them articulate their feelings and get to the bottom of what’s really going on.

Weiss quoteSeminars and retreats. Using Google, you can find everything from reasonably priced retreats hosted by religious organizations to pricey seminars hosted in scenic locations by marriage experts (often authors of books on marriage). Be sure to do your research and discuss what you’ve learned and what you expect with your partner before signing up. Some are classroom style with small group breakout sessions, while others may include public roleplaying, couples counseling, or game playing designed to foster connection.

Counseling. A good marriage counselor can help identify the underlying issues in your relationship and then facilitate the conversation as you work through them together. Look for counselors who specialize in marriage and family counseling and find out what kind of approach they use. Cognitive behavioral therapy, which focuses on changing negative thoughts and behaviors, is quite different from a Freudian approach, which focuses on unconscious meanings and motivations. Imago relationship therapy (IRT) is another approach; it explores how emotional wounds in childhood affect adult relationships so partners can better understand each other.

Marquez quoteHow will you know if a counselor is good? Our friend Ann McKnight, a clinical social worker who is experienced with couples and families, has some thoughts. After the first session, you’ll likely have an idea of whether or not the person understands the issues and can offer a direction that makes sense to your and your partner.  Don’t be afraid to ask about the counselor’s training and experience working with couples, as well as what kinds of outcomes they see. And, she says, “Do your own homework, as well, in considering ahead of time what outcomes you are hoping for from the process. Willingness to take ownership for your own role in the challenges of your marriage is important.”

All marriages go through rough patches. Often, they can recover with some extra help. Ann says that, of the couples she sees “an extremely high percentage of marriages can recover, particularly if people start to work on the marriage before they’ve reached the point of total burnout and hopelessness.”* It’s important to point out that she sees a self-selecting group in that they have sought out therapy—but you would fall into that category, too.

Whatever you do, don’t wait. Just like with your physical health, the sooner you address whatever the issue is, the greater the chance that it can be fixed.


*This holds true as long as there’s no domestic violence and/or untreated substance abuse.

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