World Menopause day is Thursday 18th October. This year the theme is sexual wellbeing after menopause.
As women age and our ovaries stop producing eggs, oestrogen levels in the body drop. This lack of oestrogen can affect the vulva, vagina, urinary tract and supporting pelvic structures. For around 50% of women this can lead to a collection of symptoms (labelled GSM – genitourinary syndrome of the menopause, sometimes still referred to as Atrophic Vaginitis). These can include: vaginal or vulval discomfort -burning, dryness, irritation, itching or a prolapse; bladder symptoms – frequency, urgency, problems emptying the bladder, leakage or repeated bladder infections and sexual difficulties including painful sex.
All of these aspects impact on sex and the desire to have sex. Post menopausal sex is more complex though than just a lack of oestrogen. I once saw sex after the menopause likened to riding a unicycle (bear with me here!) Lots of factors can make it problematic:
- You may have no unicycle (You may have no partner, or an unwilling one, one you don’t fancy, or one with medical conditions that make sex difficult for them)
- You may worry about looking silly. (This could be linked to changes in appearance, hot flushes or sweating)
- You are out of practice, or can’t make time to practice. (Many women are juggling multiple, competing responsibilities such as work, elderly relatives, children at this stage of life)
- You aren’t able to ride the unicycle (You may have other ill-health that impacts, or be exhausted, or worried about other aspects of life)
- You may worry that everyone else rides their unicycle more (There is no normal frequency of sex at any age).
What can we do to help the aspects that are influenced by lack of oestrogen?
There are topical oestrogen creams and pessaries – these are very low dose oestrogen applied locally to the tissues that need them. Regular use of vaginal moisturisers (such as Yes available on prescription) can rehydrate the skin and lubricate the vaginal wall giving a few days’ relief. Lubricants can be used during sex – and it is worth experimenting to find the best ones. There are several available, but Yes and Sylk have been found really useful by many of my patients.
Pelvic floor rehabilitation can be important. This can include self examination and treatment and treatment by a physiotherapist, to help increase blood flow to the area, keep the muscles toned, maintain vaginal length and flexibility and deal with any troublesome GSM symptoms.
Further information on sexual health after the menopause
International Menopause Society leaflet on sexual health after the menopause
The Royal College of Obstetricians and Gynaecologists have an information hub which brings together evidence based information and advice for women.
For information about physiotherapy and how we can help, or to book an appointment you can contact Carolyn Lindsay.
She has been working with peri-menopausal and menopausal women for the past 13 years as a specialist pelvic health physiotherapist. She is also currently training towards a diploma in Psychosexual Medicine (with the IPM), so that she can integrate physical and psychological support and treatment for the best outcomes for patients.