Since I wrote a piece about sex after menopause, almost 100 women (and some men) have written me to share their experiences. Some of the emails have been agonizing to read, while others have been inspiring. What I now know about midlife sexuality is that no two women have the same story. Here's a smattering of what I have learned:
- Some women suffer silently in sexless, or near sexless, marriages due to lack of libido and vaginal atrophy
- Some women report their clitorises shrinking so they lose the ability to orgasm
- Some women report no change in lubrication, and a strong libido into their 60s and 70s
- Some OB-GYN's are clueless about how to help women undergoing changes in their physiology and sexual response
- The women who persist in looking for solutions to their sexual problems tend to be successful
- Women should keep their ovaries if they can
- If you don't "use it," you're more likely to "lose it"
Some of the women who have written me have health issues other than menopause impacting their sex lives. Grace, a diabetic, is one of them. I received some criticism for running Grace's story because diabetes alters hormonal balance, an added wrinkle most post-menopausal women don't have to face.
However, many women by midlife have struggled with medical challenges: cancer, fibroid-induced hysterectomies, and clinical depression, to name a few. I have chosen to share these stories because I want to show a range of experiences, not just those who have been fortunate to traverse midlife without a health hitch.
Here are three stories that portray the diversity of women's sexuality post-menopause.
I've been post-menopause for about three years. I experienced the symptoms of vaginal atrophy almost immediately after menopause. Intercourse HURT LIKE HELL no matter how aroused I was or how much lubrication was produced naturally. It generally resulted in some minor tearing and bleeding no matter how careful my husband and I used to be.
My gynecologist did provide estrogen cream which I used for three or four months but that petered out (no pun intended) because I was tired of dealing with that gross mess it left in my underwear. Besides that, the cream is not cheap! I guess I could tell some difference in resilience of the vaginal walls while using it -- but do I want to be a slave to medication the rest of my life and also see a story on the evening news some night, condemning all who have used said medication to a potential death sentence because it's been discovered it had heretofore hidden health risks?
My libido all but disappeared in a puff of smoke. We haven't had sex in almost a year.
My husband of 28 years is a very sweet, mild-mannered man who probably is bothered by this much more than he lets on, but my last attempt to talk to him about it was met with, "oh, don't worry, it will happen when it happens."
I of course feel terrible for him and guilty as hell. Any TV show that we see that includes sex, or any reference to sex elsewhere, makes me feel guilty and uncomfortable. We used to have a rollicking good sex life which has all but evaporated. I keep thinking I really should do something about this, but I don't know what.
I had a hysterectomy and oophorectomy in my late 40s because of fibroids and endometriosis. No one told me that even postmenopausal ovaries make testosterone, responsible for libido and response in women. I also lost most of my body hair, but these days women shave their pubic hair, so I guess that isn't much of a problem. I don't have to shave my legs or underarms anymore.
Estrogen helped with the lubrication problem, and I would think the estrogen vaginal cream would work well even for women who don't want to take the pills. There is a drug, Covaryx, that is both estrogen and testosterone, and it is fantastic for restoring libido and sexual response. But for me it has a side effect of acne which is intolerable.
I wish there were something I could take on demand -- I'm a 78-year-old widow now, but recently entered into a relationship with a guy who loves Viagra!
Some women can do postmenopausal sex just fine, but others do have problems.
My advice: hold onto your ovaries!
I was in a very bad marriage and didn't have sex between the ages of 40 and 54. My ex never had a sex drive, and, after awhile, the rejection plus many other issues made the thought of having sex with him really unappealing. While I did sometimes enjoy solitary fun, it never involved penetration.
Meanwhile, menopause happened. Then I bought ben wa balls (about one to two inches in diameter). I couldn't get them in! And when I remembered that vaginal exams were excruciating, I started reading about vaginal atrophy and worrying about the hymen regrowing and, in general, started freaking out.
I researched vaginismus and finally went to a gynecologist. She said I didn't have vaginismus and I could have intercourse. I told her that I hadn't been with my husband in 14 years and she told me between menopause and the lack of sex, it wasn't surprising that there was some vaginal atrophy. She also wrote and recommended a prescription for Vagifem, a local estrogen replacement therapy. Basically, it's a pill-type suppository that I use two to three times a week at bedtime.
I started using the Vagifem and after while I was able to get the ben wa balls in.
Meanwhile, I met someone. Our first time together, I bled a little but it wasn't too painful. To the contrary, I had many, many orgasms. Now, I continue using the Vagifem. No more bleeding and I'm "juicy" again! There are no adverse side effects and I was sensitive to them because I was a fitness freak and know that estrogen can interfere with strength gains. I also can get very wet and excited without lube, athough lube, of course, has its own benefits.
Also, I continue to be multi-orgasmic. What I want people to know is that sex post-menopause can be awesome and the HRT recommended (low dose, local) can have few or no side effects.
*All names have been changed.
*I am not a medical professional and this piece is not intended as medical advice. Please consult your physician before starting any treatment for menopausal symptoms.
*If you'd like to contribute your story to this ongoing series on sex after menopause, please e-mail me at firstname.lastname@example.org.
*Photograph of Erica Jagger by Nick Holmes