Sex and Menopause: The Unexpected Physical Changes

The unexpected physical changes that come with menopause may affect your sexuality. Sometimes sex can relieve tension and sometimes it can bring it on. For many women, vaginal dryness may be the first noticeable and disturbing experience of the menopause transition.

This change alone can make sexual activities, especially vaginal penetration, uncomfortable and sometimes even painful. Some women may also experience changes in their sexual response which can greatly reduce sexual interest and desire. This may happen gradually or suddenly. How you respond to these changes will make all the difference.

Some reports suggest that about 50% of postmenopausal women will experience moderate to severe symptoms from vaginal atrophy. Vaginal atrophy is caused by a decrease in estrogen production. Less circulating estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile.

Vaginal atrophy may occur:

• During perimenopause


• After menopause


• After surgical removal of both ovaries


• As a side effect of breast cancer hormonal treatment


• After pelvic radiation therapy for cancer

Common symptoms include burning, itching, vaginal dryness, vaginal irritation, painful intercourse, light spotting or bleeding after sex, a clear or watery discharge, urgency with urination, urinary incontinence, and frequent urinary tract infections. Certain factors may contribute to vaginal atrophy-dryness. Among these are:

• Smoking: Women who smoke have an earlier menopause - smoking reduces the effects of naturally occurring estrogens in the body. Cigarette smoking also impairs blood circulation, depriving the vagina and other tissues of oxygen. Decreased blood flow to your vagina contributes to atrophic changes.


• Chemicals: Check the labels on your personal care products. Many chemicals can irritate the mucosal tissues that line the vagina.


• Dehydration: Are you drinking enough water to keep yourself properly hydrated. Start and end your day with a glass of water.


• Stress: Let it go, talk to your partner about what you are going through.


• Daily Diet: What are you eating?Eating a healthy balanced diet that includes GOOD fats and phytoestrogens, like flaxseed and soy, will make a huge difference in your overall health and well being. Women need to remember that most of our hormones, including estrogen and progesterone, are made from cholesterol. It's time to let go of the no-fat, low-fat diets. These diets are not good for your health.


• Lack of Exercise: Are you getting enough exercise? Daily exercis will alleviate stress and build a stronger body. Try to get at least 30 minutes a day. Cool down with 5 minutes of kegel exercises. This will increase the blood flow to the pelvic area, helping tone and nourish the vaginal tissues and the pubococcygeus (PC) muscle. Kegel exercises will help restore your sexual response.


• Lack of Sexual Stimulation: How often are you having sex? Sex itself can help to keep the vaginal tissues healthy. Sexual activity may help the vaginal tissues by keeping them soft and stretchable and preventing the tissues from shrinking. If you are having a severe issue with vaginal dryness use a good personal lubricant, it will help. Just remember it's not a race, take your time and be honest with your partner. I don't think you will get any complaints about extra time in the bedroom. Many women that I have talked with lately say "having sex in the morning is better", less irritating. Give it a try!

Herbs have long been used by many women and have been successful in improving libido and relieving menopausal symptoms. Here's a few:

Motherwort: Referenced in herbal texts for improving libido after menopause and noted for its calming effects.

Siberian Ginseng: Has been used in traditional Chinese medicine to improve sexual energy and stamina.

Black Cohosh: Black cohosh and Siberian Ginseng have been found to exert hormonal effects, and have been shown in some research to improve the condition of the vaginal mucosa in much the same way estrogen does.

Ginkgo Biloba: Ginkgo has been reported to improve sexual functioning, by its influence on circulation.

Damiana: One of the principal and most common uses of damiana leaf is as an aphrodisiac, and studies have confirmed its potency as a treatment for sexual dysfunction. It may be an especially effective treatment if anxiety and stress are suspected to be the root causes of impotency.

Siberian Rhubarb: Better known as ERr 731 or Rheum rhaponticum L. ERr 731 has been demonstrated significantly more effective than placebo in reducing menopausal complaints in published clinical studies. Specifically, in a 12-week study, hot flashes were reduced significantly in 4 weeks. And after the full 12 weeks, other symptoms were reduced including sleep disturbances, poor mood, irritability and anxiety, physical and emotional exhaustion, heart complaints (e.g. palpitations), joint and muscle complaints, urinary tract symptoms, and vaginal dryness and sexual problems.

Herbs and dietary changes are an excellent alternative to prescription drugs. Keep in mind that everyone's response will not be the same. Herbs are not fast acting treatments, it will take time before you begin to feel a difference.

As women we have the tendency to just cope and keep going. Many women will never address their sexual issues with their partner or their health care provider. We owe it to ourselves and our partners. Sometimes just talking about it will resolve many of the underlying issues.