A common myth about the menopause is that it marks the beginning of a woman’s sexual decline. Nothing could be further from the truth. The majority of women can continue to experience sexual pleasure well into old age, indeed as long as their health remains good. Some women even report that their sexual enjoyment starts to increase after the menopause. This may be due to a higher testosterone to oestrogen ratio than before.

Most menopausal women, however, notice some changes in the way their bodies respond during arousal and sex. This is often due to physical changes in the urogenital tract rather than a decreased psychological desire for sex. Research on sexual pleasure by Alfred Kinsey some decades ago has shown that women who have an enjoyable sex life before the menopause are likely to continue to enjoy sex after it. On the other hand, for women who have not enjoyed sex throughout their lives, the menopause is more likely to be associated with a decrease in all kinds of sexual activity.

One of the most common sexual problems after the menopause is lack of lubrication. In youth, blood flow out of the genitals is slow during arousal, causing swelling and sensitivity to touch. After the menopause, there is less engorgement of the clitoris, the vagina, and the vulva, leading to subdued arousal.

In a young woman, the vagina expands during sexual arousal to allow easy penetration. After the menopause, the vagina does not expand so much, but it still remains large enough to accommodate an erect penis (as long as you allow time to achieve proper lubrication). Healthy adrenal glands are also critical to sex drive. Long-term stress, such as bereavement and divorce, can adversely affect glandular activity. Sexual desire can also be diminished by drugs such as tranquillizers and antidepressants. Alcohol, smoking, coffee, overwork, tension and depression have the same effect.

Self-help tips

  1. Before sex, put some sterile, water- soluble jelly on your vaginal entrance. You may want to put a small amount inside your vagina and on your partner’s penis or fingers. Water- based jellies are better than oil-based ones because they are less likely to promote bacterial growth and infections, and they will not cause the rubber of a condom to perish.
  2. Avoid douches, talcum powder, perfumed toilet papers and any fragranced bath oils and foams, which can irritate the vagina.
  3. Avoid washing the inside of your labia with soap as it will dry the skin.
  4. Avoid remedies for genital itchiness containing antihistamine or perfume.
  5. Spend longer on foreplay to give your body more time to produce its own lubrication. Gentle massage of the breasts, belly, thighs and genitals can help and be extremely erotic.
  6. Research shows that regular sex or masturbation may help to keep the vagina lubricated. This may be because sexual activity stimulates the adrenal glands that in turn help to keep the vagina lubricated.
  7. Women who have low histamine levels may find it difficult to reach orgasm, whereas women with high histamine levels achieve orgasm easily. Women who take antihistamines regularly need to be aware of the possibility of decreased sexual desire and delayed orgasm.
  8. Pelvic floor exercises will make you more aware of your vagina and will increase your sexual enjoyment, as better-toned muscles will enable you to grip your partner’s penis more tightly.

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