The mother of two got beetroot in the face when I spoke to her in my doctor’s surgery last month. It is an effect that I have on many of my menopausal patients nowadays.
She would come in for help with hot flashes – and there I showed her pictures of NHS-approved sex toys and suggested to try them alone.
As part of my standard line of questions about menopausal symptoms, we had switched to sex.
GP Philippa Kay, pictured, routinely asks patients undergoing menopause about their sex lives, even though this can cause embarrassment, because such intimacy can significantly reduce the effects of symptoms
“It is important to get to know your body. And part of that is understanding what you like and what you don’t like … in the bedroom, “I said calmly.
She shivered. “The truth is that I have never … masturbated. I was told it was dirty, “she whispered.
“And I have never used a sex toy. I wouldn’t even know where to start. “
After a further discussion and a bit meekly, she finally got the courage to say, “Maybe I should try one?”
Gemma (59) is typical of many of my female patients with debilitating menopausal symptoms. Although it takes a while for them to admit it, the thing they hate the most is the effect the decreasing hormones have on their sex lives.
As soon as they have passed the shame, the flood gates open. “I’m never in the mood – I’m always tired and it hurts,” said another patient, Karen, 54 years old. “My husband and I had so much fun, but I think those days are over.”
I told Karen the same as what I say to all my patients in a similar dilemma: “Who says it should be?” The menopause, which normally starts between the ages of 45 and 55, is no fuss for celibacy. It can be the exact opposite.
Last week, former weather girl Ulrika Jonsson, 52, revealed that her sex life is healthier than ever, thanks to a passionate new relationship that ended her five-year sex “hiatus.”
Then there is radio presenter Zoe Ball, 49, whose secret to menopause survival is, she says, a lot of sex. And at the age of 58, Carol Vorderman enjoys a healthy libido and regularly gets into trouble with her so-called “special friends.”
According to studies, up to 30 percent of couples older than 75 still get intimate, at least every other week. And although British women have less sex after the transition, research suggests that this is mainly due to the erectile problems of their partner.
In short, you can have a satisfying, adventurous sex life, despite the barrage of physical changes. Yes, the lack of estrogen, which keeps tissue supple and moist, causes dryness, itching and pain during penetration. And hormonal fluctuations also cause the dreaded hot flashes, sweats and painful joints, while a testosterone deficiency can make you feel miserable and exhausted. But there are many things we can do to help.
First, tackle the physical problems: vaginal tightness and / or pain during sex can be remedied fairly easily and your doctor can advise you on whether medicines you use, such as blood pressure and heartburn, can influence libido.
Anxiety and depression are also common mood killers, so consider treating them. And also work on the psychological barriers. A psychosexual counselor, available on the NHS, can help couples often, ironically, regain their physical relationship by taking sex off the table.
According to studies, up to 30 percent of couples older than 75 still get intimate, at least every other week. And although British women have less sex after the transition, research suggests that this is mainly due to the erectile problems of their partner
The pressure to go all the way is relieved, so that time is only spent on touching and kissing, so you can concentrate on other pleasant sensations.
Eventually you can build up to sex – if you want. It’s just a matter of knowing a few tips and tricks to feel your best. After a few weeks of experimenting with her new ‘toy’, Gemma returned radiantly from ear to ear to my clinic. Getting to know her body had revolutionized her sex life with her husband. The tragedy is that she had to get permission from a doctor because, like so many women, she was too scared to ask how.
So here I tried to answer everything that women want to know about post-menopausal sex – without having to ask a single, uncomfortable question. Hopefully my answers will mean that there is nothing else to do but sit back and enjoy the results. After all, orgasms are great for your health.
‘Male’ hormone gel transforms the sex life
Many women ask me about replacing their estrogen, but few ask for a supplement to the “male” sex hormone, testosterone. But this can be transformative, especially for your sex life.
Produced in the adrenal glands and ovaries, testosterone is vital for sexual arousal, bone health, muscle strength and producing the good chemical dopamine. By the transition, the levels are half what they were in your 20s. A blood test can indicate how much you need to supplement. Currently, testosterone, in cream or gel form, is only given to women who are already taking HRT to ensure a proper balance between the sex hormones progesterone, testosterone and estrogen.
Rub into the abdomen daily, it can take three months to have an effect. If there is no improvement after six months, you are advised to stop – too much can cause acne, hair loss and excess facial hair.
Itching or painful down there?
I spend many hours with patients on dry, painful and burning genitals, so women don’t have to be ashamed when they talk about it. A patient, Annie, 59, said she felt a painful, burning sensation during sex that caused serious problems for her relationship.
Doctors have devised this urogenital menopause syndrome or GSM. These symptoms do not only occur once your period ends. They are a gradual response to the lack of estrogen in the tissues and may come years later.
Over time, the reduction of hormones in the vagina, vulva and pelvic floor muscles causes a loss of elasticity and the ability for these delicate areas to stretch during sex. There are also fewer secretions for lubrication and fewer bacteria to protect against urinary tract infections. But there are many simple, effective treatments …
Ditch lubricants with irritating chemicals
An effective way to bring fluid back into the vagina during sex is to use a lubricant. But the products sold in supermarkets – such as the infamous KY Jelly – are full of chemicals that can further irritate sensitive skin and do little to reduce pain. Instead, I recommend Yes or Sylk lubricants, which can be ordered online.
They are made with inert chemicals, making them less likely to cause irritation and are available in oil, silicone and water-based versions.
The use of a combination of water-based and silicone-based lubricant can be extra smooth, which may be necessary. But keep in mind that oil-based lubricants can affect the integrity of condoms – and yes, you may still need them (more on this later).
The magical power of hormonal creams …
Many patients are nervous about applying hormonal creams – which replace estrogen in vaginal tissues – because of fear of cancer. But they don’t have to worry.
The risks of hormone replacement treatments such as these, applied internally, are virtually non-existent in cream form.
So little is absorbed into the bloodstream. There is no effect on the rest of the body. Estrogen creams are inserted into the vagina – using applicators or using a pessary.
There are also flexible rings that gradually release the estrogen and are replaced every three months.
Doctors say that sex toys are good for you
Most of my patients can’t look me in the eye when I call the term “sex toy.” But if I describe them as medical treatment, they are more open to using it.
Studies show that women who use devices such as vibrators have improved sexual function, sleep better and suffer less pain or stress. Stimulating the external sexual organs (vulva and clitoris) increases blood flow to the vaginal area, thereby improving the symptoms of GSM-like dryness.
However, involuntary tightening of the vaginal muscles is another problem, making penetration often almost impossible. Medical devices called dilators can help.
They are small tubular objects that are inserted into the vagina to open it – starting with the smallest size and rising to slightly larger than your partner.
Lie down with your legs in a diamond shape and carefully place the dilator (covered with lubricant), let it stand for a minute and then repeat it.
Your doctor must be able to recommend a dilator – this is usually supplied in a box with different sizes.
Some have built-in clitoral stimulators to increase blood flow at the same time, so you can get some positive feedback from the exercise – it should feel good!
Beware … you can STILL get pregnant
I did not see a patient as stunned by a diagnosis as a woman when I brought her news last month.
She complained about sore breasts, hot flashes and joint pain. To her horror, tests showed that she was pregnant when she was 49.
“But I haven’t had a period in nine months!” She said.
As long as you still have a womb and ovaries, you can still get pregnant up to about 55 years old.
A patient was shocked when she discovered she was pregnant at the age of 49, even though she hadn’t had a menstrual period for nine months
Even a year after your last menstrual period, your hormones can fluctuate enormously and your ovaries can shoot an egg. But this does not mean that you will always need contraception.
People over 50 must use it one year after the last period. If you are younger than 50, it is two years old.
If your contraception no longer makes you have your period, or if it is irregular, continue to use it until the age of 55.
Sometimes doctors can perform blood tests to see how long you have to use it, depending on your type of birth control.
The combined pill can also act as a form of HRT, but you must stop using it for 50 years because the risks outweigh the benefits.
Other contraceptives, such as the progesterone-only pill or implants and longer-term flushing, can be used up to the age of 55.
How do you not get an unwanted infection?
Recently I had to give one of the most feared diagnoses and tell a 71-year-old widow that she had gonorrhea, a sexually transmitted disease (STD). The patient had recently started a new relationship and had not given much thought to birth control.
STDs in older adults are becoming more common.
Between 2012 and 2017, STDs in the over-65s increased by a quarter among women and among men by 15 percent.
A combination of rising divorce rates, sex-enhancing medication such as Viagra and pathetic sex education are the cause of the sharp rise.
The only form of birth control that protects against sexually transmitted diseases is a condom, so keep it handy, just like in your younger days!
- The M word: Everything you need to know about the menopause, by Dr. Philippa Kaye, is now available (Summersdale, £ 9.99).
Hormone replacement therapy? The benefits outweigh the risks
Millions of women give hormone replacement therapy the honor of re-lighting their bedroom fire
Millions of women credit hormone replacement therapy, or HRT, for re-igniting their fire in the bedroom.
The treatment, used by 200,000 British women, replaces the hormones they lose during and after the menopause – estrogen, progesterone and testosterone.
HRT is supplied in coils in the womb, tablets, creams and plasters. And when it comes to improving your sex life, they all work.
They not only inject fluid into dry, painful vaginal tissues, they relieve insomnia, mood swings, sweating and hot flashes.
But patients are often nervous about using HRT because of commonly reported links to breast and uterine cancer.
The type of HRT taken by most women – estrogen and progesterone – is linked to a small increased risk of breast cancer, smaller than the risk associated with obesity and smoking. The risks do not apply to HRT that is taken in the form of vaginal cream or vaginal tablets, or if you use a form that is less than 51 years old. HRT with estrogen alone increases the risk of uterine cancer, and therefore it is only given to women who have had a hysterectomy and why women with a uterus receive progesterone and estrogen to counteract the effects of excess estrogen on uterine tissue. And after you stop taking HRT, the risks gradually decrease.
In my opinion, the benefits for most women starting with HRT between the ages of 50 and 60 far outweigh the risks.