Contrary to prevailing misconceptions, menopause is not the end of sex life. It is only the end of reproductive life. Women are capable of enjoying sex even after menopause. There will be some changes in the sexual functioning owing to reduced oestrogen levels. The pace of her sexual response may slow down but does not disappear altogether. If a woman has enjoyed her sex life before the onset of menopause, she will continue to enjoy it even later. If she has not enjoyed sex earlier owing to any cause, she may not like to have sex as it involves adaptation to certain biological changes in the sexual organs.
The loss of oestrogen following menopause can lead to changes in a woman’s sexual functioning. Menopausal women may notice that they are not easily aroused, and may be less sensitive to touching and stroking that can result in decreased interest in sex. Further, the emotional changes that often accompany menopause can add to a woman’s loss of interest in sex and inability to become aroused.
The decreased levels of oestrogen can cause a decrease in blood supply to the vagina. This can affect the vaginal lubrication, causing the vagina to be thin and dry. The lower one-third of the vagina can shrink. All these may cause pain during intercourse. Research has shown that this shrinking of vagina is more pronounced in women who abstain from sex. The acid-alkaline balance in the vagina also changes towards being more alkaline and less acidic. Thus, the vagina can become sore easily and is more prone to infection.
Pelvic cramps can occur during or after sex. This is especially true in cases where the woman does not have orgasm often.
The bodily changes that occur owing to ageing and menopause can make a woman develop a sense of poor body image of herself. This can cause less inclination for sex.
Menopause can mean different things for different people. Some postmenopausal women report an improved sex drive. This may be owing to less anxiety linked to a fear of pregnancy. Also, many postmenopausal women often have fewer child-rearing responsibilities, allowing them to relax and enjoy intimacy with their partners.
During and after menopause, vaginal dryness can be managed with water-soluble lubricants. Only water-soluble lubricants must be used as non-water-soluble lubricants can provide a medium for bacterial growth.
If there are no contraindications, oestrogen replacement therapy can be undertaken under medical supervision. Oestrogen creams applied to the vaginal walls may be beneficial.
Regular sex increases immunity and reduces heart attack risk. It strengthens pelvic floor muscles. This helps in strengthening the urinary bladder and prevents incontinence. Arthritic pain is reduced. The incidence of depression is also lowered. Regular sex will improve and sustain the emotional bond between the partners.
Menopause should not necessarily mean an auto shut off to sex and auto switch on to religious activities. It is not how old you are but how young you feel that counts. A healthy and positive attitude is beyond doubt uplifting in more ways than one.
Dr Reddy is consultant, sexual medicine, Apollo Hospitals, Chennai.