Some of the changes that begin with perimenopause and continue after our menses cease can be a bedroom buzzkill. And societal views on sexuality don’t help. “There is this myth that women of a certain age shouldn’t or don’t desire sex,” says Hilda Hutcherson, a professor of obstetrics and gynecology at Columbia University. “So, women do feel a little bit guilty when their libido does not go down. The guilt that some women have regarding sex after menopause can interfere with enjoyment.”
But we all deserve satisfaction for as long as we desire it, ladies. Sisters turned to top experts in medicine and sexuality. They discussed a number of simple changes women can make when coping with “the change” that can open the door to greater confidence, desire and pleasure.
The problem: Sex is painful
Estrogen levels decline, causing vaginal dryness. Sex can also be uncomfortable due to joint pain.
Explore on your own
“Find time to pleasure yourself,” Hutcherson says. Discover your favorite sex toys and lubricants. Switching to a silicone lube, for instance, can help you say goodbye to sandpaper sex, Hutcherson says, because its satisfying slipperiness “sticks around longer.” Once you’ve selected what pleases you, you can introduce the toys and lube to your partner.
Discuss with your doctor
He or she might recommend localized estrogen tablets or creams to help with lubrication. If you’re struggling to find sex positions that ease joint pain, Lindsay Wilson, clinical associate professor of geriatric medicine at UNC Chapel Hill, recommends turning to an occupational therapist.
Experiment in the bedroom
Extending foreplay can help increase your body’s natural lubrication, says Hutcherson, because as we age it takes a little longer to get aroused. Kathryn Ellis, a sexuality counselor and doctor of occupational therapy, agrees. “Having orgasm prior to penetration or spending time pleasuring erogenous zones such as nipples, inner thighs, neck, vulva and ear lobes will increase arousal, which can increase lubrication,” she says.
If pain is still a problem, take the focus off intercourse. “There’s a spectrum of activities that provide intimacy and closeness — oral sex, mutual masturbation, you can touch each other,” Wilson says.
Position yourself for pleasure
If joint pain is an issue during lovemaking, opt for comfortable, supported positions.
“Laying on your back prevents you from having to support yourself with your knees,” says Ellis. If both partners find it difficult to put weight on their knees, Ellis recommends exploring side-lying positions. The one she recommends most often places both partners perpendicular to each other (their torsos form a T-shape). The receptive partner lies on their back with bent knees (tented over the hips of the penetrative partner) and their feet flat on the mattress. The penetrative partner lies on their side, with a bent elbow on the mattress for support. All bodies are different and the position will slightly vary from person to person. “This is a very gentle position and allows for the partner to stimulate breasts and clitoris as well during penetration,” Ellis explains.
The problem: You’re rarely in the mood for sex
Along with a decrease in estrogen, women also experience a decrease in testosterone with the approach of menopause. As levels of estrogen and testosterone downshift, so can libido.
Explore on your own
In addition to experimenting during self-pleasure, Hutcherson also recommends that patients stimulate their bodies by first stimulating their brains. You can read erotic books or watch sexy movies, she suggests. You could also try journaling about past sexual experiences or experiences you wish to have. “Do whatever it is that turns you on,” Hutcherson says.
Leverage the science on satisfaction. A recent review of research found that mindfulness-based therapy worked to improve sex drive in women. Try adding 15 to 20 minutes of meditation to your daily routine. Research also suggests that exercise can help with sex drive. Hutcherson recommends adding weightlifting to your workout routine as this can increase testosterone levels.
Discuss with your doctor
Some women may opt for prescribed hormone replacement therapy. But make sure your doc has the complete picture regarding all symptoms you experience. He or she should confirm that your low sex drive isn’t a symptom of a condition such as heart disease, diabetes or depression.
Experiment in the bedroom
Sloooowww things down and focus on the journey, not the destination. Sex therapists sometimes suggest 15 to 20 minutes of foreplay.
Position yourself for pleasure
“That might be positions where the legs are together and there is more stimulation along the labia majora and labia minora,” Ellis says. These positions can also help with lubrication.
The problem: You’re worried about bladder leaks
Nearly half of women 50 and older have accidents, which can be triggered by coughing, laughing, sneezing, exercising and yes, sex.
Explore on your own
You’ll need to double down on making Kegel exercises a daily practice if you want to strengthen your pelvic floor and support bladder control. There are several apps that can help you build the habit and develop technique. “Even if you already have urinary incontinence, pelvic muscle exercises can help,” Wilson says.
Discuss with your doctor
You might be surprised to learn that, just as you would see a physical therapist to rehab a shoulder or a hip, there are professionals who can help you to recondition the pelvic floor. Seeing a physical therapist is a great way to make sure you’re working the muscles correctly. Wilson notes that incontinence can also be treated with medication.
Experiment in the bedroom
Be sure to empty your bladder right before sexy times to help prevent leakage.
Position yourself for pleasure
“Raise the pelvis so the urethra isn’t positioned against gravity,” Ellis says. Try lying on your back with a pillow or wedge under your hips to tilt the odds of staying accident-free further in your favor.
Don’t be surprised if taking care of these nooky-spoiling nuisances actually boosts your confidence levels, as well as your comfort and satisfaction. Many of the same things that can help you get in the mood and stay in the mood can also help you feel more comfortable in your own skin. Exercise, mindfulness and even more foreplay can remind us to love and appreciate our changing bodies. And that’s the real key to middle-age mojo.
Nicole Miles
