For many older women, talking about sex can be downright awkward. But if you want to enjoy a happy, healthy sex life (which has been shown to reduce stress and improve heart health), candid discussions with your partner and doctor are often essential.
鈥淲omen over 50 make up a large part of our population, and we need to make space for menopause to be talked about more openly,鈥 says , a gynecologist at Rush. 鈥淚t鈥檚 a normal part of aging, and there鈥檚 support that can help women transition through this stage of life more comfortably.鈥
Here, Jenkins Cooper offers advice to help older women have a fulfilling sex life after menopause.
What is menopause?
As you near menopause, your ovaries produce less estrogen and other hormones. Doctors call this transitional time perimenopause, and it often starts four to five years before your final period.
鈥淭he transitional phase can be really challenging for women,鈥 Jenkins Cooper says. 鈥淥ne minute you feel pretty normal and then the next minute you don鈥檛. It can make you question 鈥榃hat鈥檚 going on here?鈥欌
A woman reaches menopause when she has gone through 12 consecutive months without any periods. After that, she鈥檚 considered postmenopausal. The average age of menopause is 51, but Jenkins Cooper says it can depend on the person.
鈥淵ou may start having symptoms when you鈥檙e 44 and someone else may be 50 years old,鈥 she says. 鈥淪o going to speak to an OB-GYN or your primary care provider as early as you can is important.鈥
The causes of sexual problems in older women
The loss of estrogen and decreased collagen from menopause can make your vaginal walls thinner, drier, less elastic and sometimes inflamed, so you may experience vaginal burning and itching. That said, sex may be uncomfortable or even painful.
When vaginal tissue is thinner and more fragile, sex can cause tiny tears in the vagina, which make women more susceptible to sexually transmitted infections.
鈥淚f you experience any postmenopausal bleeding, that should be checked right away,鈥 Jenkins Cooper says. 鈥淓ven if it seems related to sex or a possible tear, we need to rule out more serious causes, including cancer, and make sure nothing is missed.鈥
Dwindling estrogen can also decrease the healthy bacteria in your vagina, raising the risk of urinary tract infections.
After menopause 鈥 when your ovaries stop secreting estrogen altogether 鈥 vaginal problems like these become even more likely.
What to do if sex is painful or uncomfortable
Some women simply stop having sex altogether. But avoiding sexual activity actually can make matters worse; with sex, the adage 鈥渦se it or lose it鈥 is especially true. It鈥檚 also important to note that more frequent sex promotes vaginal elasticity and lubrication, both of which decrease as women age.
鈥淚f sex is painful or uncomfortable, it simply means that some changes might be necessary,鈥 Jenkins Cooper says. 鈥淛ust because these issues are likely to occur doesn鈥檛 mean that you have to tolerate them.鈥
There are effective remedies:
- Vaginal lubricants. Over-the-counter silicone-based products (such as Astroglide and K-Y Jelly) can temporarily ease vaginal dryness and discomfort if you use one before or during sex.
- Vaginal moisturizers. You use these over-the-counter products (such as Moist Again and Replens) every few days to help with dryness, as well as symptoms like burning.
- Prescription low-dose vaginal estrogen. You apply this directly to your vagina, usually as a cream. It can help restore vaginal tissue to its premenopausal state and reverse thinning and dryness, and it may also help prevent urinary tract infections.
- Vaginal suppositories. Over-the-counter hyaluronic acid suppositories can help increase moisture in the vaginal tissue. They鈥檙e a non-hormonal option that may ease dryness and can be used on their own or alongside vaginal estrogen for added support.
These options are very low-risk forms of estrogen therapy, since it is mainly absorbed by your vagina and not your bloodstream 鈥 unlike hormone therapy delivered through a pill or patch, which may raise the risk of stroke, breast cancer and blood clots. If you have heart disease, however, talk to your doctor before using topical or vaginal estrogen to make sure it鈥檚 safe for you.
- Hormone therapy. If you鈥檙e also having symptoms like hot flashes or night sweats, hormone therapy may be an option. 鈥淪tarting hormone therapy earlier in the menopausal transition helps your body maintain the estrogen it鈥檚 used to, which can ease symptoms and support vaginal health and comfort over time,鈥 Jenkins Cooper says.
- Testosterone 鈥 yes, that鈥檚 the male hormone 鈥 patches can improve sexual response. 鈥淵our testosterone starts to gradually go down in our late 20s and 30s. So for perimenopausal women, you may feel like your libido is low,鈥 Jenkins Cooper says. 鈥淎nd when we go through menopause, that level continues to go down, but it can be treated with testosterone.鈥
New positions may also be helpful in reducing discomfort brought on by age-related problems, such as osteoarthritis.
Feeling comfortable and confident at any age
While your body has changed over the years, you have so much more to offer in terms of having a healthy and fulfilling relationship.
鈥淏ody positivity is key for aging women,鈥 Jenkins Cooper says. 鈥淓mbrace your body and appreciate all that it鈥檚 been through as you entire this new chapter.鈥
Taking care of your body can help build on that confidence. Exercising at least three times a week for 30 minutes and eating right can help combat health problems that can interfere with a good sex life, such as obesity, high blood pressure and diabetes.
Jenkins Cooper adds that honest conversations about comfort, desire and mood can go a long way, too.
鈥淭alking with your partner and your gynecologist sooner rather than later can help you feel supported and find relief. So if something doesn鈥檛 feel right or is painful, speak up,鈥 she says. 鈥淧ushing through discomfort can make symptoms worse, but a conversation can lead to changes or treatments that help.鈥
Redefining 'Safe Sex'
Unfortunately, pregnancy isn't the only issue sexually active women have to worry about.
If you鈥檙e not in a long-term monogamous relationship, regardless of your age, you must insist that your partners always use condoms.
Unlike Generations X and Y, older women 鈥 and men 鈥 didn't come of age worrying about HIV/AIDS and other sexually transmitted diseases, so incorporating safe sex practices into an intimate relationship isn鈥檛 as automatic. Condom use, for many older women, fell off the radar once they reached menopause and the threat of unwanted pregnancies disappeared.
But thanks to Internet dating and erectile dysfunction medications, more and more older adults are having sex. As a result, instances of STDs in this age group are on the rise according to the AARP.
Regardless of age, it鈥檚 important that all sexually active women be proactive about protecting themselves and their partners against STDs. This means talking about your sexual health with your partner, getting screened for STDs 鈥 which can lie silent and dormant for years 鈥 and using condoms, even if you're the one who has to go to the drug store to purchase them.
If you feel too embarrassed to buy condoms at the store, you can easily 鈥 and discreetly 鈥 order them online.
