Let’s talk about sex. As a cardiologist addressing women’s health, sex is a part of overall wellness. Leading a heart-healthy life includes leading a sexual one. Let’s just dive in, and address the major issues. Even if it is uncomfortable, even if you don’t really want to think about it right now, even if you don’t like the way you look naked quite as well as you once did.
You probably remember the good old days, when you were in your 20s and flush with natural estrogen. You may not have known it at the time but back then, when you could eat almost anything and not suffer too much, or stay up all night and still have energy, estrogen was one of the reasons. Now that it is naturally declining in your body, you have probably noticed that you have a bit more (or a lot more) belly fat and a larger waist…breasts pointing in an entirely different direction than they once did…and even a butt that looks like it may be threatening to succumb to gravity. Sex is an invigorating part of life, and in peri-menopause and menopause, things have changed. Understanding what is happening to your sexual self is crucial to knowing how you can accommodate those changes and still get it on.
Vaginal dryness. As if a changing body shape isn’t already ruining your sexy mood, what do you do when your womanly parts start protesting? Vaginal dryness is no small issue. Where you once had the Colorado River, you now have the Sahara Desert. The result is that friction can hurt without lubrication. If you aren’t producing it naturally you have to add some or risk pain and even some damage, like vaginal tears. One patient was sure there was something terribly wrong with her, especially after she complained about pain during sex and her gynecologist diagnosed her with “thin walls.” Thin, what now? She told me that she was actually afraid her insides might rupture during intercourse. I explained that the vaginal walls become thinner as the estrogen decreases, and that this is part of the problem that’s causing the pain—but that sex isn’t going to “break” her. Sometimes a vaginal suppository (yes, you put it in there) filled with hormones can help (ask your doctor for good options), or you can try regular old over-the-counter lubricant. Don’t be embarrassed. Lots of people buy it. And, by the way, don’t be afraid to use a lot of it.
Lack of desire. This is complex and multi-faceted, but very real. Here’s the thing…we are inundated with commercials about men’s erectile dysfunction medication and how fabulous it works, but the commercials promising a little pink pill to help women also claim to not be nearly as effective, to be of questionable safety, and it needs to be taken every day even if it is not being used for its intended purpose. Why is it so much more problematic? Women’s sexual function (and dysfunction) is more complicated than the simple plumbing and straightforward execution of the sexual act that men enjoy. Our sexuality is more tied up with emotion, duty, distraction, expectation, and body image. And that’s not even including the tectonic shift of hormones. There are medications, including lubricants and hormone delivery systems to stabilize the hormonal tornadoes, as well as some promising non-hormonal medications. These medications aren’t always the answer. For many women, the psychological aspects are as powerful, if not more powerful, than the physical. When our hearts and brains show up to the party, sometimes that spells the end of the party.
You must understand though that the hormonal influence on desire is also very real. The decrease in estrogen is the main problem, but the steady decline in testosterone levels doesn’t help. Testosterone contributes to sex-drive and gives us that mojo we may feel like we’ve lost, and supplemental testosterone has actually worked well for some women. Other hormones impact the sexual experience too, including the feel-good hormones like dopamine, serotonin, and oxytocin, that make us feel pleasure and bond us to our partners. When those levels decline, our desire diminishes and that also make us feel more separate from our partners.
And let’s face it—that advice to “just do it anyway” isn’t so easy. It’s hard to do something so intimate, when you just don’t feel like it.
So, What Can You Do About It?
Perhaps not surprisingly, retaining or regaining your sexual self usually comes down to the basics. Hormonal strategies might work for you and I recommend that you talk to your gynecologist about them, but I also want you to think about the lifestyle choices you make every day and how it effects your well-being.
Of course, I am talking about eating a healthy diet and exercising regularly. In the past, maybe you did these things to keep your weight down, stay vital, and protect your heart. Now things are different. More than ever, eating right and exercising can help you feel like yourself again—including your sexy side. Eat your vegetables and work out like a fiend, and you will feel more vital, more virile, and more fabulous. Do nothing, sit on the couch and eat potato chips, and I can assure you that the last thing you will want is someone to put their hands on you, even if that someone is someone you love.
Getting enough sleep and managing your stress are also part of this game. Without these basics, you are not doing your part in maintaining yourself and your health during this natural transition. If you don’t sleep and you live in “fight or flight” mode, you will be neither well lubricated nor in the mood. You’ll just be hanging on for dear life. That’s not living.
Lastly, even though I have already acknowledged that “just doing it anyway” isn’t exactly a tempting prospect, sometimes allowing it to happen will trigger the hormones needed to make it happen—even if your brain is not sure it’s on board with the plan. You could try it, just to see. Sometimes, the body responds on its own, and talks your brain into re-joining the party.
Most importantly, please don’t give up. Intimacy throughout life matters. Sometimes it means even more after the childbearing years, when your partner and you are looking at each other, wondering what happened to your relationship. The bonding you get from regular intimacy can help you to avoid drifting apart. It connects you. Not to mention, it’s good for your heart.
It’s not exactly easy. It’s complicated, in fact, but it is also part of your story. It is part of your life, and you are not the only one feeling like this. To all the women who have shared with me your intimate secrets behind closed doors, I didn’t blow your cover. All women going through this understand it.
For those of you relieved to hear you are not alone, I am glad to share. You can get past this. You can stay feeling sexy and being sexy and you can own your womanhood, menopause and all, in a way that is more complex, powerful, interesting, and sexier than when you were younger and not so sure of yourself. But unless you take care of yourself, it’s not going to happen that way.
Feeling good translates to all kinds of good things in your life, and that includes sex that could make your younger self blush. You are still in there. It’s time to dust off that mojo and get back to the party. You (and your partner) will thank me later.