Let's talk about Sex.

A funny thing happens when we hear something repeated over and over – whether that message comes from friends and family, authority figures, the news media, or advertising – over time, we begin to accept the message as true.  That’s why social media so profoundly influences our worldview, why our self-talk has such a powerful effect on our personal outcomes, and why a multi-billion dollar self-help business has sprung up to help us direct that internal chatter in a productive way.  The constant repetition of one message, regardless of its validity or accuracy, has a tendency to drown out anything that contradicts it.  Just take a look at your Facebook feed if you want confirmation.

So it is with the messages we’ve heard about women’s sexuality as they enter midlife: menopause kills a woman’s sex drive, and a hormone deficiency is to blame.  

What if that just weren’t true?

A growing body of research on the subject - increasingly conducted by women – indicates that this idea is indeed a falsehood, and in fact, a woman’s level of arousal and sexual satisfaction in midlife and beyond has far more to do with her general level of wellbeing, her physical health, and the quality of her relationship than her hormone status. 

There are two things about this that really stand out for me:

1.       It’s complicated

2.       We are not just hapless victims of our bodily and hormonal changes

Yes, our hormones are shifting during midlife.  But we’ve been brainwashed into thinking that this is a problem that spells the end of our vitality and attractiveness, and that there is nothing we can do to address these changes aside from “tricking” our body into thinking it is 25 again.  (The word ‘tricking’ in quotes because it’s pretty hard to trick our bodies – usually the joke ends up being on us when we try.)

I don’t know about you, but you couldn’t pay me to be 25 again – I have no interest in revisiting that period in any way whatsoever – well, except lineless skin, but that’s a subject for another post. 

When we buy into this idea that we are no longer desirable, that we are just a dried-up husk of a woman, is it any wonder that sex drive, self-esteem, and body image suffer?   The problem is that we don’t even recognize the impact these messages have on us – they are so deeply ingrained into the cultural consciousness that we don’t question the validity of the claims, we are just along for the ride.

The truth is that our sexuality is complicated, and our level of desire, arousal, and satisfaction plays out on both physical and mental or emotional planes.  It reflects the health and balance not just of our hormones, but also of our cardiovascular system, our brain, and our nerves; as well as myriad external factors, such as lifestyle, relationships, stress levels, and more.  Emotions and thoughts have a huge impact on sexuality as well, and studies show that women who seek treatment for sexual symptoms of menopause report more stress, depression, and anxiety than those who don’t.  It’s all connected, and it’s time we got in the driver’s seat if we want different outcomes.

When we understand that eventual sexual dysfunction is not our destiny, that menopause is not the inevitable end of our enjoyment of sex; we are able to take back the power over this part of our lives.  By examining the root causes of issues that arise and working to correct them rather than masking symptoms, we can effect lasting change in our sexual response.

So, what are some of the main complaints around sex in midlife, and what can we do about them?

Loss of libido tops the list, with a decrease in satisfaction and vaginal dryness coming in right after.  Dryness is common as we age, partly due to shifts in estrogen, and also due to a decrease in blood flow to the vaginal area.  Generally we are counseled to replace “missing” estrogen with hormones in order to tackle this problem, and elevating estrogen levels will usually increase lubrication.  But hormones are not the only (or even the most expedient) way to “get the juices flowing,” if you will.  Here are some others to try:

·         Having regular orgasms, with or without a partner, keeps vaginal tissues moist and supple.  Use it or lose it, as they say.  I’ve seen articles on this subject where the author prescribes something like 7 orgasms a week as an optimal number – this seems aspirational to me, but hey, go for it!

·         Kegel exercises stimulate and strengthen the muscles of the vaginal floor, which increases blood supply and thickens the vaginal walls, making sex more comfortable.

·         A diet rich in foods that supply nitric oxide opens up your blood vessels and sends tons of oxygen and blood to your extremities, increasing lubrication, the thickness of vaginal walls, and the sensitivity of the clitoris.  Add beets, dark leafy greens, citrus fruits, pomegranate, nuts and seeds, and dark chocolate to get your daily dose of nitric oxide.

·         Smoking has a detrimental effect on sexual function.  It decreases blood flow to all the tissues and organs, and the toxic chemicals in the smoke make delicate hormones go haywire.  Just don’t do it.

·         Non-prescription feminine moisturizers can literally save the day.  This is different than a lubricant – feminine moisturizers are meant to be used regularly (daily or weekly) and keep vaginal tissues moist.  This makes every day more comfortable for women who suffer from vaginal dryness.  They can be used with or without traditional lubricants.    

o   MiaVita™ by FemmePharma and  Replens® are two that I have used and like, but there are lots of others on the market. 

o   Look for products with hyaluronic acid as the main ingredient – clinical trials have shown that this works just as well as estrogen in decreasing vaginal dryness, itching, and burning.

·         Soy has proven effective in increasing the lubrication and the general comfort of vaginal tissues in menopausal women – aim for about 100mg per day, and watch hot flashes subside as well.

·         Male sexual function is a bigger issue for midlife women than we generally like to admit.  Midlife men often struggle with erectile dysfunction, and this can have a negative effect on our own sexuality.  If this is true for your partner, you can help boost his blood flow with many of the same lifestyle shifts that will work for you. Tip: meat, cholesterol, and saturated fat all reduce blood flow to extremities and lead to fewer and less firm erections.  Just sayin’.

·         Decreased sensitivity and inability to reach orgasm can contribute to loss of libido.  This is a complex issue, because here the health of your relationship with your partner and with yourself can be as much to blame as physical changes.  Some studies have shown that the single biggest boost to libido in menopausal women is a new partner!  But before you toss the baby out with the bathwater, it might be worth it to think about how to rekindle that lovin’ feeling with your current partner.  If the issue does seem to be physical in nature, there are some non-prescription and herbal remedies that have proven effective:

o   Arousal gels such as Zestra can improve sensitivity in the short-term and could be fun to experiment with.

o   The herb tribulus has shown promise in several small studies in increasing libido and sensitivity; as a nice side effect it also protects against UTIs, which can be a problem for menopausal women.  I have personally used this and noticed a difference.

o   Ashwaganda and Maca both calm the adrenals and have libido-boosting properties – after all, it is pretty hard to feel sexy when you are stressed out.

o   Supplementing vitamins D & E helps by keeping the stress hormone cortisol levels at bay and balancing estrogen and testosterone in the system.

·         A decrease in the level of estrogen in vaginal tissues is common during menopause; estrogen is linked to certain gut bacteria such as lactobacillus, and estrogen therapy has shown to increase the presence of lactobacillius; there is some research indicating that probiotics can have an effect very similar to estrogen therapy. Look for a formulation that includes multiple Lactobacillus strains, plus L. rhamnosus and L. reuteri.  There are several brands on the market that are formulated specifically for vaginal and urinary tract issues that are worth trying.  Note: these formulations tend to be more expensive than run of the mill probiotics, but if it works, it’s worth it! 

This list is not exhaustive; it is meant to demonstrate just how many options we really have when it comes to dealing with the sexual changes that often occur in midlife and menopause.  None of the issues discussed necessarily signal a disease state or even the end of the line for your sexuality. It is not a choice between standing idly by while your vitality slips away or facing aggressive medical interventions, yet there are those who would have you believe that modern medicine is the singular key that will unlock a joyful, symptom-free menopause. 

The truth is that we can be sexy and gorgeous and vital in midlife and beyond without prescriptions. 

When we look at our lives through a holistic lens and take the time to decode the signals our bodies send with these symptoms, we can see clearly the link between the health of our sexuality and our health in general, and therefore make informed choices that support our whole being.  And the good news is that small shifts can make a huge difference here, even in seemingly unrelated areas, like diet or stress level.  You are in control. Experiment with different approaches, and see what feels right for you.  And remember to be patient with yourself – lasting change rarely happens overnight.

Have any of these solutions worked for you?  I’d love to hear about your experiences in the comments below.