Menopause Intimate Issues: Low libido, vaginal dryness, and more

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Ask Eileen

01 April 2024

Intimate issues and symptoms during perimenopause and menopause

Here are a few issues and symptoms that can be common during this time, what you need to know about them, and things that can help:

1. Low libido

Low libido or loss of libido is a common symptom in perimenopause and menopause. It can be a big issue as far as relationships go. It can cause a loss of distress. Partners can think that you don't love them anymore because you don't want to be intimate anymore.

I know some of you tell me that you couldn't care less. You just think, "I'm never having sex again, and I don't care." But for others, it can cause a lot of genuine distress.

So, the main reason for this is falling oestrogen levels. Oestrogen is our feel-good hormone. It's what gives us energy, it makes us feel sexy, and when that starts to drop, that will affect the way we feel sexually and the way we respond sexually as well.

But just be aware, there are other issues too. You can be really fatigued if you're busy or if you haven't had a decent night's sleep for ages. It could be that you are working hard, you've got family at home, maybe you're looking after elderly parents. At that particular point, it may well be that you just can't be bothered because you're too tired, and there's no other particular reason.

So, we need to look at this in different ways. If it's just fatigue and tiredness, then it's about taking care of yourself, looking after yourself, and giving yourself that little bit of rest and relaxation.

Talk to your partner. We get a lot of men contacting us too, thinking that their partners don't love them anymore because sex is off the menu, and they don't really know what's going on. So, talk to your partner if you can. I know that for some women, talking about sex with their partners can still be quite difficult. But if they understand what's happening, then it's going to make it a bit easier for them to understand what you are going through as well.

You can look at things like phytoestrogens (plant oestrogens such as soya isoflavones). They're very gentle, and they can just help to increase libido that little bit, but they can maybe take a month or two to kick in. You also have herbs such as maca and ginseng. They're known to help increase libido and desire that little bit more too. Again, these are also gentle, so don’t expect dramatic results.

2. Less oxytocin

The other thing that can happen is to do with a hormone called oxytocin. I like to call oxytocin our ‘love hormone’. When you first fall in love, your body is swamped with it. When you give birth, your body is swamped with it, because it's a bonding hormone. After giving birth, it helps you to bond with your baby; and if you fall in love, it helps you to bond with your partner.

But as oestrogen falls, there seems to be some direct link between the levels of oestrogen and the levels of oxytocin, so your connection, your love, and your emotional feelings for your partner can decrease too. And some women have told me that they wake up one morning and just decide that they don't actually fancy their partner anymore; and obviously, that's going to have a big impact on any kind of intimacy or sex life. So just be aware that that can be quite a big issue.

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3. Vaginal dryness

It can be vaginal dryness, and this, again, is such a common issue. If you're getting vaginal dryness, that's going to cause pain and discomfort during sex.

To help with this symptom, you're looking at things like a Sea Buckthorn Oil supplement. Make sure you're drinking plenty of water. You can also get natural lubricants. You need to be really careful here because some lubricants that you can get over the counter are full of chemicals and they can actually irritate the vagina. The vagina can become much more sensitive to anything like that, so just be careful and maybe try natural ones to start with. Check out your local health food store for choices.

Vaginal dryness can also make you more prone to infections such as thrush. You can also be more prone to cystitis. We all know about honeymoon cystitis, but there can also be menopause cystitis, whereby you end up getting a recurrent bladder infection due to dryness during intercourse.

Oestrogen in the vaginal area helps to produce vaginal mucus, which keeps everything well lubricated. So again, when your oestrogen levels fall, the actual production of mucus can decrease, and that can be a big factor in vaginal dryness as well.

What a lot of women tell me is that the consistency of the mucus, the colour, and the smell can change too. This can cause embarrassment if you think you're smelling that little bit more, or if everything's a completely different colour. These are natural changes. However, if there's a really strong smell, if there's a really complete change of colour, if you're getting irritation and itchiness, then it could be something like thrush. In that case, just get that checked out by your doctor to get treatment if need be.

If you're getting any kind of regular infection, even cystitis, then go for a vaginal probiotic. It could be really helpful in this particular situation.

4. Painful sex

You only need to have painful sex once, and that's you completely put off it. The vaginal wall tissue is probably the stretchiest tissue in the whole of our body. It's got to stretch to be big enough to allow you to give birth to a baby. So, the vaginal tissue needs to be moist. It needs to be very flexible in order for this to happen. But if you start to get vaginal dryness, that can then also affect the vaginal tissue itself, so it becomes thinner. It can become easily irritated. It can tear during sex, and that's very often what’s happened if you end up getting a little bit of bleeding straight after sex. It becomes less flexible, and obviously, that's going to cause a lot of discomfort when you have sex.

Another thing too is the possibility of a prolapse. The pelvic girdle muscles are the muscles that are like a big sling at the lower end of this particular part of the body, and they hold up your bowel, your bladder, and the uterus. If these muscles lose tone, if they get weaker, if they sag, then either your bowel, bladder, or uterus can shift position. It can also pull the vagina slightly out of place. And obviously, if you've got something like your bladder or your bowel pressing on the vagina or the vagina is slightly misplaced, that is going to cause a lot of discomfort during sex.

So, if you find that there's a really severe pain when having sex, or you find that you're getting a sort of dragging feeling the whole time, or when you sit down everything feels really uncomfortable, it's important to get this checked out by your doctor, just to make sure that there isn't a prolapse that needs to be treated.

This is where learning to do pelvic floor exercises before you reach perimenopause and menopause is so important because, with a prolapse, it's a very difficult one to sort. And we know all these issues with pelvic mesh that's been used over the years to try and sort this out, which has had terrible repercussions. So, getting your pelvic floor muscles kept really tight and strong is going to prevent this happening in the perimenopause and post-menopause.

Other things to be aware of

If you have an active sex life, if you're still enjoying a sex life, be aware that you're not safe from pregnancy until you've not had any periods for two years. So, if you don't want a surprise menopausal baby, then you still need to use precautions of some kind. That's really important.

Another thing, which is a really interesting set of statistics, is that sexually transmitted diseases in the over 50s, 60s, and 70s are increasing in the UK, so you need to be very careful about that. But also, it's a nice indication in a way - not getting sexual diseases, but the fact that a lot of women over the age of 50, 60, and 70 are still enjoying an active sex life.

So, when you're in menopause and perimenopause and your libido has gone out of the window, it doesn't necessarily mean it's gone for good. And a lot of women tell me that they feel much happier afterwards. They've got fewer issues with body image when they're post-menopause. They have a really good, active sex life. They are enjoying themselves. So please bear that in mind.

I hope you found this one helpful. As I said before, it's a huge issue. It can be really distressing for both partners in this situation. If any of you have had any issues with this, what have you done to help yourself? And as I said, this is one where there will be a lot of women wanting tips and advice, so please share all your helpful stories.

And until next time, take care and have a lovely week.

You may also find these topics helpful:

6 common vaginal problems during menopause
Types of fatigue in perimenopause and menopause & tips to boost your energy
10 self-care tips for perimenopause, menopause & post-menopause

Did you know?

You won’t get the menopause the minute you turn 50! The average starting age is actually between 45 and 55 and it can often depend on a number of factors including hereditary, weight and health, however every single woman will have an individual menopause.

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