Sex In The Sunset Years

By Dr Ho Choon Moy, Consultant Gynaecologist, Pantai Cheras Hospital

A hundred years ago, nobody ever thought about whether people still have sex after menopause. Why would they, when they probably don’t survive beyond their menopausal years?

Today, women have an average lifespan of 78 years, while men have a lifespan of about 72 years. If menopause takes place around the age of 50, women would be spending one third of their lives post-menopause. People today will have to deal with the many health and psychological issues related to menopause, which includes sexual well-being.

Sexuality is not only an important aspect of general health and wellbeing but also affects the relationship with the partner. After all, growing old together also means enjoying intimacy into the golden years, especially now that the children are grown.

As such, it’s important for every woman (and man) to know what happens to the body after menopause to avoid age-related sexual dysfunction.

Ageing and sexual function

As the body ages, sexual function is affected by these main factors:

Physical factors: Women have decreased fitness and flexibility. They may also have issues with body image such as feeling fat, droopy breasts, less supple skin, freckles and blemished skin, etc

Hormonal changes: The loss of estrogen after menopause affects the vaginal tract in various ways- the clitoris becomes smaller, the labial flattens, genital glands produce less secretion (making the vagina dry), the vagina becomes shorter, narrower and less elastic. The skin at the vagina walls also become thinner and tear more easily. The natural bacteria that exists at the vagina area also becomes less, making postmenopausal women more prone to infections.

Sensory changes: The sense of skin, taste and smell are also reduced

Concurrent illness of self or partner: Age brings about various illnesses such as heart problems, respiratory problems, depression, diabetes, erectile dysfunction and others. Medications for these conditions may lower sexual libido

Societal attitudes to sex and ageing: It’s still common for people to believe that women after menopause should mellow and behave like demure grandmothers. Many women let go of their zest for life after menopause because they think they have to behave in the way society expects them to.

Sex after menopause

Sexual desire is affected by hormonal and psycho-social factors. The hormones that affect sexual desire are estrogen and testosterone. Women also have testosterone, although in much smaller amounts than men.

The reduction in hormones leads to drastic changes at the vagina, which affects libido and sexual function. The vagina becomes dry, itchy and pain during sexual intercourse. Bacterial overgrowth may also result in a persistent irritating vaginal discharge.

Without treatment, the symptoms tend to worsen over time. A number of studies indicate a strong causal link between pain with intercourse and declining sexual desire.

In many cases, the main issue stems from a lack of desire. When desire is lacking, a woman will still experience pain even with adequate arousal, which in turn reduces sexual libido further.

It is important to know the factors affecting the lack of desire so as to offer the right treatment. Treating the genital area will not help if the underlying issue is a lack of desire. Other issues affecting sexual desire include:

  • Taking a longer time to become aroused

Women’s motivation to be sexual often stems from intimacy needs. Most studies indicate that sexual satisfaction is closely correlated with satisfaction with the relationship. From menopause transition onwards, female arousal may be slower to occur- perhaps only after sex initiated by their partner

  • Orgasm isn’t as intense

Women more likely to be affected by external pressures- stress, tiredness, lack of sleep

  • Sex not as great as before

Couples may have become sexually “lazy” so that sex becomes routine or boring

Staying sexy after fifty

The good news is that women can still enjoy a healthy sex life even after menopause by changing their lifestyles to suit their physical changes and taking the necessary menopause treatments. Here are some tips:

1)      Local therapies for the vagina: Keep your vagina lubricated with lubricants, estrogen cream and vaginal moisturizers so that sexual intercourse is more comfortable and pleasurable.

2)      Learn more: Sexual pleasure, and readiness to discuss these issues, has a strong cultural overlay – several studies have indicated that sexual expectations may be different in cultures where sex is closely linked to procreation or where sex is ranked as not particularly important.

3)      Change your perception: Many women regard these changes as an inevitable part of aging process and may feel that nothing can be done

4)      Stay healthy: Have regular check-ups, distress, keep a healthy diet, have enough sleep and sunshine, reduce alcohol consumption and cigarettes and speak to a doctor if you are experiencing sexual problems due to menopause.


How about some Sex-ercise?

A recent article in WebMD, an online health portal, outlines the 10 health benefits of sex. Yes, having sex actually keeps you healthier and living longer! Here’s how:

  1. Sex relieves stress – Lowers blood pressure and overall stress.
  2. Sex boosts immunity – Gives you better physical health from higher levels of an antibody called immunoglobulin A or IgA, which can protect you from getting colds and other infections.
  3. Sex burns calories – Thirty minutes of sex burns 85 calories or more.
  4. Sex improves cardiovascular health – A study published in the Journal of Epidemiology and Community Health found that having sex twice or more a week reduced the risk of fatal heart attack by half for the men, compared with those who had sex less than once a month.
  5. Sex boosts self-esteem – Having sex makes you feel wanted, loved and connected
  6. Sex improves intimacy – Having sex and orgasms increases levels of the hormone oxytocin, the so-called love hormone, which helps us bond and build trust.
  7. Sex reduces pain – As the hormone oxytocin surges, endorphins increase, and pain declines.
  8. Sex reduces prostate cancer risk – Frequent ejaculations, especially in 20-something men, may reduce the risk of prostate cancer later in life, Australian researchers reported in the British Journal of Urology International.
  9. Sex strengthens pelvic floor muscles – Kegels gives you more pleasure during sexual intercourse and minimises the risk of incontinence later in life.
  10. Sex helps you sleep better – According to research, the oxytocin released during orgasm also promotes sleep. Getting enough sleep has been linked with a host of other good things, such as maintaining a healthy weight and blood pressure.

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