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8 things no one ever tells you about sex after menopause

There’s no need to go into it without preparation.

For whatever reason, there's a stigma around older people having sex. Well, world, listen up: Tons of people still have sex after menopause, or at the very least want to know what it would be like if they did. After all, your vagina is not magically replaced with a Barbie-smooth patch of skin, rendering coitus physically impossible, as soon as you’ve reached 50 or so candles on your birthday cake.

Menopause is marked by 12 straight months without a period, according to the Mayo Clinic. It typically starts in a person's 40s or 50s—in the U.S., the average age most people hit menopause is 51—though it can sometimes happen earlier. Symptoms vary among people, but common menopause symptoms include hot flashes, vaginal dryness, and mood changes (all of which can impact your libido), according to the Mayo Clinic. Although it can be disorienting and difficult to get through at times, it doesn't have to completely kill your sex life forever.

There’s a myth that women stop having sex after menopause, and it’s completely untrue. Women are still able to receive and give pleasure as much, if not more, than they previously were,” Lexx Brown-James, Ph.D., licensed marriage and family therapist, tells SELF. Here, experts discuss exactly what to expect from sex after The Change.

1. It is definitely true that sex after menopause can be painful, at least for some time.

“The most prominent change I hear about from my patients is that sometimes sex can become painful after menopause,” board-certified ob/gyn Antonio Pizarro, M.D., tells SELF. “Most of the time, this is related to a loss of estrogen.” That can cause what's known as vaginal atrophy or genitourinary syndrome of menopause, in which the vaginal tissue becomes thinner and more delicate, Dr. Pizarro explains. Issues like pain, vaginal dryness, and urinary problems can crop up as a result of vaginal atrophy. Around half of postmenopausal people experience these symptoms, according to the Mayo Clinic.

Doctors mainly treat vaginal atrophy with some form of estrogen supplementation, but there can be drawbacks. Pizarro notes that there’s a small risk the amped up estrogen can contribute to uterine cancer unless a woman pairs it with the synthetic hormone progestin. But combining the two may then increase a woman's risk of breast cancer, according to The American Cancer Society, which has a comprehensive breakdown of the benefits and drawbacks of using hormones to deal with menopause symptoms.

2. There’s nothing wrong with needing help in the lubrication department.

Whether you decide to opt for extra hormones or not, using vaginal moisturizers like Replens and regular ol’ lube can help ease vaginal discomfort. In fact, Tami Rowen, M.D. an obstetrician and gynecologist specializing in sexual health at the University of California San Francisco, highly recommends using a lubricant to help make sex more enjoyable if you experience vaginal dryness. If you’re new to lube, it’s important to know that there are several types: silicone-based, oil-based, water-based, and hybrids. Generally, water-based lubes that don’t contain glycerin are a good choice because they’re suitable for people with sensitive skin. Further, Dr. Rowen suggests buying a lube that mimics the natural pH of your vagina. Changes to its natural state can cause an overgrowth of bacteria and lead to infections like bacterial vaginosis, according to the Cleveland Clinic. (For reference, a pH range of 3.8–4.5 is considered normal). Before heading to the store, you can do research online to find a product that fits within this scale. Dr. Rowen recommends lubes like Almost Naked by Good Clean Love (Amazon, $22). This one falls between 4.2 - 4.7 on the pH scale, according to the manufacturer’s website.

3. Your libido might dip thanks to menopause.

It’s not universal, but some people with menopause report decreased libido, says Dr. Pizarro. Issue is, it's tough for doctors to figure out how to combat a lowered sex drive—the cause isn’t exactly easy to pinpoint. “For decades, we’ve blamed loss of libido on a woman’s ovaries or hormones,” says “Libido is such a complicated thing that goes way beyond issues of the ovaries, uterus, and hormones,” says Dr. Pizarro.

Beyond whatever mysterious physiological changes might affect someone’s libido at this life stage, adjusting to menopause's physical changes might play a role. Adequate exercise helps make sure your blood is flowing properly, which is an essential part of getting wet during sex.

4. Menopause can have mental and emotional effects, too.

Most people don’t like their period, but when it goes away you feel your age,” Dr. Rowen tells SELF. For some people, “the idea of losing their period can be psychologically distressing.”

And as we mentioned, your hormones, specifically estrogen and progesterone, change during menopause. And this change may cause feelings of anxiety and depression. Lower estrogen can also trigger hot flashes that make it difficult to sleep, leading to mood swings and anxiety. Coupled with any emotional distress from losing your period, and you understandably may not be in the mood to have sex. If you feel down for more than two weeks, you may be depressed and want to speak with a therapist, the Cleveland Clinic recommends. However, finding a therapist can be a long, and often stressful, process. (This article has some useful tips about finding affordable mental health services). Generally, you will want to start by asking your insurance company for a list of providers. If you don’t have insurance, websites like Open Path include therapists who offer reduced-fee sessions.

5. And keep in mind that you can still get pregnant even after the menopause process starts.

Because menopause is defined by not having a period for 12 months straight, when you're perimenopausal, or transitioning towards menopause, your period may go MIA but then make a comeback at some point. Some people have breakthrough bleeding or periods in between, according to The American College of Obstetricians and Gynecologists. And while that doesn’t necessarily mean that you’ve ovulated, it could mean that you have. And that means you could potentially get pregnant.

6. With all that said, you can still have a great sex life in menopause.

Pizarro and Brown-James both agree on this point. In fact, Dr. Pizarro says meno post-menopausal people have very active sex lives even without taking estrogen. What’s more, sexual satisfaction might increase once someone’s been through menopause.

There are a few reasons that might happen. “The worry of being pregnant is no longer there,” says Brown-James. “Also, some people experience an increase in their sexual awareness of their bodies. Many women have not been taught to explore their bodies and have internalized ideas that the vulva or vagina are dirty or for someone else’s pleasure, not theirs,” she explains. “A lot of times, if the knowledge that none of that is true hasn’t taken root before, it gets dispelled at this point, and women realize their bodies are really for themselves.” Bonus: That may also lead to more intense orgasms, says Brown-James.

7. Or you might find that you’re not as interested in sex, and be totally fine with that.

“A lot of my patients who are many years past menopause report that their lives have changed in that way: The emphasis on and impact of sexual intercourse aren’t what they were before,” says Pizarro. When talking through potential treatment options, many of his patients decide it’s not a big enough deal for them to pursue a medical solution to lowered libido. “It’s just not something that concerns them. Their life has transitioned to a point where they’re more focused on spending time with their partner or traveling,” he explains. (We’ll travel again one day, right?)

8. It’s best not to ignore any changes that cause you distress.

You may cringe at the thought of talking to your gynecologist about sex. But rest assured, there is no reason to feel awkward. If you're dealing with these changes and are very much unhappy with them, talk to your doctor. Right now, this may be a conversation that needs to take place via telehealth due to the pandemic. If you feel dismissed, then Dr. Rowen encourages you to consider switching to another provider if at all possible. “Go find someone who will listen to you and take your problems seriously,” Dr. Rowen says. Together, you can come up with a treatment plan that may help you have a more fulfilling sex life, even after menopause.

Original article appeared on SELF | Author Zahra Barnes

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