Laura Berman Answers Your Menopause and Sex Questions

When you look at menopause, what’s going on hormonally that affects a woman’s sex life? 

Basically, lubrication is a direct result of estrogen. The more estrogen you have, the more lubrication you have. So as your estrogen starts to decline you will have difficulty with dryness as well as thinning of the vaginal walls. They become more brittle, hard, thin, easily torn — that’s all primarily from falling estrogen. Testosterone is known as the hormone of desire, and that plays a role not only in sexual desire but also in sexual response, in things like nipple and genital sensation. And then there’s progesterone decline, and that plays a role in weight gain and sleeplessness and moodiness.

We hear a lot about estrogen replacement therapy, but what can you do for the testosterone part? 

There are a ton of testosterone interventions out there for men, but no FDA-approved testosterone treatment for women yet. Certainly, many doctors out there are recommending things like DHEA supplements that may support testosterone growth or development naturally. And a lot of doctors are prescribing testosterone off-label. There was a testosterone treatment for women on the table for a while, but a group of people came out against it because they felt like low desire should not be a medical condition. And of course I disagree with that!

Do you think it’s a matter of women having to demand that their sexual issues get the same attention men’s do? 

I think so. I think boomers really have to drive this. It's like, they spearheaded the women’s movement, they can spearhead creating more medical options for the medical causes of women’s sexual function complaints! The demand has to be there for a pharmaceutical company to invest and do the clinical trials and pay for all that it costs to get it FDA approved. 

When you were listing the health benefits of sex that men who take Viagra enjoy … are there similar health benefits that come from extending women’s sex lives? 

Yes, I mean, really … First of all, it’s good for our hearts, good for our nervous system, good for our relationships in the ways I mentioned. Sex is good for your immune system, and it also actually helps with menopausal symptoms — in some cases because you’re flooding your body in those feel-good hormones. You’re also putting coins in the emotional intimacy bank, and the greater your emotional intimacy the longer you’re going to live. 

What is the first line of treatment if someone is experiencing pain with sex? 

Hormones, although a lot of women can’t take hormones and other women don’t want to. For most perimenopausal women, I would encourage the use of lubricants, whether they feel they need one or not!

Because it just makes sex better?

Yes; we think lubricants are only for old ladies, and that’s not the case. I’m a big fan of them. If you want something more organic, try organic coconut oil, the same stuff you cook with, or all the K-Y options at your local drugstore. They even have a product called Liquibeads that you can get over the counter, which lasts for three days after you pop one into your vagina. Baby boomers who are dating someone new or who don’t want to start sex with lubricants tell me they like this option. 

And beyond the over-the-counter stuff, what do you recommend? 

Osphena, an oral medicine for postmenopausal women experiencing pain, is one really easy way to tackle lubrication. It acts like estrogen to help with blood flow and lubrication, but it’s designed to avoid [absorption into the] breast tissue. Obviously, you have to talk to your doctor to weigh the pros and cons, but it can be better than traditional hormonal therapy if you are concerned about breast cancer or have a history of breast cancer.   

On to Kegels. Do you do them ... forever? 

Kegel exercises are so important. Doing them not only can give you a stronger orgasm but can help with things like bladder leakage or prolapse of the uterus or vagina. And so can core work, which helps build up the whole hammock of muscles that hold up your pelvic floor. You should specifically work on your transverse abdominals, the wall of muscles that surrounds your torso. These play a role in sexual response, too. 

Ever had clients who find that — maybe with some work — sex can be more enjoyable in the postmenopausal time of life? 

It can be amazing!  Better than it ever was. But the menopausal woman has to accept that desire needs to come from an emotional place, it’s not necessarily that drive of, Oh my gosh, I have to get laid! It’s more from a place of wanting to be close to her partner, wanting to love them in a way they can feel intimate.

I’ve counseled so many boomer couples who are just loving life in this way. With their kids grown, they may have fewer distractions and more space and time for sex — and for foreplay in particular. They can nurture and attend to their sex life. They’re vacationing in different spots and doing it in the woods ... they’re taking their time with afternoon cuddling ... or walking around the house naked. And being less self-conscious can be a boon to the sex life, too. If we’re developing emotionally properly, we get more and more comfortable in our own skin as we age. 

So women need to embrace a little different motivation for sex. But do you ever have to educate men in terms of giving foreplay more time? 

To my couples over 40, I always say, embrace the vibrator, guys. It’s not gonna replace you. As we reach into our 40s, women need more stimulation, and we need more foreplay to get there. It takes longer to reach orgasm, and orgasms aren’t necessarily as intense. 

If someone wants to talk about their sexual issues related to menopause with a professional, do you start with your doctor? How open are most, really, to this? 

Most doctors are not going to bring it up unless you do. You have to be your own health advocate in all areas, and especially in this one. But if you bring it up at your checkup, they can help find out what’s going on hormonally, and they can talk about your medical options, taking into account any of your personal risk factors. 

Otherwise, if that sex-romance stalemate has really taken on a life of its own, or if you’re having issues involving sexual communications, or struggles with pleasuring each other, or if inhibitions are getting in the way, you really want to see a sex and relationship therapist. A great resource for those can be found at the website of the American Association of Sexuality Educators Counselors and Therapists, which is aasect.org.

I love how encouraging you are about older women’s sex lives. Because reading articles about “the thinning of vaginal walls” for the 10th time can make it all start to sound depressing. 

A Chinese medical doctor once told me the chi — the life force, according to Chinese medicine — in a woman’s body is always flowing down to her reproductive organs until perimenopause, when it literally changes directions. That energetic shift, the thinking goes, is why we’re misfiring during that time. But then, he said, you move through menopause, and the chi, the life force, is now flowing to all parts of your body and not all just centered on your womb. And it’s at this age and stage that women in most societies gain the most status, because they’re the wisest, most grounded, most intuitive. They’re in a very empowered place emotionally. It’s an amazing time in life if you let go of the societal stereotypes about it.